Blockchain
In
HealthCare
Table of Contents
Topic Pg No.
1. Introduction 2
2. Architecture 4
3. Problems 5
4. Possibilities 5
5. Conclusion 5
6. References 6
1.Introduction
This IET Insight discusses the evolution of blockchain, a form of distributed ledger technology, and how
its application can produce a breakthrough in the healthcare industry; more specifically, the benefits it
can bring. It examines the ‘art of the possible’ with blockchain and how it may impact health
provisioning, accelerate innovation and enable new data-driven intelligence facilitating stratified care
and seamless integrated care.
IET Healthcare was established to promote innovation and creativity amongst future leaders in
healthcare, social care and wellbeing. Its mission statement is “because we believe that technology can
drive better health, we exist to harness all sector vices to build a healthier future for all.” By bringing
together stakeholders from groups including clinicians, patients, technologists and entrepreneurs it
ultimately aims to bring about more effective solutions to the health and care needs of international
populations.
Distributed Ledger Technology (DLT), of which blockchain is now the best known example, has the
potential to alleviate one of the major challenges of the industry: the transmission of patient data
without compromising its privacy and security. This application of blockchain can have a major, positive
impact on health management
Blockchain
Blockchain is one of the most hyped technologies of the present day with use cases and start-ups
appearing at pace. It is a decentralized ledger that uses algorithms and strong encryption to record
digital transactions or data in a transparent, secure and anonymous way. By allowing digital information
to be distributed but not copied, this technology has created the support for a new breed of internet.
The blockchain network exists in a state of consensus, automatically checking itself periodically – for
instance every ten minutes – creating intervals known as ‘blocks’. Each block typically contains a hash
pointer as a link to a previous block, a timestamp and transaction data. It is typically managed by a peer-
to-peer network (architecture) collectively adhering to a protocol for validating new blocks. By design,
blockchains are inherently resistant to modification of the data. The invention of the blockchain for
Bitcoin made it the first digital currency to solve the double spending problem – the potential risk of a
digital currency being spent twice – without the use of a trusted authority or central server
The key technical characteristics of the technology
Data integrity and provenance from cradle to grave
While many of the features such as secure, resilient, unalterable evidence are available through
traditional architectures, blockchain is unique in providing them ‘out of the box’
In blockchain there is no single point of failure – if a node fails then other participants are able
to continue accessing their data. This decentralized approach provides added resilience
A blockchain solution serves as the ‘single source of truth’
Immutability – Data can only be appended and cannot subsequently be changed or deleted. An
in-built, tamper-proof, timestamped audit trail is vailable for all transactions along with full
transaction history/ traceability
Privacy – Data is encrypted such that only authorized participants can access the data against
which they have permissions
Synchronized – All participants are accessing exactly the same data (and associated state)
Dynamic consent – The possibility for individuals to provide different types of consent according
to distinct potential data uses, taking control over who will access his/her data and for what
purpose; hence providing the ability to change consent and revoke consent in line with GDPR at
any given point in time
Personal data storage clouds enable individual access from any personal device through the
blockchain in a probative, secure, open and decentralized manner
Self-executing contractual states, based on the formalization of contractual relations in digital
form, which are stored on the blockchain and automate the execution of peer-to-peer
transactions under user-defined conditions
Multilevel de-identification and encryption technologies – Advanced techniques for encoding
and de-associating sensitive data from the owners’ identity (i.e. multi-party secure computation,
homomorphic encryptions), while allowing analytics applications to leverage the information.
2.Understanding the architecture
The full blockchain client syncs up with other nodes in the network. From then onwards the particular
server maintains all and any transaction records conducted using the framework. The integrity and
chronological order of the transactions are enforced by strong cryptographic rules. The blockchain
software operates at such a massive scale that it makes it virtually impossible (and cost prohibitive) to
hack or otherwise break into the framework or any other application running on it. Thus, there is no
need for a central third party to issue, authenticate and validate ownership of the data. The nodes in the
overall network use the peer-to-peer IP network to process and verify transactions. When several nodes
all have the same blocks in their individual databases, they are considered to be in consensus.
