Blockchain and the future of medicine

For many, the word “blockchain” either conjures up images of Bitcoin or is a source of confusion. But the seemingly abstract technology usually reserved for cryptocurrencies is on the verge of improving efficiency, transparency and trust in healthcare.

“There are tons of new approaches [using blockchain], especially when it comes to handling data, says Pedro Miranda, a PhD candidate and researcher at the Ubiquitous Health Technology Lab at the University of Waterloo, whose work has focused on harnessing the technology for use in healthcare and health research. However, Miranda warns that there are still a number of limitations to the technology.

To imagine how we can integrate blockchain into our healthcare systems, we must first understand how this technology works and where it excels.

What exactly is blockchain?

It’s easy to get lost in the weeds when entering the world of blockchain technology.

In its most basic terms, blockchain is an electronic database or ledger. It keeps track of different types of information, mostly transactions, which are then shared between different actors, or “nodes”, within a computer network, each of which can enter data into the block.

Unlike typical databases that use tables, blockchain stores and organizes data in groups, known as “blocks”. The first block is called the Genesis block, also known as Block 0 or Block 1, which is usually hardcoded into the software. Blocks only have a certain amount of storage space. When a block is full, it is “closed” and connected to a previously filled block, connecting all the blocks in the chain in chronological order. Each of these blocks is identified by long numbers that include encrypted transaction information from previous blocks as well as a sort of “mathematical puzzle” that must be completed for the block to be added to the chain.

Plinio Morita, a researcher and director of the Ubiquitous Health Technology Lab, explains that the data contained in a block is shared across all nodes in a network, each of which plays a role in verifying the information. Blocks must be verified by the network before they can be “closed”, and new blocks can then be created to log new data. The blockchain distributed in a network can be added to, but never deleted or changed without mutual consensus.

Blockchain’s immutable nature is particularly valuable from a security point of view. Since the information in a given block is almost impossible to change and requires consensus among the nodes in the network to update, blockchain essentially creates tamper-proof records.

Private vs public networks

There are several different types of blockchain technology, defined in part by the type of network it operates within: public or private.

Public networks are where blockchain first started with cryptocurrencies. Anyone can join a public blockchain and the contents of the blocks are visible to everyone. Thousands of people race against each other to complete and “sign” the blocks by solving complex math problems. In cryptocurrencies, this is called “mining” and generates a cryptocurrency that is put into circulation and can be used instead of government-issued currency.

Although a central feature of cryptocurrencies, Miranda says mining does not have a role to play in healthcare.

“In public networks like Bitcoin, the more people who use and mine it, the better it is for the network. In private networks, you close it and say only authorized people will be able to go here,” says Miranda.

A private blockchain is generally controlled by a single entity (such as a business or a health authority) that authorizes specific individuals to join the network. The network’s creator knows exactly who all the participants are from the start and the information in the blocks is limited to approved actors.

Consent and data processing

The blockchain that we would use for healthcare would not involve the excitement of thousands of miners racing to complete math problems to earn money. But the principles that make blockchain technology secure, efficient and transparent make it an attractive option for a range of healthcare services.

One possible application is in health research studies, particularly the handling of data and the consent of study participants, which is very close to Miranda’s heart. He has designed a platform for his PhD thesis that will use blockchain technology to help health researchers.

“Now, especially with the pandemic, what researchers want is a huge amount of health information,” says Miranda. “But when we collect this data, we’re talking about hundreds of thousands of people.”

“Now, especially with the pandemic, what researchers want is a huge amount of health information.”

Miranda notes that since much research is still very paper-based, there is an administrative burden that comes from managing data and consent effectively and ethically.

“Managing that amount of information with a spreadsheet or requiring participants to come to your clinic to explain the consent form and get a signature doesn’t work on a national scale or when we’re talking about public health surveillance,” he says. “It’s very error-prone.”

On Miranda’s platform, participants will be able to read about the study and decide whether they want to participate. If they agree, this information is stored on the blockchain and forwarded to relevant parties in the network (researchers, stakeholders, the institutional review board, etc.).

If the protocol of a study changes or a form needs to be updated, it can be a painstaking process to obtain updated consent from thousands of participants by conventional means, says Miranda. “We want to provide tools to reduce the amount of human error in conducting studies and improve transparency. Blockchain is the backbone that can provide that transparency.”

EMR/digital identities

Another near-term use of blockchain technology is the creation of “digital identities,” Miranda says.

