The sprawling US healthcare industry has trouble managing patient information: every doctor, medical office, hospital, pharmacy, therapist and insurance company needs different pieces of data to properly care for patients. The vital records are scattered around multiple businesses’ computers and filing cabinets. They are not all kept up to date with current information, as a person’s prescriptions changes or new X-rays are taken, and nor are they easily shared from one provider to another.
For instance, in Boston alone, medical institutions use more than two dozen different systems for keeping electronic health records. None of them can directly communicate with any of the others, and all of them present opportunities for hackers to steal, delete or modify records either individually or en masse. In an emergency, doctors may not be able to access crucial medical information. That can result in direct harm to patients.
There might be a way out, a shift towards a health care system where patients have accurate and updated records that are secure against tampering or snooping, and with data that can be shared quickly and easily with any provider who needs it. In my work on health care innovation at the Center for Health Law Studies, at Saint Louis University School of Law, I have been following the rise of a technology that may help us address the weaknesses in today’s health care record-keeping: blockchain.
A secure system to store private information
Blockchain systems, best known in connection with crypto-currencies like Bitcoin, are networks of databases stored in different places that use securely encrypted messages to connect with each other over the Internet. Information cannot be deleted, but it can be updated – though only by authorized users, whose identities are recorded along with their actions.
In the health records sector, such control characteristics would keep years of patient data secure and make any human errors in data entry easy to track down and correct. Patients themselves could review and update information, and even add new information they collect or observe about their own conditions. Both hacking and fraud would be extremely difficult .
There are many blockchain systems, each with its own security methods and practices, but developers are working to help them connect with each other, calculating how to make the process of collecting records much cheaper and faster than it is today.
Helping patients and practitioners
Blockchain can also come to the aid of other areas of the health care industry. The Centers for Disease Control and Prevention are developing blockchain-based systems to share data on threatening pathogens, to analyze outbreaks, and manage the response to public health crises. Some commentators have even suggested that a blockchain system might help track opioid use and abuse.
Clinical trials, too, may benefit from blockchain. Today, patchy data and inefficient communications among the multitude of players involved in clinical trials pose serious problems. Drug discovery and development processes could see similar benefits.
Pharmaceutical companies currently monitor drug shipments and delivery through an inefficient web of scattered databases. In 2017, Pfizer and other drugmakers announced their support for MediLedger, seeking to transfer those tasks to a blockchain, a system already employed by Walmart to track its food shipments.
First steps in the US
In addition to the major pharmaceutical companies’ supply-tracking experiments, other major US health-care companies are beginning to explore blockchain technology. In early 2018, five of the country’s largest health-care companies started using a blockchain system to collect data on health-care providers’ demographics.
What is most striking about this collaboration – including a medical claim processor and a national medical testing lab – is that it involves the participation of major health insurers who work in direct competition with one another: Humana and the UnitedHealth Group. This could signal a potential shift toward industry-wide approaches to handling health care data.
Europe takes the lead
Europe offers some examples and useful guides for US efforts to use blockchains in health care.
In 2016, the European Union began funding a multinational collaboration with privacy companies and leading research universities to build a blockchain system that would aggregate and share biomedical information between health care organizations and individual patients all across the EU. Among other things, this would offer patients secure personal health data accounts online, accessible from both computers and mobile devices.
Using a similarly collaborative approach, Sweden recently began rolling out an interoperable blockchain health data platform called CareChain. It is touted as “infrastructure that is owned and controlled by no one and everyone” and companies and individual people can use the system to store health information from disparate sources. The system also lets developers create apps and services that can access the information to analyze users’ data and offer them tips, ideas and products to improve their health.
Offering an idea of what is possible is Estonia, which since 2012 has been using blockchain technology to secure health care data and transactions, including putting 95 percent of health data in electronic form. All of the country’s health care billing is handled electronically, and 99 percent of its prescriptions are digital.
That is a future the US could look forward to, as it experiments on its own and learns from the experience of these existing projects.
Ana Santos Rutschman is Assistant Professor of Law at Saint Louis University