Blockchain Technology: Is it the Missing Piece in Healthcare?
Many people today are talking about Blockchain but one needs to look beyond the hype. The reality is Blockchain is not new. It was invented in 2008 by Satoshi Nakamoto. (8) In the past few years, it has been discussed in terms of cryptocurrency, such as Bitcoin. However, it has other applications such as healthcare, which has been a topic of interest these days. “Blockchain in healthcare: three words igniting excitement in the hearts of health information and technology professionals everywhere. Blockchain may very well be the official health tech buzzword of 2018”. (1) David Houlding, Principal Healthcare Lead at Microsoft and Chair of the HIMSS Blockchain in Healthcare Task Force, describes “There is a hunger building across the industry for real use cases with real healthcare organizations transacting on blockchain, and proof points / case studies that outline business values sought, results achieved, what worked well, and what needs improvement. Only through such hands-on experience can we validate the potential of blockchain in healthcare, refine its application, improve any deficiencies identified, build trust, and scale it both in terms of the networks of healthcare organizations participating in various blockchain initiatives, as well as scaling blockchain in applying it to other new healthcare use cases”. There are companies already applying blockchain to healthcare. Top ones include Akiri, Blockchain Health, Blockpharma, Chronicled, Coral Health, Curisium, Doc.AI, EncrypGen, Guardtime, Gem, HealthCombix, Iryo, Nebula Genomics, Medicalchain, Patientory, PokitDok, and SimplyVital Health. (2, 6, 7)
As a Nurse with experience in various clinical settings, I’ve seen the importance of good documentation and data integrity as a means for communication among members of the interdisciplinary team and for coordinating patient care. I’ve also seen the discrepancy, inaccuracy, inconsistency, duplication, providers using different database systems, and lack of communication/coordination among specialists for a patient’s treatment and plan of care (eg. meds, procedures, etc). All this leads to frustration, unsatisfied patients, and a decrease in quality care. One example out of many that come to mind is the following. In December 2017, a patient was told that she will need a repeat minimally invasive procedure for a failing prosthetic device that was placed a few years ago. This explained the reason why she experienced many uncomfortable symptoms, which coupled with her limitations, resulted in a decrease in her quality of life. However, the specialist told her that he needed to discuss her case and find out more about the previous procedure which was done by another specialist who was part of a different network. He explained to her that he needed to know more details to better understand why the prosthetic device was “failing” in her case, especially within a couple of years; and, he also wanted to know what size he will use this time when she undergoes the procedure. Meanwhile, the patient was experiencing the symptoms and the limitations in her ADLs and IADLs. It took a good eight months for the specialist and his team to gather all the necessary information from the previous specialist, to set an appointment, and to actually perform the procedure. Following the repeat procedure, the patient no longer experiences her symptoms and today has a better quality of life. I believe in this case if blockchain was used, the two specialists would have communicated sooner and the information would have been readily available to perform the repeat procedure without the long wait and the patient experiencing unpleasant symptoms.
Furthermore, how many times have duplicate tests been ordered because a quick clinical decision needed to be made yet the original test could not be readily accessed due to the various electronic health records? This results in a decrease in the efficiency and quality of healthcare and patient satisfaction as well as an increase in patient risk and healthcare costs. Hence, a decrease in healthcare value.
