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Blockchain and Healthcare—It’s Time

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Shami Dugal
May 10, 2019

The term blockchain is not that old—Satoshi Nakamoto registered bitcoin.org on October 31, 2008. The concept of linking sets of data to each other is much older. I was developing programs to demonstrate the use of double-linked lists in Fortran, so you can imagine how many decades old that is. In order to understand the value of blockchain in healthcare and other businesses, we need to grasp some basic concepts about it.

In simple terms, a blockchain is a chain of blocks that contains data relevant to some business or people. It is distributed across many computers so there is no central computer that has all of the information: the computers can all have access to the same information. From one link to the next, like intertwined paperclips, the genius is in creating a mathematical hash that links one block to the next. Once a transaction has been posted into the blockchain network, it cannot be tampered with. The term immutable is often associated with a blockchain to signify that after a block is created, it cannot be changed. That in itself provides a sense of security and the fact that the data cannot be hacked.

Because no single entity owns it, and the data is distributed, the risk of a single or group of computers going dark limits the ability to get at the data because it is accessible from anywhere. This also means that there are few restrictions going across borders. A number of governments have blocked blockchain implementations, the most well-known being Bitcoin. Countries that are concerned about the avoidance of government-authorized currency have banned it. For instance China, Russia and India may be concerned about blockchain’s potentially illegal use and avoidance of taxes.

Since it is not owned by an oligarchy or big business, there is no one to pay for the privilege of using it. As the mind wonders about its possibilities, there is a realization about the complexity of understanding, managing, monetizing and using it for business and social purposes.  

This paper has a specific focus about the applicability of blockchain in healthcare. In the HealthIT.gov website, there are a number of scholarly articles on this subject. One of the documents, the Federal Health IT Strategic Plan 2015 – 2020, does not make mention of blockchain. It does make significant reference to the incentive payments that have been made for the participation of 450,000 eligible professionals and 4,800 eligible hospitals in Electronic Health Record (EHR) incentive programs. It also speaks to the demand for sharing information across many entities including technology systems, information platforms, locations, providers and other such entities. Even this initial step of upgrading EHR systems is by no means complete; work goes on as healthcare entities continue to refurbish and replace existing platforms and systems.

Part of implementing an EHR system is receipt from and delivery of data to other organizations such as states, the federal government, providers and health information exchanges (HIE) as well as other healthcare agencies. Methods include Health Level Seven (HL7) file exchanges and web services using open communication models. The HL7 organization and standard was founded in 1987 whereas the use of web services in healthcare is more recent.  The issue is that there is no set standard by which all entities can communicate with each other in a consistent, secure manner and with appropriate levels of privacy.

If the purpose of healthcare is to enhance the quality of life by enhancing health, then its primary aim is to benefit the public. There are obvious matters of law, policy, compliance, consent, identity, privacy, jurisdiction, sharing and funding to be considered. The part that is often given less priority by thought leaders is implementation. Technology is playing a critical role in how solutions are to be delivered to participating entities including the government, corporations, providers and the public. Another important consideration is geographic boundaries. As people travel for business and pleasure, they need assurance that they will be able to receive health benefits and not suffer financially as a result of this.

With the overhaul of electronic medical records within organizations, the data transport mechanism has not yet been addressed in terms of its next stage of evolution. Whatever that is, it is likely to have an impact on the management of the medical record systems and data management methods that are in use.

This paper proposes that blockchain offers benefits that are needed in a safe, sharable and unbreakable data communication method. The underlying principles of blockchain technology illustrate that it is distributed so no single entity controls the data; accordingly it is a peer-to-peer communication with no central hub(s). It is transparent to anyone who has access to it. Once the data is created, it is static and chronologically ordered. Finally, communication between nodes or users is based on a complex algorithm that denies hacking.

It is clear that individuals, corporations and governments will need access to the data. This governance can be met through a Public Private Partnership (PPP) infrastructure to share funding, permissioning, risk and transparency over data management and its exchange.  

This paper is simply the beginning of many topics and discussions on this subject. The reward is in delivering a laser-focused solution that promotes safe sharing of information and replaces systems fraught with redundancy, errors and cost.

Author: Over thirty years of policy, strategic planning and implementation of technology based solutions in public, not for profit and private sector organizations in many subject areas, the past twelve hears in healthcare (EMR systems). Enjoy tackling complex multi-dimensional issues, and turning around projects. [email protected]

Shami Dugal, Hon. B. Math, University of Waterloo, MPA (Policy) Drake University, παα

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