Blockchain Shows Potential for Improving Patient Record Sharing and Security
As patient data have grown in size and complexity, health care institutions have recognized the challenge of sharing complete and accurate information across a network that currently relies on idiosyncratic and centralized systems. Blockchain technology could change that by decentralizing this system while retaining record security and accuracy.
First designed as an electronic cash system to transfer Bitcoin, blockchain technology has demonstrated utility in many kinds of electronic transactions. The financial industry has already used blockchain to transfer large amounts of data securely. Now, health care and technology researchers are looking to blockchain to address the growing issues of patient data management, improve the completeness and portability of patient histories, and promote more individualized care.
Overcoming technical, policy, and regulatory barriers to sharing information efficiently and securely among health care providers is a major challenge, a finding highlighted by the recent report “Sharing Data, Saving Lives: The Hospital Agenda for Interoperability” released by a consortium of seven leading national hospital associations including the American Hospital Association and the Association of American Medical Colleges.
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The challenge is that so many different entities need patient information but maintain their own records, and no standard system yet exists to exchange that information while maintaining patient confidentiality and record security. Each patient visit or interaction with the health care system creates more data, often collected into separate databases.
Early this year, IBM, Aetna, Anthem, Health Care Service Corporation, and PNC Bank announced a collaborative effort to design and create a “blockchain-based ecosystem” to provide a secure network for health care companies to “build, share, and deploy solutions that drive digital transformation” in their industries.
In particular, radiology departments and facilities with enormous collections of imaging data can expect new opportunities to provide more patient-centered care as ease of patient record sharing and information security improve.
A three-year pilot project undertaken by Massachusetts General Hospital (MGH) using simulated patient data is currently assessing the feasibility of a blockchain-based patient record system that could ultimately replace existing electronic health records. To seek ways to store and manage patient data more efficiently and securely, MGH is collaborating with MediBloc, a startup technology firm from South Korea, on a project to use blockchain.
The Basics of Blockchain
In essence, a blockchain is an electronic list of records. Each block in the chain contains an encrypted code of the previous block, along with a time stamp of the new block’s entry and an amount of data. The technology was introduced in 2008 by Satoshi Nakamoto, the pseudonym of a yet-to-be identified person, or persons, who created the cryptocurrency Bitcoin as an electronic cash system.
In proposing the new technology, Nakamoto envisioned the blockchain as a way to establish a peer-to-peer method of transferring electronic cash that cannot be counterfeited or stolen.
Each Bitcoin transaction begins with one user’s account, known as a wallet, proposing that the blockchain be changed to transfer Bitcoin to or from another user’s wallet. The computer network that supports the system independently checks the Bitcoin blockchain, using it as a ledger of transactions, to confirm ownership of the Bitcoin involved in the transaction. The transaction is then bundled along with other transactions to create a new block in the blockchain.
The new block contains a cryptographic hash of the previous block but does not contain the actual data in the previous block. This unique cryptographic code makes the system resistant to third party tampering. Altering the hash would cause it to fail to correspond with the preceding block as well as the block that follows it.
Blockchain Applications in Health Care
The blockchain pilot project underway at MGH involves the hospital’s Laboratory of Medical Imaging and Computation, which is a joint venture of MGH and Harvard Medical School. Working with MediBloc, the project aims to improve patient data management and expand collaborative access to medical images and image analysis. In addition, the pilot program will be conducted alongside MGH’s use of artificial intelligence and machine learning to find new ways to analyze patient records.
Last year, a new academic journal, Blockchain in Healthcare Today, was launched with John Halamka, chief information officer of Beth Israel Deaconess Medical Center in Boston, as its editor in chief. Halamka cites three prominent opportunities for using blockchain technology to address long-term challenges in health care:
- Medical records. As with Bitcoin transactions, medical records can be generated and entered into a blockchain, which cannot be altered without permission, thus ensuring the secure transmission of records among institutions.
- Consent management. Given the vital importance of patient consent, blockchain can also be used to maintain consent records and share that information among departments and institutions.
- Micropayments. To give patients incentives to follow their care plans, blockchain could be used to provide patients with small rewards to keep their appointments and follow through on care instructions. It could also be used to encourage patients in clinical trials to continue to provide their data to researchers.
Currently, health care institutions collect patient data and store it on their own systems. By using blockchain, they could store the same information but identify the patient with an anonymous code. Managing access to records could be done through smart contracts – computer code acting as a set of rules agreed to by all parties – and developing blockchain applications that allow a record to be stored so that it becomes accessible only under certain conditions.
Proponents of blockchain say that it can provide a structure for data sharing as well as security. A January 2019 paper in Blockchain in Healthcare Today described how blockchain could be used to manage patient medical histories, ensuring that the transfer of information between institutions is more accurate and secure.
For example, using blockchain to create a decentralized medication management system would permit prescribers to query patients’ prescription histories and enter new prescriptions into the record, secured by the patient’s individual encryption key, which patients could use to decrypt and search their own prescription history across different provider and pharmacy records. A significant opportunity for using blockchain in radiology involves storing,managing, and securely accessing massive amounts of collected imaging data. Blockchain could be used to control access to banks of medical imaging data stored in cloud servers, while retaining security and, where necessary, patient anonymity.
With existing systems, patients do not have full control over their own data, because allowing complete access would permit them to alter or delete information. At the same time, patients are becoming more privacy conscious and want greater control over who uses or shares their data. Blockchain could provide increased security and peace of mind by allowing patients to decide who can access their information and under what conditions. It could also allow patients to share their records with researchers without revealing personally identifiable data. As currently envisioned, the patient’s privacy key code along with the health care provider’s key code could unlock access to the patient’s data in the blockchain.
Not all the challenges involving transparency and interoperability are technical. Regulatory and policy obstacles must be overcome before blockchain can take a leading role in medical records management. While MediBloc is currently developing a tool to convert existing health care data into a universal format that could facilitate access and collaboration among institutions, it seems likely the speed and cost effectiveness of blockchain cannot be fully realized until legacy practices on records security and management change as well.
The pilot project underway at MGH could demonstrate how blockchain technology might improve patient data management and expand collaborative access, but health care organizations, providers, and technology companies have only begun to explore the various ways this developing technology might impact future health care.
Blockchain technology promises significant benefits for improving access to patient records and medical image histories while maintaining confidentiality and security. Blockchain could also be used to help prevent data breaches and help health care facilities recover more quickly from a breach. Eventually, blockchain technology could offer health care providers a secure and resilient system for the smooth and secure transfer of patient records, increasing opportunities for research and collaboration, and improving patient care.