Benefits can clash with entrenched interests.
The healthcare industry is known to be cautious and cautious, so one could be forgiven for assuming that healthcare and cryptocurrency have little in common. While the healthcare industry demands security and risk mitigation, cryptocurrency is built on a high-risk, high-reward model where a small investment can turn into a fortune and get back into gear. of an eccentric billionaire’s tweet.
Yet the backbone of cryptocurrency – blockchain technology – could soon be a very important part of the healthcare industry. Although best known for its association with cryptocurrency, the opaquely named blockchain is actually a new type of data storage architecture with many potential applications.
Invented in 2008, the technology involves recording data in distributed ledgers that are duplicated across various computer systems (blocks) within the network (chain). System transparency and redundancy provide a level of data security that was previously difficult to achieve. This means that if one computer system on the blockchain is compromised, the flaw would be immediately obvious to other systems on the chain. Instead of allowing cybercriminals to steal data from the dark corners of the internet, blockchain forces would-be data thieves to operate in the spotlight.
Health care hesitation
Given the rise in cases of ransomware attacks and growing concerns about medical privacy in general, blockchain may seem like a boon to the healthcare industry. Yet this potential has yet to translate into rapid adoption of the technology.
Tony Little, vice president of solutions architecture at Prescryptive Health, a technology company that provides blockchain-enhanced products and services to the healthcare and pharmaceutical industries, said there is nothing new for healthcare entities to be cautious about new technologies.
“For example, it took government regulation in 2009, in the form of the HITECH Act, to push industry to adopt the electronic medical record by generously offering money to health systems for implementation,” did he declare. Managed Health Framework®.
Little says some of the early initiatives came in the form of experiments and pilot programs like the Synaptic Health Alliance, which seeks to streamline provider directories, and the Health Utility Network, which aims to improve coordination of benefits. Although these programs are limited in scope, they involve major players in the health insurance industry, including Aetna, Anthem, UnitedHealthcare and Humana.
Xudong Huang, Ph.D., of Harvard Medical School, believes patients will be the big winners in the blockchain era.
“Compared to other types of data management/security, blockchain-based systems can offer both data security and data ownership, in my opinion,” he says.
The idea that blockchain will give patients greater ownership of data is based on the ability of blockchain-based systems to require patient permission for data retrieval. In a 2019 paper, Huang and his colleagues proposed using multisignature contracts — “multisig” for short — in healthcare blockchains. In a multisig approach, the patient and their healthcare provider would need to use their own private keys – essentially super passwords – in order to access the patient’s medical record on the blockchain. For patients, this would mean that providers could not access their personal medical information without permission. However, this would also mean that patients could not modify their health records; only suppliers could. “There have been examples of multisig contracts being used in finance, property registration, etc.,” Huang said. “I’m not aware of its application in healthcare.”
For Huang, the benefits of blockchain security in healthcare go beyond privacy-for-privacy. As a psychiatrist, one of his areas of interest is Alzheimer’s disease, a neurodegenerative disease for which there is no known cure. A concern within the Alzheimer community is the possibility that the presence of biomarkers of the disease could be
inadvertently disclosed in such a way that a patient could be discriminated against when applying for life insurance or employment, among other circumstances. Implementing blockchain would add an important layer of protection, he said.
Benefits for payers
In a 2020 review published in the International Journal of Medical Informatics, Alaa Abd-alrazaq, Ph.D., of Hamad Bin Khalifa University in Qatar, and his colleagues examined the benefits and potential barriers of blockchain in the healthcare sector. They cited four key features of blockchain that lead to direct benefits for the healthcare industry: immutability, decentralization, transparency, and traceability.
Immutability means the data cannot be changed without leaving fingerprints, and the decentralization of data makes it harder for ransomware attackers to target hospitals and insurers, as the data would not be locked to one. place.
Transparency exists in the blockchain because all transactions are visible to anyone with access to the blockchain, and traceability allows participants to understand who is accessing the information. For example, the ability to track data with verifiable timestamps could help solve supply chain problems by allowing suppliers such as pharmaceutical companies to better track their products, they added.
Little explains that blockchain can also reduce costs. He noted that often when insurers work with PBMs, the PBM controls certain data, ostensibly for security reasons.
“However, this arrangement leaves insurers needing PBM’s approval to access this data, including for auditing purposes or to comply with government reports,” he says. “In many cases, PBMs will charge an insurer a fee to access their own data.”
With blockchain, insurers can have immediate access to needed data without sacrificing data security. This not only reduces costs, but also the risk of error, he adds.
Deeply rooted interests
But while companies needing access to data could benefit from a more open and decentralized model, it would leave companies that thrive on such access in a losing position. Little notes that many of the most profitable sectors of the modern health economy rely on the acquisition and storage of data and data-based services.
“Using a blockchain goes against those traditional models, and it’s hard for incumbents to move past that to use the technology to solve the big problems plaguing the industry,” Huang says.
He says another issue is how blockchain might change the role of so-called big data in healthcare or if it will change things at all. Increasingly, healthcare companies and academic researchers have relied on creating or acquiring massive datasets to deliver medical insights that would have been impossible in earlier times. Data “silos” can be problematic in many ways, but the very presence of large datasets is part of what makes big data analytics possible in healthcare.
But blockchain could actually help — not hurt — big data breakthroughs.
“A simple solution for this is that all anonymized patient data can be published in a public database for easy access,” he says. According to Huang, the blockchain could facilitate data analysis, expanding and simplifying access between controlled entities with access to the blockchain on which the data is stored.
As Huang explains, some blockchains are entirely public while others are private or based on a permissions system that controls access. The protocol behind public blockchains, like those associated with cryptocurrencies, is designed to generate digital “tokens” that can be sold to help offset system costs, Little says.
However, healthcare-focused blockchains use systems with access limited to authenticated entities. Prescryptive, for example, has partnered with ConsenSys, which has created a permission-based blockchain product called Quorum Blockchain Service. Permission-based blockchains are best suited for highly valuable data such as medical records, but lacking a built-in revenue generation mechanism, they need to win customers based on savings potential.
“The economic incentive to run a node on a permissioned blockchain is proving to be a major hurdle,” Little says. “Using lower audit cost and data sharing may be enough to overcome these concerns, but it adds to the reasons why incumbents, who hold data today, are unwilling to share, even for the common good.”
Jared Kaltwasser, a regular contributor to Managed Health Framework®, is a freelance writer in Iowa.