The blockchain is getting a lot of attention these days. Much of the attention is misguided—pitching blockchain as if it will magically solve all security and privacy issues—and makes it challenging to understand what blockchain is and the value it can provide. When you cut through the blockchain technology marketing hype, however, blockchain does offer a variety of potential benefits when it comes to maintaining the integrity of data and transactions. And one arena in which blockchain could prove to be very useful in healthcare.
Although we often see the term “blockchain” used interchangeably with the term “cryptocurrency,” the fact is that cryptocurrency is actually an implementation of the blockchain.
So, what is blockchain? A blockchain is basically a shared, distributed account ledger, in which all of the transactions relating to a particular account are linked (the block) and the blocks in each of the distributed ledgers are linked (the chain). Using blockchain technology enables data to be processed and stored securely and ensures the integrity of transactions and data.
Blockchain technology relies on three concepts: peer-to-peer networks, public-key cryptography, and distributed consensus. The combination of these three concepts is what secures blockchain transactions and allows anonymity to be maintained. To illustrate, suppose you have a file of financial transactions (an account ledger) on your computer. Your accountant and your tax lawyer have the same ledger (file) on their computers (the account ledger is distributed), and all three computers are part of a peer-to-peer network.
When you enter a transaction into an account in your ledger, your computer sends an encrypted message describing the transaction to your accountant and your lawyer, who check the transaction—did you enter it in the correct account? Is it taxable? (distributed consensus). Once the transaction is validated, all three ledgers are updated. The identical list of transactions in those ledgers is a blockchain.
Because blockchain data must be validated across all participating nodes in the peer-to-peer network, the need to reconcile transactions is eliminated. Transaction data can be supplemented, but the data cannot be altered or removed, ensuring integrity. Any updates to a blockchain must be approved by a consensus of the participating nodes.
Put simply, the key features of blockchain help secure transactions and preserve the integrity of the data, which makes blockchain an exceptionally attractive technology for processing financial transactions or transmitting and storing any sensitive data—like healthcare data.
The Opportunity for Blockchain in Healthcare
There are a variety of issues with the way healthcare data is transmitted and stored today. Each doctor or medical facility you interact with typically maintains its own local copy of your health data. Proprietary methods and healthcare privacy laws make it challenging, if not impossible, for information to be shared or coordinated between medical professionals.
Storing healthcare data using blockchain could change that. When your healthcare data is stored in a blockchain, there would be one source of truth for your medical records and other relevant healthcare data. Because the data is distributed to multiple ledgers, access can be granted to additional health care professionals as needed. Changing the data in one ledger changes it in all of them, so everyone with access can view the change immediately. Broad access to a shared source of healthcare data could dramatically improve collaboration and cooperation between medical professionals, streamlining care and providing better healthcare results.
Blockchain could also be used to improve access to medical data for research purposes. Pharmaceutical companies could potentially offer to provide a blockchain platform to share and distribute healthcare records in exchange for access to anonymized analytical data. The information extracted could be instrumental in identifying and refining new treatments.
In fact, graduate students at MIT have already developed a system, called MedRec, that uses blockchain to manage electronic medical records. An article on Medium explains, “Importantly, MedRec allows patients to securely grant other doctors access to their personal information, as well as healthcare providers, researchers, and even the patient’s children and grandchildren.”
Potential Challenges of Blockchain and Healthcare
Using blockchain for healthcare is not without potential challenges and pitfalls. For starters, blockchain is protected by public-key encryption. It’s important to be able to share and distribute sensitive health data while also protecting it from unauthorized access. However, protecting the data with public-key encryption means that accessing the information requires particular tools and permissions to decrypt the data.
The question then becomes, who takes ownership of the decryption key? The obvious answer seems to be that each individual should own his or her key. However, parents would have to own and control the decryption key for data belonging to their minor children, raising another question—what happens if the key is lost? Most people are not familiar with cryptography concepts; average users rarely understand the sensitivity and importance of a decryption key or know how to manage it securely.
The second concern with a healthcare record stored in a shared, distributed ledger is that anyone with access to the ledger can theoretically change it. The changes must be approved by a consensus of the participating nodes with access to the data, which should be sufficient to prevent unauthorized or unnecessary updates, but it is still theoretically possible for unwanted updates to occur. Perhaps an additional control is necessary to grant the owner of the data the ability to determine who has the authority to change the healthcare data or participate in the consensus approval process.
Another potential issue, specific to healthcare data, is the protection afforded by HIPAA laws and patient-doctor privilege. Exposing an individual’s healthcare data to multiple participating nodes in order to approve it by consensus could be a major privacy issue.
Embracing Blockchain for Healthcare
Blockchain technology has many benefits and likely is here to stay. By 2020, it is expected that blockchain will be implemented across 20% of healthcare processes.
While using blockchain for healthcare can have significant advantages, we are just getting started. Efforts like MedRec need to continue to grow and evolve, moving from prototype to production. We must continue both to develop the technology underlying blockchain and explore beneficial uses beyond cryptocurrency.
Another consideration is that the successful use of blockchain for healthcare data requires a significant amount of user trust. Both medical personnel and patients must be able to believe that the data in a blockchain cannot be stolen or compromised, which will require both a well-designed user education program and additional development work to strengthen the security model that supports blockchain.
While there are certainly hurdles to get over and kinks to work out, blockchain technology can go a long way toward addressing the problem of how to make pertinent and critical healthcare information available when needed without threatening the integrity of the information or the desire of the owner for privacy. Using blockchain to enhance healthcare is a goal worth pursuing.
Tej Aulakh is a Managing Consultant at Spirent Communications and has over 15 years of experience in software development and source-code analysis for a variety of enterprise, finance, Industrial control systems, and IT solutions companies. At Spirent, Tej is leading the source-code analysis team as part of ethical hacking and security research group called Spirent SecurityLabs.