Hurdles to blockchain uptake in healthcare
Healthcare data are among the most important forms of information that exist about individuals. Though we would like to believe that this personal information is safely stored on electronic medical records (EMRs) and our password-protected health apps, there are serious issues with privacy and data security in these systems. The ease of collection and storage of health data has grown exponentially, which may mean that it’s time for leading healthcare organizations to seriously consider upgrading their security systems with more advanced technologies, such as blockchain integration. Though in some ways healthcare organizations may make good candidates for this type of technology, there are complex factors unique to the healthcare industry that make it challenging and unlikely for blockchain to be widely deployed at a rapid pace.
Between 2009 and 2020, more than 268 million patient records were exposed to data breaches. To put this in context, that represents almost 82% of the US population! The consequences of these breaches range anywhere from the loss, theft, exposure, or impermissible disclosure of patient information. These numbers are not only concerning at an individual privacy level, but also have significant consequences for the broader healthcare industry. A survey found that every individual health record breached costs a healthcare organization an average of $355 (compared to an average of $158 per lost/stolen record in other industries). This implies that between 2009 and 2020, US healthcare organizations lost more than $95 billion from data breaches alone.
The seriousness of healthcare data breaches cannot be understated. So why aren’t healthcare organizations jumping at the chance to integrate their record-keeping systems with the most cutting-edge technologies? Why not blockchain? What’s standing in the way?
Protected health information (PHI): The sharing of PHI is highly regulated and the consequences of violating HIPAA patient privacy rules are extremely serious for providers and organizations. For this reason, organizations that are considering integrating blockchain must be extremely careful when deciding what type of information to store on-chain vs off-chain. Industry leaders suggest that PHI remain off-chain (e.g., in a relational database that the on-chain data can store metadata about) and high-level data be put on-chain. It may sound simple, but these decisions must be made extremely carefully given the regulatory environment surrounding personal health information. This also may contribute to unease among healthcare organizations that may feel more comfortable sticking with their current systems.
Smooth integration: Another key issue that poses difficulties for blockchain integration is the fragmented nature of data collection and storage in the healthcare industry. For example, in the US, there are over 500 different EMR companies. With increasing consolidation of healthcare practices within larger systems, a given healthcare organization may rely on many different EMR platforms, each with its own system of record. Integrating even one of these legacy systems to blockchain will require investment and infrastructure changes that hospitals and organizations (particularly those with multiple record-keeping technologies) may be unwilling to invest in at this time. Given ongoing challenges with interoperability, it’s likely that these organizations will prioritize consolidation of their data collection systems before even considering integrating them to blockchain.
Scalability: Blockchains scale best with lightweight metadata and transaction or audit information. But when larger information types are added, they do not scale as well. Though many forms of healthcare data meet the criteria of lightweight metadata, healthcare data can also take much more complex forms, including images or full genomic datasets. The diverse and wide-ranging array of data that may need to be stored by any given healthcare organization poses challenges for scalability if blockchain integration is deployed.
Though there are some significant hurdles to blockchain integration in healthcare (and many more than the three discussed here), it is early days, and many organizations are already looking at how to address some of the issues raised above. For example, operational pilot and proof of concept studies regarding blockchain applications are underway at national health agencies such as the FDA, HHS, and the CDC. Private companies are also moving ahead with their own applications of the technology for use in healthcare specifically.
So maybe the healthcare industry isn’t quite ready for widescale blockchain integration at this time, but the technology poses many benefits to data security and cost savings in an industry that is particularly desperate for cost-cutting measures. With a growing number of digital healthcare solutions that offer new ways to collect health data, the need for cybersecurity will only become more crucial. Blockchain could become a powerful tool at the industry’s disposal, but it will likely be quite some time before it becomes standard in healthcare.
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