In the past, commercial transactions over the internet mainly relied on trusted third-party financial institutions to process and deliver online payments. This process was accomplished through trust and co-dependence. However, with the invention of Bitcoin by Satoshi Nakamoto in 2009, a system of cryptographic proof was created, which allowed two parties to directly engage in transactions. Bitcoin managed to eliminate the need for a third-party financial institution.
Blockchain is a decentralised public ledger that serves as a virtual record of ownership and transfers of the ‘assets’, as a typical ledger does. It also helps enable Bitcoin and other cryptocurrency transactions. The blockchain is updated upon every transaction involving cryptocurrency by adding a ‘block’ to the ‘chain’. Each block contains a cryptographic hash of the previous block, transactional data, and a timestamp. Blockchain is considered secure against malicious attacks because there is no centralized structure and the data is stored in numerous copies on different nodes; therefore, once a block is added to the blockchain, it becomes very difficult to edit and almost impossible to delete.
Accordingly, the security and openness of blockchain has enabled its implementation and usage across various industries and operations. Apart from its usage in cryptocurrencies, blockchain is now being used in healthcare, financial services, video games, energy trading, as well as supply chain management.
Blockchain technology in healthcare
In the healthcare domain, the development of Information Technology (IT) has changed the perception of data and its management. Due to improvements in IT and its infrastructure, data-driven healthcare is increasingly becoming the norm. Patient data collection is now considered as an effective means of providing efficient, cost-effective and sustainable healthcare services. However, even with the existing advancements, there exist certain issues within the current system of patient data collection and management:
- Fragmented medical histories due to multiple healthcare providers
- Complex medical cases spanning over years that require specialized attention
- Information exchange across various jurisdictions
- Lack of uniform mode for storage of data
- Reluctance of certain patients and providers to digitally store such data
- Lack of common standards and architecture in electronic health records (EHRs)
- Outdated communication channels between existing healthcare providers (fax, snail mail, etc.)
Apart from these issues in data collection, management, and data sharing, the nature of the data stored is also of a sensitive nature. The information collected includes personal data of a patient such as the gender, date of birth, medical history, and procedures performed. The existing system also poses challenges regarding privacy, data security, and operational efficiencies.
The synergy of implementing blockchain in the healthcare industry
In the current system, each time a patient avails of any healthcare service, he has to provide his details through the healthcare system. However, in a blockchain-based system, the information could be inserted into a nationwide or global blockchain transaction. Just like with cryptocurrency, a private key can be created for individuals to access their information. With this, patients will be able to easily access and share their information with healthcare organisations seamlessly.
In a healthcare context, the transactions could comprise a documentation of specific healthcare services provided. Moreover, all sensitive data can be encrypted for the benefit of both the patient and the healthcare provider such that only the holders of the correct keys can access the information on it. This would enable patients to access their data with ease, have more control over their data, and reduce data insecurity by providing patients better privacy. Such a system of storage- and patient-enabled control would also help reduce errors and omissions by minimizing human involvement in the recording and transmission of data. The implementation of such a system could also see the industry moving from generic healthcare solutions to more specialized, individual health care which would benefit the patients and institutes as well.
Apart from a uniform system of data management, blockchain can also serve as a basis for the following:
- Pharmaceutical supply chain
- Biomedical research and education
- Remote patient monitoring (RPM)
- Health insurance claims
- Health data analytics
There are many examples of such successful implementations. Some of them have been listed as follows:
- Medicalchain: They have begun tackling hospital discharge summaries by introducing a digitized solution that leads doctors through a structured discharge process, thereby reducing errors and omissions.
- Healthcoin: Another example is Healthcoin, an initiative that was first developed as a blockchain-based solution for helping people work towards improving diabetes symptoms. It has since expanded its vision towards building a system to construct a global electronic health record system.
- There are numerous other examples of ambitious projects that are emerging in this industry such as BurstIQ, Factom, GemOS, HealthCombix, MedRec, Patientory, and SimplyVital Health.
Apart from the obvious benefits to patients and private companies, the implementation of blockchain would also be advantageous to other stakeholders, such as governments. From the perspective of the government, this would not only be a cost-saving measure but would also encourage patient empowerment and advance existing medical research and care.
In the United States, for example, the Illinois Department of Financial and Professional Regulation has partnered with healthcare firm Hashed Health to build solutions to improve the efficiency and accuracy of cross-state medical licensure.
Whereas, in the United Arab Emirates (UAE), multiple blockchain-based solutions and partnerships have already been announced. Some notable examples include the following:
- A leader in the healthcare industry, NMC has partnered with the Emirates Integrated Telecommunications Company, or du, along with blockchain technology firm GuardTime to enhance electronic health records.
- The Dubai Healthcare City Authority and Dubai Health Authority (DHA) have partnered to link healthcare professionals’ licensing data using a blockchain system. With the help of this technology, both government bodies will link the Masaar e-services portal and Sheryan smart licensing system for licensed healthcare professionals from anywhere in the world.
- UAE’s Ministry of Health and Prevention (MoHAP) has also announced a partnership with Dhonor Healthtech to come up with a blockchain-enabled mobile app—Hayat—to improve the process of organ donation in the country. This initiative will reduce paperwork, provide easy access to information, optimize organ transplant procedures, and help reduce organ trafficking. MoHAP has plans to link the blockchain organ donation program across all the hospitals that carry out organ transplant operations in the country. Apart from these initiatives, the UAE has also partnered with VeChain and Pfizer for blockchain-based advancements.
Challenges in implementation and potential solutions
With a plethora of opportunities that come with the implementation of blockchain, there are also certain challenges that must be overcome in order to ensure its effectiveness. The most pertinent ones have been listed as follows:
- Scalability constraints: The scale of the implementation, especially when it comes to implementation with an outdated infrastructure, would require a massive overhaul. If left to the individuals and healthcare providers, they might be reluctant to make such a monumental change. In some cases, however, it may just be a lack of computing power.
- Data standardization: Since every organisation has different modes of collecting data and storing it, the implementation of blockchain could also see different standards of data collection and distribution for each transaction. For example, some healthcare providers may choose to include a doctor’s notes in a transaction while others may feel that such information is unnecessary.
- Cost of implementation: It is important to remember that the existing modes of data collection, storage, and management have required huge investments. While blockchain may prove to be an effective solution, the cost of implementing it and replacing the existing infrastructure may be impractical or burdensome for small scale operations.
- While no single solution exists to combat all of these issues, a well planned and executed policy decision by the government could help tackle many of these challenges.
- If a government ministry or regulatory body oversees the implementation of blockchain and assists with its transition by improving the existing infrastructure, providing the requisite computing power, and assuring patients about the security of the endeavour, scalability constraints can be effectively dealt with.
- Similarly, if the standards of data to be collected and shared were pre-decided and a government authority could oversee their uniform implementation, the ambiguity surrounding data standardization could be eliminated.
As far as the cost of implementation is concerned, financial assistance would only have to be provided to the smaller scale operators as the long-term benefit of such assistance at the national scale would definitely outweigh the risks involved.
Some of these challenges are currently being tackled, and they can be overcome through careful planning and application. A blockchain-based implementation could definitely see an advancement in the biomedical domain and has immense potential to overhaul the perception of healthcare.