Blockchains for Clinical, Research, and Public Health
In our previous blog, we touched on the primary attributes of blockchain technology, general use cases, and how they may benefit organizations utilizing multi-party transactions to support business processes. We heard some great comments via Twitter from readers including @Lygeia who tweeted: “…potential for blockchain in enabling patients to aggregate and share portions of their own health data.” Another reader, @naveen101, tweeted about “using blockchain as the basis for a complete overhaul of #HIPAA.” Perhaps the most significant implication of blockchain technology was shared by @ShahidNShah who tweeted that “real #blockchain disruption will come when disintermediation is embraced.”
Disintermediation is like removing the middleman from any exchange of goods, money, or information. In the health care context this most often refers to health-related data (e.g., EHR data, clinical data, payer data, research data, etc.). In some ways blockchain technology presents the next wave of technology-mediated disintermediation driven by the proliferation of the Internet and related technologies – disintermediation in the health care enterprise relates to broad socio-technological shifts in our understanding of privacy, data-sharing, open science, citizen science and patient-centered health care.
These key concepts on the socio-technical underpinnings of health care deserve their own blog – for now, we will keep our focus on blockchain and provide an overview of potential use cases in clinical, research, and public health. With the technology maturing at a rapid rate, emerging blockchain solutions should be developed and implemented with the right mindset and approach including exploration, piloting, iteration, and scale.
Established Blockchain Use Cases in Health Care
When it comes to blockchain, the word simple might seem… out of place, but the following use cases explore applications of blockchain technology in health care that can in many cases be developed and implemented today. Most of these are more suitable for private or permissioned enterprise blockchains (defined in our prior blog post), such as Hyperledger, to retain some control over the system, versus autonomous and fully immutable public blockchains that lack appropriate maturity, privacy, and scalability. It should also be noted that leading organizations such as the National Institute of Standards and Technology (NIST) and the Institute of Electrical and Electronics Engineers (IEEE) are participating in several documentation and standards development initiatives. Until such properties and controls are ironed out, the “Keep it Simple” approach illustrated in the following use cases may be the best place to start:
- Payment Processing – Blockchain was originally designed to support cross border, frictionless payments that reduced counterparty risk and the need for intermediaries. The transparent ledger allows for any participants to audit and verify that transactions were received by intended parties, assuming the individual or organization tied to public address was known to the sender. It removes the need for trust in third party processors, and with the incorporation of smart contracts and their conditional logic, automated payments and validation can be baked into processes, reducing the impact of intermediary processors in routing and validating payments. In health care, this translates to a variety of use cases including national and international aid disbursement, health care claims processing and payments, and management of contracts and grants. Through the disintermediation of processing and the ability to automate conditional logic and validation requirements, blockchain can be seen as a proactive measure for reducing fraud in payments processing.
- Registries - Registries are essential in health care. They hold relevant data on patient conditions and outcomes, vital records such as patient death or birth certificates, and consent/re-consent for participation in clinical trials or secondary use of health data. From these registries, health care professionals and researchers can obtain essential information for tracking outcomes over time and assessing efficacy of treatment. Currently, the data within most registries belongs to their sponsors or governing committees. With blockchain, control over the data in registries can be returned to patients and participants in research studies and allow for development of incentive models for keeping individual health care profiles up-to-date. Moreover, blockchain allows for a transparent, immutable record of registrations that is auditable and cryptographically signed for authenticity at the point of entry. The promise of interoperability between registries and records, and the incorporation of automated conditional logic via smart contracts makes blockchain a potential disruptor for health-related registry systems.
- Provider Credentialing – Provider credentialing plays a key role in health care delivery, with care providers facing delays in enrolment and credentialing processes that impact their ability to provide care. Blockchain technology can support a more efficient process for managing the repetitive collection and verification of information required to complete the credentialing process. This is trust-related issue which blockchain specializes in addressing. A common system or network built atop a public or permissioned blockchain can alleviate issues of trust as all participants can verify the data and trace it back to the initial authorization and transactional input into the system. This allows health care practitioners to only have to provide the information once, or as updates are needed. Once the credentialing data is authorized and appended to the ledger, it can be relied on without further verification as the data has been digitally signed and committed to the ledger in a verified and validated transaction.
- Supply Chain and Provenance - Supply chain was one of the earliest use cases for blockchain because it provides the ability to tie individual addresses to unique assets, and when combined with technology such as near-field communication (NFC) chips, can track assets throughout the supply chain from production to delivery. The ability to track pharmaceuticals on an individual unit level, from the point of manufacturing to retail/distribution and prescription fulfilment for consumers on the blockchain in near real-time provides the ability to validate and ensure the proper handling, delivery, use, and misuse of prescription drugs - a potent tool for combating the opioid epidemic) . Blockchain can also support automated resupply of any health-related goods to pharmacies, research labs, care providers, hospitals, and for national and international aid through the automation of inventory management, order requests, payment, tracking and delivery.
Emerging Blockchain Use Cases in Health Care
The following blockchain use cases for health care present additional challenges such as regulatory or compliance hurdles, extensive reliance on incumbent stakeholders, or technological requirements that push the envelope for current blockchain technology. Given the maturity of both public and enterprise blockchain platforms, with additional privacy-related controls, scalability and other barriers requiring base protocol or second-layer improvements, a tempered approach is recommended for their development and implementation.
- Enhancing Data Exchange - Blockchain can be used to support secure access to data within an exchange using smart contracts to control access to specific data and subsets for health providers, primary and secondary research. When combined with participants providing consent to their data, blockchain smart contracts can enable fair payment to create a potential ‘marketplace’ granting access to globally sourced data for health providers and biomedical research.
- Data Commons and Open Science – With the ability to automate attribution for data used in primary and secondary research studies, blockchain can also be used to support new incentive models for data sharing and open science. It can encourage participation in data exchanges by offering scientists ‘recognition tokens’ that could be integrated with new models for scientific funding, peer review, publication, and faculty tenure review. To solve issues of bad data, blockchain-based reputation systems may be used to rate the quality of data submitted, helping researchers identify more valid and reliable (i.e., measurably good) data.
- Electronic Health Records (EHRs) on the Blockchain - Blockchain can potentially be used to facilitate interoperability between proprietary EHR platforms, making data more accessible to patients and care providers regardless of the originating EHR system. Blockchain as an underlying, unifying protocol can incorporate and transmit hashed data using conditional logic, oracles (i.e., data feeds) in smart contracts, tokenization, zero-knowledge proofs, and self-sovereign identity systems to potentially provide a more secure method for transferring data between EHRs for patients and providers. As discussed above, blockchain also allows for returning ownership of data to individuals who can define granular access rights, empowering health care decision making for patients.
While we highlighted a few potential use cases above, this is not an exhaustive list – one thing we can be sure of is that additional use cases for blockchains have not even been realized. With a broad potential range of additional health-related applications (e.g., identity management, dissemination of research data, and incentive programs for research and clinical trials), blockchain technology represents exciting solutions to health care challenges that exist today.
Your exploration of blockchain applications should be tempered with an understanding of the interoperability of new and emerging platforms and technology, evolving regulatory and compliance requirements. It is certainly not the hammer for every nail, and it may not be useful to your organization if, for instance, issues of trust between multiple parties and reliance on shared data and agreements are not present. With our two-part blog, we hope this brief introduction to blockchain technology and presentation of potential health-related applications will help you understand and make informed decisions on your own approach to this exciting technology. Join us at Health Datapalooza for more on this topic during a main stage panel titled, “AI, Blockchain, Machine Learning, IOT..from Buzzwords to Reality in Healthcare.”