When you hear the term blockchain, you may automatically think of cryptocurrency and investing. Understandably so, considering that Bitcoin was at one point the only blockchain in existence, and the terms were often used interchangeably. These days, however, that’s no longer the case. Blockchain technology has evolved beyond purely monetary use and can be applied to a number of industries, from real estate to legal. Because of this malleability, blockchain will likely play an important role in the future of information-enabled health and medicine. In fact, Deloitte indicated last year that healthcare is a particularly proactive industry, and 35 percent of healthcare organizations surveyed intended to deploy blockchain in the next year. In this blog post, I’ll explore what this future state might look like and what aspects of the current “norm” in the healthcare industry will be disrupted by this emerging technology.
Let’s take a step back and first answer the question many of you may be thinking: what exactly is blockchain? Technical details aside — blockchain is a new way to organize data, enabling information to be stored across multiple parties instead of one. This disincentivizes one party from having unfettered ability to change, revoke access, or monetize that data. This codified ‘decentralized consensus’ has the ability to replace infrastructure, effort, and resources used to maintain trusted central authority in a range of industries, and this was proven by Bitcoin in the finance sector.
While not all properties of the Bitcoin blockchain are required, many components, individually or together, can be game-changing for healthcare and scientific discovery. Many governments and industries are adopting blockchain-like technology to optimize for characteristics like immutability, data security, fair monetization, user empowerment (‘own your data’), network security, and more. As organizations in health and medicine begin to design business models for exponential growth, the market will welcome new opportunities enabled by blockchain technology that were not previously possible.
Perhaps one of the most obvious applications of blockchain technology would be to help eradicate the well-known challenges around electronic health records. Currently, as you may have experienced at one point or another when changing healthcare providers, it is very difficult to transfer medical records between medical institutions, as each network uses its own system and format. In fact, less than one-third of U.S. hospitals can send or receive medical records from out-of-network providers. Some of the most common EHR software includes Cerner, Epic, Meditech, and Allscripts, to name a few. And while these are some of the more popular systems, it truly is only a small fraction of the total: in the U.S. alone, there are approximately 1,100 vendors that offer an EHR.
Unfortunately, this is also not a new problem. Back in 2009, the U.S. government made the Health Information Exchange (HIE) mandate ordering all patient health information to be shareable between all healthcare providers. In addition to mitigating inconvenience, the mandate was created based on the belief that this sharing of information would improve individuals’ healthcare experiences throughout their lives. With the introduction of electronic medical records, however, came a lack of structure or protocol for sharing information digitally, and very few U.S. hospitals are able to participate in computerized HIE. Blockchain is a well-positioned solution.
One UK-based company called Medicalchain is paving the way toward a universal electronic health record. Through the use of blockchain technology, the company allows patient health records to be securely maintained and accessed by a number of different organizations, from hospitals to nursing homes, labs, or pharmacies.
Blockchain-based medical data solutions are making headway here in the US, as well. In 2017, Microsoft unveiled Coco, a cloud-operational open source framework intended to enable the creation of blockchain networks compatible with any existing ledger protocols. This compatibility made Coco a potentially sound solution for sharing information between various electronic health record systems. Last year, Amazon Web Services partner Luxoft developed a proof of concept on behalf of a major US-based healthcare organization for a blockchain ledger to track patient billing and medical expenses. And last summer, retail giant Walmart secured a patent for a system to house medical records via blockchain technology. This system, paired with a wearable and scannable device, is intended to enable access to medical data in emergency situations when patients are unable to communicate. Once applied, blockchain technology has the ability to create synergy throughout the healthcare industry and peace of mind for patients and providers alike.
The major issue with healthcare patient records is that personally identifiable information (PII) is given to, stored, and replicated across multiple entities. In today’s tech era, data is a strong business asset, and these entities have incentives to mine that data.
If the identity (name, address, phone number, etc.), can be de-linked from the data (disease, diagnosis, etc.), we make it increasingly harder for large repositories of raw data to be created and large-scale data sharing and selling to happen. Blockchain can facilitate this at scale, enabling a government entity, when issuing a health card, to create a pseudonymous identity on the blockchain (private/public key). A patient can then derive a one-time-use public-key to attach to data that he or she shares with one care facility and another one-time-use public key for data shared with an insurer. In this rudimentary example, both receiving parties can still compare metadata, but the linking of personally identifiable data is more challenging. Blockchain can build off of this pseudonymization, facilitating long-term protection of consumer data.
Once universal, global access to electronic health records is enabled, what’s next? Simply put, easy and reliable access to medical data will open doors for both patients seeking care and professionals seeking information. First and foremost, once patients own their personal health data, blockchain technology can be used to link those patients more quickly and easily to elected care, such as clinical trials. Through the use of Smart Contracts, which facilitate digital contracts and transactions credibly and without third parties, patients could in theory opt-in to trials and be reimbursed for their participation while avoiding the need for an intermediary. This empowers patients when it comes to their care and eliminates their reliance on providers.
Likewise, assuming permission to access the health records is granted, blockchain makes it much easier for third-parties (such as providers, researchers, etc.) to evaluate patient history to enable better-informed decisions around things like insurance underwriting, research prioritization or identifying public health threats. Some companies, like Nebula Genomics, are taking things a step further. Earlier this year, Nebula announced plans to offer genome-sequencing services and monetized sharing of the associated insights. For under $1,000, the company will sequence your genome and securely store the data on a blockchain. From there, users can choose to share that data with various biotech or pharmaceutical companies in exchange for cryptocurrency. Not only does this empower the individual, but it also provides access to critical data needed for new drug development and various other medical research.
Research and Discovery
Speaking of research, it turns out blockchain is well equipped to help upgrade processes around early-stage medical research and development, as well. The scientific journal peer review process, for example, is often criticized for lack of transparency. While peer review is imperative for reliable journal creation and publishing, there is no public way to verify peer review to ensure quality. In order to create transparency, peer review information should be collected and stored in a secure and accessible database, and have the ability to comply with regulatory requirements such as privacy. Enter blockchain. The key elements of the technology make it a natural solution to many of these concerns. It’s decentralized, which eliminates the need for control by a single entity, and its reliance on encryption allows for identities to be protected as needed, such as with blind peer review. Lastly, the open source nature of the database blockchain creates allows easy access to peer review information to validate quality.
An example of blockchain facilitating global research and development has been demonstrated through Algorithmia, a platform for peer-reviewed algorithms. The Seattle-based startup recently announced the launch of the first artificial intelligence transaction model on a blockchain network. According to an article on Towards Data Science, “In that world [of a decentralized marketplace for AI models], any data scientists can monetize their skillset without the need of relying on a centralized authority. The use of the blockchain also ensures that the evaluation, optimization, and results of the models will also be completely transparent.”
While these concepts and platforms are newer to the healthcare industry, we’ve already seen the success of collaborative global research models in the form of GitHub, the development platform that was recently acquired by Microsoft for $7.5 billion. GitHub is the largest software collaboration platform in the world with more than 85 million repositories and 28 million contributing developers. This kind of wide-reaching accessibility and large-scale collaboration has the potential to be equally disruptive even when facilitated in a tightly-governed industry like healthcare.
Ultimately, the overarching takeaway from recent technological advancements is that innovation is changing the world around us, even within previously difficult-to-penetrate industries. Blockchain began as a catalyst for a new form of digital currency but has no shortage of meaningful applications. I’m looking forward to witnessing the shifting landscape of healthcare once blockchain technology is more widely adopted, including navigating the challenges that may arise.