Blockchain:
Blockchain technology is a distributed add-only digital ledger shared among peer-to-peer networks. The digital asset to be stored in the digital ledger is verified and recorded irretrievably in a chronological order. The distributed nature and the verification process ensure the immutability and authenticity of the recorded digital assets. Timestamping of the digital assets ensure proof-of-existence at a particular point of time. The digital asset could be cryptocurrency such as Bitcoin, creative material, records, contracts or other valuable information.
Smart contracts embedded in some of the blockchain databases such as Ethereum are automatically executed when certain terms and conditions are met thus eliminating middle men. When the terms and conditions are not complied with, the concerned party is notified immediately further saving time and cost.
Blockchain in Healthcare:
Healthcare industry is one of the fastest growing industries, with the Indian healthcare market expected to have a three-fold increase to Rs 8.6 trillion by 20221, and is fast embracing blockchain technology to address its major challenges. According to an IBM survey on healthcare in blockchain, about 16% of its healthcare respondents (the trailblazers) were expected to have a commercial blockchain solution by the end of 2017, and about 56% of the respondents (the mass adopters) were expected to have blockchain in production and at scale sometime by 2019. The digital assets in healthcare comprise of Health records, billing and insurance claims, clinical trial data, records on humanitarian aids, supply chain records for drugs, blood, medical devices etc.
Health records management:
The present health record database is highly fragmented with security and privacy concerns and lacks efficient interoperability amongst different stake holders viz. the patients, the healthcare providers, the insurance companies and the Government. Blockchain in terms of its immutability, permissioned access, trust, proof of ownership and existence overcomes the above challenges effectively.
Health records of a patient include their medical history, diagnostic evaluation, therapeutic regimen, Patient generated health data (PGHD), billing and insurance claims etc. PGHD is provided by the patient or their caregivers and includes the data generated from wearable tech, implanted sensors, physical activity and dietary information, records from home health equipment like BP and glucose monitors, nebulizers, insulin delivery devices etc. The following figure schematically represents the health record information for a diabetic patient.
Real-time accurate Longitudinal patient data:
One of the biggest advantages of blockchain in health record management is the generation of accurate longitudinal patient data. Longitudinal patient data is medical history of a patient over time starting from vaccination through different episodes of illness that warranted medical intervention. Easy and secure access to longitudinal patient data by the concerned stake holders ensures time and cost-effective patient care and also better treatment. The health records can be accessed by interested parties only upon permission (sharing of private key) by the concerned stake holders thus taking care of security and privacy issues.
Accurate Patient Identification:
A common concern with present health record databases is mismatching or duplication of patient records often leading to unwanted consequences. To exemplify, a family friend of mine was diagnosed by a Delhi hospital with kidney failure and was advised kidney transplantation. He spent a nightmarish week before being informed by the hospital that there had been a mistake and his record was inadvertently switched with another patient’s record. Such errors occur because of various reasons. Patient names may not be always uniformly represented with reference to first names, last names, initials etc. and same/similar names add to the confusion. Likewise, dates might be represented differently and addresses of patients might change. Hence relying on demographic data for identifying a patient in a database and updating his records often leads to mismatching or duplication of patient’s records. Having patient unique IDs addresses this issue within a single database/organization but as of now is not very successful for exchange of information amongst different stake holders because of lack of efficient interoperability and lack of uniformity amongst different databases with reference to patient identification procedures.
The cryptographic methods (Hashing and digital signatures) and the interoperability characteristic inherent in blockchain technology solve this problem and ensure accurate patient identification.
Medical tourism:
Ease of sharing and accessing health records through blockchain while fulfilling security and privacy concerns can potentially lead to a surge in medical tourism breaking geographic boundaries.
Billing and Insurance claims:
Another use scenario with immense potential for blockchain is in healthcare insurance claims. The current process of claiming insurance benefits is onerous and time consuming mainly because of the verification requirements in place for avoiding errors and frauds. The insurance formalities being tedious, mistakes and missing information galore in the claims causing rejection of claims or costly delays in grant.
The verification process on the blockchain is faster and ensures authenticity and accuracy of the claims thus minimizing frauds while the smart contracts execute and automatically enforce contractual agreements between the patient, health care provider and the insurance companies thus streamlining the process of claiming insurance benefits. Insurance claiming through blockchain would reduce the administrative burden and the transparency involved in the whole process is beneficial for all the parties.
The billing process in hospitals would benefit from the immutable and verifiable audit trail on the blockchain. With an authentic billing regimen and medical records in place, insurance claiming becomes easier.
Clinical trial records:
Clinical trial groups can have permissioned access to validated medical records of patients and choose the right individuals who would be suitable for their clinical research needs. The patients who allow access to their records can be incentivized in return. Informed consent of patients through this platform would minimize unethical practices. The clinical trial records on blockchain would be immutable and accurate leaving no room for fraudulent practices. This in turn would render the path to regulatory approvals a lot easier. Smart contracts between clinical trial groups, hospitals and the patients would further reduce the time and cost for clinical trials.
Supply chain management for drugs, blood etc:
Traceability feature inherent in blockchain makes it an ideal platform for supply chain management. Authentic and immutable supply chain data for drugs can reduce the threat of counterfeit drugs.
Blockchain can assist in managing blood bank records and facilitate interoperability between blood banks and hospitals. Other than ensuring safety of blood, it can streamline the process of finding suitable blood donors (critical for rare blood groups), letting donors track their donated blood to the recipient, allocation of blood to hospitals before expiry to avoid wastage etc. This applies for the donation of blood related products as well such as red blood cells, plasma and platelets which are more precious and are used for treatment of cancer patients, trauma patients, newborns etc.
The above use scenario illustrates just a chosen few of the applications of blockchain in healthcare. Though there are considerable challenges viz. technical, funding, ownership issues etc. in adopting blockchain for healthcare, the industry has already begun its steady march towards that end. This is evident from the foray of big players such as IBM and Microsoft as well as a huge number of startups into the arena of blockchain products for healthcare and this technology is all set to disrupt the healthcare sector.
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