Blockchain in healthcare
Tags: blockchain, blockchaintechnology, ethereum, smartcontract
Published: 2022-07-08 07:52:48

To many blockchain technology is an elusive concept, a phrase constantly spouted by awkward socially inept tech guys, and eccentric semi-deranged radio talk show hosts. To them and many, it’s just a buzzword. The concept of [blockchain technology](https://medium.com/@elena_al/blockchain-technology-f57f97c9fa6c), actually, is quite simple. It is a ledger that holds records1 called blocks that have the cryptographic hash of the previous block, a timestamp, and whatever data is relevant to the blockchain. This ledger is decentralized meaning that it doesn’t exist on a single machine; this is achieved through different means. An example is Bitcoin’s blockchain made up of different nodes in a large network that connect with each other to make sure that the same copy of the blockchain exists on each node as new blocks are added. 

Another example is Ethereum where its blockchain exists on the Ethereum Virtual Machine that’s on all computers and applications that utilize it. In the case of Ethereum and similar blockchains, it has been shown to have applications beyond currency. Within academic circles, the power of blockchain technology is discussed, yet that application rarely rolls out and is applied in one particular field: medicine. This is odd because it has a huge potential to transform data management and security in the medical field. In particular, blockchain technology would be a solution to the medical industry’s lack of collaboration between different medical institutions, lack of a true central data pool, and often lackluster data security. A big challenge in the medical industry that is surprisingly not discussed much is the lack of a centralized place to store medical data in digital form. 

While doctors will communicate with each other, and findings and studies are published in academic journals, that is about the extent of it. Every medical institution possesses its own database of patient data and such. When a patient is involved with more than one institution, their data is simply sent between institution databases. Due to a lack of a central database, data can easily be lost. An additional weakness is that data can also be obscured from  those outside of the medical institution that possesses it. This was revealed to be happening in mid- 2016 when two John Hopkins professors found that at the time, the third leading cause of death in the  United States was medical errors. This was due to way that deaths in the United States through the International Classification of Diseases (a.k.a., ICD) used to codify the many different ways that people die so that data may later be used for statistics. The problem, as noted by Dr. Martin Makary, is that “it was under-recognized that diagnostic errors, medical mistakes and the absence of safety nets could result in someone’s death, and because of that, medical errors were unintentionally excluded from national health statistics”. 

Hypothetically, let’s say there existed an Ethereum-esq blockchain that tracked every death in the United States or possibly even the world. Within the blockchain would be profiles on every person ever involved in the medical industry, whether it be an individual that got a single check up or an individual that was a patient undergoing multiple procedures for many years. This data would be stored in a raw state and reconstructed when called upon. The creation of any change to an individual’s data or the creation of a new profile would be sent from a node and would have to receive the consensus of the other nodes in the network to be added to the chain. These nodes would actually be special computers. Each medical institution would be allowed one of these special computers, and their sale would be regulated so as to gate-keep who has nodes on the network to prevent malicious actors from having an influence on the network. Similar blockchains already exist such as the one created by Honeywell to act as a repository and database.
 
Like the hypothetical blockchain described previously, it contains every part created since creation of the Honeywell blockchain. Data is stored as raw data. Only users authorized by Honeywell can access and add new blocks to the blockchain. The main difference is that the data is immutable. As a result of this, it is a lot easier to access the data. Any one with access to the blockchain would need only a part number and serial number to access the part information they are seeking. Going back to the medical error deaths, if we had a singular blockchain  similar to the one described that was searchable using fields such as names or social security numbers and contained information on deaths, the likelihood of such a crisis of medical error deaths continuing  would lessen. This is because there would be a source of data that would be easily but securely update- able as well as very accessible to those that could benefit from the information.
 
