The Blockchain in Healthcare

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The blockchain is an idea centered around the concept of a secure, digital ledger system that provides a system for efficient, auditable transactions of almost any type between entities [1]. All information related to blockchain transactions is at once both independently verifiable by all (even outside) parties as correct and also inscrutable to entities without explicit permission. The first and probably most well-known implementation of blockchain technology is Bitcoin [2], but there has been a massive expansion of blockchain use-cases since Bitcoin's initial introduction.


What is the Blockchain?

Security

Potential Use Cases in Healthcare

Though there has yet to be a breakthrough report or use-case for blockchain technology in healthcare, there are many potential ways that the blockchain could be implemented within the current healthcare structure. Any list will likely be incomplete, but these examples represent some of the published and available literature on blockchain implementations in health.

  • Health Information Exchange (HIE) - One major area that blockchains may be able to facilitate is the secure access to and communication of patient health records between individuals and institutions. There have been multiple white papers published on the topic, including groups from the Mayo Clinic [3] and MIT [4] who described a system for patient information exchange based on blockchain technology that would allow patient-controlled access to records across institutions using HL7 Fast Healthcare Interoperability Resources (FHIR), JSON, or other encoding system. In these models the actual health care data are not encoded in the blockchain, but are merely references pointing to where the data reside, such as at institutions or in a "data lake" [5]. Similarly, a group out of China described an app called Healthcare Data Gateway (HGD) that allows patients to view and directly control rule-based access to their health records with a smart phone interface and authentication provided by a blockchain network [6]. These ideas support the concept of patient-owned medical data, and would have the effect of decentralization of medical records in ways that are as yet undetermined.
  • Health Research Integrity - [6]
  • Personal Health Records - This concept dovetails with the idea of HIE using the blockchain, but focuses more on the secure maintenance of a personal health record (PHR) by patients. No production PHR has been released based on this technology, but concepts such as MedVault [7] use alternative blockchains such as Colu to store patient data directly on the blockchain. Patients could then share or authorize doctors and other health entities to access and modify their data.
  • Storage of Health Care Data - Most of the previous examples use the blockchain not as a direct data storage medium, but instead as a secure reference point for identities, access, and data locations. At least one group from a company called Tierion, which partners with the Philips Blockchain Lab , has produced a concept called Chainpoint[8], which proposes to use a Proof of Existence concept and Merkle Roots[9] to efficiently store actual patient records on the blockchain without imposing excessive transaction demands on the system.

Other Blockchain Use Cases

Cryptocurrency

Bitcoin (BTC) was the first cryptocurrency based on the blockchain, and was developed by someone calling himself Satoshi Nakamoto. The protocol was introduced in 2008 after the publication of a white paper describing the algorithm and the mechanisms for generation and distribution of BTC.

Smart Contracts

Securities Exchanges

References

  1. ↑ Tapscott D, Tapscott A. Blockchain Revolution: How the Technology Behind Bitcoin Is Changing Money, Business, and the World. United States: Portfolio; 2016. 1-368 p.
  2. ↑ Nakamoto S. Bitcoin: A Peer-to-Peer Electronic Cash System. WwwBitcoinOrg [Internet]. 2008;9. Available from: https://bitcoin.org/bitcoin.pdf
  3. ↑ Peterson K, Deeduvanu R, Kanjamala P, Boles K. A Blockchain-Based Approach to Health Information Exchange Networks. (1):1–10.
  4. ↑ Ekblaw A, Azaria A, Halamka JD, Lippman A, Original I, Vieira T. A Case Study for Blockchain in Healthcare: “ MedRec ” prototype for electronic health records and medical research data MedRec: Using Blockchain for Medical Data Access and Permission Management [Internet]. 2016. Available from: https://www.healthit.gov/sites/default/files/5-56-onc_blockchainchallenge_mitwhitepaper.pdf
  5. ↑ Linn LA, Koo MB. Blockchain For Health Data and Its Potential Use in Health IT and Health Care Related Research. 2014;1–10.
  6. ↑ Yue X, Wang H, Jin D, Li M, Jiang W. Healthcare Data Gateways: Found Healthcare Intelligence on Blockchain with Novel Privacy Risk Control. J Med Syst [Internet]. 2016 Oct;40(10):218. Available from: http://dx.doi.org/10.1007/s10916-016-0574-6
  7. ↑ Baxendale G. Can Blockchain Revolutionise EPRs? [Internet]. Vol. 58, ITNOW. 2016. p. 38–9. Available from: http://itnow.oxfordjournals.org/lookup/doi/10.1093/itnow/bww017
  8. ↑ Vaughan AW, Bukowski J, Wilkinson S, Sporny CM, Shea R, Allen C, et al. Chainpoint: A scalable protocol for anchoring data in the blockchain and generating blockchain receipts [Internet]. 2016. Available from: https://tierion.com/chainpoint
  9. ↑ Merkle RC. PROTOCOLS FOR PUBUC KEY CRYPTOSYSTEMS. In: IEEE Symposium on Security and Privacy [Internet]. 1980. p. 122–34. Available from: http://www.merkle.com/papers/Protocols.pdf

Submitted by Ben Orwoll

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