What important problems can blockchain solve in healthcare and medicine? To answer this trending question, we examined reports of healthcare organizations, studied existed projects in the industry, checked news, reviewed use cases and scopes of blockchain application in medicine. As a result of the study, we made a detailed summary of blockchain applications in the industry, their current implementation level and types of clients.
The main areas of blockchain implementation in medicine can be divided into the following sub-industries:
We have identified potential users of blockchain technologies and presented them in the table below:
Further on, we will describe in detail and elaborate on which fields of medicine can benefit from decentralized ledger technologies the most.
Medical records and patient data storage
Blockchain-based solutions for keeping, storage and exchange of medical records and patient data.
Current implementation level: Low
Potential clients:
Problem 1: Low-level security of medical records storage
Centralized data storage in paper and electronic form is subject to risk: people can fake and delete records, electronic systems and servers may fail, accidents, severe weather, natural disasters, and hurricanes can result in extensive damage to important documents. Blockchain prevents these effects and leaves the data intact even if it was destroyed in a specific physical clinic. Also, it becomes impossible to make illegal changes to the patient’s medical records unilaterally.
Problem 2: Difficulties in the process of data transferring between hospitals
It’s difficult to request medical data for transfer to other clinics/hospitals when moving, changing doctors, having treatment in another state or country. In most cases, data sharing is simply not possible, especially when it comes to providing medical assistance abroad or in another state. For example, every state in the U.S. has its own set of nursing certifications that nurses can apply for after they have completed a required education. When moving to another state a nurse has to spend extra time and money on taking another exam which is accepted in this state. This is because there is no exchange of certificates between hospitals. Blockchain, in turn, allows hospitals and other parties to share access to their networks without compromising data security and integrity.
Problem 3: High transaction costs of obtaining medical records in case of urgent need
In case of urgent need to obtain data, transactions costs can be extremely high. For example, a person involved in an accident urgently needs to receive data about vaccinations, allergies and so on. Obtaining this data at a state or country level is either too long or just not possible. Blockchain helps to create a secure, fast, universal medical data-sharing infrastructure with access to medical records at the request of the patient. Private keys allow patients to have remote and independent access to their own medical records.
Problem 4: Loss of medical test results, falsification of medical examination results, lack of systematization of vaccination information
Based on an IBM research, three of every ten medical tests are reordered because the results cannot be found. This tends to result in redundant tests, which can lead to missed diagnoses and treatments, resulting in further injury or even death. To avoid loss of medical test results people have to make a copy of them and keep it in a secure place. But even those measures won’t protect documents against fires, hurricanes, and other natural disasters. Storing important records in a distributed ledger would solve these problems and keep all the information safe. Blockchain helps to store the results of medical tests and makes it impossible to change the results of a medical examination.
Difficulties of blockchain technologies implementation associated with institutional constraints:
1. Transition of clinics equipped with modern electronic systems to the blockchain is associated with high costs.
2. Transfer of clinics to blockchain is complicated by the lack of a regulatory framework.
Use cases of blockchain technology in medical records and patient data storage:
1. Shivom combines blockchain, artificial intelligence, DNA sequencing, and cryptography to enable secure and personalized medicine. Shivom will enable DNA data donors to collaborate with changemakers in biotechnology, healthcare and medical research to contribute to the development of medical technology.
2. Gem has launched the Gem Health Network, a blockchain network for the global companies across the healthcare industry. Gem is using Ethereum blockchain-enabled technology to create a secure, universal data-sharing infrastructure.
3. MedRec uses smart contracts as an intelligent representation that links patients and providers to the addresses of existing medical records. Medrec does not ‘store’ the record directly; rather encodes metadata that allows records to be accessed securely by patients, unifying access to data across disparate providers. The metadata contains information about ownership, permission and the integrity of the data being requested.
4. Open Clinics transfers storage of medical records on the blockchain and implements the integration of a medical records sharing system among members of a partner clinic network.
E-Medicine and IOT
Blockchain-based medical IoT devices, wearables & trackers data storage, exchange platforms.
Current implementation level: Low
Potential clients:
Problem 1: Data security issues
Most patient records obtained from medical devices are kept centralized under the traditional tech, and subject to theft, loss, removal, and alteration. A major benefit of blockchain is that it can help healthcare organizations to create unified medical devices and trackers indicators databases and enable secure sharing of sensitive medical data. Blockchain improves data transaction process, as well as ensures efficient collaboration between separate health care providers and research organizations.
Problem 2: Lack of control over patients data which is needed in emergency cases
Nowadays, people wear a lot of devices such as fitness trackers, shoes with sensors designed to eliminate foot pain, plasters that warns patients about an imminent epileptic seizure, etc. The devices collect information about a person’s medical condition and can signal a health hazard. Blockchain chooses to whom and in which cases the data from these devices should be provided.
Problem 3: Unused and undervalued information
All the data generated by trackers and wearables is of high value for manufacturers of sports equipment and gym clothes. Blockchain-integrated devices data storage systems allow not only to store, but also to provide access to the collected data. Access to the data can be free, paid or can be provided in exchange for discounts or bonuses.
