Applying Healthcare Blockchain to HIT Infrastructure

April 10, 2018 - As healthcare blockchain becomes more of a reality in the healthcare industry, organizations considering adopting the technology in the coming years need to consider how blockchain will impact their HIT infrastructure.

Understanding how the technology works and what it will be used for are key to successful future healthcare blockchain deployments, according to HealthWizz CTO Sirish Bajpai.

“Blockchain is different,” Bajpai explained to HITInfrastructure.com. “It's a different animal to different people. For some, it's a database system, for others, it's a smart contract machine.”

Blockchain is still in its beginning phases in healthcare, but the unique compliance and infrastructure needs of the healthcare industry could be a driving force in the overall development of enterprise blockchain solutions.

“Blockchain has a really bright future,” said Bajpai. “Right now, we are in a buildout phase. Companies are trying out various ideas that will be delivered on certain emerging trends within the next year or so. Blockchain is too rich a technology to fail in healthcare.”

READ MORE: What Does Blockchain Mean for Health IT Infrastructure?

The future of healthcare blockchain seems to be inevitable. Organizations need to begin understanding the technology from an infrastructure perspective so it can be implemented once it matures.

While blockchain is a drastically different technology, it won’t require many infrastructure hardware changes. Blockchain is more of a software and protocol adjustment.

“Blockchain is the processes and the collaboration between organizations,” Bajpai explained. “Health enterprises and health providers will have to enter into alliances or consortiums to share value over blockchain. There will be some shift of ownership of equipment probably from cloud back to the enterprises.”

Bajpai predicted that the continued maturing of the healthcare cloud will give organizations the security they need for blockchain. Users will own their part of the blockchain but will be communicating with other users and collaborators with the blockchain protocol.

Users owning their part of the blockchain will call for a new kind of identity management protocol. Users need to be quickly and accurately identified.  

READ MORE: Why Blockchain May Not Be the Solution to EHR Interoperability

“Identity management is a major application of Blockchain, so some authorization and authentication protocols will move towards blockchain,” said Bajpai. “The concept of self-identification is a trend that is catching fire and it’s not unique to healthcare. The user has custody of their own identity and manages their identity as a set of claims.”

Blockchain can be used as a database but it differs from a traditional database because it handles data in small chunks of transactions. Blockchain has a two-layer architecture where the data being exchanged is still held in a database, but there is a layer of transactions, permissioning, and auditing on top of it.

Data storage will need to evolve to meet blockchain’s needs. The blockchain database is never deleted and once a transaction enters the blockchain, it’s there for as long as the blockchain lives. 

“The concept of this add-only data is new,” Bajpai explained. “IT professionals will have to wrap their minds around it and managing the growth of this data will be an acquired skill. That's the two-layer approach. The raw data has to live there, but you build a layer of transactional and auditable transactions on top of it with a blockchain.”

IT professionals will also need to allow access to their infrastructure as clinicians and even patients demand access to their own data.

READ MORE: Blockchain Vendor Efforts Center on IoT in IT Infrastructure

“In the health provider system, patients will demand access to their medical records provided from the systems.” Said Bajpai. “Instead of going through layers of permissioning, you'll have to provide some sort of interoperable exit to their data and manage the security and collaboration of the data over blockchain.”

Currently, health data systems are made up of controlled silos. Data gets downloaded within the system and it’s maintained within the system. There is very little data sharing going on even within the same hospital system. Blockchain is a way to break down data system restrictions and share data easily and securely by decentralizing data systems.

“People will demand access from their own applications,” Bajpai maintained. “Blockchain or decentralized apps will come on their own. Consumers will use various applications of their choice and demand interoperability and access to their data. Health IT staff will have to build and manage those processes to facilitate that access.”

Understanding the difference between access requirements for patient facing apps vs internal apps is part of facilitating access to applications in blockchain.

“Whatever data access patients are given comes through a very tightly controlled portal,” Bajpai explained. “There are different processes, as far as nurses and doctors go, within the system. That boundary probably will be diluted, and access will be granted based on the role or the identity that is presented to the system, rather than within the system or outside the system. That identity is a major application of blockchain.”

Doctors and nurses will maintain their own identity as employees of the healthcare organization and use their identity to access the privileged data sources they need.  

“User identity becomes the ticket to data access, then becomes a credential that is maintained in the system,” said Bajpai.

This way of maintaining blockchain and managing user identity is still in the buildout phase and is still in need of a standard in order to be successful. There needs to be a standard way organizations can successfully identify users.

“There are groups that are trying to develop these standards, which are called verifiable claims, or self-sovereign identity systems, Bajpai explained. “They are establishing protocols by which a system, like a healthcare system, that is trying to authenticate a user can approach and make verified claims from a blockchain system.”

“There are several drafts out there that outline the protocol for self-sovereign identity, how you can maintain that identity as an individual, as well as how we can provide access to claims in the identity system for third-parties to verify or deny access.”

Overall blockchain still has a long way to go before it becomes a standard healthcare technology. Bajpai added blockchain will likely mature significantly in the next year, which is why it’s important for organizations to begin considering where it will fit in their health IT infrastructure.  

“It's a matter of knowing what you want, and then working towards it,” Bajpai advised. “Smart contracts have a lot of future and ensuring privacy and security requirements of health systems through a smart contract would be a very good beginning.”

“All data collaboration happens through the owner or the individual,” Bajpai concluded. “That's something we are envisioning for the future. The empowerment of individuals to access data and download it on their own data systems, share it to controlled permissions, and audit that sharing through blockchain is one application in the healthcare industry that is very powerful.”