It happens every once in a while, researchers working on one problem find something that opens a new world of possibilities in a totally different arena. Physicians working on a medication, isoniazid, for tuberculosis discovered what led to the first antidepressant. I have a feeling that we may be preparing for the information technology equivalent of isoniazid.
Blockchain is an information technology that was developed to create a virtual financial ledger for transactions. You will recognize its most famous application: Bitcoin. Here is how Professor John Halamka of Harvard University explains the concept of blockchain:
"Every financial institution creates a cryptographically secured list of all deposits and withdrawals. The blockchain uses public key cryptographic techniques to create an append-only, immutable timestamped chain of content. Copies of blockchain are distributed on each participating node in the network."
Put aside financial applications of blockchain for a moment. Let's focus upon what this technology can do for healthcare.
Professor Halamka identifies three ways that patient data is shared today. "Push," "pull," and "view" are our options.
"Push" is the term for medical information sent from one provider to another. Often this is done via unencrypted email or text. (I won't mention the obvious HITECH Act problems with this.) A specialist sends an email to a referring physician about a patient, data is "pushed" from one provider to another. This transaction does not guarantee data integrity and does not provide a standardized audit trail.
"Pull" is the term for the process whereby one provider can query information from another. Think of a cardiologist querying information from a primary care physician. As with "push," all consent and permission is informal, ad hoc, and done without a standardized audit trail.
"View" is the concept that one provider can see information inside another provider's records. Since information is transferred from provider to provider, this method is of limited use in healthcare.
Blockchain offers a new, more secure, and flexible alternative to these three methods of healthcare data transfer. Instead of multiple sets of records for each patient, imagine one chart. As a patient's different providers prescribe medication, the prescriptions would become part of the blockchain ledger for the patient. Efficiency and accuracy would be dramatically increased.
With blockchain technology it is also possible to imagine benefits to researchers. Patients could allow access to certain portions of their charts while excluding access to other areas. Instead of manually removing portions of a chart to keep a patient's identity secret, certain blocks would be restricted, thus allowing access to a real time, dynamic patient chart, containing no personally identifiable information. The mind reels with possible applications.
Blockchain technology promises to be disruptive in areas outside of healthcare too. Douglas Park, an attorney and national expert on corporate governance issues, forecasts blockchain's future.
"Boards of directors need to understand how blockchain might impact their company's business model. For some companies, blockchain will make the business model obsolete and force the company to transform its business. Further, blockchain will change governance by altering how financial and operational information is accessed, verified, and audited. Boards that are on the forefront of understanding and using blockchain will have a huge advantage over those that do not."
Blockchain technology offers opportunities that may not fit within current legal infrastructures, explains Professor Reza Dibadj of University of San Francisco School of Law.
"Blockchain could redefine the concept of a patient's medical record. State laws focus on provider's responsibility to store and maintain patient records for a fixed time period. Medical providers are under legal duties to produce records to patients. These legal duties may not match the realities of blockchain technology in action. The shift will be from medical records to medical data, and the law is ill prepared for this transformation."
The healthcare sector may have a powerful new tool in the form of blockchain technology. When and how this technology will become common place in clinical settings is hard to predict. We should anticipate that the early uses of blockchain will not produce the full benefits of the technology.
Remember, the introduction of electricity to manufacturing did not increase productivity for almost a decade. However, over time healthcare providers will develop the intellectual capital necessary to deploy blockchain technology in new and spectacular beneficial ways for patients.