Blockchain brings se­cure pa­tient record trans­fer closer to re­al­ity

Middle East Business (English) - - CONTENTS -

For al­most a decade, hos­pi­tals have been wait­ing for elec­tronic health records (EHRs) to usher in a shiny new era of stan­dard­i­s­a­tion and high qual­ity health care. But while fed­eral laws and in­cen­tive pro­grammes have made health care data more ac­ces­si­ble in some re­gions, the vast ma­jor­ity of hos­pi­tal sys­tems around the globe still can’t eas­ily (or safely) share their data. As a re­sult, doc­tors are spend­ing more time typ­ing than talk­ing to pa­tients. The num­ber one thing those doc­tors would change? Stream­lin­ing the EHR process. And the most pop­u­lar strat­egy cir­cu­lat­ing among health care tech­nol­o­gists is blockchain.

Blockchain se­cu­rity ex­plained

Blockchain is the dis­trib­uted ac­count­ing plat­form that makes cryp­tocur­ren­cies like bit­coin pos­si­ble. But wait, you say! Isn’t that like what the dark in­ter­net uses? While blockchain is best known for pow­er­ing bit­coin, it’s re­ally a generic tool to keep se­cure data in a dis­trib­uted, en­crypted ledger, and con­trol who has ac­cess to that ledger. Rather than hav­ing one cen­tral ad­min­is­tra­tor who acts as a gate­keeper to data - a list of dig­i­tal trans­ac­tions - there’s one shared ledger, but it’s spread across a net­work of syn­chro­nised, repli­cated data­bases vis­i­ble to any­one with ac­cess. Which gives it un­prece­dented se­cu­rity ben­e­fits. Hack­ing one block in the chain is im­pos­si­ble with­out si­mul­ta­ne­ously hack­ing every other block in the chain’s chronol­ogy.

This makes blockchain in­cred­i­bly ap­peal­ing to the doc­tors and hos­pi­tals that need se­cure ac­cess to a pa­tient’s en­tire health his­tory. “Now is prob­a­bly the right time in our his­tory to take a fresh ap­proach to data shar­ing in health­care,” says John Halamka, chief in­for­ma­tion of­fi­cer at a Bos­ton based hos­pi­tal. For the past decade, Halamka has been re­spon­si­ble for health­care data stan­dards in the US, first un­der the Bush and then the Obama ad­min­is­tra­tion. He sees a blockchain- un­der­writ­ten fu­ture in which a pa­tient’s every health care in­ter­ac­tion goes into a ledger every provider can see. “The EHRs may be very dif­fer­ent and come from lots of dif­fer­ent places,” Halamka says, “but the ledger it­self is stan­dard­ised.”

Every time a dig­i­tal trans­ac­tion takes place, bits of code group it into an en­crypted block with other trans­ac­tions hap­pen­ing at the same time. For bit­coin, this would be a flurry of buy­ing and sell­ing. For EHRs, it might be all the things that hap­pen to you on a doc­tor’s visit (blood work, a new pre­scrip­tion, maybe some X-rays). Then peo­ple val­i­date the trans­ac­tions - in health­care, likely a physi­cian or phar­ma­cist trusted with an ac­cess key. Then the soft­ware time­stamps each val­i­dated block and adds it to a chain of older blocks, in chrono­log­i­cal or­der. The se­quence shows every trans­ac­tion made in the his­tory of that ledger, whether it be bit­coin sales or a knee re­place­ment pro­ce­dure.

It’s a chain of blocks ... Blockchain.

Halamka gives a sim­ple ex­am­ple: pre­scrip­tions. One med­i­cal record shows a pa­tient takes as­pirin. In an­other it says they’re tak­ing Tylenol, with an­other say­ing they’re on Motrin and Lip­i­tor. The prob­lem to­day is that each EHR is only a snap­shot; it doesn’t nec­es­sar­ily tell the doc­tor what the pa­tient is tak­ing right now. But with blockchain, each pre­scrip­tion is a de­posit, and when the doc­tor dis­con­tin­ues a med­i­ca­tion, they make a with­drawal. Look­ing at a blockchain, a doc­tor wouldn’t have to comb through all the de­posits and with­drawals - they would just see the bal­ance (or what the present pre­scrip­tion pro­vides). And cru­cially for pa­tient pri­vacy and se­cu­rity, hos­pi­tals and phar­ma­cies don’t have to send data back and forth to see it. They just all have to point to the same com­mon ledger. So does it work? For pre­scrip­tions, at least, ini­tial re­sults are promis­ing. Halamka re­cently teamed up with re­searchers at the MIT Me­dia Lab to test a blockchain ap­pli­ca­tion pilot called MedRec. Team- lead Ariel Ek­blaw put the au­then­ti­ca­tion log to work at their hos­pi­tal, track­ing six months of in-pa­tient and out-pa­tient med­i­ca­tion data with MedRec code de­ployed through vir­tual ma­chines at MIT. They recorded blood work, vac­ci­na­tion his­tory, pre­scrip­tions, and other ther­a­peu­tic treat­ments, sim­u­lat­ing data ex­change be­tween in­sti­tu­tions by us­ing two dif­fer­ent data­bases within their hos­pi­tal. The re­sults were so pos­i­tive that Ek­blaw is al­ready start­ing to plan more pi­lots with larger net­works of hos­pi­tals. MedRec is still an early pro­to­type, not ready for widescale de­ploy­ment any time soon. But gov­ern­ment health of­fi­cials in the US see its fu­ture prom­ise on a global scale.

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