What is blockchain?
Blockchain technology is a ledger-based technology that has traditionally been used in banking and crypto-currencies like Bitcoin. Blockchain stores information in batches or transactions call blocks. Each addition, deletion or modification of this data is composed of an additional block. These ledger entries are linked together in a “chain of blocks.”
Blockchain was designed to be decentralized and distributed across a large network of computers. There were two purposes for this decentralization; the first being redundant storage to ensure data is not lost and the second to ensure there is “trust in the data”. This trust is first created by the initial computer solving a crypto puzzle. This crypto answer is then shared with all other computers on the network, this is called “proof-of-work.” The computers in this network all verify the initial proof-of-work and if correct the new block will be added to the chain. The combination of these complex math puzzles and the verification by many computers provides trust for each block in the chain.
Why is healthcare adopting blockchain?
The healthcare industry started looking carefully at blockchain technology many years ago as a way of ensuring confidentiality, integrity and availability of health data. Rising attacks by cyber-criminals and nation-state hackers has compounded the urgency for increased protection of PII, PHI and clinical research. Recent cyber-attacks against medical research facilities working on COVID-19 vaccines underlines this urgency.
In 2017, the US FDA partnered with IBM Watson to develop a secure exchange of medical record data utilizing blockchain, In 2018, Mount Sinai opened a center for Biomedical Blockchain research to evaluate its own medical research programs and its partnerships and eMQT utilized blockchain to study the results of their sequencing of DNA from thousands of Africans with sickle cell disease.
The Healthcare industry is constantly working to increase the stability and comprehensive nature of their EMR systems. Blockchain offers secure and complete access to a patient’s global medical records. This combined need for transparency and security are at times in conflict with each other. Blockchain technology offers a means to reach both goals without impacting the other.
The security aspect is covered by the fact that every node in the network must verify and record any changes to the medical record. This means that if someone wanted to tamper with the data, they would have to control every computer in that network.
The fact that the medical record data is stored across so many network nodes assures access to that data for the patient’s provider. A single server’s downtime will not impact patient care.
More importantly, since the medical data belongs to the patient, each patient can decide who should have access to it at any given time. This control of their own data empowers patients to play a greater role in their own care.
Blockchain use cases in healthcare
There are many case studies to argue for the use of blockchain technology in healthcare:
Our healthcare institutions are constantly under attack in 2018 over 15 million patient records were compromised in 503 breaches. In 2019 according to Malwarebytes there was a 60% increase in these breaches and a majority of these breaches were over an extended period and not reported within the HIPAA mandated 60 days. Blockchain can provide data security because it has no centralized point of failure and users can only access the data with a highly complex access key, making ransomware and similar attacks useless against it.
The lack of interoperability in healthcare is one of the most common pain points as physicians seek to treat their patients in a timely manner. The decentralized nature of blockchain allows for access to medical records across states, countries and continents. It helps to alleviate the challenge created by incompatible security protocols between different institutions as the patient is the critical owner of the data. Each patient could own a digital key that they could share with their medical providers and their health insurance provider.
There is no such thing as free healthcare, even non-profit organizations must seek compensation to cover their operating costs. Blockchain with its instantaneous exchange of medical and financial information could allow insurance claims to be instantly filed and fulfilled as all data will be verified and coming from trusted partners.
What factors are inhibiting the adoption of blockchain technology in healthcare?
There are some problems that must be resolved for blockchain to become the panacea for secure access to healthcare medical records:
Blockchain suffers from the double hit of being a fairly new technology (2008) and that had been closely tied to the cryptocurrency Bitcoin. This perception has hindered its acceptance within the medical research communities.
All entities involved in patient care and medical research must embrace this new model of collaborative exchange of information with new read/write standards and the distributed platforms and systems needed to support this new blockchain technology.
One of the questions raised is if a patient is unconscious how can the patient provide the security key to access their data files. There must be a way that the patient can always carry the keys with them and does not require any conscious input from the patient. Medical bracelets with biometrics security could be a solution to this problem.
Blockchain’s ledger legacy means it is difficult for it to handle large amounts of data in a single transaction such as an MRI or CAT Scan image or even genome sequences. Backend repositories and encoded libraries will be needed to store and track these large file formats.
Blockchain does not remove deleted or replace modified records; instead additional blocks are added to the chain to represent these deletions and modifications. This process results in the need for ever-increasing storage. EMR systems and their associated redundant backups are already a huge cost to healthcare institutions, making these storage requirements larger and the constantly growing storage in support of these chains becomes a technical and financial hurdle.
Finally, in today’s ongoing medical evolution there is a battle between the time a provider spends examining the patient and the time it takes them to enter the data into their EMR systems for patient tracking and billing. Both of these times slots are under pressure to be reduced to allow the provider to be more efficient without sacrificing patient care. Any new data technology like blockchain must be applied and provide secure access of the data without adding steps and time to the doctor’s patient process.
Blockchain is here to stay
It is often said that blockchain as a viable technology, could be many years from practical application across the healthcare industry, but as we are already seeing, this is not just limited to cutting edge early adopters.
Adoption of blockchain has already taken off with over 2 dozen companies including IBM implementing their own solutions to meet not just secure access of the EMR data but also utilizing AI to identify patterns within the Block Chains to help identify leading remedies or effective treatments for a specific disease. Medical equipment manufacturers and drug research companies can track the development, manufacturing, delivery and effectiveness of the products and programs to validate their efforts to bring a product to market.
The latest example of this is Mount Sinai’s use of blockchain technology in its use of AI to rapidly read chest CAT Scans of potential COVID-19 patients. CT chest scans have been proven to be a more reliable validation of a COVID-19 viral infection than the present swab and blood testing. Mount Sinai’s research has found that its AI model can accurately detect the ground glass opacities in the lungs as well as any seasoned radiologist. This will greatly accelerate the time required to identify a positive patient and limit their time to spread the disease before being forced into quarantine.
The advantages of blockchain technology is only just beginning to be understood. When this technology is combined with AI, the possibilities to find treatments to our major sources of diseases may be endless. As US and other healthcare systems attempt to deal with both financial and pandemic crises, so the development of tools, technologies and clinical applications that encompass blockchain will become ever more necessary and desirable. As interoperability and digitalization of health services across the world increase so too will the need for verifiable patient information and the need to protect that information from attackers. Blockchain is here to stay!