The disruptive nature of blockchain technology is easy for people to conceptualize in the field of finance.
T+3(where investors are required to settle their security transactions in three business days) interferes
in traders being able to maximize earnings – payments shouldn’t take days to process while an email can
be sent in seconds. As the first use case ahead of many to come, finance is a perfect area of application
for the blockchain. But a trend toward new use cases is emerging, and one industry that is ripe for
optimization and increased efficiency through this technology is healthcare.
A shared ledger records all validated transactions and is replicated among permissioned
participants. It is the shared system of record
Privacy is assured by a shared ledger holding authenticated, validated, private transactions.
Transactions are not linked to identity of participant
Consensus is achieved by validating and committing the transactions. Known and trusted
participants results in low cost
There is support for multiple pluggable consensuses including proof of work, proof of stake,
multisignature and more
User data privacy and identity is managed by giving users control of data sharing with third
parties and mapping user rights to system resources for identified users
There is hosted business logic and data to work between vendor cloud platforms without undue
customer effort The use of blockchain supports elements of the accelerated access policy and
would aid its realization:
“Many innovations come to market with incomplete evidence of impact on patients, clinical pathways
and efficiency. The NHS, as a single system where cost and outcomes data can be collected, can offer
innovators significant value in building their evidence base. Combined with the scale and strength of its
early translational and clinical research through the National Institute for Health Research (NIHR), this
provides a compelling opportunity to create global value for strategically important innovations.”
Blockchain technology and encryption could drive innovation in preventative care and community-based
healthcare models. This technology is the missing link that could enable a synergy between rising trends
in healthcare that could be vital in helping the world improve the health of communities. Some of the
foreseen trends that could enable this innovation are as follows:
Innovative healthcare models: The rise of experiments in healthcare such as Accountable Care
Organizations (ACO) and community-based healthcare indicate an increased focus on preventative vs.
reactionary healthcare
New technology and data: The increased utility and prevalence of Electronic Health Records (EHR) and
mobile health applications (for example Apple Health) foreshadow a future where individual and
aggregate population data has greater utility
The blockchain and cryptography: A new method pseudonymously collecting, storing, protecting and
sharing health data may be possible without violating the requirements of the Health Insurance
Portability and Accountability Act (HIPAA) that have traditionally limited the utility of health data and
delayed its use in real-time.
Specific value in healthcare can be derived for a number of purposes:
1. Privacy – Consider all the sensitive information that is associated with health: identity,
diseases, treatments, payment, etc. A blockchain can help prevent this with multisignatures and
cryptography. The data is hashed onto the blockchain and then, using multi-signatures, people can gain
access only if there is approval from the appropriate number of people.
2. The ability to have insurance companies, hospital billing departments, lenders and patients
using one blockchain to manage payments could reduce redundancies across the entire industry
3. Blockchain technology and encryption will potentially drive innovation in preventative care
and community-based healthcare models. This technology is the missing link that will enable a synergy
between rising trends in healthcare that will be vital in helping the world improve the health of
communities.
4. With smart contracts the healthcare insurance, life assurance, etc. markets are enabled with
the data sharing in blockchain; they can mitigate risk more and the individual has less risk of compliance
breaches.
3.Problems with Healthcare
Healthcare is a huge market worldwide. In the USA alone, total healthcare expenditures were estimated
to be approximately $3.55 trillion in 2017, and are predicted to reach more than $5.5 trillion in 2025.
However, this important sphere of our life is considered extremely inefficient. The Institute of Medicine
estimates that between 20–30% of total healthcare spending is either wasteful or a consequence of
poor outcomes.
