Blockchain is the technology underlying the well-known cryptocurrency Bitcoin. The blockchain technology promises to be hugely disruptive with far-reaching applications in different applications in both private and public organizations. Electronic Medical Records (EMR’s) promise to be an important beneficiary of a blockchain-based structure model.
Though not fully comprehensive, there are four important characteristics of the blockchain:
- The blockchain is resilient as it operates as a decentralized network that does not need a central server and does not have a single point of failure: if one block contains an erroneous transaction, the majority of blocks (copies of the ledger) determines that their ledger is accepted as the ‘true’ ledger, and rejects the erroneous block).
- The distributed open-source origin of blockchain creates integrity as it does not require a third party for transaction execution.
- The system is transparent because all transactions are visible by all parties, depending on on the viewing rights of the users. This implies also that all parties have identical and accurate information records. Privacy is realized as the transactions are not linked to an identity.
- Finally, the ledger is unchangeable due to the hash value reference. As all of the blocks refer to the previous one, blocks are unchangeable resulting in a system with built-in confidence.
The fact that the blockchain is resilient, transparent, has integrity, and that its ledger cannot be changed makes it highly suitable for administrative data that need to be safe and accessible. Hence, the blockchain promises to deliver a widely sought-after improvement on EMR’s. These medical-records have suffered from development constraints as previous versions were never intended for multi-functional use. It left patient data scattered around multiple health care organizations, without a complete overview. With the enhancement of the enforcement of governance and regulatory controls in a completely innovative way, there is much excitement about the potential of blockchain in this line of work.
Using Blockchain technology to store, authenticate, and protect Medical Records
The increasing need for innovation has led to the development of the MedRec prototype. MedRec, as described by researchers from MIT: “is a novel, decentralized record management system for EMRs that uses blockchain technology to manage authentication, confidentiality, accountability, and data sharing.” MedRec is presented as a solution aimed at patients, the treatment community, and medical researchers. Because access, usage, and modification of EMR’s is based on blockchain transactions, and governed by smart contracts, MedRec basically entails a decentralized content-management system for healthcare data across providers, protecting data by only allowing legitimate transactions.
MedRec is developed to serve as a proof of concept of blockchain applications in healthcare. The blockchain technology takes out the need for a centralized data repository. A centralized data repository has proven to be difficult to realize, as there are many parties that want or need access to the files. Moreover, a centralized database has often proved disastrous in the age of data leaks and cyber-attacks.
‘Storing’ EMRs on a blockchain will come with major implications for patients: individuals will get more ownership over their medical records. They are able to access their records, share them across (medical) institutions and care providers, add data, and control the authorization for access by second opinion doctors, care guardians, or relatives.
As the MedRec prototype illustrates, blockchain-based EMR can use the attributes of blockchain technology to introduce a system that offers: (1) a resilient solution that is not in need of a centralized database, (2) has a built-in integrity to enable transactions to be executed following the rules of smart contracts, (3) offers a transparent solution where all users, as far as their permission allows, can have access to the same accurate information, and (4) provides users with confidence, as no alterations can be made in previous transactions, highly reducing the chances of system fraud. With its core technology becoming better understood, more and more applications are developed and it hints that the Bitcoin evangelists may just be right in saying that blockchain will change the future.
Long term social consequences: will it really improve our healthcare?
As of today, blockchain poses certain challenges that need to be overcome in order to realize large scale adoption. Among others, major challenges include the areas of complexity, privacy, costs, speed and storage. As it is a new technology, it has a complexity that needs to be understood in order to be embraced by a large community of users and beneficiaries. Although the transactions are not linked to an identity, transaction patterns can be observed that make it possible to link an identity to an address, diminishing the privacy of the ledger. Limitations in network speed and high transaction costs also stand in the way of large scale adoption. A final constraint that has to be overcome, is the storage limitation. As all the data is visible to all users, this implies that all users have to store an ever-growing database, making storage capacity a critical factor.
If the challenges are overcome, the use of blockchain technology for EMR’s seems attractive and is merely one of the possible applications of this disruptive technology. In the coming years, we are sure to see more disruptive changes in a variety of industries. Blockchain challenges the hegemony of notaries, mortgage brokers, and many other professions that we may not even be able to predict at this moment.
Moreover, and more importantly, research in the field of digital innovation has repeatedly shown that it is simply impossible to predict all the potential implications of new technologies in organizations. Are patients really eager to have control over all their own medical data? Do they want doctors to have control? Who has the last call when determining which data should be stored? And if the data is stored and controlled in a decentralized environment, will insurance companies demand access?
Since the way a technology may actually “come to life” depends on a web of different stakeholders (e.g., managers, clients, employees, regulatory bodies, societal demands, etc.) and influences the ways in which blockchain may or may not affect how we live, work, and organize need to be discovered and studied in the coming years. Be sure to follow our research at the KIN Center for Digital Innovation.