Another challenge that the medical industry faces is the lack of a central data pool. As mentioned before, though doctors sometimes collaborate with each other, they mostly work individually or within their own institutions. The worst effects of this present themselves during public health crises, such as the COVID-19 pandemic. When COVID hit the United States, it was unprepared and unable to manage the infection data. It took months to get a sufficient infection informatics to get an idea of how many citizens was infected with COVID. One such negative consequence of this is since the COVID-19 pandemic began, there are many fake test results that have circulated. This is because many things, such as intercontinental travel, now require you to have proof of a negative COVID test. However, it has been proven that test result scams “may have less of a chance of succeeding in destinations that require all test results to be delivered electronically instead of accepting printed forms”. If we had a blockchain similar to the one previously described that also tracked the presence and spread of diseases, scams such as this would be less likely to succeed, because as the sale of blockchain nodes would be regulated so only verified medical institutions would possess one. This would mean that test results not given by real medical officials would not appear in the blockchain and would be easily identifiable as being fake.
 
A similar idea has been created by the Indian company BelYO. COVID test results are kept digital and the blockchain therefore acts as a way to verify test results, as the only valid test results exist in the blockchain. Unfortunately, from our point of view, this project is very short sided. The COVID-19 pandemic, as much as some may not want to, will eventually end. In the future there will be different pandemics with different diseases. However, these diseases will likely  be similar to previous diseases. After all, COVID-19 is a SARS virus. The vision we have for a disease tracking blockchain is much bigger. It would contain profiles of all kinds of diseases, as well as data on their biology. By inputting information such as symptoms or maybe even the chemical composition of the disease, a search could return the disease(s) that most match the information given. Only verified medical institutions would have access to the blockchain and could add/change information to it. This would be useful beyond a single pandemic and could even be tied to the previous conceptualized patient data blockchain in order to track disease statistics globally.

As mentioned before, blockchain technology can offer a level of security that previous types of technology don’t. This is excruciatingly important, as the medical industry is increasingly targeted by bad actors, seeking to exploit weaknesses in their cybersecurity. As described by Josh Corman, a former member of the Congressional Task Force for Health and Human Services, at the 2017 RSA Conference, “75% of health delivery organizations in US have zero security staff” (13:25-13:30). At that same conference, he also mentions how most computers in hospitals run long outdated software and operating systems such as Windows XP, and mentioned how a single well known flaw in a software known as JBoss caused an entire hospital to be shutdown, all patients moved and all incoming patients redirected to different hospitals. This could have been avoided if the device running JBoss simply said what version of the software they were using, and Corman acknowledges this. Where blockchain technology fits into this is if hospitals were forced to used one piece of software, such as a single blockchain, again being decentralized but also singular and non-forking, this would take the task of managing security out of the hands of individual hospitals. To be it frankly, it’s been shown they can’t handle the task. The blockchain would be maintained by a group of IT professionals that also  were aware of the needs and features required by the medical industry.
 
A place such as [GitHub](https://github.com/) could be where doctors and other medical professionals would post suggestions for features and such. An example of where a decentralized blockchain would benefit hospitals is as a replacement for a system of usernames and passwords. Sharat Chandra proposed in her article in the journal, Express Computers, the idea of how “password-less authentication is one of the forms of Multi Factor Authentication(MFA) and uses either fingerprints or bio-metrics. A blockchain-based password-less authentication solution replaces usernames and passwords with bio-metrics thereby mitigating risks and uses zero trust security to enhance employee experience”. She describes how these bio-metrics would act as the field necessary to get access to the blockchain. This would act as the means by which transactions take place, as a way of putting it. Another thing that Josh Corman brings up in his talk is that most medical devices “have hard-coded passwords directly connected to the internet,” and changing them will often void that device’s maintenance contract (22:00-22:12). Chandra’s idea could be implemented by, say, having the blockchain be directly tied to the hardware. The hardware could be activated by something like a smart contract, an idea taken from [Ethereum](https://en.wikipedia.org/wiki/Ethereum), where instead of taking ETH to function, the smart contract would accept the bio-metrics as “currency”. In conclusion, the biggest way that blockchain technology may benefit the medical industry is by taking the technology out of the hands of individual medical institutions.