Blockchain in Healthcare: Building Trust and Security (Part-1)

As a step towards value-based healthcare system, the American Recovery and Reinvestment Act mandated all public and private healthcare providers to adopt electronic medical records (EMR). The adoption and meaningful use of EMRs are also the primary objectives of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and the Federal Health IT Strategic Plan. As of 2016, over 95% of hospitals eligible for the Medicare and Medicaid EMR incentive program and over 60% U.S. office-based physicians have achieved meaningful use of Certified health IT.

EHR adoption in US

With significant growth in digitization of medical records and advances in medical technology, we are not just collecting data now but also using it to improve diagnostics, detect cancer, predict the spread of flu and other viruses, and to improve population health. Advanced technologies like Bigdata, Artificial Intelligence, Text Mining, Machine Learning, etc. are enabling these improvements.

Just like medications, these pills of technological advancements came with some side effects. As healthcare organizations and vendors started to store the data in a central repository, they became vulnerable to the single point of attacks (e.g. WannaCry cyber attack on NHS) and posed questions about data privacy, ownership, and control. As data is becoming a valuable economic resource to which every stakeholder wants their share of access, these challenges have to be addressed and regulations like Health Information Portability and Accountability Act (HIPAA) try to address the issues but are either inconsistent or don’t specify a lot about ownership and control.

Thankfully, new advancements in the distributed ledger technologies (DLT) and Blockchain can aid in overcoming these challenges by establishing “trust” between these participating parties. In this article, let’s explore what trust is and how DLT-based infrastructure can establish trust and move us towards achieving true interoperability.

Cost of trust:

Trust is a firm belief (gut feeling) placed on someone or something. Since evolution, humans used the trust to transact/exchange value. When patients provide their personal data, they trust that the data will enable the practitioner(s) to make better decisions about their personal diagnosis. Regulations like HIPAA re-ensure patient’s privacy and fill the trust gap between practitioner and patient. These regulations have “systems and checks” in place to prevent malpractices adding cost and complexity to the genuine stakeholders. With current technologies and systems, there are little means to prevent data misuse/tampering by determined malicious actors. In medical terms, regulations are a reactive diagnosis while an ideal system requires preventive care.

Blockchain: a protocol to establish trust without the cost of trust

The blockchain is a protocol that establishes trust between different transacting parties without the cost of trust. It is a digitized ledger containing a group of transactions bundled into blocks forged by consensus. These blocks are arranged in a series and forged for eternity using a cryptographic hash function. The ledger (chain of blocks) thus formed is inherently distributed, decentralized, immutable and trustless.

Consensus mechanism enables blockchain users to reach a common agreement about the current state and ensures that the same information is distributed to all users. This distribution of the data across all users secures the blockchain from the single point of failures/attacks. The users(miners) in the network solve a cryptographic puzzle to arrive at a block with acceptable transactions thus decentralizing the authority to add data to the blockchain.

The cryptographic hash function is a computer program that takes the records of transactions as input and outputs a unique string of characters as its signature. This program will output the same signature as long as the input remains the same for any number of executions. When a malicious actor tries to edit a transaction in a block, the signature generated will be completely different from the signature available to other users. This property enables users to reject the malicious transaction, thus making the blockchain immutable.

Maintaining the above three properties in a trusted system (where every user trusts the other user) is easily achievable. Blockchain’s true goal is to maintain trust in a trustless system (where no user can be trusted individually), using crypto economics and game theory, by rewarding the miners to prove and verify the transactions in a block.

Since Bitcoin’s genesis, DLTs evolved to expand their scope from cryptocurrencies to smart contracts and are currently exploring ways to achieve machine to machine (M2M) transactions without compromising speed/security. In our next article, we will share more about the evolution and potential applications of this technology in healthcare.

About Authors:

Jaya Shankar Parimi, M.Tech, MBA — A certified blockchain expert with experience in healthcare, insurance, and manufacturing sectors developing technology solutions to improve business processes.

Vineeth Yeddula, CLSSMBB, PMP, CMQ/OE — Co-Founder, KPI Ninja. An entrepreneur and engineer by training with significant healthcare data analytics and performance improvement experience in multiple healthcare settings.

Engineer, entrepreneur, and educator.