Data privacy and transaction efficiency are major issues in today's health system. But worryingly, these may result not only in personal data breaches, but also create events that may lead to a poor health practice. Blockchain technology allows for patients to fully own their data, and the tractability features make it transparent for fault proof transactions and auditing.
This article focuses mainly on the Australian health system; nonetheless, most of the issues and current solutions are true for most practices around the world.
For the reader who is not accustomed to blockchain technology, here is one of the most complete definitions provided by Deloitte.
“Blockchain is a distributed system recording and storing transaction records. More specifically, blockchain is a shared, immutable record of peertopeer transactions built from linked transaction blocks and stored in a digital ledger. Blockchain relies on established cryptographic techniques to allow each participant in a network to interact (e.g. store, exchange, and view information), without preexisting trust between the parties. In a blockchain system, there is no central authority; instead, transaction records are stored and distributed across all network participants. Interactions with the blockchain become known to all participants and require verification by the network before information is added, enabling trustless collaboration between network participants while recording an immutable audit trail of all interactions”
In short, it is the immutable distributed shared database that you would use when you don’t trust the other participants, because it is almost impossible to subjugate. It makes it the perfect way of storing data such as medical or financial, that require heavy regulation and are subject to thorough auditing.
For the keen observer, blockchain is merely a database system, in fact, a very low performing database system, with a difference in executions per second that can go hundreds of times lower than a traditional database system. Blockchain’s main advantage comes from its immutability and consensus mechanism. We are trading performance for a system where trust is enforced and almost impossible to break, it may seem like a small thing, but it is the biggest change in how we handle data in more than a thousand years.
Also, when we say “blockchain is almost impossible to violate”, we refer to the fact that in order to do so, the most straightforward way would be a 51 per cent attack. As described before, blockchain uses a consensus mechanism, meaning that all nodes must agree in order to commit the execution of an operation (adding data for example), to be able to subjugate the network, and force data into the system, the attacker should own at least 51 per cent of all the computing resources on the network.
I will now return to describing where all of this started. Australia is currently transforming its healthcare system into a digital system where medical records are stored electronically. Medical records display patient identification, information relevant to diagnosis or treatment, history, allergies, medications, etc. Management of these medical records has always been a matter of concern as currently there is no unique way of storing this data. It has been seen that every practitioner uses his own style of storing patient data which creates several issues related to the ownership and integrity of the data. As per Australian legislation, patients can’t have access to their own records as sometimes it could harm them, and all the rights are reserved with their current practitioners.
Hence, whenever they want to access their information or if they want to take advice from some other doctor, they need to request the current practitioner in writing to provide their information to them or to the other GP. So, if we consider the case of an emergency, every minute counts and it could bring the patient’s life at stake. So, if we look at the overall picture of the current medical system, there is an urgent need for a one-stop platform as a solution for the medical records management.
The medical industry means different things to different people. For some it has become a way of collecting data, for some people it’s a way of progressing in their business, for some it is a small dental clinic or a big hospital but in reality, it is a combination of everything mentioned above. In the world of technology, people recognise this in different perspectives: for some it’s still like going to a doctor whose clinic maintains a medical record book for the patient’s entire life or even the patient maintains their own paper file. On the other side there are still some people who are willing to shift their work culture electronically.
Today, every medical practice has different ways of keeping medical records. Not all medical records in a private medical practice are owned by them as ownership depends on the contracts created between the organisation and doctors in private. This is a huge problem with the patient data being lost from an organisation once the doctor leaves. Some practices didn’t even adopt the methodology of storing medical records electronically which again raises the issues of confidentiality and security.
Although medical records are gaining more traction and would be the most straight forward way of solving such a big issue, if we rewind back about two decades ago, the 'eHealth readiness of Australia’s medical specialists report' which was announced from the Department of Health and Ageing published in May 2001 noted, ‘although computerised health records are gaining traction, relatively few specialists use an electronic recordkeeping system as a single repository for all relevant patient information. Only 41 percent of survey respondents used a computerised health record-keeping system, and of these just 37 percent relied solely on computerised records. Most of the specialists using computerised systems use them for administrative purposes and storing patient notes but, for data security and legal reasons, maintain separate hard-copy storage of communication to and from other providers (e.g. test results, diagnostic imaging and referral letters)’. It is only in the very recent times that the system has finally started to transition towards a centralised system. In the last twenty or so years, paper-based systems or as many as thirty different proprietary systems were used around Australia to keep track of medical records.
Moreover, when audits are being conducted all these paper-based submissions are converted into electronic records in order to make records viable for the government to store and access. This creates a huge problem as when we look into data integrity, we literally cannot rely on the sources and no organisation will indulge in the audit reports which may contain errors that would harm the organisation as a whole. Therefore, we can say that the flaws and mistakes are never traced and eventually the government is at stake and not the individuals. Not only for paper-based record but this is also a common problem with the organisation with records stored electronically, after all they are software and that allows the deletion or removal of any record or data as per the user’s choice.
