Blockchain in Healthcare: Opportunities and challenges

The use of blockchain in healthcare is a relatively new innovation with many of its uses still being explored and related technologies being developed, improved, and scaled.

As the pandemic continues to wreak havoc globally, healthcare systems are under tremendous stress, dealing with significant challenges including supply chain disruptions, counterfeiting of medical products, health data management, and security, among others.

To fix some of these issues and better prepare global health systems for future health crises, the industry is turning to new and emerging technologies like blockchain, the technology behind cryptocurrencies.

In this article, we'll be exploring the potential applications and use cases of blockchain and how the emerging technology can help address the major challenges the healthcare industry is facing today.

What is blockchain?

Blockchain is a decentralized and distributed database architecture that enables multiple independent and self-governing domains to co-operate and co-ordinate and collaborate in a rational decision-making process. The system achieves the aforementioned characteristics through series of time-stamped blocks which can not be altered randomly, instead the blocks can be changed or appended only through a consensus protocol that involves solving a mathematical equation (called mining) until it evaluates to a pre-determined criterion.

The use of blockchain in healthcare is a relatively new innovation with many of its uses still being explored and related technologies being developed, improved, and scaled. Security, interoperability. data sharing and data access are essential elements of a healthcare database. Blockchain promises to be a panacea as security is at its foundation, properties such as immutability, assured authentication, centralized access, and storage make it promising.

Blockchain in Healthcare: Opportunities

Blockchain is versatile in its scope, and it derives its versatility because of its ability to be applied to a set of processes applied through independent modules. Here we will explore some common applications and use cases of the distributed ledger technology in the healthcare industry.

Building trust in telehealth

As telehealth services are gaining momentum, concerns surrounding data security and privacy are also increasing. Blockchain can help establish a chain of digital trust between the patient, connected medical devices, and healthcare providers.

Blockchain provides a more secure way to exchange Electronic Health Records (EHR) containing sensitive private information. Because the records are shared only with authorized network members, participants don't have to worry about the misuse of sensitive medical information by any third party or unauthorized member.

Additionally, blockchain-based smart contracts, a self-executable computer program or transaction protocol, can bring greater trust and security in healthcare. A smart contract executes automatically and triggers the next step only when a predefined condition is met. Most importantly, blockchain transactions are encrypted and there is no third party involved, which means no one in the chain can alter the information for personal benefits.

Given the immutable nature and near real-time visibility of transactions, a high level of trust and transparency is achieved.

Identity verification

The concept of secured ledgers with unique authorization keys makes blockchain an ideal tool for identity verification. This can allow for the development of a system where the use of healthcare data can only be anchored by the individual whose data needs to be used.

For instance, Guartime, a data security firm headquartered in Netherland, partnered with the government of Estonia to create a blockchain system to validate patient identities. The citizens were issued a smartcard, where each card was linked to a block in the blockchain network, smartcard acted as the key which would be used to authenticate the access or change in data.

Clinical trials 

Blockchain can be a game-changer for improving the transparency and accountability of clinical trials. It not only enhances the integrity of clinical trial data but also helps enforce trust amongst various stakeholders.

Since data records are immutable in blockchain, it is nearly impossible for drug companies to influence the outcomes of clinical trials. It also facilitates secure, real-time sharing of information within a trusted framework, preventing any misuse of medical or patients' personal data.

The blockchain architecture, through custom design, can be tailored to ensure only verified data point is entered into the database. This will also allow for peer verification of clinical trials without data owner sharing or losing control over the data.

This way blockchain can solve two major problems of clinical trials - verifiable data integrity, data exchanges, and trust for collaboration.

Supply chain visibility and drug traceability 

Counterfeit pharmaceutical products pose serious health and safety issues. According to the World Health Organization (WHO), an estimated 1 in 10 medical products circulating in low- and middle-income countries is either substandard or falsified.

Now, the ongoing pandemic has exacerbated the pre-existing challenges as fraudulent life-saving medicines, test kits and vaccines are increasingly being produced.

Blockchain can play a key role in improving supply chain visibility and addressing the growing menace of counterfeit drugs. As a pharmaceutical product moves through complex distributed networks, this technology can be used to trace the origin of the item and verify its authenticity. With its shareable ledger and immutable data, blockchain can track the complete production journey of an item within few seconds and help reduce fraud.

For instance, the IBM Blockchain Transparent Supply solution enables goods-specific transparency across multiple supply chain partners. The solution helps:

• Establish supply chain integrity with step-by-step visibility of cold chain sensor data - from manufacture to delivery
• Fight fraud and theft 
• Drive time and cost out of the supply chain with data and digitization
• Address regulation requirements for drug tracking

Insurance claims 

Building customer trust, data management, and ownership, and preventing identity theft are some of the key pain points faced by both insurers and consumers in the insurance industry.

In the healthcare industry, blockchain technology can be used to fight fraudulent medical insurance claims, automate the processing of genuine claims and minimize identity thefts. Here's how:

• Transactions in a blockchain network are immutable which means they can't be altered or deleted. The transaction data can only be accessed by authorized peers, hence there’s little to no chance of fraud
• Smart contracts can be used to automate the processing of valid claims, resulting in improved customer experience. 
• Because there is no centralized server, identity information remains with the consumer. Also, any changes made will be visible to all participants in the value chain, thereby reducing the risk of identity thefts

Blockchain: Challenges and limitations

As with any emerging technology, Blockchain has its own limitations. One of the important issues with the blockchain vis-à-vis traditional data storage approaches is the distribution of personally identifiable healthcare data within a public ledger essentially giving access to the data to everyone in the network. The relatively incipient stage of the innovation means the adaptation of this technology is limited which leads to a lack of standardization in the industry which poses its own set of challenges in harnessing its full capability.

Information saved in the blockchain database needs to be secured and authenticated for use through a cryptographic process that requires the use of private and public keys. The keys required by different cryptographic processes are shared by all participants thus requiring a level of access control. Existing key management principles are not suitable because one key for all blocks means if the key is compromised, all the block can be accessed, similarly different key for a different block is not practical as it will increase the cost of storing and recovering data.

Scalability is another limitation of the blockchain system, as the number of blocks increases the system continues to become slower and requires ever more computational power and energy to function. This can be even more complicated in an IoT environment where the flow of data needs to be instantaneous.

The problem can also be complicated by the limited computational power of smart devices which are not designed to carry out computational tasks, instead, they are designed to record and transmit data, which works well in a legacy database infrastructure but may pose difficulty in a blockchain network. This may also make the sensors more expensive due to overhead on the flow of data that needs to be done

Further, there are vulnerabilities that are specific to the technology. Blockchain works through a consensus protocol that involves solving computationally complex problems. To solve the specific cryptographic problem, a miner needs to download all of the data into the local system which can run into gigabytes or even petabytes depending on the application.

In addition, usually, there is a limit on the number of transactions that can take place in the blockchain network in a unit of time, which can potentially limit the throughput of large chains. A malicious actor can severely damage the network by withholding part of a mined block which results in reduced incentive for mining which will impact the network's ability to expand blocks. Similar a double-spending attack can be carried out by reproducing the piece of digital information and thus producing a clone of a node in a network.

VisionRI's Centre of Excellence on Emerging Development Perspectives (COE-EDP) aims to keep track of the transition trajectory of global development and works towards conceptualization, development, and mainstreaming of innovative developmental approaches, frameworks, and practices.