Cryptocurrencies have been trending in the news lately because of their volatile market price, security, and popularity. Investors and money moguls alike have dumped “real” money into the cryptocurrency market, turning fiction into fortune with an intangible concept of data that holds wealth in today’s world. Believe it or not, the blockchain ledger—the decentralized network of recorded transactions for bitcoin—can actually have an application towards the HIT market. It may sound strange to apply a cryptocurrency concept to something as far related as HIT, but going into the detail of what the blockchain ledger represents and how that can apply to healthcare isn’t as far-fetched as some might initially think. Here’s why.
A bit of background: the blockchain ledger is a decentralized database that records several encrypted transactions. These transactions reside on a peer-to-peer network, sharing all data between all computers—it presents a huge advantage over a centralized database network. If the central database in a network were to fail, all the data within that network would be lost. The peer-to-peer network of transactions is a stronger data integrity model because any computer failure on the network doesn’t affect the overall integrity of the data—all “nodes” of the network serve as a full record of the blockchain ledger, making data loss or corruption nearly impossible. All nodes have neutral authority. The popularity of cryptocurrencies has skyrocketed because of how highly secure these blockchain ledgers are. It’s a data interchange concept that arose out of the 2008 stock market crash when individuals lost faith in banks that used a financial system functioning similar to a centralized database network.
So how does that fit in to healthcare? Think of the blockchain ledger as an entire ongoing record of everyone’s healthcare records, and any device that records a metric for healthcare—total mileage ran, for instance—can be considered a transaction on that blockchain that cannot be altered. A visit to the doctor could record a person’s age, weight, lifestyle habits, hereditary complications, diet, and other health factors, and then record that into the blockchain as a permanent “transaction.” It may be possible to record all health-related information from a person’s birth to any given moment in time. A physician could access the HIT blockchain and compare a patient’s entire health record with that of thousands of other patients that fit their near-exact health and lifestyle record. Misdiagnosis and improper medication could virtually disappear.
It’s not only a matter of reducing misdiagnosis or improper medication either—physicians are sometimes without the complete picture of when treating a patient. They’re only able to evaluate a patient’s health via what they can sample. For example, through phlebotomy a physician finds that a patient has a huge vitamin C deficiency and symptoms align with scurvy—the patient is diagnosed with scurvy and given vitamin C supplements. That can be recorded as a blockchain transaction and be used for further diagnosis in the future from any other physician. Every future visit to the doctor for an evaluation can improve by giving the physician a more complete snapshot of a person’s health. Patients won’t require as many evaluations. Plus, the future of healthcare may evolve into the ability to predict disease based on evaluating comprehensive trends in health. Imagine predicting cancer in people 60 years ahead and tailoring entire lifestyle habits for future at-risk cancer patients to avoid the disease. Not only that, but imagine if there’s a patient with a disease that doesn’t match with similar patient records. Perhaps this unmatched disease is something new that requires research, learning, development into new medication, and higher healthcare standards.
HIPAA and The Blockchain Ledger Data
One of the double-edged swords of the blockchain is that it’s being used as a way to remain anonymous when trading cryptocurrencies. That’s why it’s attracted the interest of hackers and malicious individuals. In 2016, a Los Angeles hospital was the target of a complete system hijack from a hacker that demanded 17 thousand dollars in bitcoin. Several of these sudden system hijacks have happened where the culprits demanded ransom in bitcoin because of the nature of bitcoin—it’s not entirely anonymous, but by joining the bitcoin blockchain you can falsify information about yourself and “cover your tracks.”
However, if a blockchain ledger were to arise for healthcare IT, it would have to remain private and under HIPAA regulation. All “transactions” under the HIT blockchain would have to remain anonymous until a patient gives consent to a doctor to view their entire set of records. With a system of data interchange that gives patients the power to allow doctors they consult to view their records, it may be a revolutionizing method of keeping HIPAA violations at bay. At face value it seems like the best technology for healthcare, but there are a lot of potential hurdles and hangups. If a patient requests their healthcare records, how do they access them? If the HIT blockchain is the main method of keeping a comprehensive health record, how will businesses interact with that? Will that kind of information stay neutral to all parties accessing it? With the rise of an HIT blockchain, suddenly we’re stuffing a highly sensitive form of data that must be carefully handled onto a new network of data interchange. If there’s a method of avoiding the privacy regulations for blockchain integration, that would be ideal. It’s a matter of finding out what that method is. For now, a slow evolution into storing medical data onto the blockchain ledger is ideal, but there’s a jungle of rules and red tape to cut through.
Likely one of the strongest aspects of using the HIT blockchain is interoperability, which is still a sought-after capability when using certain EHR systems. It’s natural for EHR companies to snuff interoperability with other EHR systems in order to sell more product, but sometimes hospitals are at the whim of using the systems they’re stuck with and poor interoperability forces workarounds. That won’t be a problem with the blockchain. Complete and total interoperability is predicted to save HIT several billions of dollars with use of the Electronic Health Chain (EHC), a patient-controlled form of healthcare information that resides on the blockchain. All data gathered through any device that can integrate with the blockchain—whether it be from a pedometer, blood pressure cuff, diabetic testing machines, sleep habit readers, or any possible device that can provide data—can be incorporated within the EHC. This suggests that no matter what physician you see, they have a complete, unbroken record of a patient’s healthcare from the start of recording—perhaps from birth!—to the last transaction recorded, without squabble over conflicting software that won’t communicate.
Healthcare Future with the Blockchain
Medication development often hinges on clinical trial studies that can take several years to complete. Pharmaceutical companies rely on doctors to identify patients that fit specific profiles to contact and ask for a clinical trial study to see how a medication may affect them (hopefully in a positive way). Using the blockchain ledger, the process of a clinical trial can be reversed—patients can willingly sign up for a clinical trial and release their EHC to pharmaceutical companies, reducing research and development time significantly. Instead of pharmaceutical companies finding willing patients to undergo studies, the patients can give access of their entire medical history in the blockchain. The efforts to find a strong sample size for the study may be reduced.
By evaluating someone’s entire history of health, hereditary impacts, lifestyle choices, diet, and maybe even their genetic predispositions, physicians can reduce improper diagnoses, find new medical conditions, develop new medications, and understand more about healthcare in the future. Integrating the Internet of Things, the EHC, and total interoperability into the blockchain can push understanding of healthcare to heights never seen before. There are obvious hurdles to full integration and we won’t see full blockchain integration into healthcare at the flip of a switch, but it’s interesting to see where we could possibly take healthcare with this newfound form of data interchange. A current project in the works is called MedRec, a prototype blockchain EHR system that gives patients access to their entire healthcare history for purposes of diagnosis and research. That’s just one prototype coming out of the woodwork lately. The percentage of HIT executives integrating the blockchain into EHR systems has grown since inception, and several new networks have spawned with their own unique structures, paving the way to what might be a complete healthcare information overhaul.