Blockchain Technology & Healthcare IT

Source: IBM

Blockchain technology is often solely associated with cryptocurrencies. So far, the Null.Beta Blog has informed you on the ins and outs of cryptocurrencies and their properties. While cryptocurrencies are fascinating, the technology behind them is more manifold and valuable in application. But first, we must define the technology behind the current wave of decentralization.

As described by Jeremy Liu in his article A Human Readable Guide to Bitcoin and Blockchain Technology, cryptocurrencies are built on their respective distributed ledgers “Blockchain”. To understand the importance in the difference between data structures, let’s take a step back and discuss; two different types of databases; centralized and distributed.

Have you ever transferred money through your bank? Or maybe you ordered an item through Amazon? In that case you have utilized a centralized database. Centralized databases are created, owned, and managed by a designated entity. We encounter centralized databases every day, and when we utilize them we trust them. We trust the owners, we trust the security, and we trust that those running the database have our best interest in mind. Centralized databases are great, they can hold massive amounts of data and can be secured by a trusted entity. Yet, as our world becomes more and more digital, transferring data becomes paramount to merely storing it. Centralized databases often have difficulty transferring data due to the lack of interoperability. Interoperability is defined as, “the ability of computer systems or software to exchange and make use of information.” This lack in interoperability is created by an array of storage devices with different levels of compatibility, and even if you trust the managers of your data, centralized databases have increasingly become targeted by hackers.

At last, distributed databases! The most well-known application of distributed database technology is Bitcoin’s Blockchain (read here, seriously, check it out). Distributed databases rely on three aspects, which we will define; User Identification, a System of Record, and a Protocol. Effectively, a distributed database offers a way to store information, where if one user stores a record/transaction on a distributed ledger all the nodes “devices” on that ledger are notified of the new information. Once the users verify and authenticate the new information, the new information is added to the ledger, or in other terms, a “Blockchain” through computations that create a hash that is based off of prior and present information. By hashing the data, it creates a transparent security system that is exponentially more difficult to hack. This system of storage allows users, in specific situations, to circumvent a centralized server owned by a designated entity. To simplify what a distributed ledger looks like; the terms listed below are the primary components of a distributed ledger:

User Identification – User identification is a logical entity used to identify a user on a system or within any data storage environment. It is used within any IT enabled system to identify and distinguish between the users who access or use it.

System of Record – A system of record, or source system of record, is a term for an information storage system that is the authoritative data source for a given data element or piece of information.

Protocol (Consensus Algorithm) – A consensus algorithm, like bitcoin's proof of work (the one we hear about most often), does two things: it ensures that the next block in a blockchain is the one and only version of the truth, and it keeps powerful adversaries from derailing the system.

While there are many auspicious benefits of a trustless distributed database there are drawbacks that we will discuss further within the article.

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When speaking in regards to cryptocurrencies, distributed ledgers allow users to safely facilitate transactions among themselves, utilizing a peer-to-peer network, all the while keeping a protected record of those transactions. Now, that is an immensely abbreviated definition of distributed ledgers and their purpose within the scope of cryptocurrencies, but we are not here to discuss cryptocurrencies.

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Healthcare

We are here to talk about the diverse amount of applications that distributed databases offer, because distributed databases are the bread and butter of future data storage technology and of much more than cryptocurrencies.

Healthcare.

Now this following example may be contrived, but stick with me. You, a doctor, have a patient who is suffering from ailment X, aliment X can be cured by applying drug A or B. You learn that your patient will die if given the wrong drug. You go to find their medical record, but you encounter one of two possible, yet hypothetical, problems.

Problem #1 – You don’t have your patient’s medical records, so without running tests you are unable to figure out which drug they are deadly allergic to. This problem is created by slow and unsecure centralized databases that make the movement of data (medical information) inefficient and costly. Healthcare data is often stored on outdated storage systems that put you and your files at risk. As healthcare becomes increasingly digital, transferring data becomes paramount to merely storing it. Centralized databases often have difficulty transferring data due to low levels of interoperability. To combat the lack of interoperability, IT security is increasingly provided through outsourced data transport services; only raising the overall costs to patients. These increasing costs stem from “middle-men” who are hired solely to transport data from point A to B. These “middle-men”, or their purpose, is what distributed database technology, in its entirety, aims to remove, since these costs can be avoided and are unnecessary. Anyone taking a fee for transporting information is highly replaceable by improved technology.

Problem #2 – Your files are held ransom. Yes… I know, it seems to be a rarity that this would happen at this, hypothetical, moment, but healthcare records have been held for ransom on two separate occasions in 2017 and ransomware has continued to become an increasingly popular tool for hackers. In February of 2017, hospitals located in Los Angeles, California, had their medical records held for ransom, subsequently bringing the hospitals to a halt. The hospitals’ computer systems were entirely shut-down until the ransom was paid. This cyber-attack forced ambulances to be re-routed and put lives at risk. Again, in June of 2017, ransomware known as the Wannacry/Wannacrypt virus spread across the world, shutting down 16 hospitals in the United Kingdom. 16! This danger of ransomware can be contended through the use of distributed storage systems, making ransomware attacks futile. The opportunity for cyberattacks to hit healthcare is present due to the overly centralized and anachronous nature of data storage systems that do not receive nearly enough security. According to the Ponemon Institute and a Metalogix report, 49% of U.S. healthcare organizations have reported that they have incurred a data breach within recent years. The article includes an alarming quote, stating that, “Seventy-nine percent of respondents said they did not think that existing tools are "very effective" at protecting sensitive content from accidental exposure or a targeted breach.” When established healthcare IT providers are saying that potential risk is high, something has to change.

