How Blockchain can bolster interoperability and information security at the same time
Blockchain technology gained international attention as the technology supporting bitcoin, a digital asset and a payment system that relies on peer-to-peer transactions taking place between users directly, without an intermediary. These transactions are verified by network nodes and recorded in a public distributed ledger, or the blockchain.
While acceptance has proceeded slowly, blockchain is gaining respect for its ability to support enormous data sets and transactions — and that capability has not gone unnoticed by healthcare industry innovators on the lookout for technology that can manage the evolution of complex and wide-ranging information systems.
Consultancy Deloitte, for instance, makes the case in a new report that a nationwide blockchain network may improve efficiencies and support better health outcomes for patients.
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“While blockchain technology is not a panacea for data standardization or system integration challenges, it does offer a promising new distributed framework to amplify and support integration of health care information across a range of uses and stakeholders,” the report explained. “It addresses several existing pain points and enables a system that is more efficient, disintermediated, and secure.”
The technology holds particular promise in use cases for Precision Medicine Initiative, Patient Care and Outcomes Research (PCOR), and the Office of the National Coordinator for Health IT’s Nationwide Interoperability Roadmap.
Indeed, Blockchain has potential value due to its shared, fixed record of peer-to-peer transactions, built from linked transaction blocks and stored in a digital ledger, Deloitte said. The network is both secure and actionable by relying on established cryptographic techniques, and letting participants in a network interact (e.g. store, exchange, and view information), without pre-existing trust between the parties.
“Interactions with the blockchain become known to all participants and require verification by the network before information is added, enabling trustless collaboration between network participants while recording an immutable audit trail of all interactions,” Deloitte explained.
This network architecture is potentially suited to work ONC has undertaken with its Shared Nationwide Interoperability Roadmap and efforts at defining critical policy and technical components needed for nationwide interoperability.
These ONC needs include ubiquitous, secure network infrastructure, verifiable identity and authentication of all participants, consistent representation of authorization to access electronic health information, and several other requirements. Current technologies do not fully address these requirements, because they face limitations related to security, privacy, and full ecosystem interoperability, the report said.
“The current state of health care records is disjointed and stovepiped due to a lack of common architectures and standards that would allow the safe transfer of sensitive information among stakeholders,” Deloitte said. “Healthcare providers track and update a patient’s common clinical data set each time a medical service is provided. This information includes standard data, such as the patient’s gender and date of birth, as well as unique information pursuant to the specific service provided, such as the procedure performed, care plan, and other notes.”
The traditional siloed approach of tracking information in a database within a singular organization or within a defined network of health care stakeholders runs up against the needs for greater interoperability across systems as data and records need to be distributed.
“Instead, health care organizations could take one more step and direct a standardized set of information present in each patient interaction to a nationwide blockchain transaction layer,” the report stated.
Both interoperability and security needs could be met through such a transaction layer.
Non-personally identifiable information that could enable health care organizations and research institutions to access an expansive and data-rich information sets could be made available on the surface information on this transaction layer and would not contain information that is not Protected Health Information or Personally Identifiable Information.
Information stored on the blockchain could be universally available to a specific individual through the blockchain private key mechanisms, enabling patients to share their information with health care organizations much more seamlessly. “This deployment of a transaction layer on the blockchain can help accomplish ONC HIT’s interoperability goals while creating a trustless, and collaborative ecosystem of information sharing to enable new insights to improve the efficiency of the nation’s health care system and health of its citizens,” the report states.
Before a health care blockchain can be adopted by organizations nationwide, several technical, organizational, and behavioral economics challenges must be addressed.
These include scalability constraints, or tradeoffs between transaction volumes and available computing power; data standardization and scope; adoption and incentives for participation; costs of operating blockchain technology; and regulatory considerations.
To shape blockchain’s future, Deloitte urged the U.S. Department of Health and Human Services to should consider mapping and convening the blockchain ecosystem, establishing a blockchain framework to coordinate early-adopters, and supporting a consortium for dialogue and discovery.
“The promise of blockchain has widespread implications for stakeholders in the health care ecosystem,’ the report noted. “Capitalizing on this technology has the potential to connect fragmented systems to generate insights and to better assess the value of care.”
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