The use of blockchain could potentially deliver increased healthcare delivery efficiency while unlocking
the research potential of NHS data assets, delivering social benefits. Patient data in healthcare remains
in silos within NHS Trusts and private healthcare providers for example, and there is little integration or
sharing of this data at scale that could bring about improved care, accelerated access, higher
productivity, cost savings and innovation in new medical breakthroughs. The health data in the main is
inaccessible to individuals maintaining transparency, immutability and integrity complying with GDPR
and the Declaration of Helsinki2 , a statement of ethical principles developed by the World Medical
Association (WMA) for medical research involving human subjects, including research on identifiable
human material and data
4.The range of possibilities
Internal use : Perhaps the easiest way to capitalize on healthcare data is internally. For example,
hospitals facing the increasing fiscal pressures of accountable and value-based care may use big data to
identify deviations from operational or care delivery standards. Institutions no longer have to rely upon
the unpredictable presence of whistleblowers; variance from outcome norms can be the smoke that
identifies the fires of best practice deviations, which can in turn identify actionable intervention
strategies. By turning big data into fast data, healthcare institutions can profit from Lean Six Sigma (the
business process improvement methodology) like never before.
Collaborative use : Similarly, many providers and payors seek to monetize data collaboratively as they
explore new models of integrated care delivery. Perhaps the most obvious model of collaborative
monetization is that of the risk-bearing, multi-provider alliance sharing once-siloed patient records in an
effort to reduce hospital admissions and keep patients in the less costly home setting.
Transactional use : Others seek to monetize data transactionally, either through direct sale or exchange
for something else of value. Payors or SaaS (software as a service) vendors who aggregate large amounts
of patient data from many sources can aggregate and benchmark that data in very useful and profitable
ways.
5.Conclusion
Whilst we present here a hugely ambitious vision of what the potential of blockchain might be there are
initiatives under way in Europe and North America that are beginning to explore the potential of clinical
service offerings by exploiting the data sharing capability offered by blockchain.
The potential of blockchain for healthcare highly depends on the acceptance of the new technology
within the healthcare ecosystem in order to create technical infrastructure. Though there are certain
concerns and speculations regarding blockchain’s integration with current healthcare systems and its
cultural adoption, the technology is beginning to prove popular in the sector.
6.References
The following reports and websites were used as background reading material for the writing of this
paper
Reports
1. Blockchain: A Healthcare Industry View, CapGemini, 2017
2. Why Blockchain Technology Is Important for Healthcare Professionals, SSRN Electronic
Journal, 2017
3. Why Healthcare Industry Should Care About Blockchain?, Frost & Sullivan, 2017
4. Chain of Everything: The use of Blockchain to enhance the security of the Internet of Things,
Technical Report, Ilesh Dattani and Habtamu Abie, 2017.
5. Blockchain & Distributed Ledgers, Thought Leadership Paper, Disruptive Analysis, 2017
6. A Secure Model of IoT with Blockchain, MIT Technology Review, Ahmed Banafa, 2017
Websites
1. http://www.cnbc.com/2016/10/22/ddos-attack-sophisticated-highly-distributed-involved-
millions-of-ipaddresses-dyn.html
2. http://www.cio.com/article/3027522/internet-of-things/beyond-bitcoin-can-the-Blockchain
-powerindustrial-iot.html
3. http://dupress.com/articles/trends-Blockchain -bitcoin-security-transparency/
4. https://bdtechtalks.com/2016/06/09/the-benefits-and-challenges-of-using-Blockchain -in-
iot-development/
5. https://www.linkedin.com/pulse/securing-internet-things-iot-ahmed-banafa?trk=mp-
author-card https://campustechnology.com/articles/2016/02/25/security-tops-list-of-
trends-that-will-impact-theinternet-of-things.aspx
6. https://blockchain.berkeley.edu/
7. https://www.r3.com/research/
8. https://www.linkedin.com/pulse/iot-implementation-challenges-ahmed-banafa?trk=mp-
author-card
About The Author
It is written by Ilesh Dattani, founder of Assentian Limited, and published by the Institution of
Engineering and Technology with input from the IET’s Healthcare Panel as a piece of opinion-based
thought leadership, but does not represent overall IET policy.
