Application of Blockchain Technology in Hospital Information System

Long Chiau Ming, PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam

Khang Wen Goh, Faculty of Data Science and Information Technology, INTI International University

Blockchain technology was found to be useful in the real healthcare environment, mainly on the management of electronic medical records, biomedical research and education, remote patient monitoring, pharmaceutical supply chain, health insurance claims, health data analytics, and some other potential areas. The main reasons for the implementation of blockchain technology in the healthcare sector are data integrity, access control, data logging, data versioning, and non-repudiation.

Blockchain is a distributed database of cryptographically chained blocks that aggregates value exchange transactions in a chronological order. Each block in the blockchain is immutably recorded across a peer-to-peer (P2P) network, and each one is cryptographically linked to the previous block.

Meanwhile, the hospital information system (HIS) is a comprehensive, standardised information system designed to organise the hospital's financial, administrative, and clinical functions. The goal of launching HIS was to increase the quality of public healthcare services, notably in terms of patient satisfaction and record management.

HIS

The current HIS, which is mainly cloudbased, has several issues that influence its efficiency and effectiveness. HIS incorporates the system of computer and improves the service efficiency, which concentrates on patient, ancillary, admission, financial, and clinical applications.

HIS consists of at least two of the following components:

1. Clinical Information System (CIS),
2. Financial Information System (FIS),
3. Laboratory Information System (LIS),
4. Nursing Information System (NIS),
5. Pharmacy Information System (PIS),
6. Picture Archiving Communication System (PACS),
7. Radiology Information System (RIS).

The HIS was implemented in order to create a non-segregated healthcare delivery system. It's a good automated file system that can exchange information for more storage in a public hospital and can be used for medical statistics and research. HIS gives the necessary data to management at the appropriate time, in the correct format, and at the appropriate location, allowing for effective and efficient decisionmaking, especially in crucial situations where limited margins of error are allowed. HIS improves patient care by accurately evaluating data, generating management recommendations, and allowing a hospital to transition from a retrospective to a contemporaneous view, all of which have an impact on the quality and care of a patient's life. HIS is critical for developing, starting, organising, and maintaining the hospital's subsystem processes, as well as ensuring a synergistic operation.

The HIS also improves health status by promoting well-being and empowering individuals and communities to take charge of their own health. The benefits of implementing HIS at the hospital include reduced transcribing mistakes and duplication of information input. Improved drug usage tracking is also a result of HIS adoption. In healthcare organisations, the HIS has been shown to improve the efficacy and productivity of patient services. Patients and healthcare practitioners have a better understanding, trust, and satisfaction as a result of the HIS adoption. This relationship will improve effective communication, resulting in more efficient chronic illness care and improved physical health and quality of life.

Types of blockchain technology

There are three different types of blockchain, which depend on the availability and management of data, and the action taken by the user. These are public permissionless, consortium (public permissioned), and private. Entities can act as a reader or writer in a blockchain. A reader will read or inspect the content of record or verify the blockchain passively. In contrast, writers involve in the consensus protocol, who have the capability to expand the blockchain. In a public permissionless (public) blockchain, the data are accessible and visible to the public. Some parts of the blockchain might be encrypted in order to safeguard a participant's anonymity. Without any clearance, anyone can join blockchain and function as a node or a mere minor. Entities are free to participate in the consensus process and write or read on a public blockchain. Only a select group of nodes is allowed to participate in the distributed consensus process, which results in the consortium blockchain. A public permissioned blockchain can be utilised inside a single industry, such as the banking sector, where public use is restricted and centralised. Many industries, including financial and political entities, as well as insurance companies, can adopt consortium blockchain, which is open for public use but still remains moderately centralised trust. A private blockchain is one in which only a small number of nodes are allowed to join the network. Private blockchain is a permissioned, distributed network that processes transactions by controlling nodes and is mostly used for private purposes.

Need for and advantages of blockchain technology in patient data management

Healthcare data is one of the most valuable sources of medical intelligence. In the healthcare sector, blockchain technology enables patients to have personal control over their data, resulting in more effective patient data management. Blockchain technology eases the stress on physicians by giving a higher level of intelligibility and amenability organisation, which functions as digital time-saving and enticing tools for patients to manage their own care.

Due to the decentralised features of blockchain technology in the healthcare industry, which produce immutable and objective data resources, individuals may access up-to-date information, statistics, and evaluations about healthcare service providers. With the support of patient-centred care and a secure P2P network, patients can freely exchange their private health records with medical providers without worrying about their information being stolen. Data sharing is essential for improving the quality of healthcare services and creating a smarter healthcare system. The Health Information and Management Systems Society (HIMSS) defines interoperability as "the capacity of multiple software applications and information technology systems to communicate, exchange data, and use that data".

Interoperability is responsible for the speed with which medical researchers may get important information from various data sources and for improving data quality and quantity. Blockchain technology in the healthcare sector is critical for storing and maintaining a patient's medical history. Because of the patient's disconnected hospital visits, which result in discontinuity and unavailability of the prior record, the patient's medical history record may not be available or adequately preserved. As a result, blockchain is employed to preserve a chronological record of a patient's history during each visit to any hospital. Due to the inaccessibility of disconnected data, blockchain eliminates the need for a patient to repeat a laboratory test, potentially lowering the expense and risk of repeating a highradiation test.

