Blockchain is one of the buzzwords that we keep hearing about with the promise that it is going to change the face of several industries including healthcare. Is that true? If it is true, then where does Blockchain technology fit in healthcare? To start let's explore the basic definition on Blockchain: “Blockchain is an openly-distributed incorruptible digital ledger of economic transactions that can be programmed to record not just financial transactions but virtually everything of value”1.
What does that mean: think of Blockchain as a huge decentralized database over a network of users and computers, with no single ownership. The network serves as a consensus to transactions, which prevents a single entity from creating or manipulating a fraudulent transaction. It is also totally transparent to the users, and now you have a basic understanding of the Blockchain 2.
So how is that different? Information held on a Blockchain exists as a shared — and continually reconciled — database 3. Some of the benefits of this design:
1- The Blockchain database is not stored in any single location, meaning the records it keeps are truly public and easily verifiable. Also by being hosted by millions of computers simultaneously, its data is accessible to anyone on the internet.
2- A decentralized network resists individual hacking attempts. By storing blocks of information that are identical across its network, the Blockchain network:
i) Cannot be controlled by any single entity.
ii) Has no single point of failure.
Where is Blockchain currently used?
The amount invested in Blockchain technology is comparatively small but aggressively growing 2. Examples include IBM and Microsoft incorporating Blockchain platforms in their customer support systems. Additionally, major companies are actively exploring the value of integrating Blockchain technology into their operations. Examples include:
- Walmart: tracking vendor payment and digital shopping.
- Starbucks: tracing beans from various countries.
- American Express: customizing rewards for cardholders.
Where does Blockchain fit in healthcare?
Several case studies have been published about Blockchain in healthcare; the three basic concepts that support its use are 4:
1- Providing proof of work
2- Guaranteeing data integrity
3- Supporting an economic model
Areas where Blockchain can be utilized in healthcare that have been discussed in literature 4,5,6 :
1- Clinical trials and the management of trial subject consent: Blockchain can be used to increase transparency, auditability, and accountability.
2- Data sharing represents an area where Blockchain can be useful. Of course, privacy will always be a challenge.
3- Patient Records: Blockchain has the potential to make patients access to their healthcare data much easier.
4- Drug tracking from manufacturer to patients: Blockchain can help establish and maintain tracking record and chain of custody records from manufacturer to patient.
How might Blockchain affect the pharmacy world?
1- Focusing on one piece of the EHR, Blockchain would potentially be able to hold the complete medication history for each patient, and any updates or changes made by any provider or the patient would be captured and recorded securely in one place.
2- Pharmaceutical supply chain is another area that Blockchain can provide a lot of value to, also Blockchain can help overcome the increasing risks around counterfeit and unapproved drugs. As with device tracking, it is possible to define smart contracts for drugs and then identify pill containers, with integrated GPS and chain-of-custody logging 4.
Challenges associated with Blockchain use:
Any new technology is presented with challenges and Blockchain is not an exception:
1- Cost is one of the main challenges that currently face Blockchain technology adoption 7. With specific customization to each institution, the start-up costs are currently very high, even though on the long run, Blockchain promises long-term benefits with regard to productivity, efficiency, timeliness and reduced cost.
2- Additionally, even when operating, the system will not be without computing resources and an incentive for those participating in the computing network. A recent estimate suggested that Bitcoin’s computing network consumed the energy equivalent of 159 countries 9.
3- Privacy and security are one of the challenges that are associated with Blockchain 7. With the need to restrict and protect data in the healthcare industry, Blockchain technology cannot work in spaces with sensitive data until this challenge is met. In a recent tale of caution, 115,000 users lost access to $190M when a cryptocurrency exchange CEO passed away and his passwords were lost10. While this is not an issue with the blockchain technology, it does highlight the need for oversight of those operating systems interacting with this technology.
4- Speed and file size may limit blockchain’s reach into the healthcare environment. For example, Bitcoin transaction’s have been reported to take several hours to finalize 9. At this time, real-time updates to a blockchain medical record may not be realistic and large files or abstract data (like radiology images) would not be candidates for this technology11.
