Blockchain in Healthcare, a solution for patient controlled records

Recently there has been a flurry of discussion and articles written on the topic of the use of Open source Blockchain in Healthcare.  The discussions have lead to a lot of misunderstanding and misconceived notions about blockchain and it potential use.

Blockchain was coined by the infamous BitCoin financial technology, which over the last few years shook the financial market and regulatory organizations.  Recently BitCoin was used to anonymously collect ransom payments from hospitals, such a Hollywood Presbyterian.  

Blockchain is bases on Distributed Ledger technology, which provides transparent distributed ledgers or databases in which to record transactions.  They are called ledgers because they can be used for sequentially storing debits and credit transaction for a financial application, such as BitCoin.  They are open and provide transparency to the transaction placed on the chain, however the associated data (payload) is encrypted and only the hash code of the data is visible.  The name Blockchain comes from the visual explanation of a steel chain, but instead of links there are chains of connected blocks. Once a block is placed on the chain it cannot be removed, same as a longitudinal ledger or record.    

Blockchain in the healthcare domain will have different functionality and features.  Bitcoin’s Blockchain an open public system, so that all can view transaction blocks on-line.  Healthcare Distributed Ledgers System (HDLS) could and most likely would be closed and shared only by healthcare organizations.  Though not needed, closed systems would likely get more support and reduce the FUD.  

Bitcoin's Blockchain is unpermissioned, anyone can use it. Validators, called “Miners” are paid for validating a transaction in a untrusted world, the Internet.   A Closed HDLS could be a permission system, using selected members of the system to validate the block.  As an example, consider a group of hospitals entering a trusted ledger systems, their membership would pay for the support of the networks.  Members would pay and chose their own validators to insure quality and nonrepudiation.  Quality and authentication would be provided via a consensus algorithm.

Distributed Ledgers also have the ability to facilitate a truly patient controlled patient record .   In this scenario, the patient could control the keys (PKI) to the records and could issue multiple keys to their healthcare organizations and revoke the access when the relationship is terminated.  The patient could also share or sell their records to research organization, reaping the benefit of sharing their data and providing better information to the research, i.e., non-autonomized data. 

The following is a list features and functionality of BC/DL

•  Signed transactions
•  Immutabe
•  Robust Security, PKI, Encryption
•  Longitudinal records providing data provenance 
•  Private consensus
•  Build in auditing 
•  Secure Peer-to-Peer
•  Nonrepudiation 
•  Distributed database
•  Smart Contracts - for billing, device provenance, Device Mgnt
•                                 AutonomousDevices
•  Transparency
•  Time stamping
•  Continuity of Care
•  No Single point of failure
•  Reconstructible Chains if a node fails
•  Peer-to-Peer communication             

Blockchain or Distributed Ledgers are not a panacea for healthcare security and interoperability, however it is a technology that has a logical fit and may produce a simpler, cheaper solution than the current system and deserves to be considered. 

Jeff Brandt
Speaker, Blockchain Symposium June 9, 2016