Even in the Australian government’s My Health Record system, only up to two years of previous history will be uploaded. The problem here is that most people do not like their information to be uploaded and being known to others. Even with all the privacy and security assurances put in place, the instinctive nature of people to distrust government bodies remains.
Finally, one last issue is the poor state of the health system when it comes to assuring that the practice is carried out legitimately. Fraudulent activities, including impostors impersonating medical professionals, claiming of false or unwanted procedures (over-servicing), illegal sales of pharmaceuticals, or even worse, fake medicines, have been appearing more often in the media. As much as 7 per cent of claims made in the private sector may account for frauds.
Using blockchain, multiple aspects of the healthcare industry could be enhanced as being a complex system of interconnected entities under heavy regulatory boundaries, patient data is highly fragmented, and the cost of healthcare delivery is continuously rising due to inefficiencies in the system and dependence on several intermediaries. The healthcare industry is one of the world’s largest industries, consuming over 10 per cent of the gross domestic product (GDP) of the most developed nations.
Even though certain developments like efficient healthcare record keeping systems, wearable devices, and various artificial intelligence (AI) implementation have come up, there are certain problems pertaining in them. One of the major problems inhibiting them is cryptography due to which it’s not a preferable option.
According to research, the only viable solution that pertained the attention is Blockchain. When we talk about blockchain, cryptography is just a one-stop-solution. Not only cryptography, it can also provide patients a comprehensive and immutable log platform where they can have easy access to their medical records no matter where they go and whom they refer.
When we talk about the basic problems of the health industry, Especially Electronic Health Records (EHR), we think of security, efficiency, cost and ownership. Given this scenario, no other solution would be more useful than blockchain.
In order to understand the opportunity ahead, we should start with trying to understand the problem(s) better. The first problem is about data integrity, since we cannot rely completely on the way the individual records are being stored and recorded differently by different medical practices. And any alterations can harm the patients in the overall terms, and, moreover, if something was to happen, we wouldn't be able to track the current validator. At any given time, the data stored on a blockchain is always true. Smart contracts impose how executions happen and the consensus mechanism ensures that this is always true for all the participants. Data on the blockchain can never be altered, it can only be appended, this is incredibly important for one of the next problems.
The next major problem is about data ownership, since even by Australian laws patients don’t have access to their own records, due to which sometimes in case of emergency their life becomes at a bigger risk. Blockchain allows for every participant to own their data, either anonymously, officially, or to a trusted third-party. This is an incredible step forward, as it implies that scandals such as the one involving Cambridge Analytica do not happen again.
Data Traceability is the last major problem aligning within the current system as we are unable to track any alterations being made to the data due to the ownership issue i.e. in short no one could be held responsible. As previously mentioned, in a blockchain, data is always appended, never modified, it is almost impossible for this to happen (recall 51 per cent attack).Hence, we can trace all of the operations recorded from the beginning of the chain till the most current and observe exactly how things have happened. For such reasons, blockchain is vastly used in supply chain and logistics problems.
We can summarise some of the opportunities here as follows:
There are currently a number of companies working on healthrelated matters, leveraging blockchain technology. I will introduce three of them here, who use blockchain in different sectors. These are Nebula Genomics, DOC.AI, and IRYO.
Nebula Genomics used blockchain technology to address the issue of genomic big data. Ultimately, it was a huge success for the company as it not only allowed buyers to efficiently acquire genomic data and protect themselves from the advancement, but the ownership was given completely towards the client side and it was highly protected.
DOC.AI has developed a platform using AI, blockchain and natural language processing which helps the patients to interact about the certain health conditions they faced and how it could be prevented. Due to this high data security and immutable sharing, people could enter their symptoms and the platform can make predictive assumptions which can eventually give them an insight into their own data and how they can interact with the doctor. It was set as a great example of how to apply AI and Blockchain along with power of community to effectively achieve more précised treatment.
IRYO, on the other hand, is working on the overall objective of building an effective platform for keeping health records unified. It ensures the safety of the data by making it utterly impervious to cyber security breaches which also protects the data from state-sponsored attacks. Through this platform they promise that the patients can share their medical history anywhere in the world as they say that all the records would be stored in a single format. Hence, we can say that blockchain has a huge potential to enhance in medical industry.
These are just a few examples, many more projects have been developed, and many more are being created every day. Blockchain technology has been the first system of record revolution since the invention of the ledger more than a thousand years ago. We can with great confidence say that blockchain has a full scope of enhancing the entire industry. All it needs is mass adoption, and once it is done it will set a new mark for medical innovation.
I would like to conclude with my favourite project. It is called Openmined, and I invite all readers to visit the group’s website. Openmind is a platform which uses blockchain to anonymously train AI models using homomorphic encryption — meaning that the artificial intelligence is trained using encrypted data that is never decrypted.
Potentially, one day we will all be able to contribute, safely, to the creation of a distributed AI that will help solve a huge number of problems that are now impossible to solve because of the lack of data.
Our future is made up of data, it is only natural that we want to keep it secure.