Healthcare blockchain could provide long sought-after solutions to IT challenges facing healthcare organizations and consumers.
The excitement surrounding blockchain’s possibilities for enterprise IT has predominantly centered on financial services. However, healthcare blockchain could also provide solutions to IT challenges facing healthcare organizations and consumers.
There are several challenges in healthcare that blockchain could help with, including data exchange barriers, supply chain problems, and patient data use obstacles in clinical research. Blockchain’s unique structure offers a decentralized and secure technology for exchanging and tracking data to help address these challenges.
So, what is blockchain, what is its potential in healthcare, and how will it impact an organization’s infrastructure development plans?
What is blockchain technology?
According to the National Institute of Standards and Technology (NIST), blockchain is a decentralized ledger that maintains transaction records on many computers simultaneously.
In order for a transaction, such as a purchase or a request to access information, to be approved, every member of the decentralized network must agree that the transaction is valid.
Once a transaction is approved and entered into the ledger, it becomes a “block.” That block’s information is connected to other blocks, forming a chain of records that are timestamped. The timestamp ensures that transactions do not overlap, and that the most recent change — an addition to an EHR record, for example — always serves as the source of truth for future transactions.
As a result, blockchain produces a dependable ledger without requiring record-keepers to double check with each other, on an ad hoc basis, if a transaction is allowable. By dispersing the data into secure blocks, the data security risks posed by holding sensitive data in a central location with a single administrator are reduced.
Blockchain can enable individuals to collect data from different sources and share only what they want.
According to a white paper by Deloitte and Pfizer, blockchain provides:
- Transparency: Data stored on the blockchain is transparent to all approved users, creating a single source of truth.
- Trust: Data is linked through secure blocks that are distributed across multiple users, enabling trust between users who don’t need to know each other.
- Disintermediation: Blockchain fulfills the role of existing intermediaries by creating an ecosystem of trust.
- Auditability: Data on the blockchain is difficult to change, creating a comprehensive audit trail.
“With the advent of these novel blockchain capabilities, the healthcare industry has started to take the technology seriously,” the white paper observed.
The big picture goal for blockchain is to have it support all digital aspects of a healthcare organization because every digital tool requires a secure and efficient way to exchange data or control access through permissions.
“Blockchain systems can seem complex; however, they can be easily understood by examining each component technology individually,” explained NIST in its draft Blockchain Technology Overview report.
For example, one component of a blockchain is a smart contract. Smart contracts are computer programs that automatically enforce agreements without the need for manual human intervention.
This can automate time-consuming tasks such as verifying that a healthcare provider has the right, under HIPAA, to view an individual’s data. The fact that the entity accessed the information is then recorded on the blockchain, creating a trustworthy audit trail for that individual’s digital record.
“A smart contract is a collection of code and data (sometimes referred to as functions and state) that is deployed to a blockchain. Future transactions sent to the blockchain can then send data to public methods offered by the smart contract. The contract executes the appropriate method with the user provided data to perform a service,” the NIST report explained.
Blockchains can be permissioned or public. Cryptocurrencies such as Bitcoin are based on public blockchains. Anyone with a computer can join the community to trade the currency.
In a permissioned blockchain, however, a participant needs to have appropriate permissions to join the blockchain network and conduct transactions with other network participants. In implementing blockchain, health IT leaders need to ask themselves who should access the ledger and what data should be made available.
Blockchain participants can validate transactions and verify identities and ownership without the need for third-party intermediaries. All relevant information can be shared with others based on their roles and access privileges.
Encryption is often used to ensure network security and data privacy, which helps prevent unauthorized access to transaction details and deter fraudulent activity.
What Are the Infrastructure Components for Blockchain?
As noted above, blockchain is based on a distributed ledger, which replicates, shares, and synchronizes digital data spread across multiple sites, countries, or institutions.
Healthcare organizations need the storage and compute infrastructure to support blockchain along with the networking capability to exchange data.
Blockchain can put a strain on the network because each time a node on the blockchain is created, it must download the blockchain data. That task uses a lot of bandwidth, explained the NIST report.
In addition, there is no central place for user key management, so users must manager their own private keys. If a private key is lost, anything related to that key is lost, such as digital assets. “There is no ‘forgot my password’ or ‘recover my account’ feature for blockchain systems,” the NIST reported noted.
Blockchain is not a data storage solution. It has limits to the amount of data that can be stored on the chain. As a result, large amounts of data need to be stored elsewhere in a manner that ensures accessibility and security.
Infrastructure requirements for blockchain will depend on many factors depending on what the organization wants to achieve. It’s a matter of finding the right balance of network, processor, disk, and CPU speeds.
What are the Healthcare Use Cases for Blockchain?
While blockchain has not yet achieved widespread adoption in the healthcare industry, many experts believe that it’s only a matter of time before the methodology begins to make its mark. There are numerous use cases for blockchain in an industry that has historically struggled to manage its large data assets appropriately.
One healthcare use case that is getting a lot of attention is using blockchain in clinical research.
Healthcare organizations continually struggle to exchange data across disparate systems. Healthcare providers, payers, vendors, and regulators have struggled with interoperability for years.
“A patient’s medical information can be scattered across medical centers, physicians, health plans and others,” explained the Deloitte-Pfizer white paper.
“Often healthcare organizations store this data in different digital formats and EHR systems, which can make the task to aggregate and analyze patient data on common terms very difficult and can result in inconsistent formats in the way data holders may make health data available to patients. The lack of continuity that surrounds medical data and EHRs is a major concern for patients,” the paper noted.
