Blockchain – Transparency, Integrity, and Clarity to the Healthcare System

by Priya Menon

This is the age of collaboration, the age of Blockchain.

Blockchains in healthcare have wide applications, stretching from medical record interoperability, drug discovery, data security, to the development of personalized (or precision) medicine. They represent another dimension to disruptive digital health technology. According to new analysis report from CB Insights, blockchain technology is set to transform healthcare.

What are blockchains and how does the blockchain technology work?

Blockchain is a permanent record of online transactions. Started in 2009, it was the foundation for trading bitcoins (digital currency). This record of transactions can be shared among a network of computers. Users on this network can add to the record of transactions. Transactions are kept secure via cryptography, and transactions have to be approved and verified by the network in a process called mining.

Blockchain is similar to a database which stores information, however the main difference is that the data is located in a network of personal computers called nodes where there is no central entity such as a government or bank controlling the data. Instead, all data is shared publicly although the contents of each data is only accessible to those with permission.

Each transaction can be thought of as a block, and the ledger that links them together is the chain. Blocks are linked together in the chain through mining.  Each participant connected to the blockchain network has a secret private key and a public key that acts as an openly visible identifier. The pair is cryptographically linked such that identification is possible in only one direction using the private key. One must have the private key in order to unlock a participant’s identity to uncover what information on the blockchain is relevant to their profile.

 

Can blockchains transform the healthcare system?

Two of the primary components that make up a blockchain are identity and historical record. This is comparable to a giant log of events and this log in unchangeable. So it provides a secure record of exactly who did what, where and when. In the recently concluded  7th annual DPharm conference  Dr Sascha Mundstein, Mobile and Digital COE, Technology Evangelist, Pfizer, Inc led a session on how blockchains can accelerate drug development process and thereby change clinical development cycle. The sessions discussed how it was imperative that blockchains were embraced and how it may be the catalyst for a new healthcare system.

While the two most commonly cited examples of how blockchain can be used in healthcare are data interoperability and security, the stream of new possibilities is flowing as well.

1. Greater transparency and quicker claims with blockchains

In situations where health plan and patient deal with contracts, the blockchain can automatically authorize information and other related contractual processed. There is greater transparency, lower administration costs and faster claims. Imagine a world where every major insurance players are connected, and are members of a simple blockchain network. You as a customer travel to any Geography and need healthcare service. The blockchain would hold certain verification information and the current coverage remaining, coverage terms, Insurance provider etc. Say you have about 6000$ remaining in your insurance cover. The payer that would be servicing you in the new geography would simply query the blockchain, process the claim, and update the blockchain again with the transaction details.

The approval for treatment or surgery happens immediately. Reconciliation between the payers can happen later. This would drastically bring down the delay since the entire latency time owing to to and fro communication between the home and host payers is virtually eliminated. The patient gets the service when he needs it the most. Turnaround time gets reduced and thus Customer Satisfaction would increase.

2. Patient data cryptographically secured in blockchains

 

When we talk about blockchain and healthcare, data exchange is typically the first topic to come up. Blockchain-enabled health systems can provide technological solutions to many challenges, including health data interoperability, integrity and security, portable user-owned data and other areas. Most fundamentally, blockchain could enable data exchange systems that are cryptographically secured and irrevocable. This would enable seamless access to historic and real-time patient data, and at the same time eliminate the burden and cost of data reconciliation.

3. Accelerated drug development process and Improved tracking of pharma supply chain

 

Based on industry estimates, pharmaceutical companies incur an estimated annual loss of $200 billion due to counterfeit drugs globally. About 30% of drugs sold in developing countries are considered to be counterfeits. A blockchain-based system could ensure a chain-of-custody log, tracking each step of the supply chain at the individual drug/product level.

Most of the times, drugs are developed and manufactured at manufacturing sites and then transferred to wholesale distributors before they are further distributed to pharmacies and retail companies before delivery to patients takes place. The blockchain technology allows opportunity to verify the integrity of the drug supply chain and enhance new drug development by leveraging the blockchain to support and manage the drug development process. Furthermore, add-on functionalities such as private keys and smart contracts could help build in proof of ownership of the drug source at any point in the supply chain and manage the contracts between different parties.

Blockchains allows for the elimination of middlemen, and gives ownership of data to all members. Everything is distributed and so there is an inbuilt fairness.

4. Secure communication and sharing of data in clinical trials

It takes about 12 years and $5 billion to get a drug into the market. a large part of that effort is devoted to clinical trials. Trials generate enormous amounts of data that are shared among the pharmaceutical company’s internal teams and contract research organizations (CROs) and, ultimately, with the Food and Drug Administration (or analogous regulatory bodies around the world). Establishing that a new drug is effective and safe is of course a scientific challenge, but ultimately it is also a data challenge (and proving efficacy and safety is very much a data challenge). Blockchain represents a powerful solution to ensure the integrity of clinical trials data from start to finish.

Patients have little access to their health data and cannot easily share with researchers or providers. Giving patients the opportunity to share their data securely, for research purposes or across their healthcare providers, creates opportunities for major advancements in healthcare. Blockchain technology, which enables organizations to work together with more trust, is designed to help make this a reality. Blockchain technology establishes accountability and transparency in the data exchange process. In the past, large scale sharing of health data has been limited by concerns of data security and breaches of patient privacy during the data exchange process.

Blockchain platforms preserve all additions to the data stream and all transactions involving that data verifiably and permanently. And blockchain networks make it easy and safe to use data by multiple parties in ways that ensure privacy and integrity.

It is estimated that 50% of clinical trials go unreported, and investigators often fail to share their study results. Blockchain-enabled, time-stamped  records of clinical trials, protocols and results could also address the issues of fraud and error in clinical trial records.

Blockchain-based systems could help drive unprecedented collaboration between participants and researchers around innovation in medical research in fields like precision medicine and population health management.

Obstacles in Blockchain Adoption

Blockchain technology is a relatively new concept for healthcare domain. In the absence of real-world business cases, the adopters need to be cautious until the capabilities of blockchain technology are proven in real-time environment. It is also  difficult to forecast the operating costs as well as potential technology post-implementation roadblocks.

Full digitization of healthcare data is imperative for successful deployment of blockchain technology and this may pose a hurdle in the wake of even some of the developed nations not able to achieve 100% digitization till date. Moreover, the implementation of blockchain solutions would require significant changes to existing systems. Considering large volumes of healthcare data, the transition may pose a major challenge.

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