Understanding Implications of Healthcare Blockchain

May 03, 2018 - As organizations continue to consider healthcare blockchain it’s important to understand what the technology can realistically do and what the technology might not be capable of doing.

Blockchain is a heavily used buzzword for cryptocurrency and it can sometimes be difficult to see where this technology will be applicable to healthcare.

A recent report released by Chilmark touches on what blockchain is and what it isn’t in the healthcare space.

“Blockchain is immutable and enables permanent records of transactions that cannot be changed,” report authors explained. “For transactions where fraud prevention, authenticity, or provenance of data are critical, blockchain can support transaction verification, and reduce fraud or data tampering.”

“Each block (a record of a transaction similar to a page on a ledger that includes a record of the previous transaction) on the blockchain is recorded in historical order so we have a sequential history or audit trail of all transactions.”

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

According to the report, a standard blockchain framework allows organizations to:  

• Enable direct money transfers between two parties without an intermediary such as a bank
• Address the double-spending challenge by utilizing peer-to-peer networks
• Conduct time-stamp transactions on the blockchain by utilizing proof-of-work methods
• Use nodes in a network to both protect the network as well as provide a structure that enhances security

However, there are still significant points of confusion when it comes to how blockchain will realistically be deployed in healthcare. Most of these concerns stem from how the technology will develop in the coming years. There still isn’t a clear and standard definition of blockchain, which can make it difficult to predict its value long- term.

For example, the report pointed out while blockchain is most commonly described as a decentralized database, it is sometimes referred to as a data structure. This lack of a standard definition and application makes it challenging for healthcare organizations to see how blockchain will fit into their health IT infrastructure.

The function of blockchain is also expected to evolve as it matures through different versions. Technology generally evolves to improve upon previous versions and blockchain will be no exception. Predicating how blockchain will evolve is difficult because the technology is so new to healthcare and so different from anything currently deployed.

The healthcare industry in particular is also struggling with the distinction of public and private versions of blockchain. Hashing the data on a public blockchain can bring up the same concerns organizations initially had over the public cloud.

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

While there are some hesitations about defining blockchain and actually implementing it, there are many ways the technology can potentially be used to address some of the more persistent health IT challenges, such as interoperability and data exchange.

“Blockchain can be a superior approach to existing technologies if the business logic in the transactions can be translated into a smart contract on blockchain,” said the report. “Where trust is lacking between parties that need to share data, blockchain can mitigate the need for parties to integrate databases.”

“Blockchain and the cloud make it possible to share only the aspects of data needed to complete the transaction or perform the required healthcare delivery task.”

Blockchain has a large role to play in numerous areas in healthcare, such as patient data management, revenue cycle management, decentralized HIE, quality measures reporting.

These advantages of blockchain make it seem like a shoe-in for widespread health IT infrastructure adoption, but actual implementation depends on what standards are produced in the coming months.

READ MORE: Open Source Blockchain Development Critical to Standardization

Standards are being developed, but there is no set standard for all healthcare organizations to use. The question of whether exchanges can be made between different blockchain standards will significantly impact how effective blockchain will be at improving interoperability.

For example, if one EHR vendor uses one standard, and another EHR vendor uses a different one, there may still be issues when an EHR needs to be exchanged between the two vendors. Standardization and frameworks need to be established to truly improve data exchange.

“To truly harness the blockchain’s potential to address healthcare needs such as data sharing and patient outcomes, developers will need to move beyond the technology itself and integrate social technologies that incentivize cooperation,” the report concluded. “It is not just the technology, as they say. As with any innovation, true evolution must happen at multiple levels: logistic, social, economic, political ¾ to name just a few.”

“Each of these components, in the blockchain context, are more complex than most other technologies from mobiles to big data that we have seen drive innovation in healthcare over the past two decades.”