Current Innovation in Healthcare
As technology advances, healthcare professionals are discovering innovative ways to leverage cutting-edge concepts to improve their practice. The evolution of Big Data, Artificial Intelligence (AI), and the Internet of Things (IoT) have created vast opportunities for pioneers of the healthcare field to revolutionize patient care.¹ Recently, another groundbreaking concept known as blockchain technology presented itself as a potential frontrunner in this healthcare technology revolution.¹ How can blockchain technology be applied to healthcare? Current and potential uses are discussed below.
What is Blockchain Technology?
Blockchain databases are a record of peer-to-peer transactions that are shared and immutable.² Simply put, blockchain technology acts as a public record of peer-to-peer transactions, meaning that anybody can see each transaction.² Once a transaction is generated within this digital ledger, the data is locked into blocks of cryptographically secured data, linked together, and locally replicated within every computer (node) in the network.² The result of this is a highly secure, decentralized platform that is traceable and unchangeable.⁴ While this concept is known well for its use in the technology behind cryptocurrencies, this technology can also be effectively utilized by healthcare professionals to solve many of the healthcare issues that are being faced today.²
Security within Cloud-Based Electronic Health Records
Blockchain databases are best used as a supplement to cloud technology. This pair can revolutionize various components of healthcare, and a primary application is the enhancement of Electronic Health Records (EHR’s).⁴ The use of cloud technology can provide an efficient storage system for patient medical records, while simultaneously having the ability to be strategically analyzed for the optimization of patient outcomes.⁴ However, data within cloud storage is not encrypted.³ Furthermore, protected health information is usually handled by a 3rd party company.³ This issue is can be solved with the application of the immutable, decentralized nature of blockchain technology as a supplement to ensure secure handling of all patient information.⁴ Key population trends can be analyzed with the security of blockchain to support providers as they predict diseases, provide better diagnoses, and discover non-adherence.⁴ Supplementing cloud storage with the unchangeable, traceable, highly secure behavior of blockchain technology ensures the absolute safety of patient data.⁴
Smart Contracts — Say Goodbye to Data Silos
Unstructured data created by heterogenous sources is considered to be a major issue for healthcare professionals.⁵ For example, a patient may visit multiple disconnected hospitals. Consequently, this can result in the necessary personal upkeep of his or her own medical records and history. Due to the unavailability of verifiable documentation, this patient may have to undergo repeat tests to obtain laboratory results.⁶ In addition, sharing data between providers has the potential to be time consuming in situations that may not allow excess time.⁶ However, a blockchain architecture, built on the Ethereum network called MedRec, was proposed as a solution for this and tested in patient populations.⁷ MedRec is a distributed network for the storage and access of electronic health records using smart contracts.⁷ Smart contracts are self-executing, permissioned contracts in which predetermined criteria enable or restrict the access of patient information to authorized users.⁷ In MedRec, any time a change was made in a patient’s medical record, the change was immediately updated within every participating computer in the network. This new method securely streamlined patient data communications.⁴ Patients also have special rights to access their own medical records at any place and time, which is useful when quick treatment is needed.⁴
As medical insurance businesses continue to grow, the number of insured persons and insurance claim events have risen as well.⁸ However, medical insurance fraud continues to grow as well, whether the occurrence is intentional or unintentional.⁸ Medical insurance fraud can occur through the tampering of medical records, and other cases of fraud occur because available patient medical records are incomplete.⁸ It can be said that a patient’s medical record is a vital source for the insurance company to pay for medical expenses while the claims are audited. However, the legitimacy of a case can be threatened in the traditional case management system.⁸ As a result, completeness, timeliness, and authenticity of medical records are essential.⁸ A secure, cloud-based electronic health record system using blockchain technology has demonstrated the ability to remove these sources of error.² In this blockchain database, medical record data is continuously updated and recorded, and past information on the blockchain cannot be modified.² The insurance company receives data in real time, ensuring the authenticity and integrity of all patient medical records.⁸ At the time the claim is required to be completed, the insurance company may gain access to the encrypted medical record data when authorized.⁸
Future Use Cases
Blockchain technology is still relatively new, and potential use cases are constantly presenting themselves. Blockchain databases focused upon provider credentialing are underway, exploring the resolution of provider credential validation inefficiencies that boast an exceptional return on investment for hospitals and payers.⁶ Blockchain technology can also be applied to clinical trial integrity reinforcement to overcome issues with fraudulent results and data removal that attempt to show results that support the researcher’s bias or funding source’s intention.⁹
Blockchain technology, best used as a supplement to current technology such as cloud-based resources, can be used as an effective application within healthcare.² This transparent digital ledger maintains an immutable, traceable, and highly secure record of transactions, making it a potential frontrunner for use within the healthcare system.² The additional use of smart contracts as a permissioned blockchain architecture drastically expands the potential of this technology.⁷ While this concept is still relatively new, there is no doubt that there are effective applications for blockchain technology to take part in this revolution of technology-based patient care optimization.
To Learn More:
MedRec — Current working model: https://viral.media.mit.edu/pub/medrec
Current models & guides for implementation into your health system: https://rdcu.be/4TFZ
1.) Panarello, A., Tapas, N., Merlino, G., Longo, F., Puliafito, A., Panarello, A., Puliafito, A. (2018). Blockchain and IoT Integration: A Systematic Survey. Sensors, 18(8), 2575. https://doi.org/10.3390/s18082575
2.) Pirtle, C., & Ehrenfeld, J. (2018). Blockchain for Healthcare: The Next Generation of Medical Records? Journal of Medical Systems, 42(9), 172. https://doi.org/10.1007/s10916-018-1025-3
3.) Radanović, I., & Likić, R. (2018). Opportunities for Use of Blockchain Technology in Medicine. Applied Health Economics and Health Policy. https://doi.org/10.1007/s40258-018-0412-8
4.) Kaur, H., Alam, M. A., Jameel, R., Mourya, A. K., & Chang, V. (2018). A Proposed Solution and Future Direction for Blockchain-Based Heterogeneous Medicare Data in Cloud Environment. Journal of Medical Systems, 42(8), 156. https://doi.org/10.1007/s10916-018-1007-5
5.) Kerkri, E. M., Quantin, C., Allaert, F. A., Cottin, Y., Charve, P., Jouanot, F., and Yétongnon, K., An approach for integrating heterogeneous information sources in a medical data warehouse. J. Med. Syst. 25(3):167–176, 2001.
6.) Thinking of trying a blockchain project? Here are some must-do first steps. (2018, March 19). Retrieved August 21, 2018, from https://www.healthcareitnews.com/news/thinking-trying-blockchain-project-here-are-some-must-do-first-steps
7.) Azaria A, Ekblaw A, Vieira T, Lippman A., Medrec: Using blockchain for medical data access and permission management. InOpen and Big Data (OBD), International Conference on 2016 Aug. 22 (pp. 25–30). IEEE.
8.) Wang, H., & Song, Y. (2018). Secure Cloud-Based EHR System Using Attribute-Based Cryptosystem and Blockchain. Journal of Medical Systems, 42(8), 152. https://doi.org/10.1007/s10916-018-0994-6
9.) Bell, L., Buchanan, W. J., Cameron, J., & Lo, O. (2018). Applications of Blockchain Within Healthcare. Blockchain in Healthcare Today, 1. https://doi.org/10.30953/bhty.v1.8
Matt Stahl, Pharm.D. Candidate, Class of 2021, *is a future pharmacist and blockchain enthusiast at the University of Iowa College of Pharmacy*