Introduction to Blockchain Technology in Healthcare
Understanding blockchain technologies and how Bitcoin and Ethereum are now playing a greater role in healthcare than before. While some people may recognize the usage of bitcoin in healthcare as a form of payment in ransomware cases, the technology behind it is much more and can be a pathway for greater cybersecurity standards in medicine! While EHRs are simply one aspect of healthcare information technology, they play a significant role in how current security standards are in medicine. These cases of ransomware prey on the weakest link in the organization, probing for a small vulnerability to capitalize on within the many lines of defense. Whether or not it is surprising, the weakest link are people themselves. Judgement is a fickle thing and often times, the wrong judgement is all attackers need to spot a chink in the armor and to take down a healthcare system. While the blame can fall on people, the blame also falls on poor managing standards, policies, and controls within those healthcare systems that are unable to prevent or recover from such attacks.
Blockchain technology, which is the software that underlies bitcoin, is a decentralized database platform which duplicates information across a network of peers that also utilize blockchain network. Essentially, it’s a “people’s database”, where those that utilize blockchain networks all help out with receiving duplicated data. In healthcare, it would help with distribution, replication, and deduplication of healthcare information across various end-nodes. Since the information is already de-identified or encrypted, it maintains confidentiality, integrity, and availability. By further ensuring that this information is distributed, it helps overcome the interoperability issue that plagues healthcare information retrieval in EHRs.
When people “mine” for bitcoin or Ethereum, to put it simply, computers from around the globe work with each other to solve a “puzzle” which is a random combination of numbers, strings, equations, etc. Whichever “node”, or computer, correctly solves the puzzle receives a data ledger essentially say, “You have earned XX bitcoin/Ether”. What they earn is then simplified by many to be traded as a form of currency. It is not actual currency itself, but more that the “IOU” that they receive can then be used to power other valuable processes. Because of the inherent transfer and trading of “currency”, blockchain technology utilizes a strong form of security that prevents the global network from foul play. Miners and the software itself is verifying any work done on the blockchain constantly. Because it is decentralized and replicated onto different nodes, each computer that runs the blockchain software will have a cached copy of the database. While it isn’t the physical information itself, it essentially provides a copy of “links” that represent the actual data reducing the actual size of information.
Embedded encryption technologies ensure selective viewership, anonymity, and confidentiality. The security also ensures integrity because someone cannot hack into the network or just one computer and manipulate information on its own. Deduplication will essentially scan for any changes made to the information on a computer, and if it recognizes any changes, it will essentially query and check that these changes were authorized and approved. If those changes are not, then those changes will be reverted using duplicate information stored on other computers. Combine this with CDRNs, healthcare information security would be greatly strengthened, available, and more consistently updated across the board.
As people move around, their healthcare history does not necessarily make the trip as well, which often leads to fragmented care due to the imperfect information available to healthcare professionals. The interoperability that would be provided in accordance with blockchain technology could help healthcare professionals have access to a more interconnected and comprehensive medical history for patients. Unfortunately, as discussed before, healthcare as a whole is often slow or even resistant to change. Many innovations have failed to penetrate and find solid ground in the healthcare sector. While technologies are being utilized, adoption and awareness of them is often slow. In a seminar I attended a few weeks ago at MATTER, a speaker discussed that the strongest advocate for adoption of changes (aside from political power and lobbying), is from the patients themselves and the value that they provide to healthcare systems. Educated and aware patients can push forward new technologies that can help promote collaboration, achieve better health outcomes, and most important keep patient anonymity and information secure.