Advantages of blockchain in payments and reimbursement

Fraudulent billing and claims are one component of healthcare that need to be removed and avoided. In essence, health insurance is used to protect an individual's assets against the potentially crippling costs of medical treatment. The patient may pay a set amount during treatment, but the remaining charges are presented as claims to the healthcare firms. The providers are compensated through the claim adjudication process, whilst the insurer determines the financial responsibility for the payments and pays the amount due to the provider.

The insurer has the option of paying, denying, or reducing the amount paid to the provider. A smart contract is used in blockchain technology to avoid fraud in payments and reimbursements. Smart contracts are a key component of blockchain technology in healthcare. The advantages of smart contracts in the use of blockchain technology in healthcare are that they are immutable and trustworthy, and they can be controlled with trusted information that is shared equitably between the parties.

Advantages of blockchain in drug and medical device traceability

Each phase of the transactional information process acts as a trusted tracking in transparent and immutable ways, such as tracking and reconciling inaccuracies in patient data, inspecting medical practitioner credentials, and justifying insurance claims. To track medicine delivery, a startup called iSolve implemented an end-to-end blockchain technology solution. Tracing prescription medicine fraud is one of the applications of blockchain technology in medical and device traceability in healthcare. The reproduction of a prescription, doctor-shopping, and changing the number to change the prescription itself are all examples of false medication prescriptions. Doctorshopping is when a fraudster visits several doctors in order to obtain a large number of original prescriptions. Experts use blockchain technology to address this issue, with a monitoring programme deployed to improve access and response time; to avoid any suspect buying patterns, prescription data is examined, alerting physicians and pharmacists.

The term "open-ended loop" refers to a situation in which the feedback between the physician (prescription writer) and pharmacists (prescription fillers) is lacking. Blockchain can break this open-ended loop. The first step in the blockchain technology solution for prescription drug fraud is a machinereadable code that works as a unique identification and is connected to the prescription written by the doctor. The name, quantity of the drug, anonymised identity of the patient, and a timestamp are all included in a block in the blockchain, which acts as a unique identification. The symbol was scanned once the pharmacists had completed the prescription. The prescription fulfilment is tracked and compared to the blockchain. The pharmacists will be notified if the prescription is suitable for filling, and the data will be provided to demonstrate the prescription's accuracy. The Counterfeit Medicine Projects, which were started by Hyperledger, a research network across industries, are addressing the counterfeit drug problem by incorporating blockchain technology. Each medicine is timestamped, making it easy to determine when and where it was created. The blockchain data was utilised to track the production of bogus drugs. The use of blockchain technology ensures a higher level of drug safety as well as a lower cost of health-related follow-up.

A pharmaceutical supply chain management system keeps track of the information gathered for manufacturing, the manufacturing process, and the distribution of the finished goods. The patient suffers significant side-effects when a false drug is administered. Product recognition, tracking, validation, discovery and response to nonstandard drugs, alerting upon nonstandard drugs, and the ability to store pertinent information, including affirmation and product information, are all key requirements for supply chain management technologies, and blockchain technology is compatible and relevant with each of them.

By storing unique device identifiers for each medical device, keeping track, and delivering firmware upgrades via smart contracts, blockchain technology in healthcare improved the safety and security of medical devices and supplies. Device monitoring may improve the safety and efficacy of medical devices by providing numerous responsive device recalls and alerts. Immutability is implemented through blockchainbased medical device tracking to prevent device loss, theft, or hostile intervention.

Conclusion

Blockchain technology is still a fairly new technology that has not been widely implemented in the healthcare sector. Electronic medical records, biomedical research and education, remote patient monitoring, drug or pharmaceutical supply chain, health insurance claims, health data analytics, and other area are the commonly used cases of blockchain technology in healthcare.

--Issue 56--

Author Bio

Long Chiau Ming

Long Chiau Ming completed Bachelor of Pharmacy (Hons) and Master of Clinical Pharmacy at UniversitI Sains Malaysia. He obtained PhD (Pharmacy) at the Department of Pharmacy and Pharmacology, University of Bath, England. To date, he has 14 years of academic, research and industrial experiences. He has supervised more than 50 research projects and 15 postgraduate research students and published prolifically in SCOPUS/ISI indexed research papers in the field of clinical studies and pharmacokinetics. Dr Long is also the Associate Editor of BMC Health Services Research and Managing Editor of Malaysian Journal of Pharmacy.

Khang Wen Goh

Khang Wen Goh is an Associate Professor at INTI International University, Malaysia. He is currently heading the Faculty of Data Science and Information Technology at INTI International University. He obtained his Ph.D. in Swarm Intelligence from University Technical Malaysia Melaka in 2019. He is a dedicated academician with more than 12 years of teaching experience in higher education and possesses more than 15 years of research experience. He is actively involved in various research areas such as Swarm Intelligence, Mathematical Modelling, Fintech, Pharmaceutical Information Technology, Healthcare Data Analysis, and Precision Farming Optimisation. He obtained 2 FRGS grants as principal investigator in 2016 and 2019 which focused on Computational Analysis on Protein Structure Prediction and Islamic Finance Portfolio Optimisation respectively.

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