Moving Patient Data Is Messy, But Blockchain Is Here to Help

I interrupt the healthcare debate with a brief discussion of blockchain, which in some convulated way is related to the debate, but also to discussion of data sharing.  The article in Wired, starts by saying the new Secretary of Health and Human Services, Tom Price, came out against electronic health records, the digital histories patients make every time they see their doctor or go to the hospital. “We’ve turned physicians into data entry clerks,” he said, arguing that the burdensome recording systems need an overhaul.

As  you should know by now, for decades (even before the ACA, but certainly after), many hospitals are still struggling with  EHRs to address standardization and high quality health care. But while federal laws and incentive programs have made health care data more accessible, the vast majority of hospital systems still can’t easily (or safely) share their data.

Enter blockchains. While blockchain is probably best known for powering bitcoin, it’s really a generic tool to keep secure data in a distributed, encrypted ledger—and control who has access to that ledger.  This one shared ledger is spread across a network of synchronized, replicated databases visible to anyone with access. Which gives it unprecedented security benefits. Hacking one block in the chain is impossible without simultaneously hacking every other block in the chain’s chronology.

“Now is probably the right time in our history to take a fresh approach to data sharing in health care,” says John Halamka, chief information officer at Boston-based Beth Israel Deaconess Medical Center.  “The EHRs may be very different and come from lots of different places,” Halamka says, “but the ledger itself is standardized.”   Halamka gives a simple example: prescriptions. Say that one medical record shows a patient takes aspirin. In another it says they’re taking Tylenol. Maybe another says they’re on Motrin and Lipitor. The problem today is that each EHR is only a snapshot; it doesn’t necessarily tell the doctor what the patient is taking right now. But with blockchain, each prescription is like a deposit, and when doctor discontinues a medication, they take a withdrawal. 

So, looking at a blockchain, a doctor wouldn’t have to comb through all the deposits and withdrawals—they would just see the balance.  The software timestamps each validated block and adds it to a chain of older blocks, in chronological order. The sequence shows every transaction made in the history of that ledger (a chain of blocks - blockchain).  And crucially for patient privacy and security, hospitals and pharmacies don’t have to send data back and forth to see it. They just all have to point to the same common ledger.

Feel free to add what you know about blockchains in other industries or businesses, or other details.