In this article, we consider the application of blockchain technology in healthcare and any challenges it may bring.
Application of blockchain
In healthcare, blockchain technology can be a powerful tool for preserving and exchanging patient data as well as enabling patients to have greater control over their medical care. Here, we explore the following uses of blockchain in digital health (either already implemented or still at the development stage): (i) supply chain management and transparency; (ii) health records; (iii) credential verification; and (iv) Internet of Things (commonly referred to as IoT) security for remote monitoring.
Supply chain management and transparency – One of the key challenges that the healthcare sector faces is ensuring the authenticity of medical products that move through the supply chain. This is particularly relevant in developing markets where there is a risk of counterfeit medicines or unapproved medical devices entering the supply chain, for example. Given the intrinsic characteristics of blockchain, the technology can be used to accurately track the journey of medical products from manufacturers to end consumers, with each intermediary validating the receipt of the items in question and providing updates on one immutable system. This has the potential to increase consumer confidence in terms of product transparency and to streamline compliance and reporting obligations for pharmaceutical manufacturers, amongst others. In addition, tech companies are now applying AI to blockchain-driven systems to predict demand more accurately and to optimise sales, taking technological advancement to a whole new level.
Digital health records – Patients’ medical records are currently stored on a number of different platforms and systems. In some cases, health institutions still rely on hard copies of patient data. This can make it very challenging for clinicians to have a holistic view of up-to-date medical records. Blockchain technology has potentially a very significant role in building and maintaining a patient-centric system for health records, effectively linking all data together. The blockchain solution would assist in the following ways:
- Transparency – patients would be able to track their records on one platform accurately and see updates in real time, creating a better experience;
- Access – patients would have greater control over who is permitted to access their sensitive data and for how long. Patients could even opt-in to share their data with researchers and scientists, for example;
- Security – health records would be kept securely and any change or data corruption would be mitigated and suitable alerts raised in the event of problems; and
- Insurance – medical insurers could receive up-to-date information on patients as soon as it is updated on the system, saving time and costs.
Credential verification – Blockchain technology is increasingly used by various organisations in validating digital credentials. One might argue that the time has come for the healthcare sector to embrace it more widely, too. The technology would help manage medical credentials and streamline the hiring process for healthcare organisations, which can often be lengthy and inefficient and typically involves institutions contacting a number of organisations to authenticate the information provided by an applicant. One of the key benefits of blockchain is that it provides access by all parties to the same information in real time, allowing updates or verification to be communicated to everyone at once, thereby facilitating data sharing amongst multiple parties very efficiently.
IoT security for remote monitoring – Over the past few years, the use of wearable IoT devices such as fitness bands and smart watches has accelerated, helping users – and permitted organisations such as insurance companies – keep track of their health in real time. For those who rely on wearables, it is crucial that the technology functions well, remains resilient and secure. Blockchain could be part of the security wrapper to provide comfort to data subjects that only those who have permission can access health data. It could facilitate data being accessed in a timely manner and without tampering by medics and clinical research organisations, amongst others. Blockchain technology in wearables could also be used in rewarding patients for maintaining a healthy lifestyle by performing certain physical activities. In turn, a smart contract mechanism (beyond the scope of this article but covered by us in our previous article “A legal ‘rubber stamp’ for cryptoassets and smart contracts”) could need to be deployed to give a reward in exchange for collecting data from an IoT device. It is yet to be seen how this will pan out in the world of healthcare, but the possibilities seem endless.
Speaking of innovation in digital health, it comes as no surprise that healthtech businesses are exploring opportunities that non-fungible tokens (NFTs) may bring to the healthcare sector. NFTs are essentially digital records (containing, for example, patient’s health data) stored in a blockchain that can be sold or purchased on virtual marketplaces. More information is available in our article “Non-Fungible Tokens: from CryptoKitties to Smart Contracts”. NFTs have the potential to act as a vehicle for people willing to share their medical records with research organisations conducting population studies/clinical trials, for example. In return, the patients could receive payment – in the form of royalty payments – for such use. Again, smart contract technology could be leveraged so that the owners of the NFTs could set dynamic rules and choose to what extent they want to share their health data with research companies, enabling them to have more control over their highly sensitive information.
Clearly, one of the key practical and legal issues regarding the use of NFTs in healthcare would be ownership of the digital health record. From an intellectual property perspective, the copyright in an NFT (i.e. a health record or part of it) would be owned by its original creator or, where applicable, its employer. Even if a patient created an NFT themselves, there still might be some underlying issues around ownership. There are also questions regarding personal data sovereignty. For these reasons, anyone wishing to leverage their health data or that of others must ensure that a full analysis is done regarding contract, intellectual property and data protection issues, amongst others.
What are the key challenges posed by blockchain?
The implementation and/or use of blockchain does not come without challenges. One of the most obvious considerations is data protection. Under the UK GDPR, an individual has a right to be forgotten, erase and/or correct personal data. Conversely, the basic position is that entries made on a blockchain are immutable, making it challenging for healthtech businesses dealing with patient data to be compliant with data protection laws. This also raises a question of how clinicians ought to correct mistakes made in a blockchain. There are ways through this, but well thought-through solutions are needed so as not to compromise the fundamental principles upon which blockchain applications are built, whilst at the same time ensuring compliance with law and regulation.
Another challenge might be the implementation costs for moving onto a blockchain-driven solution. This would depend on variables such as the volume of data, functionality and business needs, of course. These types of projects are likely to pose a variety of challenges on their own ranging from managing internal stakeholders’ expectations to full technology integration, accompanied in each case by proper analysis of regulation and legal structures. In addition, blockchain has received some criticism for lacking efficiency when it comes to storing particularly large amounts of data due to its inherent features and capacity constraints of replicating the blockchain across each and every node/instance in the blockchain network.
The pace of change in this area is significant and the potential healthcare solutions are very exciting. We look forward to seeing how and to what extent the next couple of years are going to re-shape digital health, bringing blockchain solutions closer to reality.