During the 2014 to 2016 Ebola outbreak, many doctors and nurses relied on the World Health Organization (WHO) and the Centers for Disease Control (CDC) to stay updated on disease exposure, monitoring guidelines, and the progress of the epidemic. Both organizations compiled disease counts and provided updated weekly or monthly reports. But imagine the possibilities if the process of compiling epidemic statistics was simplified and provided real-time data accessible to any and all healthcare personnel with an internet connection?
The technology to take this next step exists now, is incredibly secure, and has the potential to transform the way we track epidemics like Ebola or influenza.
“Blockchain” technology creates a continuously updated, distributed ledger used by bitcoin and other cryptocurrencies. Recently, there has been growing interest in using blockchain outside of cryptocurrencies, especially in the banking industry. However, discussion of the use of blockchain technology has reached beyond banking and accounting to focus on increasing sustainability or other social impacts as noted in “Digital Currencies and Blockchain in the Social Sector.”
Healthcare is yet another area where blockchain can make a substantial impact. Blockchain technology could be used to enable the WHO and CDC to better monitor disease outbreaks over time by creating distributed “ledgers” that are both secure and updated hundreds of times per day. Issued in near real-time, these updates would alert healthcare professionals to spikes in local cases almost immediately. Additionally, using blockchain would allow accurate diagnosis and streamline the isolation of clusters of cases as quickly as possible. Providing blocks of real-time disease information—especially in urban areas—would be invaluable.
In the United States, disease updates are provided in a Morbidity and Mortality Weekly Report (MMWR) from the CDC. This weekly report provides tables of current disease trends for hospitals and public health officials. Another disease reporting mechanism is the National Outbreak Reporting System (NORS), launched in 2009. NORS’ web-based tool provides outbreak data through 2016 and is accessible to the general public. There are two current weaknesses in the NORS reporting system and both can be addressed by blockchain technology.
The first issue lies in the number of steps required to accurately report each outbreak. A health department reports an outbreak to the NORS system, the CDC checks it for accuracy, analyzes the data, then provides a summary via the MMRW. Instantiating blockchain as the technology through which the NORS data is reported, every health department in the country could have preliminary data on disease trends at their fingertips without having to wait for the next MMRW publication.
The second issue is the inherent cybersecurity vulnerabilities using a web-based platform to monitor disease reporting. As we have seen with cyberattacks both domestic and abroad, cybersecurity vulnerabilities underlie most of our modern-day computing infrastructure. Blockchain was designed to be secure because it is decentralized across many computer networks and, since it was designed as a digital ledger, the previous data (or “blocks”) in the blockchain are difficult to alter.
While the NORS platform could be hacked with malware to gain access to our electricity and water infrastructure, instituting blockchain technology would limit the potential damage of the malware based on the inherent security of the technology. If this does not sound important, imagine the damage and ensuing panic that could be caused by a compromised NORS reporting a widespread Ebola outbreak.
The use of blockchain in monitoring epidemic outbreaks might not only apply to fast-spreading outbreaks like the flu, but also to epidemics that have lasted for decades. Since blockchain allows an unchangeable snapshot of data over time and can be anonymous, partner organizations could provide HIV test results to an individual’s “digital ledger” with a date of the test and the results.
Individuals could then exchange their HIV status securely, in an application, before engaging in high-risk behaviors. Since many municipalities provide free or low-cost, anonymous HIV testing, the use of blockchain would allow disease monitoring and exchange of status in a secure and trusted manner. The LGBTQ community and other high-risk communities could use an application to securely exchange HIV status with potential partners. With widespread adoption of this status-exchange system, an individual’s high-risk exposure could be limited, further reducing the spread of the epidemic.
While much of the creative application around blockchain has focused on supply chain-like models, including distribution of renewable energy and local sourcing of goods, it is important also to think innovatively about how blockchain can be used outside of supply chain and accounting.
In healthcare, blockchain has been discussed frequently in relation to electronic health records (EHRs), yet even that could be underappreciating the technology’s potential. Leaders in the blockchain arena should invest in application development for epidemic monitoring and disease control using blockchain technology. Philanthropic organizations should call for grant proposals on instantiating blockchain for epidemic and disease control. Newly developed applications could be integrated and eventually replace web-based platforms currently in use at the WHO and CDC. In addition, application development at the individual level would provide another tool in the arsenal of fighting decades-old epidemics like HIV.
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