Clinical research, which is the foundation for medical innovation, is burdened by patient data access barriers. The Deloitte-Pfizer study identified the following barriers:
- Limited accessibility and knowledge of clinical trial opportunities
- Few incentives for patients to share their medical information
- Lack of trust that sensitive medical information will be kept secure
- Lack of digital health record interoperability and ease of aggregating data
The clinical research community has attempted to address several of these issues, but its efforts have so far come up short.
Heather Leigh Flannery, Health Circle Global Lead at ConsenSys and Co-Founder and Board Chair of Blockchain in Healthcare Global, believes that blockchain can help with clinical research.
“We have an incredible opportunity in the near term to address a major crisis in healthcare, which is the reproducibility of scientific evidence,” she told HITInfrastructure.com.
“As many as 60 percent to 80 percent of clinical trials have, unfortunately, been found to be not reproducible. This means that we’re making clinical decisions, we’re approving drugs and devices, we’re doing many, many things where the data itself is substantially distorted, largely due to the challenges with working with clinical trials data across multiple sites, multiple years, and multiple stakeholders,” Flannery said.
A blockchain network can link patients, drug companies, research institutions, healthcare providers, and regulators. Using blockchain, patients can submit their medical information and search for clinical research opportunities that meet their medical profile, explained the Deloitte-Pfizer white paper.
Researchers could provide incentives to patients by giving them access to the research results and rewarding them with crypto-tokens for their participation.
Blockchain can protect patient privacy by de-identifying the data so that only trusted users can access it and associate it with records on the blockchain. This allows researchers to analyze the anonymous data and then get access to the information on the donor to use in their studies.
Blockchain could help solve interoperability challenges, added the Deloitte-Pfizer report.
“Blockchain platforms are uniquely positioned to facilitate interoperability by creating a level playing field among data contributors where there is no single owner of information, where all participants can maintain their own copies of the data, and where the underlying patient can maintain their identity,” the brief stated.
“Although this blockchain would require standards and agreements from various stakeholders, its distributed nature and capabilities (e.g., smart contracts that autonomously and consistently execute rules) can better facilitate widescale adoption among groups that do not inherently share information with one another when compared to other traditional technologies,” it added.
Supply chain management
Blockchain can also be used to “track drugs, medications, from manufacturing to distribution, to use in dispensaries, to be able to root out counterfeit drugs, to be able to get better transparency and efficiencies on the usage sides, or the point of use at the dispensaries, like a pharmacy,” David Houlding, Principal Healthcare Lead at Microsoft Azure and chair of the HIMSS Blockchain in the Healthcare Task Force, told HITInfrastructure.com.
Blockchain provides “new ways to collaborate that improve efficiencies and transparency, add security, avoid a single point of failure, and strengthen data integrity,” he added.
Aditya Kudumala, a principal at Deloitte Consulting who worked on the blockchain report, said that blockchain improves the visibility of the information flowing through the supply chain network, facilitates collaboration, and improves traceability of drugs in the network, which helps to remove fraud and waste in the system.
“The blockchain is helping us create that whole chain of custody in a much better way than what we had before. We can have near real-time exchange of information happening from the manufacturer of the drug to the distributors, to the logistics providers, to the sites and, and ultimately to the patient,” he said.
Organizations can also track the movement of physical assets, such as medical devices, laptops, or other portable technologies, added Houlding.
”The medical device track and trace is similar to the drug supply chain use case, except you’re tracking medical devices, so anything from a pacemaker to an MRI machine, tracking it from point of manufacture through the supply chain, through its use, even through multiple life cycles of use,” he said. “If there’s a recall, you can go to the blockchain and very quickly determine exactly which devices are impacted and shorten the recall cycle from a year down to hours.”
Provider directories and credentialing
Blockchain could be used to reduce costs and administrative burdens associated with maintaining accurate provider directory data.
“There’s a lot of inefficiency, a lot of redundant work, operational costs in maintaining provider directories,” said Houlding.
“What if we could just track that information in a shared decentralized ledger on blockchain and have consistent copies of the provider directory information between providers, buyers, and cut out those operational costs, avoid those bounced transactions, et cetera,” he said.
The Synaptic Health Alliance is one organization working on that use case. The alliance, which includes Aetna, Ascension, Humana, MultiPlan, Quest Diagnostics, Optum, and UnitedHealthcare, is looking at how to use blockchain technology to maintain up-to-date health plan provider directories.
In the longer term, the Alliance wants to examine how sharing data across healthcare organizations using blockchain technology can improve data accuracy, streamline administration, reduce costs, and improve access to care.
Provider credentialing is another use case. The Professionals Credentials Exchange recently launched an an effort to use blockchain to ease the administrative burden of healthcare professional credentialing. The exchange includes National Government Services, Spectrum Health, WellCare Health Plans, Accenture, and The Hardenbergh Group.
“If those credentials were on blockchain and the validation and verification of those credentials was also on blockchain, you could cut out a lot of inefficiency. It could have real benefit to doctors in terms of being able to practice faster,” said Houlding.
Blockchain is an exciting innovation that shows promise for the healthcare industry. While there are significant benefits to be derived from this technology, doing so successfully will not be easy.
By carefully considering how the technology could meet their needs, organizations could significantly increase the likelihood that their blockchain initiative will succeed.
Date: December 26, 2018
Source: HIT Infrastructure