You may be bored of hearing about blockchain as the panacea to all problems of the world. So am I (and I’m so intrigued by it that I even research it as a law lecturer).
Nevertheless, the technology behind Bitcoin holds promises for the medical sector — from ensuring more accurate patient records to facilitating data collection for medical research. And, if we are to believe some tech companies, even contributing to a COVID-19 solution.
Whether you are a medical doctor, a policymaker, a scientist relying on medical data for your research, or you are just curious, it’s worth knowing how blockchain can help you achieve your goals (and when it can’t).
Still not quite sure what blockchain is?
You’ve heard about blockchain so many times, but you’re still not quite sure what it is exactly? You are not the only one.
Blockchain is the technology behind Bitcoin, thrown into the world after the 2008 financial crisis. Dis-intermediation was one of its core objectives: to bypass financial intermediaries (banks), it created a peer-to-peer digital network for financial transactions.
Transactions are added to a blockchain ‘ledger’, which records every transaction ever submitted to it. The ledger is like an accounting book: it archives previous entries and shows you the current state of affairs. Blocks of transactions are grouped together chronologically, timestamped and linked by cryptography (computer code to keep data secure) , creating a chain of blocks that is very difficult to alter.
This makes blockchain a transparent, auditable and tamper-resilient record-keeping technology.
What’s special about this type of network is that it is distributed: all data ever added to a blockchain are distributed across all participants and the chain of information is constantly updated across the network. If a participant’s computer crashes, that’s no problem: all other participants still have a full copy of the chain of blocks and can continue adding data to it, constantly broadcasting new entries to all other participants.
Soon it became clear that this type of distributed ledger technology held promising applications in many industries, not just the financial sector. Blockchain has been used to track the provenance of artworks and diamonds, to increase transparency in supply chains and to ensure authenticity of second-hand aerospace parts, for example.
For the medical sector, too, there are a myriad of applications promising efficiency and transparency improvements, better data management and easier access to data for scientific research.
Better management of medical data
A person’s health data are often scattered around different, siloed (isolated), databases.
Imagine Alice, an international student who recently moved to London. Part of Alice’s health records may be with her current GP in London, parts may be with her previous GP in Italy (where she used to live), parts may be with the psychiatrist she consulted while studying in France. Her FitBit may store some of her health data and a DNA-testing company has other bits.
Now imagine you are an A&E doctor in London having to diagnose Alice during a medical emergency. Or a scientific researcher looking to recruit Alice for a scientific study. Or Alice herself, who would like to have access to, and control over, all her health data. Would life be made any easier if there was a tool collecting all of Alice’s health data in one place?
A number of blockchain companies think so. And they think blockchain can help achieve this.
How? A blockchain keeps a record of all medical data about Alice, chronologically ordered. It will show the latest status (the last prescription medicine Alice bought, or the last scan she had), as well as Alice’s entire medical history (every prescription medicine she has ever bought, every scan ever taken of her body, every immunization she has had since birth).
Ownership of all that data can be given to Alice, who decides whom to share it with. Alice can decide to share information about her allergies with her dentist, but not her record of psychiatric consultations. She can decide to share her data for a research study and receive instant compensation for it through smart contracts. Or she could donate her mammography data to an organization like BreastWeCan!, which uses blockchain to collect breast cancer screening data and applies machine learning to advance medical research on the topic.
Several companies and organisations have started to use blockchain to create a more complete and accurate health record for each patient.
Projects such as Massachusets Insitute of Technology’s MedRec and companies such as MedicalChain use blockchain to gather a patient’s health data from across siloed sources, promising patients to gain control over their medical history and health data.
Estonia already uses blockchain to retrieve health data from different health providers and create a common record for every patient. The data stored on-chain allow the government automatically to compile national statistics, which can help track epidemics or identify health patterns.
Companies such as Iryo use blockchain to help refugees and migrants keep a copy of their health records, as they move from country to country or from camp to camp.
There is one great concern, of course: privacy and data protection.
Scattered medical records may make life harder for an A&E medic to diagnose Alice during an emergency. However, they equally make it harder for a hacker to steal Alice’s health data in one go. If all of Alice’s health data are stored on a blockchain platform, it becomes a highly appealing target for hackers and thieves.
Blockchain companies are working on some promising solutions. For example, health data can be stored on so-called ‘private blockchains’, which limit access and editing privileges to pre-approved participants only, as opposed to public blockchains (like Bitcoin and Ethereum), which allow anyone to read data, propose and approve new entries. The advantage is more privacy. However, if we start using different private blockchains to store medical data, we need to ensure these blockchains can ‘talk’ to each other (the so-called ‘inter-operability’ issue). If not, we simply end up with new data siloes.
Clinical trials and medical studies
Blockchain could also facilitate data collection and monitoring for clinical trials and other medical studies. These require large troves of data to be collected from particular patient groups and monitored throughout the study.
Right now, identifying and recruiting the relevant patient population for a particular study is a complex process, which relies mostly on word-of-mouth and personal connections. Blockchain could help identify and recruit patients for a study and automatically reward them for sharing their data.
For example, Alice may only know about a clinical trial measuring the effect of tai-chi breathing exercises on mental well-being because her psychiatrist happens to be running the trial. In constrats, blockchain could automatically alert Alice if there is a trial or study looking for patients like her to share data or participate. Smart contracts could automatically compensate Alice for enrolling and for submitting health updates at regular intervals.
As a transparent record-keeping technology, blockchain could also record all of the clinical trial or study data in real-time, improving accuracy, facilitating data-sharing and regulatory compliance with patient safety requirements.
Because blockchain is a distributed peer-to-peer network to exchange data, it can be used to foster collaboration on medical research and drug discovery. Anonymised health data and other scientific information can be stored on-chain, creating a transparent, time-stamped data pool for researchers to work with. Smart contracts can be used for data-sharing among researchers and research institutions.