In his Udemy course, Dr. Robert Robinson, Academic Physician and Clinical Associate Professor at SIU, states “Blockchain technology has the potential to impact cost, quality, and value of healthcare delivery. Applying blockchain to healthcare data can result in automated data collection and verification processes, verifiable data, aggregated data from multiple sources, immutable data that is tamper resistant, secure data which has reduced vulnerability to cyber crime, and also distributed data which can give redundancy and fault tolerance to the system. All these features are very valuable in the healthcare environment”. And, just as ethics is fundamental in nursing and medicine, it must also be applied to blockchain technology as depicted by Georgetown’s “Blockchain Ethical Design Framework”. Dr. Cara Lapointe explains “the realization of this potential requires an ethical approach that recognizes the relationship between design and human outcomes. As blockchain solutions are built and deployed, the Blockchain Ethical Design Framework provides a way to ensure that social value is protected”. (4)
With blockchain, there can be high-quality care and better treatment. We need data to have a better picture of the patient’s medical history, complete the physical assessment and/or to make decisions about a patient’s plan of care, yet at times it can be challenging to access it especially when it is stored in multiple databases. Blockchain will allow data to be more accurate and easily and quickly accessed. Also, treatment will be more coordinated and tailored for the patient. The end result is patient safety, high-quality care, and patient satisfaction. This explains why as a nurse and healthcare professional I have an interest and enthusiasm for the possibilities that blockchain has to offer. Although blockchain can offer great potential and benefits in healthcare, one must keep in mind its challenges and its barriers to adoption. Dr. Sean Manion and Heather Flannery along with a team of industry leaders in blockchain and healthcare are working hard to address this issue as described in the mission statement of Blockchain in Healthcare Global (BiHG), their recently launched trade association formed under the IEEE ISTO (https://ieee-isto.org/). As of today, they have identified sixteen categories of barrier, which include “access, capital formation, compliance, cybersecurity, education, ethics, financial forecasting, governance, heuristics, identity, interoperability, offchain data, policy/regulation/legislation, scalability, standards and certifications, and trust”. And, BiHG is helping its members to work collaboratively to overcome these barriers.
Hence, blockchain technology can be the missing piece in healthcare. However, it will need careful planning and studying before its application as well as collaboration with blockchain enthusiasts and experts. Houlding explains “I think 2019’s going to be really interesting, in terms of some of those pilots wrapping up, case studies being published, and obtaining attestations from healthcare organizations as to what worked well. I think that is going to be a watershed moment for blockchain — because as you get more providers, payers, etc., standing up and saying, ‘Hey, we did blockchain for this use case, this is the business value we saw,’ you’ll see more organizations gravitate towards those use cases, join those consortiums and grow those networks. Blockchain, again, is very much a network technology, so it benefits from the network effect. The more organizations that connect, the more value there is for the network”. (1) In addition, Dr. Manion, CEO of Science Distributed, believes science will be blockchained by 2025. He explains “As researchers begin to use shared, decentralized databases (blockchains) to ensure integrity of research data, the verifiable trust along with new found speed and efficiency of research will create a cascade that will usher in a new era of science”. (5) He summarized his talk that he gave in Dec 2018 at the second annual Digital Medicine Conference (NODE Health Summit) as follows, “Blockchain will impact the average patient/provider in the following timeframe (whether they know it or not): 1–3 yrs — Admin/finance applications, provider credentialing/directories, medical device tracking, tele-health, regulatory administration (e.g. IRB review); 3–5 yrs — Pharma supplychain, pharma R&D, clinical research, basic biomed research, public health; and 5–7 (or maybe 10yrs due to regulatory variability) — Electronic health records, interoperability, invisible health”. Essentially, it’s a matter of time as to when we can understand and see the impact of using blockchain in healthcare. However, it is important for scientists, researchers, as well as providers to get involved with uses of blockchain so that it can be developed in such a way to be most beneficial for patient outcomes.
REFERENCES
1. Bilek, M. (2018, December 5). Blockchain in healthcare: building the network. Retrieved from https://www.himss.org/news/blockchain-healthcare-building-network
2. Buntix, JP. (2018, August). Top 6 companies exploring blockchain in the healthcare industry. Retrieved from https://nulltx.com/top-6-companies-exploring-blockchain-in-the-healthcare-industry/
3. Houlding, D. (2018, May 30). Healthcare blockchain reset- seeing through the hype and starting down the path. Retrieved from https://www.linkedin.com/pulse/healthcare-blockchain-reset-seeing-through-hype-david/
4. LaPointe, C. (2018, March 8). The blockchain ethical design framework for social impact. Retrieved from http://beeckc.enter.georgetown.edu/blockchain-ethical-design-framework-social-impact/
5. Manion, S. 2017, January 16). Science will be blockchained by 2025. Retrieved from https://www.linkedin.com/pulse/science-blockchained-2025-sean-manion/
6. MedicalStartups (2018, August 17). Top 11 blockchain for healthcare startups. Retrieved from http://www.medicalstartups.org/top/blockchain/
7. The Medical Futurist. (2018, March 27). Top 12 companies bringing blockchain to healthcare. Retrieved from https://medicalfuturist.com/top-12-companies-bringing-blockchain-to-healthcare/
8. Wikipedia. Blockchain. Retrieved from https://en.wikipedia.org/wiki/Blockchain
