We are living in an exciting time for both IT and health care. With the improvements in genetic research and precision medicine, we are witnessing ingenious approaches to disease prevention and treatment. Advancements in healthcare software development have not lagged behind, producing large databases for health information as well as tools to keep track of this health data and most importantly, they helped keep people engaged in the own health care. All of these health care and IT advancements put together can serve as a catalyst for transformative change in health IT.
According to the requirements of the American Recovery and Reinvestment Act, both public and private health care providers must transition to electronic medical records by January 1, 2014 to maintain the current Medicare and Medicaid reimbursement levels. This new requirement caused significant growth in both the availability and utilization of electronic medical records as well as the development of healthcare software to accommodate this growth. However, the overwhelming majority of these systems cannot share their health information.
Using blockchain as an access-control manager to health records would promote industry interoperability which is a critical component of any infrastructure that supports the Patient Centered Outcomes Research as well as the Precision Medicine Initiative. A blockchain based nationwide health IT infrastructure has a lot of potential to foster healthcare software development and precision medicine to promote medical research and encourage patients to become more responsible for their health.
The Underlying Principles of Blockchain Technology
Blockchain is a peer-to-peer shared register for the next generation of transactional applications that establish trust and transparency. Blockchain is also the underlying technology for Bitcoin and is a design pattern with three main components: distribution network, a shared register and digital transactions.
Blockchain is a decentralized peer-to-peer architecture with nodes made up of network participants. Every member in the network keeps an identical copy of the blockchain thus contributing to the overall process of verifying and certifying digital transactions for the network.
Members of the distributed network input digital transactions into the shared register and if they need to add transactions, they can run algorithms to evaluate to evaluate and validate the proposed transaction. If most members in the network agree that this is a valid transaction, it will be added to the shared register. All changes to the shared register will be available in all copies of the register instantly. Also, since all network members have a complete copy of the blockchain, no one can tamper with or alter the data.
All types of information of digital assets can be stored in the blockchain and it is up to the network which implements the blockchain to define the type(s) of information that the transaction contains. All information is encrypted and digitally signed to validate the authenticity and accuracy of the information. The transactions themselves are structured into blocks which contain a cryptographic hash to the previous block within the blockchain.
A public blockchain can serve as an access control manager to health records which are contained within the blockchain. As of today, there are no open standards or implementations of blockchain that incorporate this function but there is research to support that this is a feasible solution. Bitcoin has already showed that verified, auditable computing is possible via a distributed network that is accompanied by the shared register. Also, today’s technology for data storage, encryption and security are available and are in use.
Bitcoin and the Limitations of Private Blockchain for Health Care Application
The very foundation of Bitcoin is an open-source cryptographic protocols which have been proven as a secure platform for crypto-currency exchange. Even though we do not know the identities of the people behind the transactions, the platform itself provides transparency since any person can access the blockchain and view balances and transactions for any Bitcoin address.
What make the Bitcoin public blockchain unsuitable for a healthcare blockchain is the lack of data privacy and absence of quality security. Also, there are scalability concerns since the standard for Bitcoin block sizes and the maximum number of transactions per second are not suitable for large-scale widespread blockchain applications.
Personal and construction led blockchains can address the privacy, scalability and security concerns, but they would also pose different challenges since they may not be vendor neutral and do not employ open standards.
A Blockchain Model for Healthcare
All blockchains for health care must be public and incorporate technological solutions for three vital elements: scalability, data privacy and access security.
In terms of scalability, a distributed blockchain that contains health records, images or documents, will have data storage implications as well as data throughput limitations. If we use the Bitcoin blockchain as a model, all members of the of the distributed network of the healthcare blockchain would possess copies of every single health record, for every individual, in the United States which is not practical from a data storage perspective. Replicating all health records for all members of the network would put a strain on the bandwidth, since health data is dynamic and expansive, not to mention the throughput concerns about the data. In order for healthcare software to benefit from blockchain, it would need to work as an access-control manager for health data and records.
The user would have access to his/her data as well as control over how this data will be shared. There will be assigned access permissions by the user to designate who can access and write data in his/her blockchain. They would be able to view and audit a log of who accessed the blockchain, including when and what data was accessed. The user would also be able to revoke permission access rights to any individual who has a unique identifier using the same dashboard.
Technical Advantages of a Health Care Blockchain
The foundation of blockchain is an open-source software, open APIs and commodity hardware. These three elements allow faster and easier interoperability between systems and can efficiently handle large amounts of data as well as more blockchain users. There is a fault tolerance built-in to the architecture as well as a disaster recovery function as well as widely used data encryption and cryptographic technologies which are accepted as industry standards.
Since the health blockchain will be created as an open-source software, it will be peer reviewed by skilled experts and will be dependable and robust under strenuous circumstances that cannot be matched by closed, propriety software. Open-source products promote innovation in the applications market, thus providing a huge benefit to health care providers and individuals with the availability of a wide-range of application choices which could be matched to their specific needs and requirements.
The blockchain would operate on widely used and trusted commodity hardware, which provides the largest amount of useful computation at a low price. It the most economical and efficient architecture for genomic research. Extra hardware space would be shared with health researchers to promote faster discovery of innovative drugs and treatments.
Advantages for Healthcare
Among the advantages blockchain provides medical researchers is the creation of a single storage location for all health information, tracking personal data in real-time and the ability to set data access permissions at a granular level.
Health researchers need broad and complete data sets so they can better understand diseases, speed up biomedical discoveries, accelerate the development of drugs and provide customized individual treatment plans based on patient genetics, environment and lifecycle.
Blockchain definitely has a place in medical software development and healthcare professionals should strongly consider using blockchain as a basis for their interoperability strategy and using blockchain to advance precision medicine.