Blockchain in Healthcare : a New Revolution is Coming
This is an English translation of the original article published in Cotidianul.ro in Romanian about blockchain in healthcare.
Over the last 20 years, the economic system has moved from a centralized model around large organizations that provide goods or services to consumers, to a decentralized system where businesses have an intermediary role between two parties. These two systems are based on mutual trust, which is necessary for the good functioning of the model.
In 2008, the financial crisis led to a total loss of trust in governmental third parties and banks. At the same time, an anonymous person or group of people, known as Satoshi Nakamoto, published a whitepaper describing an electronic peer-to-peer cash system that allowed transactions to be carried out without passing through intermediaries such as banks. This marks the birth of the famous Bitcoin cryptocurrency and of the underlying technology, blockchain.
“Nodes” operated by “miners”
Imagine the blockchain as a large public ledger that records all transactions between two parties. This information is entered in the ledger in chronological order and permanently timestamped. Thus, each transaction is unchangeable and immutable. In addition, in order for a new transaction to be added to the ledger, it must be connected to the previous transactions through a complex computer process. This allows the formation of a chain of blocks – blockchain. Even if the ledger is public, the transactions are anonymous because the parties involved are only represented by a complex code that prevents access to the real identities.
In addition to being public, the blockchain is distributed. This means that all computers in the network have a copy of the ledger that they can consult and to which they can add new transactions. The computers in the network are “nodes” and the individuals who update the registry are “miners”. Their work is not free and therefore, for each transaction added to the ledger, they are rewarded bitcoins. Bitcoin is the first crypto-currency created in 2008. Since then, many other tokens have been launched with more or less success.
Increased interest in health care
The security, the privacy and the lack of intermediaries allowed by blockchain technology have prompted a growing interest from all sectors of activity in the last couple of years, and especially the health care industry.
Nowadays, there is no secure system allows to collect and share all the data a patient produces in his medical history. This raises several issues.
First, each patient being unique, with a particular pathology and a precise response to a treatment, it is impossible to apply a common therapeutic strategy to all patients without addressing their individual characteristics. In addition, what works in a patient may not work on another because of inter-individual variability. Consequently, access to complete medical records is essential, with the aim of adapting treatment and providing personalized assistance.
Secondly, the exchange of information between medical communities is a major challenge. Even today, doctors use unsecured social networks to communicate and share patient data. Moreover, when a researcher wishes to collect medical data for a study, he has to tour the hospitals and read the medical records stored in the archives to search for relevant information. This considerably slows down the study.
Finally, the patient has lost his central role in the health care system over the years. From a legal point of view, many countries do not always grant patients the right to own their health data. This leads to problems such as unapproved exchange of patient data.
Blockchain, the rescue solution?
In the case of medical records management, blockchain can be used as a large catalogue that stores all patient-related health data sources as blockchain can store proof of the existence of different types of data, such as prescriptions, medical imagery or biological tests. Thus, blockchain technology allows to gather all of the patient’s medical data in one place and provide a complete vision of the patient’s entire medical examinations.
However, blockchain does not allow everyone to view the content of the documents. It is the patient who decides with whom he shares his data. This can be done through smart contracts. This term designates contracts in the form of computer codes, executed automatically when certain criteria are met. Thus, these smart contracts allow patients to identify authorised people who may have access to medical information. When an authorised person confirms their identity, the contract is executed immediately and allows the data to be viewed in a secure manner and with the patient’s indispensable consent.
Bitcoin or virtual gold
Many authors compared this virtual token to gold. Similarly to gold, the amount of bitcoins put into circulation is finite. Indeed, in the Bitcoin blockchain, an algorithm limits to 21 million the number of bitcoins that will ever be produced. Moreover, the creation is initially rapid, and then slower as the bitcoin stock is exhausted. Once the final amount is reached, it will be impossible to produce anymore. It will become, as gold, a rare good.
Blockchain technology provides unprecedented security, an important feature when it comes to transactions. Indeed, when a new block of transactions is added, a consensus on the latest version of the register is implemented between the miners. This version is validated by a majority plus one of the nodes, so if a person wants to modify the registry, they need to control more than 50% of the network. To do this, a colossal computer power is needed, which the giants of the Internet do not possess.
Blockchain is not just a ledger
This technology allows you to confirm the existence of a document at a time “T”. This is a “proof-of-existence” and so each document receives a unique code called “hash” that is recorded in the blockchain. Hashes prove that the document existed in a precise form at a time, “T”. A different hash is produced each time a new version of the document is registered. This allows users to track any changes.
Ever since its creation, blockchain technology has prompted much interest in the financial sector with bitcoin success. Increasingly, its applications are expanding especially in the health care sector, a sector in full digital transformation. Beyond managing medical data, blockchain technology has easy-to-use applications such as securing the drug supply chain or controlling data from clinical trials. Many authors compare the emergence of blockchain technology with Internet discovery and web site development in the 1990s.
Although many health applications do not go beyond proof-of-concept, blockchain brings hope for a more transparent industry leveraging more interoperability. Proof of its success is the fact that in US, companies such as Philips are developing partnerships to create a “healthcare blockchain”. In France, the start-ups are already challenging the existing social security system with digital technologies such as blockchain, artificial intelligence or deep learning. The year 2017 will certainly mark the beginning of a digital revolution in health.