Incentives to use blockchain in E-Medicine and IOT:
- According to an analysis done by BIS Research, the global blockchain in the healthcare market is estimated to amount to a massive $5.61 billion by 2025.
- Berg predicts that by 2021 there will be 50.2 million people remotely monitored using connected healthcare devices — a compound annual growth rate (CAGR) of 48%.
Restrictions:
- Applying this kind of technology definitely demands a strong series of computer, high 24/7 energy consumption and fast connection speed. With healthcare enterprise which tends to run on an “off chain” database, the switching costs are high. In fact, most cost benefits will not be realized until old systems are decommissioned. Organizations also need a trusted solution provider. Currently, few start-ups have sufficient credibility and technology stability for government or industry deployment at scale.
- The lack of common standards and clear regulations is a major limitation on blockchain applications. With healthcare, since medical data is sensitive information with a high level of concern, regulations are of course stricter than most industries. For example, in the United States of America, HIPAA rules have multiple subchapters and healthcare entities are going to have to master them all for blockchain.
- To apply blockchain in the healthcare industry, natural competitors need to cooperate, making sure that their data is correct, transferable and adaptable to the others system. The issue is agreeing on the governance decisions. Overcoming this issue often requires a credible sponsor, such as a regulator or industry body, to take the lead.
Use cases of implementation decentralized leather technologies in E-Medicine and IOT:
1. Estonian e-Health Foundation & Guardtime company entered into a partnership for integrating a Blockchain-based system to secure millions of medical records.
2. IBM Watson Health is in partnership with the Food and Drug Administration to use blockchain to exchange health-related data in a secure and efficient way.
3. Modum.io is a startup that combines the IoT with blockchain by placing a sensor device on the package that can regulate and track temperature, humidity, and shock, along with a smart contract that automatically checks, accepts or rejects acceptance criteria for a product.
Medicines and medical equipment supply chains
Blockchain-based systems for certification and tracking of medicines and medical equipment at each stage of production and sale.
Current implementation level: Low
Potential clients:
Problem: Low-level transparency and high fraud risk within the existing drug certification approach
There is a high proportion of counterfeit and non-certified medicines reaching consumers. According to the World Health Organization estimates, one million people die each year from counterfeit medicines. Based on the research, 1 in 10 medical products in developing countries is substandard or falsified. This means that people are taking medicines that fail to treat or prevent disease. In addition, about 8% of medical equipment is counterfeit. The complex structure of medical equipment/medicines supply chains allows fraudsters to introduce counterfeits at various stages. Marking, certification, verification of medical equipment at each stage of supply chains and recording information in the blockchain will ensure high reliability of supply chains. It will make it easy to track the medical equipment supply chains and to prove its origin. Blockchain helps to reduce illicit medicines trafficking and reduce the risk of buying counterfeit medicines.
However, the adoption of the Drugs Supply Chain Security Act may stimulate the development of this direction.
Use cases of blockchain implementation in medicines and medical equipment supply chains:
1. Major pharmaceutical conglomerates Pfizer and Genentech, together constituting a market cap greater than $300 billion, recently announced the MediLedger blockchain platform, powered by JP Morgan’s enterprise-focused, Ethereum-based Quorum, designed to keep counterfeit goods out of medical supply chains. The MediLedger project is slated to go through various pilot tests that simulate marketplace supply-chain conditions of both Genentech and Pfizer. Confirmation of transactions is carried out on the basis of the “Proof-of-Authority” algorithm. The blockchain will record public data on medicines, records on the production and movement of medicines.
2. One Network’s cloud platform is going to provide an end-to-end fulfillment backbone that manages the entire distribution process of medical supplies.
3. IBM announced a partnership with Chinese supply chain management firm Sichuan Hejia to introduce the Yijian Blockchain Technology Application System. The system covers several pharma retailers, hospitals and banks, and is intended to track drugs through the supply chain and encrypt trading records to improve the legitimacy of authentic transactions.
Prescription medicines
Electronic systems for monitoring the issuance and use of medical prescriptions.
Current implementation level: Low
Potential clients:
Problem 1: The risk of medical prescriptions counterfeiting and abuse of power by doctors and pharmacists
According to a CDC analysis, there were 19.354 deaths involving prescription opioid pain relievers (excluding non-methadone synthetics) in the USA in 2016. Blockchain and electronic prescriptions control systems provide the ability to verify the origin of the medical prescriptions (the reason for issuing, the prescribing doctor, etc.). Thus, the prescribing doctor is fully responsible for the consequences of the prescription of drugs.
Problem 2: Resale of medical prescriptions
Illegal sales of prescription drugs are among the most serious types of prescription drug crimes. Sales of such drugs can typically result in felony charges, which are punishable by criminal consequences such as 1–5 years in prison and/or criminal fines. Professionals such as doctors or pharmacists may face additional consequences, such as a loss of practicing license or a loss of certification. Pairing patient and prescription information and a simplified verification process reduce the risk of illegal medicines retrieval.
