What is Blockchain?

Blockchain describes a chain of data or transactions as blocks linked or chained together by cryptographic signatures, each of which is called a hash, stored in shared ledgers, and supported by a network of connected processes called nodes. Nodes maintain a copy of the entire blockchain and are continually updated and kept in-sync.

Adding or Updating Data

Adding or updating data on a blockchain requires consensus of the network making it nearly immutable. Once a block is written to a blockchain, it cannot be altered or deleted. Blockchain transaction records are immutable because each block of data is linked to the previous block by including the previous block’s unique “hash,” which is mathematically derived from the block’s content. If a bad actor were to change the content of a block, the block’s hash would change, which would then “break” its connection to the subsequent block. This would require the bad actor to then re-hash the next block, and all subsequent blocks in order to cover their tracks. However, since there are multiple copies of the ledger, the bad actor would have to simultaneously change every version of the ledger at each location, which is practically impossible especially as blockchain networks grow large and risk of collusion becomes negligible.

A Decentralized Solution

Blockchain is characterized by being a decentralized, or a distributed solution, rather than a centrally controlled solution. Blockchain is typically a peer-to-peer network, hence there is no single point of failure. Blockchain is available on a variety of platforms and protocols and brings with it concepts that may introduce nuances or changes to existing healthcare business models. While blockchain achieves a certain level of “democratization” of data, blockchain does not necessarily open access to data as “democratization” may imply, but it may address existing needs and uncover new business, administrative and clinical opportunities that were not previously considered.

Blockchain technology depends on consensus for the validity of transactions, and while transactions can be interpreted widely, not all healthcare activity is transaction-based, and not all healthcare transactions may be appropriate for blockchain solutions. Blockchain brings with it the potential for smart contracts, digital computer code that automates the execution of binding agreements among parties. Blockchain also provides the ability to create value for transactions through “tokens”. This tokenization of the blockchain has been implemented in cryptocurrency settings such as Bitcoin, Litecoin and Ethereum.

While depending on well-known and tested underlying technology, such as networking, hashes and encryption, blockchain is very different from traditional programming, networks, databases, and web interfaces. A new understanding of design, patterns, data sharing, and implementation is required with blockchain. Blockchain and distributed ledger technology have great potential across healthcare to improve patient care and reduce costs. These emerging technologies have already started to take hold in healthcare networks, from clearinghouses to drug supply chains to provider-credentialing processes and other critical areas.

The purpose of this section is to provide a basic understanding and framework for the use of blockchain technology; it is not intended to be an exhaustive description of blockchain and related technologies.

Continue to learn about this technology with the links below.

Myths in Blockchain

Like any emerging technology, there is a lot of hype surrounding blockchain and what it may mean for various industries. Along with this hype comes the spread of misinformation. Due to how controversial cryptocurrencies have been in the media, blockchain has garnered much attention, which in turn has created many myths about the technology.

The following three myths have been propagated often; we hope to dispel these inaccuracies to paint a clearer picture for this technology.

MYTH #1: Blockchain = Cryptocurrency

One big myth surrounding blockchain is that it is inherently tied to cryptocurrencies; this could not be further from the truth. Blockchain is the foundational technology that enables cryptocurrencies to exist. The notion that a blockchain is always tied to a cryptocurrency is inaccurate when the reality is that cryptocurrencies rely on blockchain to function.

MYTH #2: Blockchain is Unhackable

Another common misconception about blockchain technology is that it cannot be hacked. While blockchain is resilient by nature to many typical vulnerabilities, it is still susceptible to a wide range of attacks. The most notorious vulnerability is the 51% attack, wherein a single entity gains control over 51% of the blockchain and can then control the ledger. Like any piece of software or network, blockchains are also susceptible to code exploits and social engineering.

MYTH #3: Blockchain is a Panacea

Blockchain has also been touted as a technology that can solve every problem for every industry. This, too, is a myth. While blockchain presents significant promise in a number of industries, it is counterproductive to assume that it is some miraculous technology that provides the perfect solution for every use case.

Adoption and Implementation

When applying the technology, it is essential to identify real-world scenarios in healthcare where blockchain may be relevant and valuable. In this section, you will find resources to assist in the identification of use cases within the healthcare space and guide your organization’s exploration of possible solutions.

Considerations in Healthcare

There are a number of considerations when pursuing the implementation of blockchain technology for a particular use case, especially within the healthcare setting.

Blockchain Use Cases in Healthcare

Digital Identity Management

Identity is fundamental to almost any blockchain use case in healthcare - inclusive of identity management of individuals (e.g., patient, participant, provider), unique device identifiers for medical devices in the health supply chain, or organizational participants or validators in a network.

Financials, Insurance & Records

With early distributed ledger technology successes seen in the financial technology arena, the escalating cost of healthcare, and the continuing challenges around fraud (particularly from a federal perspective), healthcare finance has well-aligned needs for the characteristics of blockchain.

Clinical Research & Data Access/Monetization

Recruiting and retention remain two of the biggest challenges in clinical trials, and despite innumerable attempts over the years, improvement remains largely unrealized. Clinical trial data sharing and the ability for research participants to experience value discovery (including personal health data monetization) are some of the promises of blockchain for these uses cases.

Health Supply Chain Management

Product supplies, from initial inception to end-of-life, is the most prevalent use case for distributed ledger technology across industries. In healthcare, medication, clinical supplies, blood products, and medical devices are examples where blockchain is being leveraged for operations, compliance, and forecasting among pharmaceutical manufacturers, blood banks, providers, pharmacies, and payers.

Get Involved

Interoperability & Health Information Exchange Community

This HIMSS community serves as the central convening point for interoperability and health information exchange (HIE) professionals to promote meaningful education and thought leadership in the health information and technology industry. We connect professionals committed to transforming health through standards-based interoperability and HIE, with opportunities for networking with peers, sharing ideas, learning best practices and leveraging collaborative opportunities.

Blockchain in Healthcare Task Force

Volunteers on this HIMSS task force will explore and educate the healthcare community on the practical applications of blockchain and distributed ledger technology within the healthcare setting. Members of this group are tasked with (1) highlighting real-world examples of the technology’s use, (2) creating resources to better understand the technology and considerations for implementation and (3) sharing subject matter expertise on the various use cases to which the technology can be applied.

To learn more about HIMSS blockchain activities, please contact us at blockchain@himss.org.

This content was created by the 2018-2019 HIMSS Blockchain in Healthcare Task Force. To learn more about HIMSS Blockchain activities, please contact us.