The health care industry is one of the most data-intensive industries in the world. Every day, health care practitioners generate thousands of gigabytes of data from EMRs, medical images, and other sources. This data are valuable, need to be protected, and must be easily shared between patients, their clinicians, and any other stakeholders required to provide the best health care. That's where blockchain comes in. Blockchain technology is considered to be one of the most disruptive technologies of our generation, as evidenced by the completion of more than 700 million transactions since the inception of Bitcoin. Its potential applications are far-reaching and have the ability to change the way we interact with the world around us, especially in the health care domain which is yearning for a revolution. I believe blockchain technology will disrupt many facets of our current health care infrastructure, most specifically the interoperability and security of patient health care data.
What is Blockchain Technology?
At its core, a blockchain is a decentralized and immutable ledger that records and stores transactions made in bitcoin or another cryptocurrency. These transactions are added to transaction “blocks” that are shared and validated among the distributed peer-to-peer network of computers. Because the transactions are stored across many computers, the data cannot be retroactively altered or tampered with without changing the data on all of the computers. This shared system is what many refer to when they describe the decentralization that is inherent to blockchain technology. Decentralization means each computer in the network is treated equally; there is no central authority in blockchain technology, eliminating any third party intermediaries and vastly improving the security of the data.
Furthermore, the blockchain allows for the execution of smart contracts; contracts that can be self-executed without any central or governing authority. These contracts are essentially codified contract agreements that are based on predefined rules and criteria, and when the criteria are met the contract is executed. This can serve as a way for patients to control and share their own health care data without a central governing body.
Blockchain in Health Care
There are a number of domains in the health care industry that could benefit from real time and secure data transmission, such as:
- Drug discovery and clinical trial research/data
- Pharmaceutical supply chain and distribution
- Health plan (insurance) administration and claims data
- Laboratory data
- Hospital data
- Pharmacy data
- Patient health care data
I would like to specifically emphasize the value blockchain technology could bring in the sharing of patient health care data. In our current infrastructure, our health data is stored in silos controlled by third party organizations, such as hospitals, insurance companies, and pharmacies. Each of the involved companies or organizations lack interoperability. There often exist extensive barriers across each that can make data sharing very challenging, cumbersome, inefficient, and often costly. For example, it is not uncommon for a new patient to be seen in a clinic or hospital without the clinician having reviewed or received a copy of the patient’s prior medical records (even within the same city and state). Sometimes the anecdotal history from a patient will suffice for a clinician to make a clinical decision, but oftentimes it does not. This could result in patient safety concerns (medical errors) and health care inefficiencies such as redundant procedures, examinations, and overuse of an already inundated system.
In fact, in 2016, Johns Hopkins University published research revealing that the third leading cause of death in the U.S. was medical errors. This is a significant finding as the source of these medical errors can often be attributed to poorly coordinated care, communication breakdowns, and misdiagnoses. I have not only witnessed poorly coordinated care in a clinical setting in the context of a clinician, but I have also experienced this myself as a patient. Even when I have felt up to the challenge and the hassle of obtaining my own records when switching between hospitals or health organizations, it is often too late as the new visit has already occurred and previous information often gets shelved or lost. Using blockchain technology and the scenario above, a patient's health care data could be securely accessed in real-time by the necessary clinicians and the patient would be the custodian and owner of their own data.
In addition to facilitating the sharing of health care data, blockchain technology would also reduce the risk patients currently face by having their health care data stored in a centralized manner by third party intermediaries. Additionally, in today’s infrastructure patients assume no ownership of their own health data, and thus do not benefit financially from the immense profits that are generated by this industry. However, patients are undoubtedly responsible when things go wrong with their data, such as seen with the more than 300 million health care record breaches that have occurred between 2009 and 2021. Using blockchain technology there are capabilities for patients to regain sovereignty of their own data, and enjoy the financial benefits that come with this information. As a Harvard Business Review Article describes so well, our health data is derived from our body: It is our asset and we should control it.
Up until the existence of blockchain technology, there was no way for health care data to be decentralized and secured on such a large scale. The adoption of this technology will come with its challenges, as does the adoption of any new technology, but I believe it will strengthen interoperability, reduce costs, and enhance patient outcomes and clinical care. Not to mention, blockchain technology provides a potential solution for patients to own and sell their own data.
What do you think of blockchain? Is it the next big thing for health care, or a fad? Share in the comments.
Dalga Surofchy, PharmD, APh, is an Advanced Practicing Pharmacist currently working as a Clinical Manager of Medical Affairs at a boutique pharmaceutical consulting group. He also teaches as an adjunct faculty at UC San Diego. He holds a Bachelor’s degree in Biology from UC Berkeley and a Doctor of Pharmacy degree from UC San Francisco. His interests are in precision/personalized medicine, preventative medicine, health equity, education, and market/patient access. His previous roles include a mix of outpatient and clinical pharmacy. Outside of work, he enjoys playing basketball, surfing, rock-climbing, skiing, and spending outdoor time with his family. Dalga is a 2021–2022 Doximity Op-Med Fellow.
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