TORONTO – The opportunity exists in healthcare to hand over control of medical records to patients who can choose not only what info providers can see but what personal data gets added to records via wearables, genomics and even lifestyle choices.
And once patients begin accumulating more data about themselves in personal health records (PHRs), they can opt to anonymize that information and sell it to researchers, vastly expanding the pool of information available for clinical studies.
Because no data is as sensitive as a medical record, being able to assure its security and immutability through blockchain encryption represents a unique opportunity to "repatriate" and "monetize" that record for the patient, according to Dr. Eric Hoskins, chair of Canada's Federal Advisory Council on the Implementation of National Pharmacare.
Hoskins moderated a panel on blockchain and the future of healthcare last week at the Blockchain Global Revolution Conference here.
Electronic health records (EHRs) were supposed to create a longitudinal ledger – ensuring healthcare events are tracked in their correct chronological order and span a patient's continuum of diagnosis and treatment. But EHRs, which were mandated by the U.S. and other governments, were based on proprietary software from a myriad of vendors – meaning they weren't good at sharing information between providers and weren't always adept at ingesting data from new sources.
In essense, that means copious amounts of healthcare data is now being collected and recorded, but as yet isn't being used, studied and shared broadly. That, too, is an area where blockchain could make a difference in the years ahead.
Getting paid for health data
There is already a multi-billion dollar industry that collects patient information, strips it of basic personal identifiers such as name, address and Social Security Number, and then sells it off to researchers, drug developers, marketers and others. Medical informatics companies such as Iqvia (IMS Health), Optum, and Symphony Health reap the profits of selling the healthcare data while the people from whom it's collected have no control over how it's used. Nor do they get any compensation for it.
Several new start-ups are developing avenues for patients to securely sell their anonymized data to researchers and others, including Hu-manity.co, which last year partnered with IBM to develop a healthcare data platform.
Rhea Mehta, CEO of Bowhead Health, a blockchain technology company that sells a health and wellness tracker, said her company is using Ethereum blockchain and smart contracts that self-execute without the need of a third party to ever touch patient data in order to distribute it.
"Patients can become owners of data and, with their consent, share data with practitioners and allow them to sell anonymous data to buyers," said Mehta, who took part in the blockchain-and-healthcare panel.
By enabling patients to add their own details around lifestyle – what they eat, how much they exercise and sleep, a personal health record would offer physicians greater personal insights for more targeted clinical decision making.
In order to securely record, share and crunch vast amounts of sensitive data coming from external sources such as wearable medical devices and fitness trackers, a standardized database with artificial intelligence capabilities is needed.
For example, in November Amazon announced a data analytics product aimed at scouring unstructured data within EMRs to offer up insights physicians can use to better treat patients.
Securing patient data with blockchain
Blockchain uses hashing, the creation of a unique digital signature for each encrypted block of data added to an electronic distributed ledger. The hashes map back to encrypted patient data as it's added sequentially to a blockchain ledger – and because it's immutable (unchangeable), it creates an audit trail for government oversight. Smart contracts – self-executing business automation apps – can also be used atop blockchain to automatically ingest and process new data.
Mehta said clinical trials also suffer from outcome switching, where pharma companies are "fudging" the results of drug tests. Blockchain's unchangeable ledger would help ensure data from trials couldn't be manipulated.
For example, earlier this year, researchers at UC-San Francisco created a proof of concept to ensure the integrity of clinical trial data based on blockchain that could enable a global clinical trial network. UC's proof of concept used a permissioned blockchain overseen by the U.S. Food and Drug Administration, which operated a web portal to register users and maintain the ledger.
Jorden Woods, managing partner DoubleNova Group Inc., a boutique management consultancy with a focus on high-tech startups, said blockchain could also reduce fraudulent medications from entering the pharmaceutical network. He cited blockchain's ability to provide a "single source of truth" through its transparent electronic ledger technology, which can also track product provenance in a supply chain.
"There's hundreds of billions of dollars of fraud in medications," Woods said. "One hundred thousand people die each year taking poison – drugs that were not what they thought were taking."
Additionally, 30% to 40% of the costs of administration of the pharmaceutical industry by U.S. government agencies is considered waste because of inefficiencies from a disparate tracking system. A single, standardized network for regulators to oversee drug manufacturing and distribution could reduce that waste, Woods said.
"Blockchain's cryptography can provide the underlying security so patients and doctors can share data. In terms of single source of truth, it's very important for everything from supply chains to doctors and patients being able to communicate," Woods added.
Finally, another problem that could be solved by blockchain involves ransomware, which costs a typical hospital on average $5 million per year. Ransomware cybercriminals rely on their ability to cut off access to a single source of data – say a relational hospital database.
That can imperil hospital operations and patient lives.
But blockchain is distributed, meaning there isn't a single copy of data; instead, there are many copies saved across any number of computer nodes. Blockchain is also immutable, so it is far more difficult to corrupt data on the network - both data provider and users can prove the data hasn't been altered.
That would lower the chances of successful ransomware attacks against healthcare providers.
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