Managing medical records is a chore that hasn't yet found a satisfactory technological solution. Medical records differ from other databases in their size, importance, and the need for government-mandated privacy.
Medical records are exhaustive and can include both sensitive patient information and insurance-related paperwork. A single trip to the hospital can trigger an avalanche of associated paperwork. Much of this paperwork is mission critical, detailing other standards for care or sensitive billing information. And sensitive is the operative word regarding almost all medical paperwork. The U.S. government's strict Health Insurance Portability and Accountability Act of 1996 (HIPPA) controls who can view which records and when, and that particular law leaves truly little room for error.
The current technological solution for managing medical paperwork hasn't evolved much beyond dusty basements crammed with paper folders behind locked doors. There are some centralized systems in place, but they suffer from a host of problems - accessing information quickly, controlling access effectively, and making sure that unauthorized individuals can't get their hands on potentially sensitive information.1
This kind of information management can literally be the difference between life and death. Medical records detailing an allergy that don't get to the right caretakers in time can result in accidental deaths, and a single significant hack of an organization's medical records can compromise thousands of individuals.
Blockchain offers a solution. Blockchain's core tenets of security and transparency are perfect fits for the medical records industry, with the potential to replace cumbersome paper systems and centralized servers alike. We're going to take a brief look at the advantages the blockchain can give to medical records management and take a look at some of the projects active in the market now.
First, let's look at the three prevailing data management strategies in use today - push, pull, and view - and how blockchain offers an advantage over each.2
Push systems rely on encrypted data channels to transmit patient information from hospital to hospital. They require sturdy, permanent infrastructure to keep them secure. Flexibility is extremely low, as push systems as "pipelines" for data from one hospital to another.
Pull systems are the inverse of push systems. They also require prebuilt infrastructure, but the information is available on request. In other words, a medical provider asks the hospital for information. It suffers the same drawbacks as pull systems when it comes to flexibility.
View systems can be thought of as push-pull lite; the data are held in a central location and can then be viewed, but not accessed or changed, by medical professionals.
All three systems require a rather heavy infrastructure and byzantine requirements for access. There is also no standardized audit trail on any of the systems, so changes made by one provider may not be registered or recorded correctly by another. Finally, there's the issue of software. If two providers use incompatible or imperfectly compatible software, the opportunities for faulty or misplaced information multiply. Incompatible systems also create a host of vulnerabilities that potentially malicious actors can use to illegally access sensitive medical information.
Just for starters, there are fully 26 different medical record information systems in the city of Boston alone.3
The blockchain's advantages over traditional systems are immediately obvious. The secured ledger system ensures that all information entered into the blockchain is immediately encrypted and available only to those with the necessary access.
That wouldn't be a giant leap over traditional systems without the key blockchain innovation of limited transparency. The data available on a blockchain are available to all participants in the chain, although the ability to change or access key portions of that data is limited via the use of private keys and other cryptographic technology.
In a blockchain system, two medical providers can quickly share necessary information without risking data "leakage" through insecure channels. Blockchains are also famously interoperable, so there's no need to fret about proprietary systems or standards. The blockchain itself acts as an information protocol standard - specifically, it dictates how information is stored and how it may be shared.4
Patients can also access blockchain information, rather than going through the usual cumbersome secretary-paper protocol or labyrinthine terminal systems. Each patient, potentially, could be made the guarantor of his or her own personal information via a private key on a medical blockchain. This also has the advantage of improving patient choice. The concept of linked hospital or doctor networks could become meaningless since the patient possesses the ability to freely move his or her information to a new provider.
There's a further, more Sci-Fi benefit to putting medical information on the blockchain. The growing use of artificial intelligence to examine blockchain information could put powerful tools in doctors' hands when it comes to making diagnoses or tracking the spread of infectious disease. Adoption may be a slow, painful road - like it is with most blockchain systems - but the blockchain coupled with artificial intelligence represents an entirely new way of processing and interpreting medical information.
Despite the Sci-Fi premise, there are several major projects already working to integrate the blockchain with extant medical technology.5
Nebula Genomics is taking a shot at handling medical records above and beyond the mundane.6 The project is aimed at sorting through and cataloging the immense amount of information generated by research into the human genome. The goal is for a patient to possess his or her full genomic medical history, spurring both research and potentially new cures based on the data. Nebula's project is a far cry from managing broken bones and sniffle-related doctor visits, but it serves as a powerful proof of concept for the future of the industry.
Doc.ai takes this idea a step further.7 The project is geared toward collecting medical information from individuals and using it - combined with artificial intelligence - to look for patterns related to health and possible treatment. Think of it as a much more advanced version of someone googling their symptoms or scanning WebMD to find out exactly what's wrong. The data collected by Doc.ai can be shared with medical providers to replace the usual checklist of screening symptoms most of us have to endure when we visit a doctor's office, and it can point to real, fast solutions to medical problems.
Finally, Patientory brings it all together with a unified system for sharing medical information between hospitals, care providers, and patients.8 This is the holistic holy grail that aims to replace both paper records and centralized systems with quick, mobile capable management of patient medical information - without risks or reams of paperwork.
Medical technology is perhaps one of the most mission-critical new applications for the blockchain, and the potential for this tech to change and even save lives is immense. Moreover, the blockchain promises to advance not only how medical care is recorded and billed, but essentially how it's done. Projects like Nebula and Doc.ai offer a radical alternative to traditional research and diagnostic methods, while platforms like Patientory promise to make the data gleaned from these systems easy to transmit and use.
Blockchain technology has grown by leaps and bounds, from new financial systems to the Internet of Things. Now, the blockchain may very well be changing the way we live and take care of ourselves.
1) Moving Patient Data Is Messy, But Blockchain Is Here to Help, Wired. https://www.wired.com/2017/02/moving-patient-data-messy-blockchain-help/
2) The Potential for Blockchain to Transform Electronic Health Records, Harvard Business Review. https://hbr.org/2017/03/the-potential-for-blockchain-to-transform-electronic-health-records
3) Who Will Build the Health Care Blockchain, MIT Technology Review. https://www.technologyreview.com/s/608821/who-will-build-the-health-care-blockchain/
4) Are Blockchain and AI the Keys to Unlocking Interoperability in Healthcare? Medical Economics. http://www.medicaleconomics.com/health-law-and-policy/are-blockchain-and-ai-keys-unlocking-interoperability-healthcare
5) 12 Companies Bringing Blockchain to Healthcare, Medical Futurist. https://medicalfuturist.com/top-12-companies-bringing-blockchain-to-healthcare/
6) Nebula Genomics. https://www.nebulagenomics.io/
7) Doc.ai. https://doc.ai/
8) Patientory. https://patientory.com/