Blockchain is a relatively new technology system that can be customised to transact trusted actions, not being under a centralised control involving governments or banks.
It is closely associated with the concept of Bitcoin, which is described as a form of financial currency called “cryptocurrency”.
Many new cryptocurrencies have been launched, most emulating Bitcoin’s success in varying degrees.
Because of its high trust level, Bitcoin (and others) have achieved a value status not unlike gold, and as an investment, there have been recently quite phenomenally high returns generated for investors.
Some cryptocurrencies even align themselves with a gold “backing” ensuring that an investment in certain gold financial instruments covers the cryptocurrency value.
Many financial analysts have described cryptocurrency investment as speculative, and one that is building to a “bubble” status that will surely burst (not unlike the initial frenzy that surrounded the initial dot.com revolution surge).
However, governments around the globe are beginning to see the value in this type of technology and are beginning to formally recognise it and thus create stability for financial and other related blockchain systems.
Blockchain is the name given to the basic infrastructure system which is further described as a distributed system recording and storing transaction records.
More specifically, blockchain is a shared, immutable record of peer-to-peer transactions built from linked transaction blocks and stored in a digital ledger.
Blockchain relies on established cryptographic techniques to allow each participant in a network to interact (e.g. store, exchange, and view information), without pre-existing trust between the parties.
In a blockchain system, there is no central authority; instead, transaction records are stored and distributed across all network participants.
Interactions with the blockchain become known to all participants and require verification by the network before information is added, enabling trustless collaboration between network participants while recording an immutable audit trail of all interactions.
Different industries are able to build industry-specific platforms that sit on top of the blockchain infrastructure customising access and information structure to suit its industry users.
Interest by investors in blockchain healthcare systems is becoming very frenetic so pharmacy is sure to be involved and caught up in this blockchain revolution.
And yes, it will prove disruptive for those who do not keep up with innovation.
We are all engaged with constant change as the norm, with Information Technology underwriting most of this change.
As always, opportunity exists for those who maintain a high level of awareness, and while blockchain healthcare is in its infancy, it is possible to predict those areas that will have a growth spurt and create disruption for the unaware.
Global growth in blockchain systems is currently estimated to be around 60 percent per annum.
The following titles illustrate what activities blockchain technologies are likely to affect.
Pharmacists, no matter where they practice, need to be aware of possible impacts, how they may adapt to them and and how they may generate opportunity and wealth by value-adding to blockchain technology.
Implementation challenges and considerations
Blockchain technology presents numerous opportunities for health care; however, it is not fully mature today nor a panacea that can be immediately applied.
Several technical, organisational, and behavioral economics challenges must be addressed before a health care blockchain can be adopted by organisations nationwide.
A blockchain powered health information exchange could unlock the true value of interoperability.
Blockchain-based systems have the potential to reduce or eliminate the friction and costs of current intermediaries.
The promise of blockchain has widespread implications for stakeholders in the health care ecosystem.
Capitalizing on this technology has the potential to connect fragmented systems to generate insights and to better assess the value of care.
In the long term, a nationwide blockchain network for electronic medical records may improve efficiencies and support better health outcomes for patients.
Improvement and authentication of electronic health records (EHR’s) – Clinical Health Data Exchange, Interoperability and protocols on record sharing.
When we talk about blockchain and healthcare, data exchange is typically the first topic to come up.
Blockchain-enabled health IT systems that can provide technological solutions to many challenges, including health data interoperability, integrity and security, portable user-owned data and other areas.
Most fundamentally, blockchain could enable data exchange systems that are cryptographically secured and irrevocable.
This would enable seamless access to historic and real-time patient data, while eliminating the burden and cost of data reconciliation.
Drug Traceability Supply Chain Integrity and Provenance
Where each transaction between drug manufacturers, wholesalers, pharmacists and patients can be tracked to verify and secure drug product information important for tackling issues such as counterfeit drugs.
Based on industry estimates, pharmaceutical companies incur an estimated annual loss of $200 billion due to counterfeit drugs globally.
About 30% of drugs sold in developing countries are considered to be counterfeits.
A blockchain-based system could ensure a chain-of-custody log, tracking each step of the supply chain at the individual drug/product level.
Furthermore, add-on functionalities such as private keys and smart contracts could help build in proof of ownership of the drug source at any point in the supply chain and manage the contracts between different parties.
Certain rule-based methods can also be created for patient data access.
Here, permissions can be granted to selected health organisations.
Clinical Trials and Population Health Research
Where altering or modifying data from clinical trials by fraud, can be eradicated.
It is estimated that 50% of clinical trials go unreported, and investigators often fail to share their study results (e.g. nearly 90% of trials on ClinicalTrials.gov lack results).
This creates crucial safety issues for patients and knowledge gaps for healthcare stakeholders and health policymakers.
Blockchain-enabled, time-stamped immutable records of clinical trials, protocols and results could potentially address the issues of outcome switching, data snooping and selective reporting, thereby reducing the incidence of fraud and error in clinical trial records.
Further, blockchain-based systems could help drive unprecedented collaboration between participants and researchers around innovation in medical research in fields like precision medicine and population health management.
In the US, there were a total of 450 health data breaches in 2016, affecting over 27 million patients.
About 43% of these breaches were insider-caused and 27% due to hacking and ransomware.
With the current growth of connected health devices, it will be very challenging for existing Health IT infrastructure and architecture to support the evolving medical network ecosystems.
By 2020, an estimated 20-30 billion healthcare connected devices will be used globally.
Blockchain-enabled solutions have the potential to bridge the gaps of device data interoperability while ensuring security, privacy and reliability around Internet-connected medical devices.
Companies such as Telstra (user biometrics and smart homes), IBM (cognitive Internet of Things) and Tierion (industrial medical device preventive maintenance) are actively working around these user cases.
Precision medicine and Genomics research
Where patients, researchers and providers can collaborate to develop individualised care via access to genetic and other data, secured on blockchain.
Nationwide interoperability – Blockchain as an enabler of nationwide interoperability
In the US, the Office of the National Coordinator for Health Information Technology issued a shared nationwide interoperability roadmap, which defines critical policy and technical components needed for nationwide interoperability, including:
* Ubiquitous, secure network infrastructure
* Verifiable identity and authentication of all participants
* Consistent representation of authorization to access electronic health information, and several other requirements.
However, current technologies do not fully address these requirements, because they face limitations related to security, privacy, and full ecosystem interoperability
Claims Adjudication and Billing Management
An estimated 5-10% of healthcare costs are fraudulent, resulting from excessive billing or billing for non-performed services. For example, in the United States alone, Medicare fraud caused around $30 million in losses in 2016.
Blockchain-based systems can provide realistic solutions for minimising these medical billing-related frauds.
By automating the majority of claim adjudication and payment processing activities, blockchain systems could help to eliminate the need for intermediaries and reduce the administrative costs and time for providers and payers.
Blockchain could also have significant ramifications for improving some of the huge logistical information tracking hurdles of reliability-centered maintenance (RCM) functions.
Blockchain technology applications in healthcare shows promise for solving issues such as its used in EHR distribution of data and nationwide interoperability. However, more research, trials and experiments must be carried out to ensure a secure and established system is implanted before using blockchain technology on a large scale in healthcare.
Pharmacy leaders should also be conscious of ensuring that pharmacists become contributors and authorised users of a blockchain system that will eventually evolve within Australia.
A lockout would spell clinical death for pharmacists and there are many detractors who would work to achieve that outcome.
Past i2P articles relating to blockchain technologies: