Blockchain: Overhauling the ‘crippled’ record management system in healthcare

Ritesh Gandotra, Director, Global Document Outsourcing, Xerox India, elaborates on how adopting blockchain structure to EHRs will help manage authentication, confidentiality, accountability and data sharing while allowing medical researchers to access insights into medical treatment

For longest time, the healthcare sector has witnessed constrained development of fundamental design changes for Electronic Health Records (EHRs). Stepping into 2017, we’re faced with the critical need for innovation that not only personalises but also prompts patients to engage in the process of managing their medical data.

The current need of the industry is a solution that is not only innovative but also decentralised — a record management system that handles EHRs using blockchain technology. Historically, EHRs were never really designed to manage multi-institutional and lifetime medical records; in fact, patients tend to leave media data scattered across various medical institutes – as he/she moves from specialist to another or when visiting beyond your boundaries of your city. This transition of data often leads to the loss of past data. The problem is further aggravated as record maintenance can prove quite challenging to initiate as patients are rarely encouraged and rarely enabled to review their full records.

This leads to patients interacting with records that are fractured manner, reflecting how the records were managed.

If health records of patients are managed by a service provider, the interoperability challenges between different providers and hospital systems pose additional barriers to effective data sharing. This lack of a well-coordinated data management system results in the fragmentation of health records.

According to a 2017 Xerox eHealth Survey, 69 per cent of healthcare providers and payers are uncomfortable with the risks of value-based care, and 77 per cent agree that some providers are losing money by adopting the approach. Xerox addresses this concern by analysing a provider’s underperforming value-based contracts and identifying opportunities to improve specific financial and clinical contractual outcomes.

What is essential in today’s data-driven economy is how patients can benefit from a records management system that provides a holistic and transparent picture of their medical history. This proves critical in establishing trust, as patients that doubt the confidentiality of their records may abstain from full, honest disclosures or even avoid treatment. In the age of online banking and social media, patients are increasingly willing, able and eager to manage their data on the go.

Today, cloud computing among with the Internet of Things (IoT) concept is a new trend for efficient managing and processing of data online. Data management platforms based on cloud computing for management of mobile and wearable healthcare sensors, are demonstrating ways IoT is enabling healthcare.

According to the Protenus Breach Barometer report, there were a total of 450 health data breaches in 2016, affecting over 27 million patients. About 43 per cent of these breaches were insider-caused and 27 per cent due to hacking and ransomware. With the current growth of connected health devices, it will be very challenging for existing health IT infrastructure and architecture to support the evolving IoMT (Internet of Medical Things) ecosystems.

By 2020, an estimated 20-30 billion healthcare IoT connected devices will be used globally. Blockchain-enabled solutions have the potential to bridge the gaps of device data interoperability while ensuring security, privacy and reliability around IoMT use cases.

In essence, deploying a blockchain structure to EHRs makes lot of total sense. Building on a distributed ledger protocol originally associated with Bitcoin, a blockchain uses public key cryptography to create an append-only, immutable, timestamped chain of content. Copies of the blockchain are distributed on each participating node in the network. The Proof of Work algorithm used to secure the content from tampering depends on a ‘trustless’ model, where individual nodes must compete to solve computationally-intensive ‘puzzles’ (hashing exercises) before the next block of content can be appended to the chain. These worker nodes are known as ‘miners,’ and the work required of miners to append blocks ensures that it is difficult to rewrite history on the blockchain.

This clearly indicates why healthcare authorities, governments and the provider community globally are intrigued by the new possibilities presented by blockchain implementation. But at the same time it is critical for the industry to foster ecosystem partnerships and create standards or frameworks for future implementation at a macro level.

For the healthcare industry, a ‘block’ content represents data ownership and access permissions shared by members of a private or peer-to-peer network. By establishing a secure blockchain, medical records with viewing permissions and data retrieval instructions can be defined for execution on external databases. This can also allow a cryptographic hash of the record to ensure against tampering, thus guaranteeing data integrity.

The integrity and security of any and all blockchain transactions can carry cryptographically signed instructions – enforcing data alternation only by legitimate transactions. Such policies can be designed to implement any set of rules which govern a particular medical record, as long as it can be represented computationally.

Additionally, a blockchain ledger will help keep an auditable history of medical interactions between patients and service providers/ hospitals, likely relevant for regulators and payers (e.g. insurance) in the future.

In other words, adopting blockchain structure to EHRs will help manage authentication, confidentiality, accountability and data sharing while allowing medical researchers to access insights into medical treatment – potentially revolutionising how data is gathered and accessed for research purposes.