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
The latest hack of Hollywood Presbyterian Medical Center again bring to our attention for the need of security in healthcare to be updated. The Current system is failing! Distributive Ledgers an architecture that supports Bitcoin, which is called Blockchain, could provide the security and control of patient records and providers communication.
One of the issues with modern Electronic Medical Records (EHR) is the inability to interoperate. HL7 standards organization has provided protocols for transmitting the information, however that is only a small part of the problem. Issue such as provenance, Digital Signing, content management, identity and encryption to name a few, inhibit easy sharing of data. There is now a technology that could eliminate the majority of these issues and provide us with the promise of a Cradle-to-Grave EHR, that is Blockchain.
Blockchain is the OpenSource technology that support the somewhat infamous Bitcoin. Regardless of your opinion of Bitcoin, Blockchain technology is a very viable open distributive ledger solution. Blockchain provide a P2P (point to point) encrypted realtime mesh network, where transactions are timestamped and verified on an open ledger system. Consensus is the system used to validate the integrity of a message or document, each time a document is altered, a new block is added to the chain providing a linear and reproducible record of access and updates via a hashing function.
I mentioned "without disruption" in the title because, health organizations have suffered a lot of disruption in the last few years with the advent of the EHR requirements. I believe there is a better way to design, using an adjunct processor solution, i.e., by providing interfaces to the EHR via HL7 FHIR and providing a Blockchain API, the EHR can use a Blockchain without significantly disrupting their EHR installation.
To answer the question of the Blockchain records, there are many solutions already available for storing records on open Blockchain, the Bitcoin chain. however, even thought blocks do not contain readable data, it may be optimal to store the records on private Permission networks, such as hospital networks and validate via consensus process or Paxos, such as, Practical Byzantine Fault tolerance used by Hyperledger,
The following are some of the feature that would be provided to a medical record using Blockchain:
- Digital Signing of charts/records
- Linear chronological tracking, Audits records
- PKI cryptography/encryption
- Distributed decentralized,
encrypted P2P
messaging network
- Ubiquitous sharing of data
- No Single Point of Failure
- Public Records - Birth to Death longitudinal record
- Uses
‘Proof-of-Work’ technology
- time-stamping
- Private or public chains
- Distributed databases
