Understanding Blockchain Basics

While the technical aspects of blockchain are not the primary focus here, a foundational grasp of its mechanics is crucial for comprehending its healthcare applications.

At its core, a blockchain is a time-stamped, immutable chain of data records managed collectively by a network of computers rather than a single entity. Each data block is secured using cryptographic techniques, creating a chain that is resistant to alteration.

The attractiveness of blockchain technology lies in its decentralized nature, enabling the establishment of a trustless system. Trust has historically been a vital element of human progress, facilitating cooperation that has allowed our species to thrive. However, this reliance has shifted from interpersonal trust to faith in large organizations, such as banks, which have sometimes faltered due to greed—illustrated by the 2008 financial crisis.

In response to these vulnerabilities, blockchain emerged, introduced by an anonymous figure named Satoshi Nakamoto, who proposed a decentralized cryptocurrency known as Bitcoin. In this framework, transaction data is distributed across various nodes, ensuring that updates are communicated throughout the network, thereby decentralizing data storage.

Now that we grasp the principles of blockchain, let’s examine how it can address healthcare challenges.

Challenges of Healthcare Data Management

Current healthcare systems face significant data management issues, primarily surrounding patient identification and the shareability of information—often referred to as interoperability.

Each patient is assigned a unique identification number within a specific hospital or healthcare trust. For instance, if a patient visits a hospital in London and later receives care in Edinburgh, they will have two distinct identifiers tied to different visits. When returning to their London doctor, the prior records from Edinburgh remain inaccessible, as they are stored locally.

While some institutions are gradually transitioning to cloud-based systems, this does not resolve the interoperability concern, as different hospitals may format their data inconsistently.

The crux of the problem lies in the absence of a widely adopted, decentralized, and standardized format for storing patient records accessible by all healthcare providers.

Ensuring Data Privacy

You may wonder how patient confidentiality is maintained if any computer can access a healthcare blockchain containing sensitive data.

There are two types of blockchains: public and private. Public blockchains, which are commonly discussed, allow anyone with the technical know-how to interact with them. However, this access does not equate to unauthorized access to personal data, as only a ledger of transactions is available. While beneficial for creating a global transaction framework, this model is unsuitable for healthcare, where privacy is paramount.

In contrast, private blockchains restrict access to authorized users, also known as permissioned blockchains. There has been growing interest in these private models due to their capacity to provide enhanced control and security for enterprise applications, addressing the specific needs of businesses.

Hashing and Data Integrity

To fully comprehend the application of blockchain in healthcare, one must understand hashing—a process that converts a text string of any length into a fixed-length output.

Hashing is essential for data security and integrity, particularly in detecting unauthorized alterations. When a specific input is hashed, it consistently produces the same output. However, even minor changes to the input result in vastly different hash outputs, making any tampering immediately apparent.

By placing health records on the blockchain, patients would gain ownership of their health information, relieving hospitals of this responsibility. Patients would be identified via a hash ID linked to their health records, accessible only with a private key that they control. This key would allow healthcare professionals, such as general practitioners and specialists, to access the necessary information, thereby addressing issues of information silos.

Moreover, data stored on the blockchain is immutable, meaning it cannot be altered by malicious actors. Each block in the chain is linked through a hash pointer, and any changes in one block would disrupt the entire chain, making tampering virtually impossible.

Empowering Patients in Research

Having control over their data also empowers patients to decide who can access it within the research community. The MedRec project highlights this potential, allowing patients to share anonymized metadata with researchers.

> "We incentivize medical stakeholders (researchers, public health authorities, etc.) to participate in the network as blockchain 'miners.' This provides them with access to aggregate, anonymized data as mining rewards in return for sustaining and securing the network via Proof of Work."

The Risks of Blockchain in Healthcare

Despite the promising prospects of integrating blockchain into healthcare, the technology is still in its infancy, particularly beyond the financial sector. The healthcare industry is often cautious about adopting new technologies, especially those dealing with sensitive patient data.

Transitioning healthcare infrastructure globally would necessitate collaboration among various stakeholders, including software providers, to adapt systems designed for specific tasks into a cohesive blockchain framework.

Healthcare professionals and tech experts must work together to demonstrate the advantages of blockchain for record-keeping in order to encourage investment in its development.

The Future Outlook for Healthcare Blockchain

Blockchain technology offers unique solutions to the challenges currently faced by EHR systems, promising secure identification and interoperability of healthcare records. However, implementing blockchain in healthcare will require substantial investments in both time and resources.

To sway industry professionals and regulatory bodies, demonstrable improvements in efficiency and cost-effectiveness will be essential. Nonetheless, I believe it is only a matter of time before healthcare records are stored on the blockchain. This innovation promises advantages that other EHR systems cannot match, restoring ownership of medical information to patients and allowing them greater control over their healthcare journeys.

For further reading, consider this white paper on MedRec, a prototype for electronic health records and medical research data:

Dr. Matt is a UK-based medical doctor and writer passionate about advancing healthcare through digital medicine and innovative research. Follow him on Twitter and Medium for insights into the latest medical research and technology.