Will Blockchain Technology Solve EHR Data Sharing and Security Challenges? 40% of Executives Lack Understanding

A major obstacle to achieving population-wide health management is the lack of interoperability in electronic health record (EHR) systems, a fact widely recognized within the industry. This was explicitly stated in the report submitted to Congress by the U.S. Office of the National Coordinator for Health Information Technology (ONC) in December 2015.

In its December 2016 report, the Office of the National Coordinator for Health Information Technology (ONC) acknowledged the correctness of its research direction and the efforts made thereto, yet it did not highlight any clear progress toward establishing universal standards for interoperability. Through the 21st Century Cures Act, the Department of Health and Human Services (HHS) aims to exert greater pressure on vendors of electronic health records (EHRs) who have shown limited voluntary compliance, requiring them to achieve interoperability compliance by the end of 2017.

However, President Trump’s new “one-in, two-out” principle requires federal agencies to repeal two existing regulations for every new regulation issued. This has effectively delayed the progress of the interoperability proposal by invoking the Cures Act, becauseTo bring this proposal into effect, a substantial body of regulations must be formulated. As healthcare development has not been “put on hold,” new technologies are flourishing in response to emerging challenges.

Why Is Interoperability in EHR Systems So Elusive? Indeed, a major obstacle is the fierce competition among EHR vendors, who are reluctant to share the data they hold. Additionally, deep-seated concerns about simplistic technical solutions have also hindered progress. How can hospitals and other system vendors share data securely? Among health IT professionals and even within the Office of the National Coordinator for Health Information Technology (ONC), blockchain technology has emerged as the most widely circulated and favored solution.

VCBeat has learned that the concept of blockchain is not complex. It mainly consists of three parts: a widely distributed network, a shared account with valid access identities, and digital transactions. VCBeat has learned that although blockchain technology is famous for inspiring Bitcoin, which has long been called “the currency of cybercriminals,” it actually serves merely as a general tool and acts as a data guardian within a distributed encrypted account, enabling monitoring of individuals who use the account.

"This technology does not employ a central administrator to act as the data custodian for digital transaction records. Instead, it utilizes a shared ledger that is widely distributed across a network composed of multiple synchronized and replicated databases, accessible to all authorized participants. Blockchain technology relies on numerous independent nodes rather than a central hub."

From now on, you will hear much about medical blockchain technology, as other major industries worldwide have already adopted it due to its unprecedented security. The secret weapon of blockchain technology lies in the fact that it is impossible to attack a single block on the chain without simultaneously hacking all other blocks. This poses a significant challenge for cybercriminals. Such an exceptional data security mechanism could well become the tipping point for blockchain adoption.

Nowadays, with the aid of electronic health records and integrated databases, the storage and transmission of patient data are trending toward centralization. The inherent decentralization characteristic of blockchain technology reduces the size of individual database nodes, thereby facilitating widespread data distribution. Patient data will become more diversified, making it significantly more difficult for hackers to launch attacks and diminishing the impact of any successful breaches. This robust level of security benefits both healthcare providers and patients, as only authorized users can seamlessly access the data.

What Does Blockchain Technology Mean for Healthcare Itself? John Halamka stated, “Electronic health records may vary and originate from different regions, but the shared accounts themselves are standardized.” John Halamka is the Chief Information Officer at Beth Israel Deaconess Medical Center.

Every medical event, such as an X-ray scan or a blood test, generates a digital transaction. Code groups this digital transaction with other digital transactions into an encrypted block. Each transaction is validated and confirmed by a physician or clinician who holds the custody management key, and then timestamped. The software timestamp of each validated block generates a sequence that displays the order, steps, and content of every transaction.

Physicians and healthcare leaders place the highest priority on securing and rationalizing workflows related to electronic health record (EHR) information and broader healthcare procedures. Consequently, blockchain-enabled interoperability holds particularly promising potential, given its capacity to transfer relevant patient data from one vendor to another, free from geographic constraints or proprietary EHR system limitations. For physicians, this facilitates the development of personalized treatment plans. These plans are collaboratively developed by a patient’s various care providers and are grounded in comprehensive medical history, genetic data, life cycle stages, and living environment.

