Recently there has been an incredible amount of excitement about applying blockchain technology to healthcare. This weekend I attempted to try and move beyond the hype and find a tangible application of blockchain in healthcare that I could fully understand. Despite many hours of research, I am disappointed to report that most of what is out there is hype or in development - there are very few (if any) actual applications.
In addition to lack of real world applications, many of the blockchain healthcare projects require significant changes to the core blockchain technology used in bitcoin. This is concerning because blockchain is still quite new and the best example we have of it working is bitcoin itself. Bitcoin is quite delicate and the developers of bitcoin are extremely cautious with any changes to it. Applying the core blockchain technology to healthcare will of course require changes but such changes are very risk and should be done with caution or we risk losing the key benefits that are promised.
Given this, I thought it would be useful to understand bitcoin's use of blockchain before trying to find opportunities for applications in healthcare. This way we can filter applications in healthcare against the features bitcoin already provides so we can transfer our confidence in bitcoin to our healthcare application of blockchain.
Benefits
* Immutability - Once data is stored on the blockchain you can be confident that it will never be changed. This is possible because blockchain is essentially an append only transaction log which resides on many machines.
* Durability - Once data is stored on the blockchain, it will never be lost. This is accomplished by duplicating data across many machines - traditional backup/restore mechanisms are neither applicable or needed.
* Reliability - Once data is stored on the blockchain, it can be retrieved at any point in the future. This is possible because the data is stored on many machines and data access requires access to just one of the machines.
* Transparency - Once data is stored on the blockchain, it is visible to everyone. This is possible because blockchain does not implement any form of authentication or authorization to access the data.
* Anonymous - Anyone can put data on the blockchain. This is possible because blockchain does not implement any form of authentication or authorization
* Integrity - Blockchain transactions are validated against a defined protocol. This protocol can include logic such as ensuring validity of the actors involved in the transaction via public key cryptography and validation of the data in the transaction.
What opportunities are there in healthcare for applying these blockchain benefits? The first thing that comes to mind is integrity of healthcare records which I will describe in a subsequent blog post.
Blockchain is still quite new to me so feel free to leave a comment if I got something wrong. Questions are always welcome as well!
I see how it can be a robust, distributed pattern for asserting that health care information lives on and is collaborative and immutable. But how does that apply to active health care information when PHI not only must be well protected but also may require revocability in rare cases. I don't claim to know much on the topic so set me straight if I'm uninformed, please.
ReplyDeleteOne application for this pattern I can see may be to use it for distribution of anonymized health data for the purpose of open analysis. I'm not sure what already exists in this department but it seems to fit with it's abilities.
One common misconception is that patient records (PHI or anonymized) can be stored in the blockchain. Technically this is possible but both are quite large changes from bitcoin's use of blockchain today and are therefore risky.
ReplyDeleteStoring PHI - According to HIPAA, PHI must be encrypted at rest and at transit. Bitcoin does neither - transactions are not encrypted at all no encrypted transport layer is required to access them. While it is possible to add infrastructure on top of blockchain to encrypt data, the need to revoke access completely goes against the other properties of blockchain that make it useful and is therefore a questionable use of the technology.
Storing Anonymized Data - This eliminates the need for infrastructure to control encryption but increases the transaction size significantly from what bitcoin uses today. Bitcoins transactions are ~250 bytes and there are scalability concerns even with that (google bitcoin blocksize). Healthcare records are much larger (megabytes in size) and increasing the average transaction size increases scalability concerns. I suspect this problem will eventually be solved but there is significant risk in this kind of system today. One strategy is to store the data off chain and put the URI to it in the transaction - this is something I will discuss in my next blog poist
Looking forward to more on this topic! I wonder if the blockchain could be used as more of a data integrity/completeness check rather than an actual storage solution. For instance, storing a document's checksum in the blockchain rather than the document itself- then associated systems could confirm the integrity and completeness of their copy. Outside imaging transfers come to mind, I always have a nagging feeling there are more images I don't have, but I have no way of knowing for sure.
ReplyDeleteMy future blog posts will explore using blockchain for an integrity check on DICOM data which would allow a client to verify that they a) have the latest copy and b) the copy they received is correct.
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