The Promise of Blockchain for Electronic Health Records
When you think about blockchain technology, with its decentralized digital database, the first application that comes to mind is cryptocurrency (e.g., Bitcoin, Ethereum). However, the blockchain platform can be used for the reliable, transparent and secure transfer and storage of many types of data—including electronic health records (EHRs)1
Blockchain technology is already being explored by major corporations for applications as diverse as crude oil futures settlements, managing skills-based credentials and food tracing.2 In 2018, PwC found that 84% of businesses in various industries were involved with blockchain technology.3 In a 2020 report, they forecasted that by 2030, blockchain applications would add $1.76T to the world’s economy and would create 40 million jobs.4 But what about the vast and vital field of healthcare, especially when it comes to handling the sensitive data contained in electronic health records?
Blockchain technology has the potential to revolutionize the healthcare industry, particularly when it comes to health informatics and personal data—but only through the efforts of innovative, highly trained professionals. In this article, we examine how electronic health records are currently handled, the pressing issues with EHR technology as it exists now and how blockchain can solve these challenges for a safer and more robust system.
What is Blockchain and How Does it Work?
Blockchain is a distributed peer-to-peer database, also known as distributed ledger technology (DLT). Rather than being centrally located and managed, the database is shared among various computer network nodes. Information is stored digitally, in unique time-stamped blocks, and the different blocks of data are linked together with cryptography in chronological order.5
The difference between a blockchain and a traditional database is that with a decentralized blockchain, the data is immutable (i.e., permanently recorded and cannot be deleted or changed). With Bitcoin, since there is no central database, no single person or organization controls it. The data is collectively controlled and anyone can view it.5
In addition to cryptocurrency, blockchains are also used for non-fungible tokens (NFTs) and smart contracts, as well as for decentralized finance (DeFi) applications.5
What Are Electronic Health Records?
An electronic health record (EHR) is a digital collection of a patient’s medical history. An EHR will include diagnoses, treatment plans, medications, lab and test results and the person’s known allergies, and the data is managed by doctors. By contrast, a personal health record (PHR) collects information from different sources, such as the person’s wearable devices, doctors’ offices, clinics, care centers and pharmacies. PHRs are mostly managed by patients themselves.6
How Are Electronic Health Records Currently Handled?
What EHRs and PHRs have in common is that a person’s medical data is stored in a centralized database, which is controlled by a single organization that is responsible for the security of that data. With PHRs, services like Apple Health and Google Health take the ownership of medical data away from the patient and put it into the hands of a third party. EHRs are no different, as most rely on a single entity to protect sensitive data from both internal and external attacks.1,7
There are three key problems with the current system for electronic health records: security, ownership and trust. These three issues are driving the move toward blockchain technology as an alternative architecture for handling sensitive patient information.
Security is a serious issue. Among various industries, healthcare is the most frequently targeted for cyberattacks. Patients in hospitals account for 30% of large data breaches.8 The HIPAA Journal reports that between 2009 and 2021, 4,419 healthcare data breaches were reported to the Health and Human Service (HHS) Office for Civil Rights, and that these breaches led to the exposure of more than 314 million healthcare records. Unfortunately, the number of breaches is trending upwards annually.9 In 2021, almost 50 million people in the U.S. had their health information breached.8
Another big problem with electronic health records being in the hands of large organizations is the question of data ownership. Data brokers like the infamous Equifax, a company that was responsible for a serious data breach in 2017, purchase people’s personal data and sell this information to advertisers. 10 This is typically done without the person’s knowledge or consent. With health data, there’s also the issue of HIPAA regulations. Since 1996, the HIPAA Privacy Rule has established national standards that protect patients’ medical records and other identifiable health data. This applies to all electronic health information that’s handled by healthcare providers, health plans and healthcare clearinghouses.11
Digitized health records that can be shared among various parties make the data more susceptible to hackers. There is also a lack of transparency because individuals do not know who can access their private health data, and for what purpose. Concerns about EHR security, as well as patient privacy, lead to a lack of trust among both healthcare providers and patients. This distrust can negatively affect healthcare delivery and public health monitoring.12
The Benefits of Using Blockchain for Electronic Health Records
By using a decentralized database architecture and smart contracts, blockchain enables PHRs to be securely stored in a way that is “immutable, traceable, transparent, auditable and secure."6 Smart contracts are self-executing contracts that contain the terms of the buyer/seller agreement written into the computer code. Since these contracts exist in a decentralized, distributed blockchain network, the transactions can be tracked but not changed or reversed.13
In terms of electronic health records, studies have found that blockchain and smart contract technology promotes the secure sharing of patients’ health records. Doctors can encrypt and upload EMRs and process large quantities of medical data so information can be securely searched. This provides privacy protection and data security.14
What is the Status of Blockchain in the Field of Healthcare?
The most exciting development in the push toward using blockchain technology for electronic health records is a framework called Healthchain. This was developed to address the problem of outsourced private health information centrally located in the cloud. Researchers sought to create a solution that would deliver patient privacy and data security while improving scalability, interoperability and data integrity of EHRs as they are shared and accessed among key shareholders.15
Healthchain architecture uses blockchain technology, built using Hyperledger Composer and IPFS (InterPlanetary File System). Stored data is encrypted using a unique cryptographic public key encryption algorithm. This creates a robust solution for storing and protecting electronic health data. Results have been promising, though challenges remain.15 Although the study showed that Healthchain can provide a reliable and secure health data network, further work is needed.
Ongoing challenges include:
- Efficiency and throughput (number of transactions per second)
- Size of the data block (must be reduced)
- Operating costs for data processing
- Scalability (ability to implement across the healthcare industry)1
These are massive obstacles that must be overcome to ensure a secure and widely implemented health information network. This highlights the immediate need for trained individuals who understand the technology and can innovate in this space to move the Healthchain technology forward.
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- Retrieved on May 12, 2022, from pharmacytimes.com/view/blockchain-has-potential-for-the-future-of-personal-health-records-electronic-health-records
- Retrieved on May 12, 2022, from cmswire.com/information-management/a-look-at-the-current-state-of-blockchain/
- Retrieved on May 12, 2022, from pwc.com/jp/ja/knowledge/thoughtleadership/2018/assets/pdf/blockchain-in-business-en.pdf
- Retrieved on May 12, 2022, from pwc.com/gx/en/industries/technology/publications/blockchain-report-transform-business-economy.html
- Retrieved on May 12, 2022, from investopedia.com/terms/b/blockchain.asp
- Retrieved on May 12, 2022, from techrxiv.org/articles/preprint/Blockchain_for_Giving_Patients_Control_over_their_Medical_Records/12906518
- Retrieved on May 12, 2022, from pubmed.ncbi.nlm.nih.gov/33296379/
- Retrieved on May 12, 2022, from beckershospitalreview.com/cybersecurity/healthcare-data-breaches-by-the-numbers-9-stats.html
- Retrieved on May 12, 2022, from hipaajournal.com/healthcare-data-breach-statistics/
- Retrieved on May 12, 2022, from investopedia.com/news/blockchain-could-make-you-owner-data-privacy-selling-purchase-history/
- Retrieved on May 12, 2022, from hhs.gov/hipaa/for-professionals/privacy/index.html
- Retrieved on May 12, 2022, from sciencedirect.com/science/article/pii/S1110866520301365
- Retrieved on May 12, 2022, from investopedia.com/terms/s/smart-contracts.asp
- Retrieved on May 12, 2022, from ncbi.nlm.nih.gov/pmc/articles/PMC7537906/
- Retrieved on May 12, 2022, from journals.plos.org/plosone/article?id=10.1371/journal.pone.0243043