Blockchain technology is generating a lot of interest and excitement in healthcare because of its potential to improve transparency, relieve administrative burdens and reduce costly waste within the system. However, there are also those within the industry that caution about the realistic prospects for the adoption of blockchain technologies in U.S. healthcare as well as the challenges of implementing this still-emergent technology.
In August, a Deloitte survey found that most global executives see great value in blockchain’s potential to reinvent processes across the business value chain, while there is interest and investment in a wide range of use cases. The research revealed that 74 percent of all respondents reported that their organizations see a “compelling business case” for the use of blockchain—and many of these companies are moving forward with the technology.
As an academic researcher, Tim Ken Mackey, an associate professor of anesthesiology and global public health at UC San Diego School of Medicine, has been exploring the possibility of leveraging blockchain to enhance supply chain management in healthcare, as well as other use cases.
Mackey is the director of healthcare research and policy at UC San Diego – Extension, and he also is the director of the Global Health Policy Institute. He holds a Ph.D. in Global Public Health from the joint doctoral program at UC San Diego-San Diego State University. His work focuses on a broad array of multidisciplinary topics, including research in disciplines of public health, health technology and innovation, supply chain, pharmaceutical policy, and public policy and law.
Mackey will bring his blockchain expertise to the upcoming Convege2Xcelerate conference taking place Oct. 22 at Columbia University in New Yok City. The conference is sponsored by Partners in Digital Health, publisher of Blockchain in Healthcare Today and Telehealth and Medicine Today, and will feature sessions on transformational technologies including blockchain, telehealth and artificial intelligence (AI).
While Mackey is a proponent of exploring the use of blockchain in healthcare, and sees real-world applications for U.S. healthcare, he also sees a number of ethical, technical, regulatory and business issues that need to be resolved. Recently, Mackey spoke with Healthcare Informatics Associate Editor Heather Landi about blockchain’s potential and challenges in healthcare. Below are excerpts of that interview.
From an academic research perspective, what is your interest in blockchain and what use cases are you exploring?
I was first brought into it because we were exploring how it could relate to combatting counterfeit medication, so using blockchain in the context of supply chain, and seeing whether it’s a good tool to combat the illicit trade of counterfeit drugs. I originally came into blockchain from my public health experience, and from there, I’ve been looking at blockchain in a number of different use cases and different healthcare verticals. The primary one is drug supply chain, but that could be a lot of different things within the drug supply chain; it could be recall management, pharmacovigilance, and it could be track and trace.
Outside of supply chain, we also look at different design principles and different use cases of blockchain and how they are supposed to fit a particular healthcare challenge. Genomics is one area that looks more towards consumers sharing their data. That’s different from a supply chain blockchain, which is more for compliance purposes, versus also an EHR (electronic health record) blockchain, which is intended to share different healthcare records and improve different population health outcomes across different health systems, but at the same time, keeping the patient data within the health system and providing provenance to that data.
Also, medical devices might look at blockchain more for contractual issues like maintenance of products and making sure there is an audit log for recall. Medical devices oftentimes have blockchains to pull in data from other sources to get people to share data with their devices, so they can create more data to hopefully improve the continuity of care across that device. There’s a lot of different use cases out there, and the interesting thing is that a blockchain has to be malleable to whatever healthcare challenge it is trying to address, and the design principles, which are primarily—is it a permissions blockchain versus a non-permissions blockchain, is it a private blockchain versus a public blockchain, what’s the consensus mechanism? Those principles have to map to those use cases, and oftentimes, they don’t.
Could you expand on that idea of mapping blockchain to particular use cases?
A good example of blockchain adoption that is happening pretty rapidly, although it’s not fully into production, is in the clinical trial space. And let’s keep in mind those three principles—public versus private blockchain, permissions versus non-permissions, and consensus mechanism. For a clinical trial, you can have one component of that clinical trial process that is a public blockchain. What I mean by that is, if you want to recruit patients and you want to access patient registries, or you want verified information that patients have certain conditions, then a blockchain would be amenable to that, to match patients and make recruitment a lot more cost effective. That could be a very public blockchain that doesn’t really have any permission structure that allows people to share their data in a verifiable way.
But, once you enter those people into the clinical trial, you’re probably going to have some kind of private or hybrid blockchain where the data is only available to certain entities—the clinical sites, the physicians, and the researchers—that are involved in the study protocol. In that case, that public blockchain turns into a private blockchain, or a very specific permission-structured blockchain, which is really meant to drive the study protocol within the clinical trial. So even within one vertical, you may have different business cases for the structure of a blockchain. However, many people are very much against private blockchains; they want fully public blockchains. Those design principles have to be thought out first within the context of the healthcare use case before we even think of the technology, and that’s the disconnect we often have.
There are some in the industry who believe blockchain is overhyped or that the challenges of implementing it might outweigh the benefits. Do you believe blockchain is showing its potential?
It depends on the vertical, but that doesn’t mean that blockchain can’t work for a particular vertical or that it’s not a good technology for that vertical, but that there may be regulatory considerations, such as GDPR (General Data Protection Regulation) and HIPAA (Health Insurance Portability and Accountability Act), or business considerations that make it hard for more widespread adoption. Blockchain is really primed for proof of concept development, but often the hard part is translating a proof of concept into something that can go into production and can be used by multiple parties, and that’s where the most benefit comes from blockchain; if you are allowed to share data, but keep ownership of it and have provenance of the data and trust in that data. Getting to that phase is going to be harder.
As one example, in supply chain there is much discussion is about how much data are we going to share on the blockchain. This is a fundamental question that is not about the technology, it’s more about different trading partners and how much they want to share data. That issue is not about trust of the data, but it’s about proprietary information that may be contained in the data, and how we govern the sharing of data. Those things are outside technology but rather are core business considerations that are different for supply chain than they are for consumer health. That’s often the roadblock to more widescale blockchain adoption. Proof of concepts and prototypes are pretty easy to stand up, but when it gets to real-world testing, and also the regulatory framework and whether the regulatory framework will absorb that type of technology or incentivize it, those are separate issues.
Those are some of the barriers, and they are not technology-focused. I think that’s why there is a bit of a disconnect between people who are technologists and think, ‘It’s a great technology and we should just use it,’ versus the healthcare space where people say, ‘These are our processes, and blockchain may be good for those processes, but there are inherent regulatory, legal and business issues, that make it hard to adopt.”
The core principles of blockchain are that it is an immutable shared ledger and it establishes provenance and integrity of the data. Those core elements are things we want with health care data. There are a lot of healthcare challenges and issues that could benefit from a shared ledger, such as reining in misuse of healthcare data as it relates to healthcare fraud and abuse and for drug recalls. And then there’s simple things like medical licensure, where the use of blockchain for credentialing could make that process more efficient. Many healthcare use cases relate to some component of data provenance, some level of sharing of data, and also the security of data. But, from a pragmatic view, there are some healthcare challenges where you don’t need those underlying elements, you just need to improve a process. And, if that process doesn’t require those underlying data provenance elements, then maybe this discussion about blockchain is going to distract more than it adds.