Blockchain Medical Record Tracking
Blockchain technology holds the potential to solve some of the thorniest issues in healthcare today.
By Dava Stewart09/02/2019
Blockchain is the buzzword of the day, but it’s almost always discussed in the context of currency and financial transactions. In healthcare, blockchain is often-mentioned, but it seems to be seldom understood. However, blockchain technology holds the potential to solve some of the thorniest issues in healthcare today.
What Is Blockchain, Anyway?
One of the first things most people misunderstand regarding blockchain is that there are two different types of blockchains: public and private. At its most basic, a blockchain is blocks of information, chained together. A more useful way to think of it, though, is as a shared ledger.
“What blockchain technology really introduces is a way for us to have a common view of truth, like a single source of truth stored on a digital ledger that’s shared between members of a network, rather than a ledger that’s owned by any one central entity,” says Ian Fish, partner and healthcare services leader, IBM Canada.
Consider, for example, how the supply chain for vaccines works. The manufacturer keeps a ledger of transactions related to each batch of vaccine. Many vaccines must be kept at a particular temperature to remain effective, can’t be exposed to ultraviolet light and must be used within a set amount of time. After the manufacturer ships the vaccine, the transportation companies involved have their own ledgers, logging dates, batch numbers, temperature, destination and so on.
When the vaccine arrives at its destination, the recipient has yet another ledger tracking the delivery. Each of the organizations that handles the vaccine has its own version of the truth of what happened to the vaccine. If all of the ledgers related to the vaccine were compared, would they be identical? It’s unlikely.
“When you have these multiple ledgers, it actually creates a recipe for errors but also fraud—people taking advantage of gaps and understanding across organizations and then leveraging those gaps as a means to drive fraud,” says Fish.
Any time multiple organizations keep logs of transactions, there’s likely to be discrepancies. Blockchain eliminates the need for multiple ledgers, because it’s a shared ledger between members of a network. All of the members agree to a common set of rules, which are set out, normally, in a smart contract. Once a transaction is added to the blockchain, it cannot be deleted or tampered with, giving all parties a single view of events with no discrepancies.
Each member of the network has access to the blockchain through a key. Keys can be public or private, depending upon the smart contract, as well as the type of blockchain and how it’s being used.
How Blockchain Could Improve Medical Records
A vaccine supply chain is actually a real-world example of how blockchain technology could be applied in healthcare soon. The fact that the healthcare system is made up of several separate and distinct organizations is most often viewed as a barrier—consider the difficulties with interoperability, for example—but that’s actually a good reason blockchain could improve how the system works. Blockchain delivers the greatest value when multiple actors attempt to create an end asset. “Blockchain is not a party of one, it’s a party of many,” notes Fish.
A more ambitious goal, but one with merit, is the use of blockchain to transform how medical records are handled. In the financial industry, blockchain is used to track the changing status of an asset. “Think of a medical record as an asset,” says Fish. “Just like a currency in a bank account, and each time your bank account increases, there’s a transaction that may contain the details of the transaction.” Except, with your medical record, the transactions may be which provider or physician saw you, the date, the cost and other details.
“In a health system, where the ecosystem is using this shared source of truth for patients’ records and consent directives, we can greatly improve the accessibility of health data while maintaining privacy and security via smart contracts. We actually enforce the rules by which everyone in the ecosystem must abide by to access or add,” says Fish.
Along with reducing the opportunity for fraud and errors, improving privacy and creating an immutable record of transactions, blockchain offers one more hugely important benefit when it comes to healthcare: It works with existing assets. Health networks could use Epic, Cerner or Edipec—or any other records system—and still participate in blockchain.
Overcoming Necessary Barriers
As with any new technology, some barriers to implementing blockchain are present. One of those barriers has more to do with the culture inherent in the healthcare industry rather than the technology, and that’s the fact that blockchain requires cooperation among multiple organizations.
“Setting up governance is probably one of the bigger barriers to actually making a blockchain ecosystem,” says Fish. Blockchain will change the way that people work, and that can be a difficult proposition.
When you consider how the healthcare system currently operates, things could go wrong in so many places, and blockchain would eliminate some of them. Organizations would need to make some changes, but, Fish points out, blockchain “enables a different way of thinking and a different way to participate and collaborate without actually changing the direct governance within each independent organization.”
Dava Stewart is a writer interested in the intersection of healthcare and technology based in Chattanooga, Tennessee.More →
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