“When you go to a clinic or hospital, after they take your blood pressure or other information from a monitor, that information is linked to your health card. But at the end of the day, it’s not your information. It stays with the hospital or the provincial government,” explains Miranda. “With digital identities, the hospital will still have a copy of your records, but that data actually belongs to you and will be tied to your digital identity.”

Digital identities, or electronic medical records (EMRs), put patient data in their own hands and allow it to travel to different healthcare providers without having to rely on health records to be transferred between them. With patients in control of their own health data, we no longer have to worry about delays or interoperability issues, such as waiting for a clinic to fax a patient’s medical records before seeing a new doctor.

Blockchain technology can also improve issues of redundancy; keeping data with the patient can help prevent different clinicians from doubling up on tests, for example.

But there are a number of kinks left to iron out before digital identities can become a reality. Blockchain is, by design, a high-stakes host for sensitive health information. To put it in cryptocurrency terms: If someone forgets the “key,” a digital password for their Bitcoin wallet, what was in that wallet is lost forever. With health records, patients losing the “keys” will mean losing their medical history.

Another issue is accessibility – not everyone is comfortable using this technology. But Miranda says he is sure that the platforms will be easier to use.

“Ten years ago, only geeks were using blockchain,” says Miranda. “But now, if [you want to buy cryptocurrency] it is a user-friendly website, like online banking. You don’t need to be a computer programmer to use it. In a few years, I think it will be the same with digital identities.”

Who will be responsible for managing these platforms has yet to be determined, although Miranda says it is most likely that provincial governments will have a stake.

“I feel that digital identities are one of the main players. Eventually we will probably see [the use of Blockchain] applied to digital identities together with consent processing.”

Manage drug supply chains

Blockchain is also a fast and secure way to manage drug supply chains as it can keep a log of each shipment as it is received at each stop along a given route, says Miranda.

It is already being used in the pharmaceutical industry to track certain shipments and help crack down on the production and sale of counterfeit drugs, a growing industry in recent years that has resulted in an estimated 100,000 to 1,000,000 deaths worldwide each year .

One study cited that “blockchains can be used to trace the origin of drugs, transport drugs and procure raw materials,” which also “reduces the number of intermediaries involved in the pharmaceutical process, thereby reducing costs and improving safety.”

What blockchain cannot be used for

The same features of blockchain that make it incredibly secure also make it too cumbersome for certain tasks – for now.

“Blockchain never deletes data, it just updates the data on the ledger on that record, and then it adds a new row to that ledger,” explains Morita.

The immutability of blockchain presents distinct obstacles with regard to health information. The Act on the protection of personal data and electronic documents (PIPEDA) states that patients have the right to change and delete their health information, which is currently impossible with blockchain.

“With every change you make to the system, you create a new record that essentially says, ‘The other record is no longer valid, this new one is the valid record,'” says Morita. “So the volume of the data is growing exponentially.”

Miranda says what blockchain can do is help bring transparency to the process of sharing data.

Blockchain technology is not ideal for housing data itself, rather it logs the connections between the data readers and the data stores. For example, if a doctor wants to access a patient’s data, the blockchain network will log the patient’s consent to share that information. It will then redirect the doctor to the (non-blockchain) database that stores the patient information and authorizes access.

What blockchain has in store

In addition to patient autonomy, transparent and accurate consent processing, and drug supply tracking, immutable records are also in the works to organize fair lists of organ transplant recipients. Researchers have highlighted how a blockchain-backed organ donation system could provide a fairer, safer and more efficient transplant network. The immutability of blockchain can help prevent people from “jumping the queue”, as well as better synchronize databases and allow for more efficient donations. Expanding a transplant waiting list on a larger scale, say internationally, can also dramatically improve the chances of finding a viable donor with whom patients can easily exchange and verify health records.

Once researchers have solved the problem of scale, another significant advantage is that “blockchain offers a good structure for gathering information about genomics data, pandemic data and other public health data,” adds Miranda.

Improving the problem of scale could allow anonymized genomic data to be shared securely around the world. This kind of widespread data can be enormously valuable to researchers developing therapies and diagnostics. Blockchain has also been used to support COVID-19 contact tracing in countries like South Korea due to its ability to efficiently and securely relay data across the network, a use of the technology we’re likely to see refined for future pandemics.

Miranda says that once certain issues are addressed, there are countless possible applications for blockchain technology in healthcare. “Anything you want to keep immutable, transparent and anonymous, blockchain is great for doing that.”