The potential of blockchain for healthcare – the hype and the reality
Blockchain technology can profoundly transform healthcare IT for the better. Unfortunately, with the current hype, blockchain is used and abused as a panacea for many issues of modern healthcare IT, namely interoperability and secure storage. Blockchain will not solve those issues and expecting it to is setting ourselves for failure and disappointment.
Interoperability
Interoperability “describes the extent to which systems and devices can exchange data, and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user.”
While blockchain technology could potentially provide the foundational interoperability (allowing data exchange from one IT system to another), it does not provide structural (the structure or format of data exchange such that the purpose and meaning of data is preserved and unaltered) or semantic (the ability of two or more systems to exchange information and to use the information that has been exchanged) interoperability, which is what we need to achieve in Healthcare IT.
Let’s look at digital photographs for comparison. If every smartphone would use its own standard for storing and displaying digital images, the photos we take would never be able to leave our phones and be shared with our family and friends. For that reason, phone softwares have adopted common standards for digital images and that makes exchanging digital photographs quick and effortless.
In a similar fashion, healthcare IT interoperability can only be achieved by standardised data formats and interfaces for data exchange. Blockchain cannot solve this problem. This means Healthcare IT vendors must stop their practices of rent-seeking through vendor lock-in by using proprietary standards and adopt open standards such as OpenEHR for electronic health records data format and OpenAPI for data exchange.
Secure storage of data
There are two issues when using blockchain as a secure storage of health data:
Inefficiency – Blockchain is a network of thousands of nodes and a piece of information added to the blockchain is stored on each and every single node of the network, replicating it thousands of times. This makes storage incredibly expensive and inefficient. To prevent data loss, replicating it a few times is enough and we do not need blockchain to do this.
Openness – All data stored on the blockchain is publicly accessible. We do not want to or are legally allowed to make personal health data available to everyone. Often a proposed solution for this is to encrypt the data before storing it on blockchain. That is a dangerous proposition as we must keep in mind that while blockchain is eternal, encryption is not. Encryption that cannot be cracked today, could be cracked in the future, especially when quantum computing becomes a reality, making all that information wide open for everyone to see.
The true value
At Iryo, we believe that the true power of blockchain technology is providing a never-before-seen degree of immutability of data stored on it. In healthcare, that should be harnessed in two ways:
- Providing a method for detecting data tampering.
- Providing a fully decentralized access control list.
When a new piece of information is added to a person’s health record, by using a hashing algorithm we can generate a digital fingerprint of that data and store it on the blockchain. If that data is subsequently tampered with the digital fingerprint will change and we can easily detect the change by comparing the new fingerprint to the fingerprint that was stored on the blockchain.
Blockchain can be used to store information on who has permission to access a certain piece of data. Patients are able to decide who they will give these permissions to and such grants are written on the blockchain. In centralized systems, such lists are controlled by a system administrator, meaning that there is a single point of failure. Access rights can be changed by a rogue administrator or an attacker that gains administrator rights. With blockchain, that cannot happen.
Lastly, we at Iryo believe that blockchain technology is opening up a crucial public debate on the need for decentralisation of certain systems. In healthcare that means empowering patients so that they become the true owners of their health records and other health data and get to decide who they share it with.
Vasja Bočko is the Chief Executive Officer and co-founder of Iryo, a startup that is focused on building infrastructure and tools to enable secure and patient controlled exchange of healthcare data with the use of blockchain and crypto technologies.