Blockchain technology will also improve many medical procedures and even reduce associated costs. For example, integrating blockchain with other technologies can streamline the claims process, enhancing the overall healthcare experience for all stakeholders. Medical researchers will gain access to comprehensive and extensive datasets, facilitating a deeper understanding of diseases, accelerating biomedical discoveries, and advancing drug development.

Blockchain technology enables patients to continuously access their health data and encourages healthy lifestyles, thereby reducing the risk of major diseases and delivering significant benefits to patients. Chris Kay, Chief Innovation Officer at Humana and a proponent of blockchain technology, stated in a recent presentation: “A fundamental understanding of your health score is the foundation of our ability to manage health. Imagine having a dedicated, easily accessible health record throughout your life, where you can decide who sees it and what content they can view.”

Data stored via blockchain technology is controllable, to the extent that it can “eliminate the conflict between the time patients receive medical care and the time of payment and settlement.”

Many industries, including healthcare, are focusing their core business attention on blockchain technology. A 2016 report by Deloitte, which surveyed 308 executives, indicated that healthcare and life sciences organizations are shifting their focus toward blockchain technology, with 35% of respondents stating that their organizations planned to deploy blockchain technology within the next year.

The level of blockchain technology implementation in other industries, particularly in the financial sector, is remarkable. In August 2016, a report by the World Economic Forum indicated that 80% of banks would launch blockchain technology projects in 2017, and over the past three years, investment in this field by at least 24 countries has exceeded $1.4 billion.

Of course, the widespread adoption of blockchain technology must overcome certain challenges. One such challenge is not surprising: according to a survey by Deloitte, there is a significant gap in blockchain knowledge.Polls show that fewer than 40% of managers report having only a superficial understanding or no knowledge at all of blockchain technology.However, more than 25% of respondents indicated that their organizations view blockchain technology as “critically important,” ranking it fifth in importance.

It is difficult to predict the ultimate role that blockchain technology will play in healthcare, as it is no different from all the other technologies or initiatives that have caused disruption during the information revolution in the healthcare sector. However, we need to gain a deeper understanding of another obscure and complex discipline. The lack of technical standards also poses an obstacle for this immature technology. Similarly, regulatory uncertainty surrounds this technology, and the industry requires the new administration to establish new federal regulations.

It should be noted that the Office of the National Coordinator for Health Information Technology (ONC) appears to place significant emphasis on blockchain technology, viewing it as a potential solution for healthcare data sharing. In August 2016, the ONC announced that 15 submissions emerged as winners in its Conceptualization Capability Challenge, themed “Applications of Blockchain Technology in Health Information Technology and Healthcare-Related Research.”

The award-winning factors encompassed the various solutions proposed in these papers, including those addressing market viability, creativity, information dissemination, and fostering change capabilities, as well as those supporting universal health and health informatics goals—such as facilitating the flow of medical information to where it is most needed, precisely when it is needed. Follow-up conferences, including blockchain-focused sessions, will continue to track these developments.

Blockchain technology (and other interoperability-based technologies) may create opportunities, but the most easily overlooked issue remains, as always, the slow pace of transformation in the healthcare industry. It is indisputable that healthcare organizations prioritize patient care. Historically, segments of the industry beyond direct patient care, along with their reimbursement mechanisms, have been regarded as a major burden—complex and difficult to comprehend, much like the aforementioned challenges.

These areas already cover new technologies (though perhaps not the very latest medical innovations), new payment models, federal initiatives, institutional regulations, coding standards, and even security mechanisms. However, without a more robust, IT-based national population health management system to provide support, challenges such as excessive cost increases, barriers to accessing care, and demographic shifts will remain unresolved.

Editor’s Note: D’Arcy Guerin Gue, the original author, is a co-founder of Phoenix and brings over 25 years of experience in executive leadership, strategic planning, information technology services, knowledge leadership, and industry relations. She focuses particularly on patient engagement and its compliance with federal regulatory requirements. Currently, she serves as Vice President of Industry Relations at Phoenix Health System, a division of Medical Planet System.