In conclusion: Blockchain provides promising advances in multiple industries as well as in healthcare. But as with other technologies, careful consideration needs to be applied to provide the best use case for this technology at any institution.
Published on behalf of the Clinical Application Workgroup for the Clinical Application SAG:
Alec Huang, Pharm.D. Epic Business Intelligence Developer. Thomas Jefferson University Hospital. Philadelphia, PA.
Ben Iredell, Pharm.D. MBA, BCPS, Pharmacy Informatics Manager, Cedars-Sinai Medical Center. Los Angeles, CA.
Chad S. Stashek, Pharm.D., M.S., Clinical Informatics Pharmacist, Affiliated Faculty. Oregon Health & Science University. Portland, OR.
Hesham Mourad, Pharm.D., BCPS, BCCCP, CPHIMS, Medication Management Informaticist, Assistant Professor of Pharmacy. Mayo Clinic. Jacksonville, FL
John Siejak, Pharm.D., CPHIMS, Pharmacy Informaticist, Kaleida Health. Buffalo, NY
Lisa Starost, PharmD. Manager – Pharmacy Informatics and Program Director, PGY2 Informatics Residency. Indiana University Health. Indianapolis, IN
Tanya O. Ezekiel, Pharm.D., BCPS. Clinical Informatics Pharmacist. Prisma Health–Midlands. Columbia, SC
1- What is Blockchain Technology? A Step-by-Step Guide For Beginners. Retrieved from: https://blockgeeks.com/guides/what-is-blockchain-technology/. Accessed 1/11/19.
2- Blockchain and Its Potential Impact to Healthcare and Pharmacy. Retrieved from:https://www.wolterskluwercdi.com/blog/blockchain-potential-impacts/. Accessed 1/11/19.
3- Blockchain Identity Management, Part I. Retrieved from:https://tekmountain.com/blockchain-identity-management-part-i/. Accessed 1/12/19.
4- Liam Bell William J Buchanan Jonathan Cameron Owen Lo. Applications of Blockchain Within Healthcare. Mon, 09 Jul 2018 in Blockchain in Healthcare Today.
5- John D. Halamka. Real Blockchain Use Cases for Healthcare. Wed, 11 Apr 2018 in Blockchain in Healthcare Today.
6- Kevin A. Clauson et al. Leveraging Blockchain Technology to Enhance Supply Chain Management in Healthcare: An Exploration of Challenges and Opportunities in the Health Supply Chain Wed, 11 Apr 2018 in Blockchain in Healthcare Today
7- Five Challenges Blockchain Technology Must Overcome Before Mainstream Adoption. Retrieved from: https://www.nasdaq.com/article/five-challenges-blockchain-technology-must-overcome-before-mainstream-adoption-cm899472. Accessed 1/13/19.
8- Big things ahead for Blockchain in healthcare, new report shows. Retrieved from: https://www.healthcareitnews.com/news/big-things-ahead-blockchain-healthcare-new-report-shows. Accessed 2/7/19.
9- Bernard Marr. The 5 Big Problems With Blockchain Everyone Should Be Aware Of.
https://www.forbes.com/sites/bernardmarr/2018/02/19/the-5-big-problems-with-blockchain-everyone-should-be-aware-of/#6a2ebdff1670. Accessed 2/10/19
10- Doug Alexander. Crypto CEO Dies Holding Only Passwords That Can Unlock Millions in Customer Coins. https://www.bloomberg.com/amp/news/articles/2019-02-04/crypto-exchange-founder-dies-leaves-behind-200-million-problem. Accessed 2/10/19
11- RJ Krawiec, et al. Blockchain: Opportunities for Health Care. Deloitte Touche Tohmatsu Limited. https://www.healthit.gov/sites/default/files/4-37-hhs_blockchain_challenge_deloitte_consulting_llp.pdf Accessed 2/10/19