by Sterling Harpst, 2019 PharmD Candidate
There are many news stories about the digital currency Bitcoin, and some have heard of the technology behind it: blockchain. However, most people are probably unaware of the impact this technology could have on our society, especially within the field of healthcare. Demand for blockchain, is exploding, so let’s look at its potential applications to consider from a patient perspective.
What is Blockchain Technology?
The blockchain is a permanent and public database that shows all transactions that have ever taken place on it.
Think of it as a single spreadsheet that can be simultaneously accessed and edited by a network of computers all around the world. Each time a participant on the network enters a new transaction, the change is reflected on all spreadsheets in real time. What makes this unique is its decentralized nature. In contrast to traditional networks in which the spreadsheet is owned by a single company (i.e. a bank), the blockchain stores the original information in millions of locations at the same time, with no single owner. This ensures all information stored on the blockchain is public and verifiable. It also greatly increases the protection of data, preventing hackers from corrupting a central location that houses every file on the network.1
When a digital transaction or “block” is initiated, it can only be finalized on the spreadsheet if there is public consensus among other participants on the network. This consensus requires multiple decisions regarding whether the information being transferred from one party to another is accurate and decisions are then compared to one another. Once a threshold consensus has been reached, the data is time-stamped and permanently linked to the previous transaction, forming a chain of information that is impossible to alter.2 The blockchain “spreadsheet” can only be distributed to other participants in the network, rather than copied, which eliminates the possibility of altering data and allows for an unbiased and trustworthy source of transaction information. Therefore, this type of network eliminates the need for a middleman to perform these services.
Although this new type of system can be difficult to comprehend, it has the potential to change nearly every aspect of business. In the same way that e-mails can be sent without fully understanding the underlying technology, the blockchain can be used by anyone. This still begs the question for patients – how will it affect me?
How the Blockchain Will Impact Healthcare
Electronic Health Record (EHR)
One of the most significant problems with the healthcare system today is the lack of information sharing. As a patient, many individuals find it hard to understand why one doctor can access their entire medical history, while another has only incomplete notes regarding once yearly office visits. The middleman, in this instance, is the electronic health record company. These entities protect the information that is stored on their software to incentivize other businesses to adopt or pay for the ability to communicate with their program. This can leave patients with partial, mismatching records that hinder the doctor’s ability to provide the best care. Many companies, however, are now proposing the use of a blockchain to solve this problem.
As described earlier, the blockchain allows for a digital “spreadsheet” to be shared across computers with access to the same network. The spreadsheet in this instance, would represent the patient’s electronic health record (EHR). This blockchain network would be personally controlled by the patient, who could then grant access to doctors or other healthcare professionals as necessary. Patients would even have the ability to grant access to only certain parts of the health record, leaving out personal information that doesn’t pertain to the specialist they may be seeing. Once an appointment has concluded, the patient can then subsequently revoke privileges to see the information, if they so choose. Examples of companies pursuing this type of blockchain solution for EHR include Iryo, Patientory, Guardtime, Coral Health, Medicalchain, and more.3
In the new and growing fields of pharmacogenomics and genetic testing, current industry business models have prompted some to seek another use for the blockchain. 23andMe and AncestryDNA are a few of the most well-known genetic testing companies in the direct-to-consumer market today. By selling patients an opportunity to receive a genetic test through the mail, the need for prescriptions or consultation by a healthcare professional has become something of the past. What few patients know is, a significant portion of their revenue comes from selling the genetic information to pharmaceutical manufacturing companies for the purpose of conducting research. Pharma companies pay billions of dollars each year to obtain this information and use it to direct their future drug development efforts. Unfortunately, patients do not see any kickback revenue as a result.
This practice has prompted companies such as EncrypGen, Nebula Genomics and others to offer a unique answer to this problem. In their models, the “spreadsheet” would be the results of a genetic test. In the same way mentioned prior, patients could both allow and revoke access privileges for Pharma companies to this information. Instead of Pharma companies acting as doctors to use the test results to make clinical decisions, they would instead pay the patients directly for their data.3 This would incentivize patients to not only further research efforts but receive payment at the same time.
The Future of Blockchain in Healthcare
A new generation of healthcare technology companies have launched efforts to create an information structure that performs each of these functions and many more using the blockchain. From prevention of drug counterfeiting to managing data loss in natural disasters, startups are appearing across the country to fix problems that have plagued the healthcare system for decades. Many think this technology is coming to our businesses and personal lives very soon, while others believe it is far from being fully integrated. Either way, with the potential to revolutionize several different areas in healthcare and beyond, the blockchain is a technology worth paying attention to.
- Elliott C, Rosic A, Lind, et al. What is Blockchain Technology? A Step-by-Step Guide For Beginners. Blockgeeks. https://blockgeeks.com/guides/what-is-blockchain-technology/. Published June 22, 2018. Accessed June 25, 2018.
- Mearian L. What is blockchain? The most disruptive tech in decades. Computerworld. https://www.computerworld.com/article/3191077/security/what-is-blockchain-the-most-disruptive-tech-in-decades.html. Published May 31, 2018. Accessed June 25, 2018.
- Top 12 Companies Bringing Blockchain To Healthcare. The Medical Futurist. http://medicalfuturist.com/top-12-companies-bringing-blockchain-to-healthcare/. Published April 4, 2018. Accessed June 28, 2018.
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