Blockchain technology could revolutionize how healthcare data is accessed and shared.
Healthcare is disjointed
The current state of health care records is disjointed and stovepiped due to a lack of common architectures and standards that would allow the safe transfer of sensitive information among stakeholders in the system. Health care providers track and update a patient’s common clinical data set each time a medical service is provided. The information includes standard data, such as the patient’s gender and date of birth, as well as unique information pursuant to the specific service provided, such as the procedure performed, care plan, and other notes. Traditionally, this information is tracked in a database and Electronic Health Records (EHR)within a singular organization or within a defined network of health care stakeholders.
The flow of information originating from the patient through the health care organization each time a service is performed does not need to stop at the individual organizational level as is the case currently in most institutions.
Health care organizations could take one more step and direct a standardized set of information present in each patient interaction to a proposed nationwide blockchain transaction layer.
The surface information on this transaction layer would contain information that is not Protected Health Information (PHI) or Personally Identifiable Information (PII); rather, select and non-personally identifiable demographics and services rendered information could enable health care organizations and research institutions access to an expansive and data-rich information set using Blockchain Technology.
What is BlockChainTechnology?
Blockchain is a distributed system for recording and storing transaction records. More specifically, blockchain is a shared, immutable record of peer-to-peer transactions built from linked transaction blocks and stored in a digital ledger.
Blockchain relies on established cryptographic techniques to allow each participant in a network to interact (e.g. store, exchange, and view information), without preexisting trust between the parties. 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 an immutable audit trail of all interactions.
Blockchain Technology would be best applied in situations where multiple parties generate transactions that change information in a shared repository, parties need to trust that the transactions are valid, intermediaries are inefficient or not trusted as arbiters of truth, and enhanced security is needed to ensure integrity of the system.
The blockchain’s inherent properties of cryptographic public/private key access, proof of work, and distributed data could create a new level of integrity for health care information systems by strengthening data integrity and patient digital identities. 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. As such, one must have the private key in order to unlock a participant’s identity to uncover what information on the blockchain is relevant to their profile.
Potential Applications of Blockchain Technology to Healthcare
Blockchain Technology may include applications to verify a patient’s digital identity, genetics data, or prescriptions history and gives patients complete ownership of their medical records, allowing them to grant and revoke provider access to their data by use of their private keys with providers in turn being able to issue prescriptions on the blockchain.
Healthcare systems could use blockchain technology to transfer value, such as cryptocurrencies or intellectual property rights. Providers, plans, or fitness centers can co-develop programs to incentivize and reward patients for healthy behaviors as a value proposition. 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.
This deployment of a transaction layer on the blockchain can help accomplish interoperability goals while creating a trustless, and collaborative ecosystem of information sharing to enable new insights to improve the efficiency of the nation’s health care system and health of its citizens.
Implementation within a healthcare system organization would require selection of a blockchain protocol—the underlying blockchain technology and framework that guides the structure of the blockchain and development of applications.
The choice of blockchain protocol is important, because it will influence the range of possible applications and the number of users participating on the network. While blockchain may have significant potential to improve data interoperability, security, and privacy, it is important to note the boundaries of the technology.
A Template for Achieving HealthCare Data Interoperability using Blockchain
As a transaction layer, the blockchain can store two types of information: (1) “On-chain” data that is directly stored on the blockchain or (2) “Off-chain” data with links stored on the blockchain that act as pointers to information stored in separate, traditional databases. 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.
Creating interoperability requires frictionless submission and access to view data. As such, the blockchain could serve as a transaction layer for organizations to submit and share data using one secure perhaps national system.
A specific set of standardized data would be agreed upon ,generated and stored directly on the blockchain for immediate, permissioned access, supplemented by off-chain data links when necessary. A standardized data set could include information such as demographics (gender, date of birth, other data), medical history (immunizations, procedures), and services rendered (vital signs, services performed, and other data).
Once a standardized set of health care information is established, the specific data fields can be created in a smart contract to employ rules for processing and storing information on the blockchain, as well as stipulating required approvals prior to blockchain storage.
Each time a patient interaction occurs, health care organizations will pass information to the smart contract —where the parameters of the contract will verify that valid information been submitted. As an example, the smart contract can stipulate that all fields need to be provided prior to blockchain storage or that a specific field must contain a particular data type (e.g. numerical) to be valid.
Once the smart contract validates that the correct data fields have been submitted, it will direct the transaction to the blockchain for secured storage. The blockchain public/private key encryption scheme creates identity permission layers to allow patients to share distinct identity attributes with specific health care organizations within the healthcare ecosystem on as-needed-basis, reducing vulnerabilities stemming from storing PII on all sides and allowing for data access time limits to be introduced by patients or providers.
Furthermore, potential hacking of a single patient’s private key can limit the potential adverse damage, as the hacker would need to individually hack every single user to obtain unique private keys to access identifiable information of value. In an era of ubiquitous perimeter firewall breaches and ransomware, the process of asynchronous encryption protects patient identities moving across or within organizations.
Additionally, all health care organizations connected to the blockchain can maintain their own updated copy of the health care ledger—and as a result—if a historical block were to be adjusted, it would require 51% of network participants to approve the change, as every single copy of that blockchain would need to be updated to reflect the change.
Blockchain technology could revolutionize how healthcare data is accessed and shared between healthcare systems and organizations by providing interoperability one of the keys to unlocking the power of data inherent in a historically-sized cohort of patients.
Big Data analytics and cognitive computing/machine learning can be applied to blockchain data set to further analyze the intersection of demographics, genetic markers, and a range of other data.
Precision Medicine Initiative (PMI) efforts can leverage the standardized data set to shape its data access framework initiative and use the information to conduct clinical research, patient safety event reporting and adverse event identification, and public health reporting.
Additionally, due to the blockchain’s privacy and security properties, researchers and partnering organizations could potentially access a single source of truth of information that maintains integrity of the health care information for each patient across the healthcare system.
1.Deloitte Consulting LLP analysis.
2.HHS Strategic Plan: FY 2014 – 2018. (n.d.).
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