Since the rise of blockchain in the cryptocurrency field, the technology has entered various mainstream markets. Because it can improve the security and efficiency of the financial industry supply chain, blockchain is now also being used in the healthcare industry. Its advantages include improved security, work efficiency, accuracy, accountability and interoperability, and can enhance patients Authorization.
As the “baby boom generation” enters the age of aging, the Western healthcare system is about to face an influx of patients, while at the same time there is a severe shortage of medical service personnel. Better treatments mean that older people with chronic diseases (such as asthma, obesity and diabetes) can live longer than the previous generation, but these will put more pressure on healthcare budgets. Some new legislative measures have identified some new approaches to alleviate these problems. The main way is to improve efficiency, including returning only results instead of processes, and digitizing all medical records. Although the electronic storage of records has improved efficiency in some ways, the current database is still fragmented, interoperable, and vulnerable to hacker attacks. Therefore, a system that can provide higher security and interoperability is needed.
If you don’t know yet, the blockchain is a decentralized digital ledger that can distribute and share records on a designated computer network. Each new transaction becomes a block to be added to the existing chain (blockchain). This kind of blockchain greatly reduces the effectiveness of network attacks because the attacker can only attack one chain at a time. Moreover, the chain is tamper-proof, requiring most network members to verify and record transactions. This feature can also help stakeholders identify any suspicious activities that have occurred. If there is no longer a need to reconcile differences between ledgers, blockchain can simplify processes and exchanges. By improving overall transparency and accountability, blockchain can reduce what PricewaterhouseCoopers calls the “cost of trust”.
Apply blockchain to solve healthcare problems
Since the rise of blockchain in the cryptocurrency field, the technology has entered various mainstream markets. Because it can improve the security and efficiency of the financial industry supply chain, blockchain is now also being used in the healthcare industry. Its advantages include improved security, work efficiency, accuracy, accountability and interoperability, and can enhance patients Authorization.
Challenges facing medical record management
Cyber threat
The downside of digitizing medical records is that centralized databases are a very interesting target for cybercriminals. According to statistics from Bloomberg and a 2018 study by the Ponemon Institute, hospitals are increasingly being attacked by millions of records, causing millions or even billions of dollars in damage. IBM’s 2015 white paper on the cost of data breaches estimated that one-third of patients will be victims of data breaches. In addition, cyber attacks may hinder medical services and directly harm patients.
Interoperability
There are many electronic health record (EHR) systems on the market, but they often do not communicate well with each other. The Pew Charitable Trusts believes that because patient records are scattered across multiple systems, data transmission between different HER systems often causes errors. According to research by Quantros and Leapfrog Group, these errors may cause delays in treatment, missed diagnosis, and even further harm to patients.
The market expects that blockchain will benefit both patients and healthcare providers alike. Patients can easily upload, access or transfer their health data records without redundancy. They can also control access to records by providing private keys to healthcare providers or organizations. For healthcare providers, they can reduce the cost of accessing patient data by eliminating middlemen. All stakeholders on the blockchain can keep their own copy of the latest ledger, most of which require approval before they can be changed, so it is very easy to find differences when they need to. In addition, if a single sharing agreement is implemented, the blockchain will be able to improve the interoperability between different HER systems.
Many startups are focusing on applying blockchain to medical record management. MedRec and Patientory enable patients to manage and control access to their medical records. MediBloc has already been used by several hospitals in South Korea, and is currently working with Massachusetts General Hospital in a large-scale pilot project. Nebula Genomics and EncrypGen focus on protecting and managing the genetic data of patients, while doc.ai promises to manage medical and genetic data. Iryo is committed to creating a unified health record and eliminating the need for interoperability. Medicalchain combines telemedicine with patient data storage that supports blockchain, and a British medical group is currently cooperating with it to carry out pilot projects.
Medical equipment development issues
Since it takes several years for medical equipment to be approved by the regulatory agency, when the equipment arrives at the hospital, it is actually out of date. In addition, it should be noted that older devices were not originally designed with too much connectivity, so they can be easily targeted by hackers. A large number of studies have shown that medical equipment such as ultrasound imaging machines, cardiac pacemakers and medical pumps are extremely vulnerable to cyber attacks. Some foreign criminal groups have launched attacks on hospitals in Europe, North America and Australia and demanded ransoms, costing millions of dollars. For years, security experts and governments have been warning of such attacks. In the end, after nearly a decade of hard work, medical equipment manufacturers began to respond to this threat.
