As I mentioned in the previous article, Healthcare Privacy, Farrah Fawcett and Blockchain, a blockchain is a distributed database that acts as a ledger for transactions. It is best known as the technology behind Bitcoin, a type of digital currency that is both easily accessible and very secure. Blockchain technology allows users to transfer bitcoin anonymously and securely while still insuring that the data itself is trustworthy.
Each bitcoin’s history is chronicled forever within the blockchain – which is itself distributed over hundreds or thousands of servers all over the world. This makes it extremely difficult for hackers to manipulate the information within because in order to do that, they would have to break into all those systems simultaneously instead of just breaking into one centralized system.
A STORY
Let’s look at an example of how EHR’s would work if built on a blockchain platform. Cindy Lou is a 52 year old resident of Whoville. which has a comprehensive, community-wide EHR system built on blockchain. She has a wreck driving home from a Christmas Eve party and is taken to the Whoville Infirmary ER while still unconscious. Cindy has multiple disease states including epilepsy, type 2 diabetes, DVT, and PTSD (from a Christmas Eve 50 years earlier). Because Cindy set up her profile with designated family members able to approve access to her records in the event of an emergency, the ER staff was able to get all of her information including that of the mental health facility treat where they learned that he PTSD was being treated with carbamazepine (a drug with many significant side effects) and from her vascular surgeon where it was learned DVT was being treated with warfarin (which carbamazepine interacts with). Since the blockchain technology is easily accessible by different software vendors, there were no interoperability problems between the different organizations. Furthermore, the WHO (Whoville Health Organization) was able to utilize the blockchain database to gather non-identifiable health information to determine that there was an alternative medication for PTSD that did not have the drug interaction problems and produced significantly better outcomes.
WHY DON’T USE WE THIS TECH FOR HEALTHCARE RECORDS?
So why is this exciting technology not in use for healthcare records worldwide? Lets imagine an alternate universe. Instead of the blockchain based system, imagine if the Grinch started his own EHR software company in which the database is centrally located and entirely controlled by the company. Initially, anyone could connect to the database, as long as they bought the proprietary interface. Concerns from smaller providers lead to regulations requiring free access to the database, which they did, but it never gave the seamless integration of the official interface. As a result, fields such as allergies, drugs, etc. would inexplicably disappear or even be changed. So when Cindy Lou was admitted to the ER, information from her mental health records was not available and the warfarin field did not transfer to the hospital’s system from her vascular surgeon’s (supposedly) compatible EHR system.
Could a system using blockchain technology really be used nationally to solve some of the issues related to healthcare or is this just a fairy tale? Estonia already has such a system in place. What is holding the res of the world back?
Bio:
Jeff Harris is a Pharmacist with over 25 years of leadership experience in hospital, retail, and home health environments. Due to a spinal cord injury, he is currently on long term disability. Jeff is passionate about patient safety, risk management and cybersecurity issues in healthcare. He continues to research and write about improving healthcare on a pro-bono basis.