While both examples are extreme, the slow transfer of medical data and lack of security, greatly reduces efficiency within an already inefficient industry. The solution to both of these hypothetical problems is to utilize distributed data structures within centralized systems. Perfect interoperability could be achieved by utilizing distributed database technology for the consistent, smooth, and secure transfer of data, and since distributed databases are so difficult to compromise, they offer the security that is needed for mission critical data. Distributed database technology is more efficient due to its synchronous updates that are broadcasted across all nodes on their respective ledger, therefore reducing the need to send data files back and forth. Secondly, Blockchain technology is extremely safe. For example, in order to compromise Bitcoin’s Blockchain it would require hundreds of millions of dollars. While healthcare distributed ledger would be different in protocol, the difficulty in ability to hack it remains.

What does a healthcare system with Blockchain look like?

It can be difficult to wrap one’s head around how the technology behind Bitcoin can be used to secure your medical records. We defined some basic properties of a distributed ledgers earlier, so to make this concept more transparent, we are going to redefine them in context to the current healthcare system.

User Identification – This is the patient. Each patient would have a public address that would contain their information. A common question is - how does this information not end up in the wrong hands? Just as cryptocurrencies use public addresses and private keys, healthcare can too. Your private key could allow specific hospitals and healthcare organizations access to your information. One of the benefits of distributed database technology within healthcare is that, you, the patient has total ownership of your healthcare records. Ownership of one’s data decreases liability to firms and gives consumers more control.  

System of Record – This is your medical record or any data that you wish to transfer/record on the distributed ledger. An issue with current systems of record are their storage capacity. So while distributed ledger technology is a great alternative to purely centralized storage, larger data files (e.g. X-Rays) would clog a blockchain’s nodes, rendering it useless. A hypothetical solution to storage limitations is either using nodes that have more storage capacity, hence not PC’s, or creating a way to link files to centralized sources therefore mitigating a large amount of risk. Healthcare IT will continue to need centralized databases for the foreseeable future, but distributed ledger technology integrated with enterprise systems adds significant layers of security and enhanced interoperability among healthcare organizations.

Protocol –  This is the platform and algorithm that the distributed ledger would use to store and verify that records have not been tampered with. A leading and efficient protocol for healthcare IT has yet to emerge in the market.

Source: http://www.hlbhitblog.com/From-Interoperability-to-Big-Data-ONC-s-Quality-Improvement-Vision

Think smartwatch

Imagine if data from your health and wellness devices could signal doctors or researchers to specific healthcare trends or problems specifically with your health. Our current healthcare system operates on a decades old schedule that consists of annual or bi-annual “check-ups”. But what if your data could alert your doctors or insurers to potential ailments, and you could be notified immediately? Yes, that may be possible with blockchain technology. Although, we haven’t seen this type of data harvesting implemented yet, it poses a revolutionary way to track healthcare trends and improve the effectiveness of diagnoses.

Does all of this actually work and are institutions really using it?

The answer is an astounding YES!

Distributed ledger technology within healthcare has begun to spread rapidly.

Estonia – “Estonia has long been known as one of the most digitally advanced countries in Europe. And now its government is putting ground-breaking blockchain technology to use in securing its citizens’ medical data. The country’s eHealth Authority has signed a deal with Guardtime, a blockchain pioneer, to secure the health records of over a million Estonians.”

PWC Blog

Illinois – Illinois is considering utilizing blockchain technology to store physician’s medical licenses. “The program's backers expect to build a license registry and medical credential-sharing system running on a blockchain, with smart contracts automatically updating information. The ultimate goal is to create an authentic and transparent chain of records for patients and healthcare provider networks.”

Coindesk.com

Other governments, including state and national institutions are implementing blockchain technology within their individual healthcare universes. If you would like to read about more examples, read here.

While this has been a brief overview of distributed ledger technology within healthcare IT, I hope that it has expanded your scope and understanding of the universality of this technology. Healthcare IT will continue to change due to distributed ledger technology, and we are in the nascent stages of development. It’s uncommon to be cognizant of an early technological shift, and it is rarer to understand it. To emphasize that point, Coindesk.com, one of the most prolific publications for Blockchain news, only has 10 articles on their site pertaining to Blockchain technology in healthcare. With that said, we at Null.Beta hope that you continue to read our articles and progress your knowledge.

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Will Hughes

Sources:

Coindesk

Deloitte Consulting

HealthcareIT.gov

PWC.Blogs.com

Techopedia.com