Cloud-Based Healthcare Blockchain Improves Efficacy, Control

June 12, 2018 - As healthcare blockchain becomes an impending reality, organizations are looking to major vendors to see how blockchain adoption and implementation will be approached in health IT infrastructure. Major vendors like Microsoft are prepared to take on specific requirements healthcare organizations need to successfully implement blockchain in the coming years by taking advantage of cloud computing.

Implementing blockchain in a cloud environment such as Azure can relieve the stress of deploying blockchain on-premises, according to Microsoft Principle Healthcare lead David Houlding CISSP, CIPP. Deploying blockchain on-premises is a longer path that requires organizations to open up firewall ports which can make healthcare organizations feel vulnerable.

“Going to the cloud and spinning up a blockchain node quickly is faster and enables organizations to pilot much more quickly and there’s some interesting efficiency tools,” Houlding explained to HITInfrastrucutre.com.

“We have Azure Blockchain Workbench, which is compatible with the three leading, most mature, blockchain platforms — Corda R3, Hyperledger Fabric, and Ethereum Enterprise,” he continued. “Azure Blockchain Workbench enables rapid prototyping and deployment of blockchains in the Azure cloud. Healthcare can get past technical challenges and get to do the real transacting, tackling some of the more healthcare-centric challenges like interoperability and integration identify.”

Healthcare blockchain is still in its pilot phase and while the healthcare industry figures out how to apply and leverage blockchain, working with vendors can help accelerate the adoption process and help organizations create more detailed plans for how they intend to use blockchain in the coming years.

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

Houlding has observed that many different blockchain islands are forming which will result in an “archipelago of blockchains” in healthcare. There will be one for provider credentialing, another for provider directory, and several for drug supply chain. There are about ten use cases that are attracting blockchain customers in healthcare.

“Any one healthcare organization may conceivably have to connect to multiple blockchains, so there could be multiple blockchain nodes per blockchain network,” Houlding explained. “Blockchain protects the availability of the overall network. If any given node goes down the network lives on and when that node comes back up it sort of catches up with its ledger and can live on.”

Blockchain can help protect the healthcare network, but it doesn’t need to protect the availability of a particular organization’s network to do that. Houlding suggests thinking about blockchain as a super highway with the blockchain knowing the on- and off-ramps of that highway. Each healthcare organization needs at least one node to access the highway. If an organization’s node goes down, it no longer has access to the blockchain.

Given the immaturity of blockchain in healthcare, a node going down isn’t especially detrimental in the earliest phases of development. But such an occurrence can’t afford to happen when the blockchain moves into its production phase.

“As healthcare moves towards production use of blockchain, protecting availability of the blockchain network to the healthcare organization is important,” said Houlding. “What you need is redundant blockchain nodes for a particular blockchain network. For example, two blockchain nodes across availability zones, load balancing, automated failover and redundant network connectivity, maybe cloud mitigation for anti-DDoS so that the blockchain is available to the healthcare organization. Their on-ramp/off-ramp is available when it’s needed, and it works.”

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Microsoft’s Confidential Consortium Framework (CoCo Framework) is targeted at private consortium-type blockchains like those that would be found in the healthcare industry. Houlding indicates that over 90 percent of healthcare blockchain use cases he sees opt for private consortium blockchain. All the organizations connected using this framework are highly trusted.

“CoCo framework is streamlined a private blockchain and the type of network of organizations using the blockchain,” said Houlding. “It can streamline its consensus algorithm to assume well known and highly trusted organizations connecting and thereby achieve much higher throughputs typically in the realm of several thousand blocks per second.”

For comparison, public blockchains such as Bitcoin can only throughput around 10 blocks per second.

“For enterprise use cases the throughput’s really important,” Houlding stressed. “The security is obviously of paramount importance in healthcare in light of regulation and privacy concerns, and CoCo framework has some very interesting additional security controls or safeguards.”

“It has the secure enclave at its heart, so that each blockchain node has a protected, secure enclave that protects the core code and data from an integrity and confidentiality standpoint,” he continued. “Even if malware lands on the same machine, the core code and data of the blockchain node are protected. It’s much more resilient to that malware.”

READ MORE: How to Approach Healthcare Blockchain Vendor Selection

The kinds of data breaches that have been observed so far in blockchain haven’t attacked the blockchain itself. These breaches are focused on the nodes or the enterprise systems connecting to those nodes. However, that doesn’t eliminate the possibility of hackers developing malware that will attack the actual blockchain.

“We need to assume that as blockchain takes root in healthcare and people start transacting valuable data, attacks and malware will come,” Houlding warned. “We’ve got to think about protecting that with strong controls. That can be hardware enforced through technologies like SGX from Intel, Software Guard Extension.”

Blockchain technology can potentially give organizations a clear and traceable repository of data pulled together from hundreds or even thousands of desperate data sources. This is the kind of data lake that can make possible innovative discoveries using AI and machine learning. While this use of blockchain has yet to be realized, it is a future possibility thanks to the computing power of the cloud.

Healthcare organizations interested in blockchain need to consult their current cloud provider to understand what kinds of offerings they are developing for blockchain. Working with a vendor such as Microsoft can help organizations deploy and manage blockchain efficiently and grow to meet the future demands as blockchain usage expands in healthcare.