Even though paper records for most medical practices have evolved to digital, all of that data currently resides in silos, where consumers attempt to reconcile data among their providers and health payors. This can be challenging, as there is no single source that identifies where all of an individual’s health data resides, let alone the order in which it was entered.
From the proliferation of digital health data comes a second challenge: that of keeping the data secure. The past few years have seen an explosion of data breaches and medical identity theft. Consequently, health care providers are looking for the most effective ways to secure the personal health information they hold.
Could blockchain technology provide an answer? Blockchain is one of the hottest topics related to data security today, but beyond the inherently sensitive nature of health data are the persistent challenges of interoperability, patient record-matching, and health information exchange.
Up to this point, providers have exchanged health data via one (or more) of these three models:
- Push: medical information is sent from one healthcare provider to another
- Pull: Providers request information from other providers
- View: Providers can view data inside another provider’s record
Blockchain offers a fourth model – one which has the potential to enable secure lifetime medical record-sharing across providers. Several InsurTech startups and incubators are already investigating how to use blockchain technology to secure, store, and access medical data, both for underwriters and healthcare providers.
What is Blockchain?Blockchain technology is far more than a buzzword: in simple language,
it is a generic tool that enables data to be recorded and stored in an authoritative, distributed, encrypted and secure ledger. The technology enables control of who can have access to that ledger.
Blockchain is also a write-once and append-only system, which means the records comprising the database, once uploaded and accepted, cannot be changed: records can only be added to the ledger. Multiple parties with access can share data and the structure ensures these participants that past records have not been altered15.
The term “distributed database” refers to the fact that the data as well as the devices in the chain are not in one central location or controlled by one gatekeeper. Rather, the system is decentralized: a constant and growing list of ordered records, or “blocks,” are stored in secure sequences, or “chains,” on all participating systems. Each block in a chain is time-stamped when it is created and contains a link to a previous block in the chain, so it is clear when a record was uploaded and in what order.
There are three types of blockchains: public (bitcoin is the best-known example), private, and consortium. For bitcoin, the data is organized so that transactions can be verified and then recorded into the system through the consensus of every party in the network (essentially, a peer-to-peer network). This distributed infrastructure translates to the highest degree of security – even if one device is compromised, it does not affect the rest of the computers in the chain.
In a private or consortium network, an individual entity controls the blockchain and determines which entities can participate as nodes.
Since records in a blockchain are decentralized, each individual participant in the chain holds a copy of the record and each copy constitutes a block in the chain. Each member of a blockchain network (known as “nodes," or “miners” for public networks) contributes to the collective process of validating and certifying digital transactions for the network. Potential revisions to a record must be compared against each and every participant’s copy before being approved, which strengthens security and reduces the likelihood of unauthorized changes. Once a change has been approved by all participants, the revised block/record (copy) is redistributed to each participant (or node)13. Since all members of a network have a complete copy of all updates, no single member has the power to tamper or alter the data as no single entity exclusively owns the data.
How Blockchain Technology Could Benefit Healthcare“EHRs were never designed to manage multi-institutional life time medical records. Patients leave data scattered across various organizations as life events take them away from one provider’s data silo and into another.”
Dr. John Halamka, CIO, Beth Israel Deaconess, Boston, Massachusetts.2
The average individual in the U.S. has approximately 19 distinct medical records from seeing 18.7 different doctors during their lives18. This is problematic for a number of reasons, but most importantly, because the U.S. has no unique patient identifier. Therefore, it is nearly impossible to aggregate every individual’s encounters into a single, longitudinal health record.
Blockchain could benefit the health care space in a number of ways:
- Identity Management: Could be resolved since every transaction must be validated by all members of a chain before it is approved.
- Managed Consent: Patients could authorize all data-sharing, allowing them to specifically manage who is accessing their information.
- Data Preservation: Multiple health care providers could view, edit, and share data while safeguarding records of diagnoses, medications, and services rendered.
- Privacy: Unauthorized individuals could be prevented from accessing patient records.
- Health Information Exchanges (HIEs): Rather than relying on intermediaries for data exchange such as public exchanges or private provider networks, participants could join a network without building specific interfaces between entities.
- Health Care Claims Processing/Validation: Current processes could be simplified to eliminate a series of validations and multiple third parties acting on behalf of other entities.
- Public Health: By creating shared streams of de-identified patient information, authorities could more readily identify epidemiologic trends or threats, e.g. pandemics.
- Patient-Generated Data: Could easily be uploaded and stored securely with all other medical data.
Challenges / Remaining Questions“It’s psychology that’s a challenge. We still have the culture where every health care provider thinks of themselves as the single steward of the data that is deposited in that organization.”
Dr. John Halamka, CIO, Beth Israel Deaconess, Boston, Massachusetts17
Before a health care blockchain system could be adopted nationwide, several technical, organizational, and environmental challenges must be addressed. These include: uncertainty, scalability, data standardization and scope, operational costs, and regulatory considerations.
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