How Blockchain Will Revolutionize Healthcare

A new model for health information exchanges

The health care industry is ripe for a makeover with blockchain technology being the makeup. That is because the technology has the potential to transform the health care ecosystem by increasing the security, privacy, and interoperability of health data, which in effect decreases the outlandish costs of the overall healthcare system. Blockchain technology could provide a new model for health information exchanges (HIE) by making medical records more efficient, disintermediated, and secure. While this industry has many inefficiencies, blockchain is by no means the one-stop solution; instead it provides grounds for experimentation, investment, and proof-of-concept testing.

How can blockchain provide opportunities for health care?

​A blockchain powered health information exchange could unlock the true value of interoperability. Blockchain-based systems have the potential to reduce or eliminate the friction and costs of current intermediaries.

Interoperability: Electronic health records (EHRs) lack interoperability and are exceedingly costly. Because EHRs are unable to effectively communicate with each other, physicians and surgeons often treat acutely ill patients without obtaining access to their medical histories, current medications, and prior imaging studies. Achieving full interoperability has been projected to save the U.S. health care system $77.8 billion per year, largely by avoiding redundant tests and imaging studies and by decreasing administrative expenses.

An electronic health chain (EHC) that uses blockchain technology could be a convergence point for a patient’s health information. In a truly interoperable network, data gathered over the course of a patient’s life through personal health & wellness, diagnostic, and therapeutic activities such as patient encounters, procedures, laboratory testing, radiology, smart devices, and even third-party genetic testing services, could all be securely incorporated into a patient’s unique EHC.

Data gathered over the course of a patient’s life could be securely incorporated into a patient’s unique EHC

On a large scale, this is what it would look like all mapped out

In the 2015 report “Connecting Health and Care for the Nation, a Shared Nationwide Interoperability Roadmap,” the Office of the National Coordinator for Health Information Technology set a goal of establishing full EHR interoperability by 2024. They’ve issued a shared nationwide interoperability roadmap, which defines critical policy and technical components needed for nationwide interoperability, including:

1. Ubiquitous, secure network infrastructure
2. Verifiable identity and authentication of all participants
3. Consistent representation of authorization to access electronic health information, and several other requirements

Research: A health care data supply chain could revolutionize the next generation of scientific research. Surgical and medical research today is encumbered by the difficulty of building large datasets across existing silos of patient data. The cost, labor, and error associated with manually updating databases like ACS NSQIP, the National Trauma Data Bank, or the National Cancer Database can be avoided if clinical data are integrated into a common, searchable EHC. Moreover, the power of these data will be amplified in coming years if the troves of genetic data from public online sources and wearable devices can be effectively incorporated into the EHC.

Security: Blockchain technology also stands to improve the security of health care delivery. Fraudulent Medicare billing, for instance, costs the health care system anywhere from $70 billion to $240 billion per year. Establishing an immutable blockchain in which patients are informed of all changes to their health care records and bills would eliminate the possibility of such abuse. Establishing such a system would have significant indirect effects, such as in the counterfeit drug industry. Counterfeit drugs are understood to pose both a public health threat and a significant cost to the pharmaceutical industry, costing the Eurozone 10 billion Euros per year. Blockchain-based systems that aim to track each step of pharmaceutical procurement and delivery — with each intermediary contributing a cryptographic key to a final product hash — are already being developed to eliminate this problem.

There are also security issues related to the centralized nature of these records in their current form, making them frequent targets of cyber attacks. More than one-third of the U.K. National Health Services’ (NHS) trusts report coming under cyber attack, and more than 110 million U.S. citizens had health care data stolen in 2015 alone. In 2016, hackers targeted several hospitals in so-called “ransomware attacks,” where hackers locked EHR systems until ransoms were paid, with at least one hospital in Los Angeles, CA, admitting to paying 40 bitcoins to meet hacker demands.

Data ownership: Moving from today’s information exchange paradigm, an EHC has the potential to return ownership of health care data to patients themselves. Health care providers would need encrypted keys to request information from patients, and patients could, in turn, select who has access to their medical records and when. Patients could potentially preauthorize information sharing with legitimate providers in unforeseen emergencies without actually pre-sharing that data, and choose to which, if any, research entities to lend their data, effectively making people some extra money.

Impediments & the future

Significant challenges and limitations to implementing health care blockchains remain. To achieve a universal EHR blockchain, there is a need to adopt common data standards, appropriate software or “middleware” must be built to interface with blockchain ledgers, incentives must be aligned to attract the processing power for the network, and important decisions must be made with regard to how much data will be fully incorporated into an individual’s EHC. In order to fast track this process, government agencies should be at the forefront by creating incentive programs and funding pilot programs to help reach a better future.

We are going to see several industries adopting blockchain technology in the coming years, most visibly within the realms of agriculture, finance and logistics. While health care may not be the first industry to adopt the technology successfully and on a large scale, it is an industry with one of the biggest opportunities to not only revolutionize electronic health information, supply chains, and data ownership, but also to assimilate expansive tranches of data for research purposes.