Imagine this: Your entire medical record is on the blockchain. Monitoring systems and IoT devices automatically update your data, so when you go for diagnostic tests, the results are recorded without a third party. Because of the immutability of blockchain technology, your medical records cannot be changed, and the results are available from anywhere, without any other system, as long as you have the right credentials. Insurance is tied into the system and can be paid out automatically through smart contracts. Even clinical trials have their data automatically recorded, so they can’t be tampered with.
The whole system is streamlined; costs of transferring medical records between institutions are reduced, compliance costs go down and auditing is much easier. It could even mean an end to ransomware attacks against hospitals. Medicare fraud–which has cost around $30 billion over the past 20 years–could also be reduced, because it is almost impossible to alter the data.
This is the kind of dream that many blockchain pundits have for healthcare. Leveraging the advantages of blockchain technology to make records more secure and efficient. A complete, integrated, blockchain-based system. Simple and effective. But is it practical?
As with a lot of blockchain solutions, the answer is not anytime soon. Sure, the technology has tremendous potential to disrupt our healthcare systems, but the reality is that it is still relatively new and untested in practical situations, while healthcare systems tend to adapt at a glacial pace–as of 2014, only 74% of hospitals had an electronic health record system. If healthcare systems are still technologically in the late nineties, anyone holding their breath for a blockchain-based revolution is going to pass out well before the gears are set in motion (and then have to visit the hospital and deal with its convoluted and outdated system).
The Blockchain Dream
Medical records present many challenges to the healthcare system. The data is important and valuable, both to patients and criminals. Medical records are immensely useful for fraud, and they can be sold on the black market for more than 100 times what credit card data will fetch. Because of this, privacy and security need to be at the forefront of any system. Access is also crucial, which often conflicts with the two prior needs.
The current healthcare record system is a mess of disconnected databases with data transferal issues, that is suffering from a growing number of breaches. Blockchain and other digital ledger technology have all the hallmarks of a perfect solution. They are secure, almost impossible to manipulate, auditable and can be easily accessed with public and private keys.
Healthcare organizations, such as hospitals and insurance companies need to share patient information to conduct their business. One of the big problems with the current system is knowing whether the information that has been shared is accurate and that it hasn’t been tampered with. A permanent blockchain-based record could completely solve this issue. Those with the right credentials could verify a record at any time. The system would be easy to audit, more streamlined and much more effective.
The Problems of Blockchain in Healthcare
A lot of high-minded blockchain entrepreneurs are presenting big solutions to complex problems, but some are out of touch with the realities of the systems they want to change. Coindesk reported Alyssa Hoverson Schott, a doctor from Sanford Health, as saying, “It’s just not possible for the healthcare system to be real time as it relates to claims.” She went on to elaborate that because of the immense workload that doctors are under, they do not have time to immediately record data or results to the blockchain.
Another major issue is that companies could be locked-in to their blockchain vendor. The cost of transferring blockchain-based medical records to another organization would be exceptionally high, so a business could find themselves trapped with a vendor who raises the service price to unreasonable levels.
Also, blockchain infrastructure isn’t at the stage where it can handle something as large or as important as US health records. Apart from Bitcoin, blockchain technologies have only really been experimented with for the last couple of years. In most sectors, startups are still working on proof-of-concept, rather than applying their technology in practical ways. Healthcare is no different, and the reality is that the technology hasn’t been tested thoroughly in real-world applications.
When you take into account just how important medical records are, how much organizations could lose by deploying immature technology, as well as the slow pace of IT in healthcare, it is clear that large-scale blockchain solutions are a long way off. Michael Gucci, who is both a doctor and a Bitcoin entrepreneur, estimates that the technology won’t be implemented for another 10-15 years.
The Reality of Blockchain in Healthcare
This article aims to be realistic, not pessimistic. It’s easy to get sucked into all of the blockchain hype and completely lose sight of the ground. These attitudes lead to bubbles and speculation that can be just as damaging to the blockchain industry as the established players who keep their heads in the sand. While a completely integrated blockchain-based healthcare solution is somewhere on the vast horizon between dreams and reality, there are some individual applications that we may see much sooner.
While it may not be a big problem in the developed world, some countries have significant issues with counterfeit medication. Accenture has proposed combining blockchain and IoT technology to track drugs and make sure that they haven’t been tampered with. In the developing world, the supply chain can be difficult to trust, so using distributed time-stamping on these products could ensure that they are genuine, which in turn could save lives.
Decentralizing Patient Databases
Medical data breaches have become more common in recent years. One of the reasons for this enormous rise in medical data theft is that as the transfer has been made to electronic health records, much of this data is pooled in centralized databases. Some of these can have between 5 and 10 million records, which is a huge target for hackers.
Adrian Gropper, the CTO of Patient Privacy Rights, proposes that we need to decentralize these databases so that hackers cannot steal as many records at once. He proposes making the databases smaller and only housing the records for one doctor or community, instead of millions of people. Gropper is building a patient-centered medical record platform that is based on blockchain technology. He believes that this solution could keep the data diversified and make it harder to hack, as well as much less fruitful for criminals.
Estonian Health Records
In what may be the clearest demonstration on the future of blockchain technologies and healthcare, the Estonian eHealth Foundation has partnered with the data security startup, Guardtime. Together, they plan to develop a blockchain-based system that will secure the medical records of more than 1 million patients. The system files and signs the data, with new signatures generated whenever the information is altered. The data itself isn’t stored on the blockchain, just the hash values that indicate when files have been updated. This system keeps the records secure while leaving a clear trail of any alterations.
While the Estonian project may not be the integrated health system that some blockchain fanatics dream about, it certainly shows the potential for the technology within the healthcare system. Despite the advantages that lay in blockchain-based solutions, we need to recognize that the technology is still in its infancy. With the slow pace of the health system, especially where it comes to IT, it will be a long time before we see blockchain technology used in any significant way.
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