Block-Chain-Technology-in-Healthcare-By Claire Sweeney, Research Scientist, ARCH.

The buzz surrounding blockchain is rapidly approaching fever pitch, giving every Joe Soap the chance to take a gamble on the world of financial trading. However, there is much more to blockchain than just bitcoin. If you choose to believe the hype, then blockchain is a panacea for many of the problems encountered in today’s modern society. Even if you adopt a more cynical view, it’s hard to ignore the potential that blockchain offers to reform many industries.  In 2017, the Harvard Business Review declared that blockchain “has the potential to create new foundations for our economic and social systems” (1).

Blockchain can be a pretty difficult concept to get your head around, or at least it was for me! Bettina Warburg explained it quite simply in her 2016 TED Talk; at its core, blockchain builds upon a basic human principle which underpins many of our current institutions. We as humans are persistently seeking ways to reduce uncertainty about others, to exchange value as safely as possible. At present, political and economic institutions serve as middlemen to attenuate this uncertainty, through banks, corporations and governments, acting as gatekeepers of centralised data. However, this form of institutionalised trust, with multiple third-party intermediaries is expensive, time-consuming, and in many cases, ineffective. Blockchain replaces the middleman with complex mathematics to build a repository based on truth, not trust, cutting costs and saving time in the process.

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Blockchain creates a shared, distributed ledger that stores a registry of transactions and assets across a peer to peer network of synchronised, replicated databases, visible to anyone with access. Smart contracts permit transactions to be conducted between anonymous, disparate parties by creating an autonomous agreement which self-executes when the set of conditions previously agreed upon by two parties are met, thus eliminating the need for third parties (2). Cryptography secures transactions and locks the transaction history in blocks of data that are linked together. This creates an immutable, unforgeable record of all transactions across the network, on all computers using that network. The security benefits of this are unparalleled, as, if a historical block were to be adjusted, every other block in the chains chronology would also need to be hacked which is almost impossible.

Blockchain certainly holds potential in paving the way for the shiny new era of universal, interoperable Electronic Health Record’s (EHR), the utopia for many healthcare systems. A group of researchers in MIT are currently developing a system called MedRec, a novel, decentralised record management system utilising the blockchain technology. While the blockchain does not create a storage repository for patient’s medical information, it does provide an auditable record of the electronic chain of events, giving a clear log of data access and ensuring that the integrity of the data is uncompromised (3). This also holds considerable potential for realising the potential of wearable sensors, providing a secure means for patients to transfer the data from these devices to health care professionals and other relevant parties.

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Much of the discourse surrounding blockchain and the EHR centres around the enhanced ‘security’ of data which this technology confers. Certainly, blockchain safeguards against data tampering, but, as cynics are keen to point out, it does not independently increase data confidentiality. To ensure confidentiality, the underlying infrastructure storing the patient’s data needs to be carefully chosen (4). These weaknesses in the blockchain technology have been exploited by hackers in the context of bitcoin, with the exchanges and wallets used to store bitcoin data falling prey to repeated security breaches.

Another area in which blockchain is garnering significant attention is in the fight against counterfeit medicines. A recent World Health Organisation (WHO) report found that counterfeit drugs account for approximately 10.5% of medicinal products on the market in low and middle-income countries, encompassing all therapeutic categories and resulting in an estimated global annual loss of $200 billion (5).

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© INTERPOL

The effects of counterfeit drugs are far-reaching. In severe cases, they can result in death, disability or prolonged illness due to lack of clinical efficacy. Antibiotics and anti-malarials which are crucial in treating infectious diseases, account for 65% of counterfeited drugs (5). It is estimated that counterfeit medications may be responsible for 116,000 avoidable deaths from malaria and up to 72,430 deaths from childhood pneumonia (6). Clearly it is a public health priority to find feasible solutions to impede the circulation of counterfeit drugs and find safer supply chains. It is also a legal imperative with legal instruments such as the US Drug Supply Chain Security Act (DSCSA) necessitating that companies develop new electronic, interoperable systems to track prescription drugs to decrease supply chain leakage and reduce counterfeiting (7).

Existing supply chain models in globalised economies are long and complex with sourcing, manufacturing, packaging and distribution all occurring in different areas. At present, there is very little visibility for manufacturers throughout the supply chain to track authenticity. This creates multiple entry points for counterfeit products to enter the supply chain (8). Using blockchain technology, there would be a permanent, indelible, digitized record of trade workflow, tracking shipments from end to end so that all details such as date, location and storage temperature are logged.

Blockchain holds considerable potential for healthcare and beyond and if leveraged correctly, it could reform many of our current systems. One thing is for certain, even if the bitcoin bubble bursts, blockchain is likely to be around for many years to come!

 

If you have any research requirements which ARCH can assist you with, you can contact Claire on: claire.sweeney@ucd.ie or call 01-7165406.

Disclaimer: The views and opinions expressed are those of the author and do not necessarily reflect those of Applied Research for Connected Health or UCD. All content provided on this blog is for informational purposes only. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information. These terms and conditions of use are subject to change at any time and without notice.

 

  1. Harvard Business Review. The Truth About Blockchain Brighton, Massachussets: Harvard Business Publishing; 2017 [updated 2018 January; cited 2018 January 26th]. Available from: https://hbr.org/2017/01/the-truth-about-blockchain
  2. Visual Capitalist. The Power of Smart Contracts on the Blockchain 2017 [updated 2017 October 24th; cited 2018 January 29th]. Available from: http://www.visualcapitalist.com/smart-contracts-blockchain/.
  3. Harvard Business Review. The Potential for Blockchain to Transform Electronic Health Records Massachusetts: Harvard Business Publishing; 2017 [updated 2017 March 3rd; cited 2018 January 26th]. Available from: https://hbr.org/2017/03/the-potential-for-blockchain-to-transform-electronic-health-records.
  4. Broderson C, Kalis B, Leong C, Mitchell E, Pupo E, Truscott A. Blockchain: Securing a New Health Interoperability Experience. Accenture LLP; 2016.
  5. World Health Organisation. WHO Global Surveillance and Monitoring System for substandard and falsified medical products. Geneva: WHO; 2017.
  6. World Health Organisation. 1 in 10 medical products in developing countries is substandard or falsified. Geneva2017.
  7. Bernstein I, editor Drug Supply Chain Security Act. Presented at: FDLI DQSA Conference; 2017.
  8. Apte S, Petrovsky N. Will blockchain technology revolutionize excipient supply chain management? Journal of Excipients and Food Chemicals. 2016;7(3).