Blockchain: Addressing interoperability challenges in healthcare

October 4, 2018

This technology could have a disruptive effect on the industry in the next five years.

With the potential to deliver an efficient, cost-effective, reliable, and secure system to conduct and record transactions, blockchain is quickly gaining popularity in the enterprise space. What started as an enabler of cryptocurrency transactions has today found mainstream adoption across the banking and gaming industries. Given its inherent benefits, healthcare is likely to be the next big adopter of blockchain technology. 

According to a Frost and Sullivan report, blockchain would have a disruptive effect on the healthcare industry over the next five to ten years. Forbes calls blockchain the unifying glue that will hold together a highly fragmented healthcare record. Many regard blockchain’s potential to resolve healthcare interoperability challenges as a game changer. 

Blockchain basics

To understand blockchain’s impact on interoperability, it’s important to understand how blockchain works in simple terms. A blockchain database is a distributed database that records and stores transaction data in the form of time stamped “blocks” linked to each other in such a way that no one can alter any transaction data. Members of the blockchain network who validate the transactions are called nodes. Blockchain technology allows different types of nodes to enter the network using specialized software to perform different functions like mining and storing data.

Mining nodes in the network are assigned a secret private key that is paired with a public key. The public key acts as the “public address,” which is visible to all participants. The private and public key pair is cryptographically linked such that identification is possible in only one direction using the private key. Hence, a message encrypted using a private key can only be read by any node with a public key linked to the private key, thus limiting the number of users to access or read an encrypted message or the corresponding data. 

Any action on a blockchain is a function of the network, so to alter any transaction data, a person would need to modify the same data in all the nodes in the network – making hacking practically impossible as someone would need to hack into all the systems in the network at the same time. In addition, blockchain is consensus-based, so every transaction needs approval from more than half of the participants or nodes before execution. While every transaction in blockchain is public, access to the content of each transaction can be restricted based on the sensitivity of the transaction.

Blockchain addresses current interoperability challenges

One of the key challenges in healthcare interoperability is that healthcare organizations are at different maturity levels when it comes to their data quality, governance mechanisms and use of standards. Some organizations tend to use FHIR (Fast Healthcare Interoperability Resources), while others use the CDA standard for data exchange. Still others share data using the HL7 2.x standard. These varying data standards directly reduce interoperability. Enter blockchain, which helps overcome this challenge by accessing data through APIs. This achieves standardization of data formats to enable seamless data transmission, irrespective of the capabilities of EHRs to communicate with different HL7 versions. Moreover, blockchain addresses current challenges around syncing patient data with multiple, disparate healthcare information systems, while assuring patient data security and privacy through a distributed framework for managing patient identity. 

Breaking down EHR data sharing barriers

Blockchain architecture is built on principles of decentralization and cryptography, which could contribute to more secure and highly interoperable EHR systems. From the patient perspective, the challenges of interoperability manifest in the sheer number of systems where parts of a patient’s record are stored. While the ideal is to make patient information accessible to any care team member at any point of care at any time it’s needed, currently, patient data is stored in silos that don’t interact with each other. This lack of coordination in data management and exchange 

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With a blockchain implementation for EHRs, members of a private, peer-to peer network can share the block content with appropriate viewership permissions, while the original member maintains ownership of the data shared. Data sharing is managed with “smart contracts,” which are self-executing contracts that embed the terms of agreement within them. Smart contracts allow automation and tracking of state transitions, such as a change in viewership rights or creation of a new record. To guarantee data integrity, blockchain includes a cryptographic hashing of records. 

In this architecture, it’s the patient who holds the stewardship rights to their health record, and access is permitted to only limited healthcare entities (people or organizations) through smart contracts. Members of the patient’s care team can add new records to a patient's profile, and the patient authorizes specific providers to view, or even update, the information. Shared data across the blockchain network enables near real-time updates across all healthcare entities. In addition, it is the same data that is available to all, reducing data duplicity. Not only does this approach improve patient and provider engagement, it contributes to the evolution of patient records to be truly patient-centered and patient-controlled. 

Changing healthcare for the better

As blockchain technology continues to evolve, its long-term impact, especially in healthcare, is likely to be profound. As commercial blockchain solutions begin to reach the market, we would see many new features and capabilities that enhance healthcare interoperability and data sharing, while ensuring the highest possible levels of data privacy and security. With greater adoption of blockchain in the healthcare context, it may offer some real solutions to the interoperability challenge, while also putting patients fully in control of their health records.

Dhaval Shah, Sr., is vice president of the medical technology market for CitiusTech, a specialist provider of healthcare technology services and solutions.