Applying blockchain to health

When discussing blockchain, many may express that they know little (if nothing) about it. Others may consider it as another fad that will blow over soon to make place for the next one. However, blockchain should be regarded as a revolution, and its principle and applications are not that complicated, but more importantly, this technology is truly becoming a new standard encompassed in our daily activities, including in the health sector.

What is a blockchain?

Principles

Imagine a big register, just like an account book, which registers all the exchanges made between users of a given network. This registry offers a history and among its features, is shared among all members of the network, as everyone has a copy automatically updated.

Transactions are stored in encrypted form and written as blocks. These blocks are linked, each one added to the previous one. We have just described is a blockchain.

This register allows at any time to trace back all transactions since its creation. Each block as linked to other blocks by the data it contains. It is very difficult if not impossible to edit a recorded transaction. Thus, the longer the blockchain is, the more participants are included in the network, the more secure the blockchain is.

In fact, there is not a blockchain but many blockchains, all different, with a specific set of goals. The reading, writing or validating rights of these registers are described from their inceptions and are established accordingly to the intended use. These rules don’t change (except in exceptional cases).

Bitcoin, the first customer-oriented application of blockchain

Following the financial crisis of 2008, bitcoin was the first decentralised and digital cryptocurrency created. It is a new means of digital transaction independent from any financial authority and is the first application of new technology. Blockchain. Its founder, Satoshi Nakamoto, said: "The root problem with conventional currency is all the trust that's required to make it work. The central bank must be trusted not to debase the currency, but the history of fiat currencies is full of breaches of that trust."

Blockchain is based on a trust built upon a large number of participants who secure the protocol. Beyond the fact that many people talk about crypto-currencies, which are just a financial application of this technology, this type of protocol could indeed revolutionise the health industry of tomorrow.

What applications in health?

Even if they are not well known to the general public, many companies are established every month dedicated to applying Blockchain to health. Many areas can be radically changed by blockchain. Most envisioned applications of blockchain shared a few of the following characteristics: an exchange of information between several actors, with a need for protected access; a (certified) inability to falsify data; a decentralized approach (and therefore continuous access including when server failures); the automation of sensitive processes and / or the interoperability of different IT systems.

Personal health data

Sharing of health data, whether produced by a patient/citizen or a health professional, are suitable for the use of blockchain. The volume of data is constantly growing, through more extensive documentation of health professional activities, but also through the use of connected devices or other activity and event tracers. The use of blockchain for Shared Medical File should also be considered, especially when considering the many challenges encountered by many countries. It could allow a patient to manage personal data in a transparent, safe and tamper-proof manner, and decide who can access this data among various stakeholders in health: medical doctor, pharmacist, pharmaceutical industry or health insurance for instance. Health data will be stored in multiple copies using encrypted forms, or on a specific server whose access is secured by a blockchain. The patient will be the only one having the digital key to access and share data of his choice.

Drug Authentication

Another field to consider is traceability within a supply chain. Such traceability has been included in the European Falsified Medicines Directive, which has led to the establishment of a medicines verification system at the point of dispensing.

The solution currently under implementation relies on trusted third parties (called National Medicines Verification Organizations) which centralise data on each box produced by the pharmaceutical industry. At the time of dispensing, the pharmacist will check the authenticity of the drug by scanning a box-specific QR code.

One can imagine that the use of Blockchain could simplify and automate the process of drug authentication in European countries or make it possible to develop a low-cost solution for developing countries.

The food industry has already integrated these opportunities and is currently testing them. Carrefour (a major French supermarkets chain) uses blockchain to trace chicken chain using CrystalChain. Each intermediary has a unique identifier allowing to add a chain after the others.

Certification and monitoring of outsourced processes

As the pharmaceutical industry outsources more and more activities, more and more players are involved. How to ensure the public trust? Blockchain technology could bring many solutions.

Applying blockchain to all the processes of research, development and manufacture of medicine mean that the entire history of a finished product is recorded, secured and inalterable. Thus, even if powered by external providers, this blockchain would allow audit process at any time and facilitate easy access to all relevant information for instance in case of crisis. A standardised system between all actors involved could be applied in particular to clinical trials or quality control and batch release (with the potential to limit shortages or batch recalls).

Claims to health insurances

Another field involving information transfer is health insurance claims (for health products and/or services). Blockchain could be a strong asset given the inalterability of claims. If data of dispensing (or authentication) is crossed with claims, fraud detection would be easier, but also claims may be better monitored (and quickly processed). This would be a real time saver for health professionals and insurance companies. Blockchain has the potential to offer an automatic, secured and almost immediate process to pay claims.

Medicines records of the pharmacy

In many countries, community pharmacies have to keep records of the dispensing of specific medicines, such as psychotropic drugs, narcotics or other medicines monitored because of a significant risk of misuse.

And many other applications

Among other applications, one can imagine more collaborative research, and therefore more efficient while securing the interests of the parties involved in this research.

More and more pharmaceutical companies have developed or supported Patient Support Programs, which aim to empower specific patients living with their treatment. Greater confidence could be gained if blockchain is used when sharing data, resulting in the wider use of such programmes and improving patients treatment.

Conclusions

Many people talk about blockchain, but in fact, there is not a single blockchain, but several. This technology has its limits and needs to be further improved. But it is the key to many major innovations in many areas. It is no coincidence if Google’s interest dates back to 2012 and if IBM is already offering its services in this area. Applications of blockchain are multiple, and we are only at the beginning of its development in health, given its advantages (see above, with the characteristics).

Blockchain threatens the idea that we need a trusted third-party in the authentication and integration of data. Just like architects who once traded drawing tables for computer-assisted drawing (CAD) software, blockchain will challenge the roles of many players as the use of this technology will expand in health and beyond.

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Article co-authored with Ambroise Payelleville. For the French version: https://www.dhirubhai.net/pulse/blockchain-son-impact-pour-la-sant%C3%A9-ambroise-payelleville/