Potential blockchain applications
Blockchain can create a tamper-proof data link, and its immutability can prevent hackers from using hijacked devices to cause harm to the system, such as controlling insulin pumps and delivering lethal doses of insulin to patients. However, due to the slow response of the medical device sector to cyber threats, there is also a lot of room to make up for it when adopting it.
Drug quality challenges
According to the World Health Organization (WHO) report, the quality of medicines is a global issue. Substandard and counterfeit products lead to drug resistance, resulting in poor patient prognosis, loss of patient confidence and even death. In addition, because some drugs (such as vaccines) need to be stored in a specific temperature range (cold chain) from production to clinical use, there are also some market opportunities here. A damaged cold chain can cause drugs to lose efficacy, impair patient care, and increase costs. Losses due to damage to the cold chain amount to billions of dollars each year. Global manufacturing has also increased the complexity of the supply chain, making it difficult to investigate suspicious or illegal activities of counterfeiters. According to the data of Jim Nasr, the former chief software architect of the Centers for Disease Control and Prevention (CDC), the economic losses related to counterfeit medicines are approximately US$200 billion, and more importantly, approximately 1 million people have died from counterfeit medicines. In the pharmaceutical industry, wholesalers often return drugs to manufacturers. Without proper certification methods, these drugs must be discarded, costing the industry US$7-10 billion each year. At the personal level, there are many unused drugs that can be reused, and the authentication capabilities of the blockchain will help combat counterfeit drugs. In addition, by certifying drugs, the blockchain can reuse or resell returned drugs. The timestamp function of the blockchain helps to improve the security of the supply chain and ensure the maintenance of the cold chain. In addition, blockchain can reduce the cost of drug development, production, and transportation. FarmaTrust is working on several projects in Mongolia and Thailand to help combat counterfeit and substandard medicines. Novartis and Merck are both trying to use blockchain to identify counterfeit drugs, and SAP is also working with IBM to improve the integrity of drug shipments.
Health insurance challenge
The processing of insurance claims is all-encompassing and tedious for the customer and the health insurance provider itself. Consumers may find legal terminology too challenging, lack of transparency in the processing process and subjective decision-making, leading to friction and delays. Lack of objectivity and predictability can also lead to possible fraud. Blockchain can increase transparency to improve claims processing. By using smart contracts that can be regularly updated and monitored, blockchain can minimize subjective factors, reduce the number of disputes, speed up claims and reduce costs. The startup SimplyVital Health hopes to coordinate care and predict the cost of care through the blockchain to reduce operating expenses, and HealthCombix intends to use this technology to prevent fraud.
Clinical research challenges
Clinical trials are expensive, partly because of the costs associated with patient recruitment and retention. The patient’s withdrawal will invalidate all relevant data and cause obvious cost waste. The use of blockchain technology helps to make clinical trials more accountable, transparent and cost-effective. Innoplexus aims to improve the efficiency of new drug development and trials. By allowing patients to control researchers access to their data, Exochain hopes to gain more trust from patients and increase recruitment and retention. Pfizer, Amgen and Sanofi are collaborating to use blockchain technology to store patient health data, accelerate clinical trials, and reduce drug development costs. CDC is cooperating with IBM, hoping to use blockchain’s time stamp, peer-to-peer health report and data processing functions to study disease outbreaks in real time. The US Centers for Disease Control and Prevention also plans to track the growing proliferation of opioids in North America through blockchain.
in conclusion
Although blockchain technology can bring many benefits to the healthcare industry, there are still some issues that deserve attention as described below. But rest assured, the advocates of blockchain will continue to find solutions to further improve the technology. First of all, the blockchain requires a lot of storage and computing power. Therefore, it is necessary to discuss which information can be stored in the data chain and which need to be discarded. Adopting a private data link that can be accessed by fewer people than the public data link may be a solution. Eliminating non-standardized information (such as images and doctor notes) on the data link is also a cost-effective way. In addition, since the existing general-purpose CPU cannot support the encryption and verification of the blockchain, the industry may need to develop specialized processing hardware.
At present, the legal definition of blockchain is still unclear, and more extensive and in-depth discussions are needed on how to make it comply with HIPAA standards. Therefore, from the perspective of government supervision, there is still much work to be done. In terms of security, although the distributed system configuration of the blockchain is more secure than the existing centralized database, more in-depth research is needed on how the blockchain can better overcome cyber threats. For example, although blockchain can prevent data damage, it cannot do anything about damaged data that has been entered into the system.