Problem 3: Medical marijuana market is not streamlined and transparent
The medical use of cannabis is legal in 33 states of the USA and is used to treat symptoms associated with diseases such as AIDS, cancer, and glaucoma. Medical marijuana retail sales for the U.S. was $4.5 bln in 2018. Blockchain helps to systematize the realization of medical marijuana, to track legality of sale and purchase.
Incentives to use DLT in prescription medicines:
- Attention to the problem of prescription medicines from the state suggests the development of this direction. However, the development of this direction can be carried out exclusively within the framework of an integrated approach with the participation of state bodies.
Use cases of blockchain technology in monitoring systems for issuance and use of medical prescriptions:
1. A pilot project to create a unified register of electronic medical prescriptions in the Novgorod region, Russian Federation. Connecting the internal electronic system of hospitals, electronic accounting systems, medicines labeling systems and a single registry of medical prescriptions to the Ethereum blockchain.
2. BlockMedx has been working on an end-to-end prescription platform using the Ethereum blockchain. The system implements crypto tokens to facilitate transactions. Prescriptions that are transmitted using the platform can be verified together with the physician and the patient’s details.
Clinical trial results
Blockchain-based databases for clinical trials.
Current implementation level: Low
Potential clients:
Problem 1: Lack of personal data safety
Confidential blockchain ensures patient privacy during data exchange processes. Healthcare institutions can add or provide access to information kept on a blockchain without breaching the patient’s privacy. Then, other users within the network also can access this information, such as insurance companies and CROs. Сlinical trial participants’ personal data remain protected since all the information is passed anonymously.
Problem 2: Lack of transparency
Often, clinical trial results are confined to general numbers and conclusions. Blockchain allows to verify an actual number of the participations in a sample and make sure that the data is not exaggerated or falsified. Blockchain allows verifying the original source of the information being transacted and detecting any attempts to tamper with it. At the same time, complete anonymity of participants is maintained.
Problem 3: Unavailability of data
When all data is shared openly within a network, issues with data systems interoperability are reduced. For example, in the clinical trial space, availability and accessibility of patient information could be used for patient feasibility analysis and population studies.
Three of the biggest pharmaceutical conglomerates — Pfizer, Amgen, and Sanofi — are working side-by-side to find the most effective ways to utilize blockchain technology, from storing safe data to speeding up clinical trials and ultimately lowering drug development costs.
IBM Watson Health and the FDA are developing an initiative that will define how blockchain can be used to exchange healthcare data from varied sources including electronic health records, clinical trials, and wearables.
Digitalization of medical services
Digitalization of healthcare services, interaction with patients, visits, and consultations.
Current implementation level: Very low
Potential client:
Digitalization of medical services allows excluding physical visits to a doctor in case of treatment that doesn’t require a visit to hospitals. In third world countries, a trip to a doctor’s office is a big journey and an error in determining the required specialist can be too expensive. Blockchain technologies have a lot to contribute and can be easily integrated into e-medicine.
Problem 1: Low opportunities to get preliminary acquainted with the patient’s medical history
Automation of the process of interaction with the patient provides the transfer of patient data to the doctor. It makes a visit to the doctor more effective in terms of therapeutic effect and reducing the cost of medical treatment.
Problem 2: Physicians rankings
To ensure patient confidence in the chosen doctors, the blockchain can store information about the medical practice of physicians and their ratings.
One example of blockchain implementation in medical services digitalization is Robomed. Robomed uses digital solutions (online tests, chatbots) that allow patients to determine the specialist they need.
Health Insurance
Use of smart-contracts in automation of insurance payments and execution of insurance contracts (smart-claims).
Current implementation level: Very low
Potential clients:
Problem 1: High transaction costs and delays in insurance payments
High transaction costs associated with the provision of documents to the insurance company and delays in insurance payments. Confidential blockchain helps to automate the processing of insurance claims, reduce time and transaction costs. Implementation of smart-contracts and electronic filing systems provide automatic execution of insurance contracts after achieving compliance with the smart-contract.
Problem 2: Risk of fraud on the part of the insurer/policyholder
Blockchain helps to resolve many problems connected with document management, such us incomplete set of documents, forgery, unreasonable refusal, sale of fake policies, etc. Smart contracts will increase the transparency of insurance relationships by requiring additional verification. In case of providing incomplete or ambiguous information about the insured event, the smart contract requests additional research.
Restrictions:
- The development of the direction within the framework of private firms is complicated by the high level of dependence of the insurance industry on legislative acts.
Blockchain technology use cases in health insurance:
1. Medical Chain develops a platform for storing patients medical records and providing access to this data to insurance companies.
2. SolveCare is a platform for decentralizing healthcare services and unifying, coordinating and administering payments.
Conclusions
In general, the level of blockchain implementation in medicine varies from low to very low. One of the major reasons for this situation is that all changes in the health-related sector take place at the municipal and state level. Implementation of blockchain technology in most of the medical sectors is possible with total or partial government participation.
Besides the fact that the industry is one of the most regulated and conservative, the introduction of new technology requires serious financial investments. But in spite of that, there is an increasing number of initiatives in this direction. There is a chance to see some interesting implementations of blockchain the medicine and healthcare industry in the next few years.
