Imagine a world where individuals have ownership of their personal health data.
They have a complete picture of their health over time with aggregated information from different healthcare providers and wearable devices. They no longer worry about the security and integrity of their sensitive medical information. They have the power to decide exactly who can access their comprehensive health data and for what purpose. They are empowered and engaged patients with trust in the healthcare system, therefore they are healthier patients. This world could become our reality with the appropriate implementation of blockchain technology.
The lack of interoperability in the sharing of medical information is a classic issue that was faced by healthcare organizations well before the advent of EHRs. Even in their digital form today, medical records are stored in siloed, centralized IT systems that make sharing difficult. A large amount of time and resources are spent on simply requesting, sending, receiving and compiling patient data.
Blockchain technology could break the traditional siloes of medical record storage and make the process of sharing EHRs significantly easier. A blockchain is essentially an encrypted ledger of transactions, or blocks of data, that are immutable and linked chronologically together in a chain. Copies of the ledger are distributed across a specified network of users, and any additions to the chain are updated for all users in real-time. Putting this technology into practice not only provides security benefits above everything it provides the ability for individuals and healthcare stakeholders to gain access and track recorded health information.
In our imagined world, the transactions would consist of doctor’s appointments, surgical procedures, x-ray images, prescriptions, blood test results, patient-generated health data, etc. Individuals would be in charge of sharing the decryption key for their own associated blocks of data with their chosen healthcare provider(s). Both patients and providers would greatly benefit from accurate, up-to-date and comprehensive EHRs.
The aging, legacy IT infrastructures currently employed by many healthcare organizations are prime targets for ransomware and other cyber attacks, especially since they store valuable health information in a central location. A stolen medical record is worth more than a credit card on the black market. And the more fragmented an EHR is across providers, the higher the patient’s risk of exposing personally identifiable information to cybercriminals.
The decentralization of EHR storage through the use of a blockchain could greatly improve the security of health data. First of all, if a hacker were to breach a blockchain, they would only gain access to one or two blocks of data, which are unusable without the context of the rest of the chain. Additionally, due to the peer-to-peer sharing of a blockchain, it is impossible to alter a block of data without alerting the entire network. This ability to track and verify changes would prevent malicious tampering and ensure the integrity of EHRs.
There is a vast amount of data available in all sectors of today’s technology-driven society, which is raising questions about consumer data rights. In many cases, the collection and use of consumer data for commercial purposes is largely unregulated. The European Union’s recently enacted GDPR is an example of groundbreaking legislation that protects the rights of consumers to decide how their data gets used.
Healthcare is not immune to questions of data access and ownership. HIPAA does not provide any answers since it was written well before data became an inevitable part of our lives. Only one state (New Hampshire) designates the ownership of health information to the patient. Yet there is a multi-billion dollar industry fueled by medical data trading, and individuals are often asked to sign blanket consent forms that allow for this at moments when they are sick and vulnerable.
Patients have always been at the center of healthcare and our systems of health data management need to reflect that. Blockchain has the ability to democratize data access in favor of the consumer, eliminating the need for a costly ‘middleman’ in transactions, i.e., a centralized, siloed database. Individuals could not only control access to their medical information, but could sell it directly to data brokers themselves. Transparency when it comes to the collection and use of health data will be absolutely essential to maintaining trust in healthcare institutions.
We can all agree that the relationship between a patient and their healthcare provider is crucial for positive health outcomes. Individuals with high levels of trust in their doctors are more likely to adhere to treatment plans, follow lifestyle recommendations, take prescribed medications and stay with the same provider over time. All of these factors lead to an improved quality of life and a decrease in an individual’s lifetime cost-of-care.
In a report on digital health technology, Accenture found more than 90% of health executives believe treating patients as partners and ensuring the security of customer data are both important or very important to gain consumer trust. The consumer-centricity and security features of blockchain would allow for improvement on both of these fronts, especially when applied to EHRs.
It should come as no surprise that 91% of health executives believe blockchain and smart contracts will be critical for their organization over the next three years. Blockchain has the power to: a) reduce costs and increase operational efficiency, b) build trust while improving the quality of comprehensive care and c) empower individuals to take charge of their health. It’s time for us to reimagine the future of healthcare information technology.
Taking into consideration the current, outdated health IT infrastructure in a COVID-19 pandemic world, an organized health data management system can provide unprecedented benefits for health authorities in identifying and notifying at-risk populations susceptible to the disease. A blockchain network provides the ability to reduce risks in caring for patient populations at large and is easily coupled with advanced technologies such as machine learning and artificial intelligence.
The views and opinions expressed in this blog or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.
Blockchain and distributed ledger technology are taking hold in healthcare as the industry learns more about the potential to improve patient care and reduce costs.
Originally published 20 December 2018; updated 9 July 2020