Last week, when the Office of the National Coordinator for Health Information Technology (ONC) and the National Institute of Standards and Technology (NIST) announced a challenge soliciting white papers on the topic of the use of blockchain technology in healthcare, it got me interested in trying to understand the concept a little better.
Besides Healthcare Informatics, I also write for a publication about IT in higher education called Campus Technology, and a few weeks ago I wrote about a talk about the potential for blockchain in education as it applies to transcripts. Phil Long, chief innovation officer and associate vice provost for learning sciences at the University of Texas at Austin, noted that a transcript is the record of what a student has accomplished at a university. The document is managed and controlled by the institution, not the student. In contrast, Long said, blockchain has the potential of providing an immutable record of an individual learner's accomplishment that can be disclosed in a public context. "The single thing that attracted me most is the potential it has to reaffirm the learner's ownership of their own record," he said.
As I noted for Campus Technology, last year, the MIT Media Lab began issuing digital certificates to the participants in its Director's Fellows program. The authentication behind the certificates relies on blockchain technology, best known for its connection to the cryptocurrency bitcoin. In a blog post, Philipp Schmidt, director of learning innovation at the Media Lab, described how blockchain works: "In essence, it is a just a distributed ledger to record transactions. What makes it special is that it is durable, time-stamped, transparent and decentralized. Those characteristics are equally useful for managing financial transactions as for a system of reputation. In fact, you can think of reputation as a type of currency for social capital, rather than financial capital."
So how might this apply to healthcare? To get a better picture, I called up Micah Winkelspecht, founder and CEO of Gem, a Venice, Calif.-based startup developing blockchain application platforms. One of the company’s main focus areas is healthcare, and its first partner is the Philips Blockchain Lab.
Winkelspecht said that whether we talk about the higher education transcript or the patient health record, it really boils down to the fact that we have always kept records in some kind of a centralized system and we give very little access or control to the people who should be owning their records. “There is a major push toward a more patient-centric focus in healthcare, yet your data is stored all over the place in kind of a Frankenstein concoction of records with very little interoperability of file formats between systems.
He said the project Gem is working on with Philips is not meant to replace EHRs. “But we are exploring the ways we can provide real-time access to data across multiple providers and caregivers. We are looking at how we move medical-related data on a blockchain.”
One of the misconceptions about the blockchain is that you store the data on the blockchain, Winkelspecht said. Blockchains are actually inefficient as data stores, he explained, because by their very nature, all the data is replicated on every node across a network of nodes. That is how they work. “So it is highly redundant, but that means it is very inefficient for storing large amounts of data. We use the blockchain as a document registry for data stored in external data stores.” So you can kind of think of it as like a library catalog that tells you where in the library your book is. But they are also using it to record a permanent time-stamp of the fingerprint of every piece of data that goes into the system as well. “You can make very strong guarantees about the underlying data’s integrity, and furthermore we apply an identity layer so that anytime anyone performs an action on that blockchain, it is an authenticated action. And we can go back and look at every modification to a piece of data, every addition. We can say with precise definition who did what at what time.”
So I asked Winkelspecht what I would see if I were a patient who had recently seen a few doctors. He said the blockchain would point me to a universal patient case file, with a universal identifier for me as the patient. “So no matter which doctor is interfacing with the system, they are recording information against the same universal patient identifier, which is recorded on the blockchain,” he said. When you go to primary care doctor, they create a visit report, and prescribe you see a radiologist. That all goes into your patient case file as a visit. Then when you go to the radiologist, they leverage the same identifier for that patient, and they upload their scans, and their report gets tracked against that identifier. When the patient goes back to the primary care doctor, all that data is available to that physician under the same record.