While we obviously don’t need blockchain to share data, this distributed ledger technology can make it easier to identify relevant data and have selective data-sharing. Instead of sending entire data collections around to different institutions, the blockchain can collect all relevant information (e.g., lab data from various organisations) and selectively grant access to parts of the data to specific researchers.
The blockchain itself keeps a record of who has accessed which part of the dataset. This creates an audit trail that can improve data protection and privacy.
Checking health providers’ records
Blockchain projects have been set up to record a digital fingerprint of university degrees: as data are tamper-resilient and therefore hard to alter, blockchains can help verify the authenticity of university degrees and other qualifications.
Likewise, it can also help track licenses of health providers and physicians, making it harder to commit fraud through fabricated credentials. In the US, the State of Illinois experimented with a pilot project using blockchain to issue and track medical licenses. Companies such as Hashed Health equally use blockchain to accelerate the credentialing of medical practitioners.
Provenance and recalls of medication (and blood diamonds and fake artworks)
In December last year, KPMG, IBM, Walmart and Merck completed a blockchain pilot to facilitate compliance with medical supply chain laws, prevent the distribution of counterfeit drugs and facilitate recalls of medication.
MediLedger (counting Pfizer and Gilead among its working group members) likewise relies on blockchain to track pharmaceutical products across the entire supply chain. This should help regulatory compliance for pharma companies. For example, the US Drug Supply Chain Security Act imposes strict electronic track & trace obligations on pharma companies for certain prescription drugs, to reduce the risk of counterfeit drugs, among other things.
A blockchain-based track & trace system can also help with recalls of medication thought to be contaminated or otherwise harmful. If each batch of medication receives a unique blockchain-ID and is tracked on-chain throughout the supply chain, faulty or contaminated batches can be tracked and recalled more easily and swiftly.
Others initiatives, like that of adjunct-professor Mackey of the University of California San Diego, use blockchain to study medical supply chains and make them more transparent. This can help governments or international health organizations to “more easily identify ‘choke points’ in medical supply chains and anticipate shortages,” Mackey explained to Forbes.
Several companies already use blockchain for supply chain management in other sectors. Distributed ledger technology is already used in food supply chains: Walmart, Nestlé, Carrefour and many others are using IBM’s Food Trust blockchain technology to track the provenance of their food supplies.
Interestingly, Everledger uses blockchain to track the provenance of diamonds and prevent ‘blood diamonds’ from entering the supply chain.
And Christie’s partnered up with blockchain company Artory to bring transparency to a notoriously opaque art world by tracking the provenance of artworks.
The main difficulty in supply chains is to link a physical item to a unique digital identifier and ensure that this link cannot be manipulated throughout a product’s lifecycle.
For example, before a batch of prescription drugs leaves the manufacturer’s gates, the manufacturer can give it a unique identifying code and put the code on-chain. However, how can you ensure no one manipulated the physical batch of drugs, replacing it with a counterfeit batch that copied the original batch’s unique identifying code?
One obvious solution is to make it as hard as possible to imitate the original ID-code. However, you can aggregate many different data sources to verify the authenticity of the batch of drugs arriving at the hospital. For example, you could use IoT (Internet of Things) devices in the truck transporting the drugs, measuring and recording on-chain the temperatures at which the medication was stored as well as its geographical coordinates, following its precise trajectory. You could have intermediaries involved in the supply chain sign (with a unique private ‘key’ or digital password) for delivery on-chain.
If anything suspicious or abnormal happens in the supply chain (e.g., the cold chain is broken or the truck transporting the medication leaves a certain radius), the blockchain could automatically flag this. The system is not 100% waterproof, but it can improve the trust and auditability of medical supply chains.
Unsurprisingly, in the wake of the coronavirus outbreak, we’ve seen several companies claim their blockchain technology can aid the fight against the coronavirus pandemic.
Last month, the World Health Organization got together with Oracle, IBM, Microsoft and others to create a blockchain-powered open data platform to verify the accuracy of coronavirus data. Called MiPasa, the hub wants to help health officials with early detection of COVID-19 carriers and hotspots.
In Germany, a start-up uses blockchain and decentralized identity to help people get prescription medicines without physically having to go to a doctor, to avoid unnecessary contact.
Other blockchain-based tools simply offer better visualization of the spread of the coronavirus. You don’t need blockchain to create such a visualization tool, although distributed records and smart contracts can help feed more data, in real-time, to the tool.
However, not all experts agree. Sam Smith of MedConfidential described the slew of tech press releases on COVID-19 tools as “completely irrelevant” but something tech companies do “to promote their new shiny”, Forbes reported.
Health experts undoubtedly have much more COVID-19-related pressing things on their mind than figuring out how to integrate blockchain into their existing toolbox. Nevertheless, the opacity of medical supply chains and the recent scandals of fraudulent suppliers and defective equipment being offered to desperate medical staff show there is much room for improvement in medical supply chains. Blockchain can be one tool to make supply chains more transparent and trustworthy.
Blockchain is no miracle cure, but just another tool in the toolbox of health professionals and companies. It can improve the accuracy and completeness of patient records, facilitate gathering data for medical studies and clinical trials, and bring more transparency to medical supply chains. The greatest potential of blockchain lies in the opportunity to combine it with other technological innovations to improve medical procedures, services and research, such as sensors in IoT (Internet of Things) or Machine Learning.
Large-scale applications will take time to develop and may look very different from what we see now. However, it seems a matter of time before it enters doctors’ cabinets, medical supply chains and patient applications.
If you still don’t quite get how blockchain really works: don’t worry. If it is truly successful, you should not even notice blockchain replacing our existing databases behind the scenes.