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Why a Blockchain EHR makes sense for a patient-centered approach

  • Posted on August 22, 2016

blockchain

The following post was originally published on Health Data Management.

By now, most people have heard of blockchain, at least as the Bitcoin ledger. As awareness of blockchain has grown, people have come to understand that it is a powerful technology in its own right. Blockchain is a general purpose, trustworthy, open, indelible ledger in the sky and embodies a fundamental and broadly applicable communication pattern. Financial services seized on blockchain quickly as a way to execute transactions without the cost and delay of escrow, starting a trend that should have that entire industry shaking in fear. Such is the power of a general purpose technology.

As if that weren’t enough, blockchain is also computationally complete, which is a fancy way of saying that you can program the blockchain just like a computer. These apps, however, will be distributed, trustworthy and autonomous, giving rise to ‘smart contract’ applications as normal as trust funds, as banal as casinos or as esoteric as self-spawning corporations.

In health care the opportunities are numerous, with electronic health record (EHR) data one potential, interesting application. Current closed systems prevent interoperability, portability and collaboration. The problems with EHRs are well-known, and from an architectural perspective you really couldn’t design a worse solution. A better architecture would be globally accessible and localized to the patient, like you would build on blockchain. Each patient’s medical history would be securely recorded as they journey through life, following them as needed. The whole model is so much better and simpler than the tangle of today that this ought to be considered a watershed opportunity to rethink our medical data architecture.

Such a solution would also be more secure from massive breaches as the attack surface is a single patient, and a distributed ledger doesn’t have the same kind of vulnerabilities to ransomware or social engineering attacks. Although the data is distributed, access is global, so data analysis on a large sample of patients would be possible, thus improving population health. Of course, all access to patient data would be opt-in by design, indeed by platform, since the patient has the cryptographic last word on the matter.

As health care slowly shifts focus from acute and centralized to chronic and distributed, collecting health data ‘telemetry’ from distributed patients will be an invaluable capability. A blockchain EHR would be well-suited to this scenario, as well. Internet of Things (IoT) patient monitoring devices or gateways would simply write to the blockchain with a cryptographically guaranteed data provenance. If the patient chose, they could even authorize AI-enhanced bots to oversee their health data telemetry and provide warning of any alarming trends. The possibilities are truly exciting.

Of course, there are challenges, including issues with patient identity and actually building the thing. Who pays? Does it have a business model that works? It doesn’t seem likely that a coalition of EHR vendors will rise to the task. Government is a possibility, but it would be long and painful process. More likely, an existing online EHR or new VC initiative will see this as a differentiating capability and build it out for their lucky patients, then sell it as a service to their competitors. Meanwhile, they will be writing ‘smart contract’ blockchain apps to automate reimbursement, fraud detection, best practices compliance, prescription provenance, etc., further distancing themselves from the competition.

In summary, blockchain is a big, new, general purpose technology, teeming with possibilities. It’s premature to say we know how it will be used and how it will evolve, but we can already see clear potential for industries like financial services and health care. Despite the challenges, the potential benefits and capabilities of a blockchain EHR make it worth investigating.

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