Harvard Macy Community Blog

Fostering the ongoing connectedness of health professions educators committed to transforming health care delivery and education.

Blockchain Mania

Have you recently found yourself wondering “What is Blockchain? And why do I keep hearing about it?” If you answered yes, then this blog is for you! To begin, Blockchain is not the answer to everything. It also isn’t miraculously a savior for the problems we have in healthcare. Also, there is no universal definition for it. What it is though, in relation to health, would primarily be in advancing securityand trust in data.

Satoshi Nakamoto developed Blockchain. As a matter of fact, he also developed the world’s famous cryptocurrency; Bitcoin. Truth be told, no one really knows who Satoshi is. It is the name that is widely used for whoever happens to be this anonymous individual or group. Lucky him (or them), he’s now worth almost $19 billion for his development of Blockchainand Bitcoin. So, while everyone is playing detective to find out who the mysteriously dubbed Nakamoto is, let us get to understanding what the buzzword of the year “Blockchain”really means, if it is over-rated or not, and how it is relevant to healthcare.

For those not familiar with Bitcoin, it is an electronic currency (not physical). You can only buy and spend it online. Because it is based online, this raised questions about how we could validate and authenticate that someone actually owns that money. This conundrum led to the development of Blockchain. In the non-virtual currency world, which I presume is your world and mine, we deal with physical currencies. We can easily authenticate what has gone in and out of our bank accounts, because we deal with a bank. The bank in this case is called a Ledger.Think of the Ledger as an entity that record keeps all the transactions you make. In your case and mine, only the bank records that information, so if you are banking with Bank A, then it’s the only bank that can update this information. Bank C or B can’t. So, with a very valuable asset like money, you must really trust the bank for you to have it handle and authenticate all your transactions. Similar to the non-financial world, only University X can authenticate your University X degree and only Hospital X can verify you worked at Hospital X. With Blockchain, instead of having only one entity or Ledgerbe able to validate this information, it opens the validation process to the whole public. And when 50% or more of those trying to validate you certify the authenticity of that transaction or process, then it is permanently stored in your record like a Blockand no one can delete it, rendering it tamper-proof. Over time, numerous Blocksof your data are sequentially gathered creating a Chain. A trustworthy chain of records. Reminder: All this is processed internally by the computers.

To quickly summarize, Blockchain is a digital record of all the transactions a certain individual or entity has made. There is no central authority that controls this record. Instead, validation happens through a public and therefore decentralized process by those who were involved in the transaction. Information can only be added but never deleted or copied.The industry that will be hugely transformed by this is banking. So now you may wonder, how can we apply and use Blockchain in healthcare?

Patient records:There is no central authority that governs and controls or verifies all your medical records. Instead, you may have different records at different hospitals, and each hospital has authority only over the record it keeps. If we were to use Blockchain, this would mean that for a diagnosis of tuberculosis to be recorded for the patient, all the hospitals you have been to have the opportunity to validate that. Once that happens, your diagnosis of “tuberculosis” is permanently stored. That record cannot be deleted, but what could happen is a new more up to date record saying “No longer has tuberculosis” can be added rendering the previous one invalid. This way new and old “transactions” or records are kept safe without tampering risk. Over time, more data is added longitudinally and the patient or a whoever the patient authorizes, decides access to this information. This improves interoperability and sharing of records between different health providers.

Medical research: Blockchain can allow patients to share their data anonymously for research. Similarly, researchers can share back the results of their investigations anonymously to the anonymous user. This level of privacy can encourage recruitment of participants for research in matters that need large samples such as precision medicine. Furthermore, a Blockchain can safely keep one’s publications and protect intellectual property more efficiently and in an inexpensive way.

Health insurance: For insurance companies, Blockchain is an ideal technology that allows them to track medical records and detect fraud. It can also improve the efficiency of the process of reinsurance through what are called smart contracts. These contracts are digital and as such eliminate the need for middlemen, therefore reducing costs. Because they use Blockchain, they are authentic and binding.

But will this really happen? I think it could be implemented because data in the healthcare industry is decentralized without a governing body. I don’t see it as revolutionary however, but rather evolutionary for data privacy, security and efficiency. Investors clearly think we will use it in communications, finance and trading, as they have heavily invested billions for Blockchain technology use in those industries. Interestingly in 2018, out of the almost 2 billion-dollar investments that went into Blockchain application and its development, only 2.8% of those investments targeted the healthcare sector. Will the healthcare industry be an early adopter, or will it continue watchfully waiting? Does the healthcare industry’s tendency to be risk averse prevent us from gaining the benefits of adopting new technologies at an early stage? What do you think?



Did you know that the Harvard Macy Institute Community Blog has had more than 140 posts? Previous blog posts have explored topics including creating new models for academic publishing, well-being in health care, and procedural competency.


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Sunday, 16 December 2018