What would happen in an ideal world if you have a health-related emergency in a foreign country? As soon as you arrive at the hospital, doctors could access your medical history instantly and know immediately whether you have any conditions that would affect your treatment. As you are treated, your medical records would be updated and any diagnostics, such as x-rays, would be included as soon as results are available. When you are discharged, the hospital could arrange a follow-up appointment with your hospital or clinic at home, and even forward your medical bill to your insurance provider for immediate payment.
This scenario is the “holy grail” of the electronic healthcare industry. Medical data interoperation between all healthcare institutions and patient portals is a future that we can all look forward to. Medical data will be instantly accessible by authorized consumers (both patients and healthcare professionals) with no geographic limitations. Data interoperability will span healthcare domains, such as hospitals, clinics and pharmacies, and geopolitical regions, such as cities, states, and countries.
While it’s certain that healthcare data interoperability will reach this ideal, the question of how we get there remains. Many barriers exist to achieving total interoperability. For example, patient medical data storage is subject to legislation at all levels of government. There are laws about EMR retention, privacy, availability, and authorization. There are even laws about data in transit and at rest. Violations of these laws can result in hefty punitive measures. In the United States, the fine for violating the HIPAA (Health Insurance Portability and Accountability Act) – which protects medical records and other personal health information – can be as high as $50,000 for leaking a single patient record. A small breach where multiple records are leaked could cost an organization millions.
All interconnected systems would need to guarantee that exchanged data could satisfy every healthcare law and standard, since laws from one region may not be enforceable in another. If a medical record was sent from a system governed by HIPAA to a system outside the United States, and a data breach or theft occurred while in transit or in storage, HIPAA would not have the jurisdiction to enforce fines or penalties.
Blockchain technology can solve some of these healthcare data interoperability and security problems. Although not a “silver bullet” on its own, there is much promise in the Blockchain concept as a part of a bigger solution. Blockchain allows for decentralized authorization, immutable transaction logging, and distributed ledger – all features which can bring the goal of healthcare data interoperability closer to reality.
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Blockchain offersa distributed ledger, which is a database of transactions that are distributed across a network of machines. A transaction is a medical action performed at a given time; for example, a prescription given to a patient from a doctor. Each transaction is validated by each machine based on a set of rules agreed to by all participants within the Blockchain network. Transactions are only accepted if consensus is reached between machines, which decentralizes authorization. As well, transactions are distributed across multiple machines, ensuring availability. If a network or power outage renders several servers offline, the system as a whole will continue to operate because of the geographical distribution of the servers.
Another important Blockchain feature that adds value to healthcare data interoperability is that transactions are stored in such a way that makes it very difficult to tamper with them without being detected. Secure storage ensures that all transactions are immutable, protecting the integrity of the medical data.
Blockchain technology even gives patients the power to create rules around how his or her electronic health records are shared and modified. The cryptocurrency Ethereum has a feature called Smart Contracts, which is an agreement between two or more parties written and enforced by code. This feature has the potential to revolutionize healthcare by allowing healthcare providers to create rules to control prescriptions of drugs, especially dangerous and highly controlled drugs such as opioids.
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Blockchain technology on its own is not sufficient to create a complete electronic healthcare record (EHR) solution, however. There are limitations and problems with using cryptocurrency Blockchains such as Bitcoin or Ethereum. Cryptocurrency Blockchains are designed to run on a public network and the data stored is by nature anonymized. A transaction moves value from one “wallet” to another. These “wallets” are identified by large numbers that are never resolved to a name. Health records, on the other hand, cannot be fully anonymized. Standards, such as HIPAA, are very strict about patient data privacy in transit and at rest and would not tolerate sensitive medical data being stored on “public” servers.
A healthcare solution must use multiple private Blockchains based on health domains. These Blockchains may exchange data, but the data is controlled by the Blockchain that owns the data. A patient may consent, for example, to give some medical information to a research company. A smart contract is created within the private EHR systems to give access to some medical data and a token (a long number) is given to the research Blockchain. A transaction is then created on the research Blockchain indicating that a patient has given consent to share medical data and the token is stored. The token can then be used to access an anonymized version of the medical record. Rules around the lifespan of a token can be determined by a smart contract. It may only be valid for a single fetch, or a finite period of time, or may be valid until the patient explicitly revokes access.
One idea to govern the behavior of a transaction across the barrier of another Blockchain network is to associate the request with a new smart contract, which is linked to the source smart contract, creating a smart contract chain. This chain of smart contracts would give the patient control over his or her own medical records, allow medical data to follow the patient across multiple domains and geographical regions, and ensure compliance with standards across the chain. I will expand upon this idea in future articles.
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As the Blockchain technology matures, its potential to revolutionize all aspects of healthcare will become more and more evident. The number of companies experimenting with medical Blockchain technology, such as Medicalchain, will grow exponentially. We are on the cusp of a major breakthrough in healthcare data transfer that will ultimately use Blockchain to improve the quality of healthcare for us all.
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