By Arleen Thukral, MS, CCE, CHTM
The current state of healthcare records is disjointed due to a lack of common architecture and standards that allow for the safe transfer of sensitive information among stakeholders in the system. Healthcare providers track and update a patient’s common clinical data set each time a medical service is provided. This information includes standard data, such as the patient’s gender and date of birth, as well as the procedure performed, among other notes.
Traditionally, this information is tracked in a database within a singular organization. Instead, healthcare organizations could take one more step and direct a standardized set of information present in each patient interaction to a nationwide blockchain transaction layer. Information stored on the blockchain could be universally available to a specific individual through the blockchain private key mechanisms, enabling patients to share their information with healthcare organizations much more seamlessly.
Blockchain is a distributed and immutable (write once and read only) record of digital events that is shared peer to peer between different parties. Blockchain relies on established cryptographic techniques to allow each participant in a network to interact without preexisting trust between the parties.
The Benefits of Blockchain
In a blockchain system, there is no central authority; instead, transaction records are stored and distributed across all network participants. Interactions with the blockchain become known to all participants and require verification by the network before information is added, enabling trustless collaboration between network participants while recording immutable audit trail of all interactions.
Storing medical information directly on the blockchain ensures that the information is fully secured by the blockchain’s properties and is immediately viewable to those permissioned to access the chain. In contrast, encrypted links are minimal in size and are activated once a user with the correct private key accesses the block and follows the encrypted link to a separate location containing the information. As an example, the blockchain cannot directly store abstract data types such as x-ray or MRI images.
An interoperable blockchain can also strengthen data integrity. According to U.S. Department of Health and Human services, 2,682,462 individuals were affected by breaches of unsecured protected health information in the last 24 months. The amount of breaches being experienced in healthcare isn’t going to slow down. The blockchain’s inherent properties of cryptographic public/private key access, proof of work and distributed data create a new level of integrity for healthcare information.
Each participant connected to the blockchain network has a secret private key and a public key that acts as an openly visible identifier. The pair is cryptographically linked such that identification is possible in only one direction using the private key. This limits potential hacking as the hacker would need to individually hack every single user to obtain unique private keys.
Another exciting feature of blockchains are smart contracts: simple software programs that run across all nodes in the network and can extend the validation logic at each node in a way that is automatable and undeniable. An estimated 5%-10% of healthcare costs are fraudulent, resulting from excessive billing or billing for non-performed services. For example, in the United States alone, Medicare fraud caused around $30 million in losses in 2017. Blockchain-based systems, however, can provide realistic solutions for minimizing these medical billing-related frauds.
Querying information on the blockchain can also be done through a series of application program interface (API) calls that each connected organization can invoke. By invoking these APIs, organizations can immediately query specific blocks on the chain or submit defined query parameters.
The blockchain transaction layer could enable immediate access to a rich set of standardized, non-patient identifiable information. Blockchain serves as an integration factor without assuming storage or data standardization responsibility for a diverse range of stakeholders. This information can be made available to research institutions enabling efforts of precision medicine.
Moreover, researchers at MIT Media Lab have developed a prototype system called MedRec, using a private blockchain based on Ethereum. It automatically tracks who has permissions to view and change a record of medications a person is taking.
There are tremendous efficiencies to be gained from disintermediation of trust through access to the distributed ledger to maintain a secure exchange without complex brokered trust. Blockchain technology presents numerous opportunities for healthcare; however, it is not fully mature. One challenge which remains to be solved is scalability constrains with near real-time updates.
Blockchain-powered solutions are not currently optimized for high-volume data that needs absolute privacy and instantaneous access within a single organization. Instead, these technologies are designed to record specific transactional data events that are meant to be shared across a network of parties where transparency and collaboration are mission-critical. We shall all have to wait to find out how things unfold.
Arleen Thukral, MS, CCE, CHTM is a VISN 20 biomedical engineer at VA NorthWest Healthcare Network in Seattle. For more information, contact 24×7 Magazine chief editor Keri Forsythe-Stephens at [email protected].