Anderson, C. (November, 2018). A Look at Blockchain and Applicability to Nursing. Online Journal of Nursing Informatics (OJNI), 22(3). Available at http://www.himss.org/ojni
To advance the health of our communities, a shared research agenda and our knowledge, we must embrace the tools available to us. Yesterday it was paper, today electronic data capture, and tomorrow it may be blockchain tokens. Nurses have a vital role in transforming health care and must be prepared to understand, use and apply these digital health disruptors.
Last year Diane Skiba, Ph.D., FACMI, ANEF, FAAN, compiled a list of blockchain definitions while exploring the applicability of blockchain to academia. Dr. Skiba illustrated that “Blockchain is a peer-to-peer distributed ledger technology for a new generation of transactional applications that establishes transparency and trust” (Linn & Koo, n.d., p. 2). Watters noted that “blockchain is a distributed database that provides an unalterable, (semi-) public record of digital transactions. Each block aggregates in a time-stamped batch of transactions to be included in the ledger (the blockchain). Each block is identified by a cryptographic signature. The blockchain contains an un-editable record off all the transactions made" (2016, pgh. 7).
Also in 2017, HIMSS launched a Blockchain Workgroup, which has since published an official definition for blockchain: “a technology for transactional applications that can be used to share a ledger across a business network. This ledger is the source of all transactions across the business network and is shared among all participants in a secure, encrypted environment. This technology grew out of the bitcoin technological innovation. Blocks, or transaction records, are added to the chain in a linear, chronological order. Each node (or participant connected to the network) gets a copy of the blockchain, which gets downloaded automatically upon joining.” (HIMSS, 2017, p.28).
Blockchain in Healthcare
Now that we have our definitions somewhat underfoot, let’s see if blockchain technologies can address our macro problems in healthcare? These technologies offer potential solutions relating to health data storage, security, confidentiality, data integrity vs. the right to be forgotten, resource management, and compliance. I attended a blockchain summit hosted by MATTER, the University of Illinois at Chicago, SAP, and Advanced Clinical that presented three distinct blockchain use cases. The first illustrated that blockchain technologies could solve the problem of provider data quality. The second use case demonstrated fee-for-value reimbursement by using the blockchain to intentionally share data based on outcomes. And the third demonstrated how a single payer system could leverage blockchain technology to secure an individual health record. Did I mention these were practical, real-world use cases from payers, an accountable care organization in Arizona, and the United Kingdom’s National Health System?
During the summit, I also learned that as organizations embark on a deeper dive into blockchain, they need to answer the following questions:
- Is there any opportunity for shared value creation? A shared interest needs to be established with a minimally viable network to ensure accurate and timely data.
- Are there willing partners? Everyone has to agree to the rule and support the need for regulatory and audit requirements.
- What are the technical factors? There is no “blockchain in a box” and solutions should be standards-based; however, standards are still evolving, and governance is usually custom.
- Is there a commitment for ongoing governance? Incentives and business models should be in place and begin with non-sensitive data and consortium-based frameworks.
Nursing Use Cases
Let’s drill down into four specific use cases from a nursing lens: education transcripts, credentialing, health data, and open research.
- Nursing students owning their education
Dr. Skiba (2017) illustrated ideas around students owning their education and helping to transform higher education through learning pathways, access to content and collaborative development.
- Nurses owning their credentials
By creating a “token” on a shared ledger – an automated system of verifications on the blockchain – an application programming interface for education verifications can be triggered and stored in a shared ecosystem. (Nurse Token Team, 2018).
- Nurses as partners in moving data back to the person
The European Union’s Blockchain Observatory and Forum identified nurses as an added value in facilitating the communication between the different actors involved to deliver the best outcomes for patients and citizens. Nurses are key to improving access and outcomes in a person-centered approach and to ensuring the continuity of care across the primary and secondary health and social care sectors. (De Raeve, 2018).
- Contributions to the nursing body of knowledge through open science
Sean Manion, M.D., is driving a paradigm shift in the field of research. By 2025, he predicts all key scientific data will be verifiable by blockchain processes. Today, science faces a crisis of trust and blockchain technology is maturing at the right time to fix it. Data collection programs such as the National Institute’s All of Us precision medicine program could significantly benefit from the security of a blockchain to reach its goal of 1 million data volunteers. (Manion, 2018).
In Closing, Dive In
I hope you enjoyed our introductory journey into blockchain. We explored definitions, macro opportunities for blockchain technologies, questions to consider on your organization’s blockchain journey, and nursing-specific use cases. For a deeper dive into more blockchain resources, explore the open access peer-reviewed journal Blockchain Healthcare Today and immerse yourself in this listing of blockchain TED talks. To hear more from the HIMSS Blockchain Task Force, explore their blog posts and toolkit. Last, dig into the Office of the National Coordinator for Health Information Technology’s Blockchain Ideation Challenge that tackled the use of blockchain in health information and technology and health-related research; the 15 winning organizations’ white papers are available for archive viewing.
De Raeve, P. (2018). Blockchain supports nurses in the continuity of health and social care. European Federation of Nurses Associations (EFN). Open Access News. August 8. Retrieved from https://www.openaccessgovernment.org/blockchain-supports-nurses/48506/
HIMSS. (2017). HIMSS Dictionary of Health Information Technology Terms, Acronyms, and Organizations. 4th edition. Boca Raton: Taylor and Francis.
Linn, L. & Koo, M. (n.d). Blockchain for health data and Its potential use in health IT and healthcare related research. Retrieved from https://www.healthit.gov/sites/default/files/11-74-ablockchainforhealthcare.pdf
Manion, S. (2018). Science Distributed. https://sciencedistributed.com
Nurse Token Team. (2018). Nurse Token Whitepaper, version 1.2. Retrieved from https://www.nursetoken.io/whitepaper/18_NurseToken_Whitepaper_EN.pdf
Skiba, D. J. (2017). The Potential of Blockchain in Education and Health Care. Nursing Education Perspectives, 38(4), 220–221. https://doi-org.ezproxy.kpu.ca:2443/10.1097/01.NEP.0000000000000190
Watters, A. (2016). The blockchain for education: An introduction. Hack Education- The History of the Future of Education Technology. Retrieved from http://hackeducation.com/2016/04/07/blockchain-education-guide