Blockchain in the healthcare system
Blockchain is on everyone’s lips. A great deal of discussion is currently going on about the potential applications this technology has in sectors where one would not expect to see it taking root considering its origins. In the healthcare sector, for example.
The blockchain concept is already being used in pilot projects in other sectors as well. In the healthcare industry, especially in Germany, a sceptical attitude exists in relative terms towards integrating this technology. Amongst other things, this is due to high bureaucratic hurdles and a fundamental scepticism towards new technologies and the related potential risks for privacy and data protection.
However, the potential blockchain technology has in the healthcare sector suggests we take a closer look at its possible applications.
Blockchain can best be described as a digital database, which, unlike a traditional database, is characterised by three main features: decentralisation, immutability and transparency.
Unlike centralised structures, as a distributed ledger technology, blockchain exists in the form of a network: a copy of the blockchain is located on each participating computer. This makes the integrity of the data almost completely tamper-proof. An example from the finance sector demonstrates this very aptly: While in traditional finance, the bank is the central authority that „users“ have to trust, in network structures the bank can be eliminated. All cryptocurrencies (e.g. Bitcoin) function according to this principle. A cryptobank does not need to exist and transactions take place completely autonomously through the users and their end devices.
Data can be added to the blockchain, but it cannot be changed or deleted. All data remains in its original state. This makes every transaction visible to every user. Merely access rights can be changed, which we will discuss below in the specific use cases addressed.
Transparency is already explained by the decentralised existence of copies with all the users involved in the blockchain. With the necessary access rights, you can view the data at any time without restriction.
Possible fields of application in the healthcare sector
At first sight, the element of transparency appears to be highly misplaced in the healthcare sector. However, transparency in this context does not mean that the patient is quasi ‚transparent‘ and unauthorised persons can view his data. In fact, exactly the opposite is true: blockchain has the potential to bring the healthcare sector much closer towards patient centralisation.
The management of medical data in the form of digital patient records based on blockchain technology can make the patient the „master of his data“. Besides public blockchains, such as those used to trade cryptocurrencies, private blockchains also exist that only permit access to those who have permission to access them. The possibility of storing data in external databases also exists, to which reference is then made in the blockchain.
An example of this is MedRec, a blockchain-based technology for managing electronic patient records, which is currently under development.
Examinations such as x-rays and CT images, medication histories and similar can be stored in external databases and be referenced to in the blockchain. This therefore means that the data is available on the computer systems in place at the relevant healthcare provider. An index makes reference to this data in the blockchain and manages the corresponding access rights. The patient can then decide for himself who can access his data, and can access it at any time himself. This simplifies considerably the cooperation between the different specialists treating the patient, and the storage and administration of his personal data.
What is more, health data obtained from fitness trackers, smart watches and similar can be added to the blockchain and evaluated based on this technology. This means that an individual early warning system can be created for the patient, which keeps him informed of his health status. In this use case, the transaction exists in the exchange of the performance evaluation by doctors and scientists via-à-vis the anonymous transfer of patient data for research purposes.
In medical research, blockchain technology is also useful for managing the results of studies. The reliability of research results can be tracked objectively because it is transparent and secure from manipulation. The question of who made the initial discovery can also be addressed in this manner, since all the data and transactions are visible and immutable.
Another function that distributed ledger technologies can fulfil is that of assuring data integrity. This can, for example, play an important role in quality assurance for medications. One case in the point is the Swiss start-up modum.io, who have developed a sensor system that measures the temperature of medications during transport from the manufacturer to pharmacies and stores this data in the blockchain. Since the information cannot be changed afterwards and can be reconstructed by all the participants involved, quality assurance for the medications is guaranteed in full.
In this context, blockchain technology also provides a solution for preventing the trafficking of counterfeit medicines that is also a serious problem in Germany. Blockchain can map a product chain for a medication, which is completely resistant to manipulation and which unequivocally confirms the identity of the medication. One way of implementing this is by using QR codes attached to the medications, which make reference to the data stored in the blockchain.
Dentacoin Foundation in the Netherlands have created a concept to improve patient loyalty and optimise quality management. This concept is based on the Ethereum blockchain and combines a cryptocurrency with intangible values in the form of digital patient feedback. Dentacoins (DCN) is a proprietary cryptocurrency developed for the dental industry. Patients can collect Dentacoins by writing dentists‘ reviews, recommendations and experience reports, which they then manage like bitcoins in a personal digital wallet. The immutability of the data and the transparency of all the transactions are features which first make the highly valuable concept of trusted reviews altogether possible: Compared to conventional assessment portals, where the authenticity of contributions is not always guaranteed, a guarantee exists here, because only „real patients“ are allowed to give feedback. What is more, the fact that it is impossible to delete the data prevents individual reviews from easily being filtered out. The Public Dentacoin Presale has already begun. The first dental clinics are now using Dentacoins for their feedback systems to improve patient loyalty and treatment quality.
Doubts in the healthcare sector
As with any innovation, blockchain-based healthcare solutions are riddled with doubts. Fears about patient privacy may stand in the way of integrating this technology, particularly in Germany. German citizens have a right to have their data deleted. In the blockchain, however, this data cannot be changed or deleted once it is created.
What is more, privacy takes on a special status in the healthcare sector in Germany and is subject to strict regulation.
Another aspect is that a great deal of financial and administrative effort has already been invested into integrating the database systems presently in use at practices and hospitals and so no one is going want to dispense with them quickly.
Concerns also exist about how to integrate these new solutions into day-to-day working life at practices and clinics. The administrative paths are often so long that real-time data management appears problematic.
Another factor is the fear of job losses: As a disruptive technology, blockchain-based solutions can perform with tasks undertaken to-date by staff or more traditional technologies.
Blockchain clearly has enormous potential in the healthcare sector. The challenge now is to exploit this potential by coming up with well-designed and clearly structured applications.
These potentials exist mainly in reducing complexity, the potential for decentralised collaboration and the creation and administration of authentic and secure data.
However, most solutions based on this technology are still in their infancy and their uses would doubtlessly still need to be tested before they can be fully integrated into the healthcare system.