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Across the world, the cost of healthcare continues to rise, and populations continue to grow. The Wall Street Journal has stated that the United States “will soon spend close to 20% of its GDP” on healthcare. Of course, when it comes to the issues the healthcare industry is facing, you couldn’t pin it down to just one. However, it’s fair to say that across healthcare as a whole, lack of transparency and disorganization is a major issue.
In the UK, the NHS may look like one huge organization that provides “free” healthcare to all, covered by tax; however, it is actually hundreds of smaller organizations. The problem here is that these different operations have different ideas about when it is necessary to update software or upgrade systems. In NHS England, for example, crossing over the county border can mean a whole different way of doing things and a different way of reporting and recording the same information. This is one of the reasons that trying to access data from hospitals across different counties isn’t a smooth process and can often lead to confusion. This is something the NHS recognizes as a problem, and have been encouraging different parts of the NHS to upgrade and unify their systems. This pressure became stronger after the 2017 NHS hack that disproportionately affected the hospitals with outdated systems.
Wherever you are though, this is a problem. Companies and governments then have to try and calculate the best way to get the desired results. For example, does that mean they encourage, or force, everyone onto a particular software? What if this software doesn’t meet the needs of all areas of healthcare? What if it turns out to be not fit for purpose but the whole country has already switched? There is great risk in this strategy, which is why the healthcare industry is getting excited about blockchain.
There has been a lot of buzz around blockchain in general over the last year. We are starting to see blockchain technology move away from finance and break into new areas where it provides significant and often surprising benefits. However, the healthcare industry as a whole is somewhat conservative; taking risks, even on something small, could cost lives. If we look back to the example of a company deciding to overall their software systems so that everyone is unified under one system, consider the amount of training required, consider that the information may be displayed so differently to some that a healthcare professional may miss something crucial. This is why there is excitement, but also caution about blockchain in healthcare.
John Halamka, Editor in Chief of Blockchain In Healthcare Today said:
“[M]y goal is to publish high-quality opinion pieces and research papers about use cases that really require blockchain.
“Just using blockchain in healthcare because it’s cool does not make sense.
“In 2017, I worked on several production blockchain applications, so I have a sense what works and what does not. Blockchain is not meant for storage of large data sets. Blockchain is not an analytics platform. Blockchain has very slow transactional performance. However, as a tamperproof public ledger, blockchain is ideal for proof of work. Blockchain is highly resilient.”
So what areas will blockchain be useful in Healthcare?
Medical records are the main area where blockchain has the power to transform the way we do things. Any time a medical record is created by a healthcare professional, it can be stored within the blockchain, thereby providing absolute proof of that record. Most countries and states have laws surrounding when medical records can be changed, often stipulating that there must be a legitimate reason to alter records in any way. However, there are still complaints from patients of their medical records being altered.
Part of the problem here is transparency, it can often be difficult to access your complete medical records, and it can often be time-consuming. The only way to prove that your doctor has altered records is to ask for all records kept by all of your physicians and check for any discrepancies. This works because the information is sent from one doctor to the next, and then kept on the later doctor’s system as well. If your primary care doctor has altered anything, it should show up. Having a blockchain-based system would remove the need for a multi-step process, improve transparency, and remove the ability for healthcare professionals to alter records.
Blockchain is often cited as being more secure than other forms of housing data. When it comes to medical records, security is extremely important, and yet we are seeing a rise in hacks despite efforts to counteract them. In 2018 it was revealed that 176.4 million patient records were exposed over the previous 8 years. These medical record databases were being sold on the dark web for $300-$400 dollars. This puts medical records up there with credit card information in terms of how valuable they are.
The next area blockchain could make the process vastly simpler is consent management. Within the healthcare industry, a patient needs to be able to grant an authorized professional select, total or partial access to their personal data. However, different states often have different regulations around sharing this data, and what they are required to ask. This is complex in current healthcare systems where parents often aren’t clear about what they are shaing, or there seems to be an “all or nothing” type attitude to the sharing of information.
Other industries solve this by having a consent management database that will store consent preferences across different types of data. The agriculture industry does this in order to share information with the government and regulators. Having a blockchain-based consent management system would make the whole process run more smoothly and improve trust in the system. Transparency is also provided as consent can be audited by third parties.
There has also been some research on the use of blockchain in clinical trials. In 2017, Imperial College London hosted a Hackathon exploring Bitcoin and Distributed Ledger Technologies in Healthcare and Life Sciences. The experiment concluded that blockchain would help clinical trials by removing the need for third parties and middlemen, and provide clear and untampered data that could be trusted by everyone. Clinical trials are the backbone of modern medicine, and these concepts are extremely important to its integrity, so this looks to be an area that blockchain can improve by increasing the trust levels.
Under a decentralized healthcare system, it is also thought that blockchain could be useful in the form of micropayments. For example, your healthcare data would be stored on a blockchain, and you could consent to it being used, or consent to submit more data for research purposes and receive a reward for this in the form of a micropayment. You could also be paid via micropayments for your role in clinical trials.
We are still in the very early stages of blockchain’s role in healthcare. We are seeing more and more blockchain startups arise that are researching and developing new blockchain solutions for healthcare, and so even by this time next year, we may have a stronger picture of blockchain’s role in healthcare.