Bitcoin first came about in 2008, when a white paper about it (“Bitcoin: A Peer-to-Peer Electronic Cash System”) was circulated around a cryptocurrency mailing list. Then, came the blockchain technology. Though there were controversies of who the creator might be, blockchain has since grown tremendously with more businesses leveraging it.

Blockchain, fundamentally, is an independent and tamper-proof database, where it co-exists in many locations – shared and maintained by multiple parties engaging it – which is also known as a mutual distributed ledger (MDL). Blockchain principles were first applied in the financial world as the technology that allowed Bitcoin to operate. Now, however, its revolution has made its way into many other industries, including healthcare.

Although it is only the beginning, a study by IBM found that 56% of the surveyed healthcare professionals (HCPs) have solid plans and will implement a commercial blockchain solution by 2020. Currently, the healthcare industry and tech innovators are grasping with the feasible solutions, and possible solutions with blockchain in the future.

Gaps in healthcare attracting the need for blockchain

While the healthcare industry has been catching up with the innovative technology era, there are still places lacking in providing an efficient healthcare system.

Healthcare sector today has various platforms, such as the electronic health records (EHR) system or data warehouse. These data often have different formats, hence making it difficult to share information across multiple platforms. Not only do HCPs feel emotional disturbed, this also poses a large security risk for millions of people.

In addition, with the lack of ability to share databases with other HCPs, more repeated and unnecessary tests may need to be carried out – such as cases of patients consulting new HCPs with zero records of the patient.

Even so, John Halamka, Chief Information Officer at Boston-based Beth Israel Deaconess Medical Centre, believed that these problems are tailor-made for a blockchain to solve.

“Now is probably the right time in our history to take a fresh approach to data sharing in health care,” he said.

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Blockchain – a future ‘hero’ to healthcare

Even so, what’s all the buzz about the use of blockchain in healthcare?

The main reason people are proposing blockchain is that it offers stronger privacy protections with its multiple servers, which make it less vulnerable to attack. In addition to providing simpler access to the data, it also allows patients to have control over their own records.

Halamka and researchers at the Massachusetts Institute of Technology (MIT) Media Lab have developed a prototype system called “MedRec” using blockchains to manage medical data. Through this prototype, electronical medical records (EMR) can be improved, while patients’ record can be retrieved securely by any HCP – without the need to waste time, money and duplication in procedures.

In cases where patients wish to allow researchers to use their personal medical records, their data would be provided anonymously, which could make medical breakthroughs possible faster.

Dr Bryant Joseph Gilot’s goal in infusing blockchain into healthcare, is to speed up the clinical trials process, while still protecting the integrity of the data – and ultimately, “get the ones that succeed out to patients sooner”. Photo credit: Tech Target
Dr Bryant Joseph Gilot’s goal in infusing blockchain into healthcare, is to speed up the clinical trials process, while still protecting the integrity of the data – and ultimately, “get the ones that succeed out to patients sooner”. Photo credit: Tech Target

For Dr Bryant Joseph Gilot – a surgeon transitioned to the blockchain healthcare field – the immutability in blockchain is the key to speeding up traditional clinical drug trials. Currently with people at Blockchain Health, he is building an application that protects the sensitive data in clinical drug trials.

"The data in clinical medicine is very sensitive. We really need to be able to lock it down," he said. "So, building cryptographic application on top of blockchain will be interesting."

There is also no delay in claim underwriting and payment, as the smart contracts on the blockchain allow automated decisions. HCPs do not need to send invoices to patients or insurance companies and wait for payment clearance. Instead of going by the usual fee-for-service model, patient-reported outcome (PRO) will be used.

Possible challenges to overcome

Although much praised has been given to blockchain, it still has potential pitfalls.

HCPs and the healthcare systems are a bit slow on the uptake. Till date, only 9% of HCPs and systems have firm plans for blockchain implementation this year. Many are still considering the plan, and those without plans are due to the undetermined costs.

Another is that blockchain is still immature. Its lack of technical standards causes some regulatory uncertainties, which is the reason many are waiting to see how will the federal regulations unfold.

Scientists in the National Institute of Standard and Technology (NIST) – who has recently drafted a report on blockchain – advice that “a high-level understanding of the technology” is needed so that “it can be applied effectively”. The report is there to help ensure organisations considering rolling out blockchain pilots have thought through the practical considerations of using the technology.

Taking example of modifying the stored data, NIST said that “it is much more difficult to change data or update the 'database’ software.” As such, “organisations need to understand the extreme difficulty in changing anything that is already on the blockchain.”

“To avoid missed opportunities and undesirable surprises, organisations should start investigating whether or not a blockchain can help them," researchers added. MIMS

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