Blockchain in Healthcare: Evolution and Use Cases (Part-2)

In the last blog, we discussed how the financial incentives put in place through regulations encouraged healthcare providers to embrace health information technology (HIT). The investments in HIT infrastructure improved medical care and lowered medical costs. However, providers realized that data centralization limited their ability to achieve interoperability and made them vulnerable to cyber-attacks causing mistrust on HIT. We also explained how blockchain technology enables a standard trust architecture to overcome these problems by allowing untrusted entities exchange value by supporting immutable records. In this article, we will look at blockchain implementations and the possible use cases for healthcare providers.

Blockchain Evolution:

Since its genesis, blockchain evolved to expand its scope across industries. The first-generation implementation is digital currency (bitcoin) which enabled payments and remittances between different parties. Bitcoin is an open platform that solved the problem of double spending with digital currencies using proof of work where the group of miners will be rewarded to solve cryptographic puzzles to secure and approve transactions in a block.

The second-generation implementation enabled blockchain for general purposes through shared ownership of physical assets in digital form (ethereum). The potential use cases attracted enterprises (hyperledger) who could trade-off the openness of blockchain for speed. This trade-off classified blockchains into two categories: permissionless (open for anyone but slower) and permissioned (faster but limited access). In this phase, Turing complete smart contracts enabled computer programs to execute predefined actions after meeting certain conditions. This development led to decentralized autonomous organizations (DAO) as well as distributed applications (DApps) on blockchain platform, which attracted startups to issue tokens and raise funds through ICO’s.

The blockchain developers are working to achieve machine-to-machine economy by using on directed acyclic graphs (DAG’s) and algorithms that do not require a trade-off between speed and security while minimizing the computational power required to reach consensus. These advances in the DLT are enabling new use cases every day across industries. In 2018 alone, 50+ ICOs focused on healthcare are launched or scheduled for launch. In next section, we will highlight few use cases and ICOs working towards that –

1)   Interoperability - A decentralized patient-centric health information exchange

As we discussed in the earlier article, the data centralization resulted in security vulnerabilities which instilled mistrust among health providers towards HIT. This mistrust has become a massive barrier to share data between providers crippling the ability to improve care. ICOs like SimplyVital, MedicalChain, and MediChain are trying to solve this problem by putting medical record transactions on permissioned/permissionless blockchain to create a smart healthcare ecosystem. The patient data from different sources (wearables, practitioners, pharmacies, insurers) is encrypted and stored on the blockchain.

In a permissionless system, the patient owns and acts as an access control manager for their information. In a permissioned system, the healthcare providers (or other designated stakeholders) will own and act as the access control managers. The access control manager gives limited time access to stakeholders like practitioners, insurers, or researchers who wish to run advanced analytics to extract insights from this data. In both ways, there is immense value created using the collected data and the future depends on which system captures the most value.

2)   Data auditing and fraud prevention - A transparent healthcare organization

The immutability is an attractive feature in blockchain technology for people in management and governance positions who find “data massaging” as a hindrance to achieving transparency. A permissionless ledger providing access to same data for all parties can not only enhance transparency in data but also enables fraud analytics and risk management. Any fraudulent activity identified by a participant in the network is flagged and distributed to everyone immediately.

Prescription medication abuse is a public health crisis tearing apart families, driving up medical costs and a major enabler of medication abuse. These people get access to prescription medicines without medical justification through unethical practices or forged prescriptions. Medibond is working to set up a trinary multi-signature protocol to keep the process of filling prescriptions transparent and enable auditing the historical data.

3)   Crowdsource driven research - A distributed, autonomous research organization

Like privacy, health research has high value to the society. Healthcare research has led to significant discoveries, the development of new therapies, and a remarkable improvement in health care and public health. Advances in HIT transformed health research facilitating studies infeasible in the past, and leading to new insights regarding health and disease. Most of these studies are constrained by human or capital resources. Neuron is using blockchain and artificial intelligence to connect and empower patients with a common cause to collect data sets, raise funds and attract talent to drive healthcare research.

These are some use cases underway to shake up the healthcare sector. It's unlikely that all of them will succeed in disrupting the industry. However, even if a few succeed, the healthcare world will look dramatically different from the one we are witnessing today. The next generation of value-based care measures will be decentralized moving towards community-owned care.

Disclaimer: This article is neither an endorsement nor advises to invest in any ICOs/Cryptos.

About Authors:

Jaya Shankar Parimi, M.Tech, MBA – A certified blockchain expert with experience in healthcare, insurance, and manufacturing sectors developing technology solutions to improve business processes.

Vineeth Yeddula, CLSSMBB, PMP, CMQ/OE – Co-Founder, KPI Ninja. An entrepreneur and engineer by training with significant healthcare data analytics and performance improvement experience in multiple healthcare settings.