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Blockchain "does not intend to eliminate existing legacy systems," said Maria Palombini, director of community development and initiatives at the IEEE Standards Association. In most cases, the idea is the network approach to integrate IT applications and innovate the ways in which they manage data.
This is what Massachusetts General Hospital hopes, for example, with the partnership announced last month with MediBloc, a Korean blockchain startup. The goal is to drive new DLT-based storage and exchange mechanisms that complement, rather than supplant, their existing electronic medical record.
The hospital intends to "explore the potentials of blockchain technology to provide secure solutions for the exchange of health information," said Synho Do, director of the MGH Imaging and Computation Laboratory.
One of these means of exchange could be the patient, as described by Palombini in our history. (You can also listen to our recent webinar with her here.)
"When you think about all the data (in and EHR), what do you put in? Genetic data, hospital records, vaccination records, lab results – there's a huge amount of data," he said. "The question becomes:" Do I have to do it over and over every time I go to the hospital or do I go to my doctor? "
Soon we could see a world where "everything you have in your medical record is placed in the blockchain, and then the patient is managing his health record," he said. "I have my health card and then I go to my doctor to give him a sign to access my archives."
In many ways, EHRs are an ideal application for distributed network technology such as blockchain. As the medical student of Drexell Neumann and Weill Cornell Medical College explains, it could also be a "panacea" for some of their older challenges: interoperability and safety.
The open access of Blockchain would allow to modify the EHR of an individual (new images, procedures, laboratories) to be updated in real time on an EHR blockchain and immediately available to the parties involved in the assistance of an individual (suppliers health care, pharmacies, insurance companies, patient), "he said." No more problems with the compatibility of different CCE systems or waiting for faxes. "
Furthermore, "the use of a decentralized ledger in the EHR also means that data can not be held hostage," he added. "Every user has an updated copy of the blockchain, so hackers can not get control of the ledger and keep it as a ransom by WannaCry to many suppliers in 2017."
Writing for the Harvard Business Review, a longtime Beth Israel Deaconess Medical Center CIO and passionate blockchain Dr. John Halamka, says the technology could help address the "annoying problem" that addresses health care systems everywhere: "how to share more medical data with multiple stakeholders for multiple purposes while ensuring data integrity and protecting patient privacy. "
It has to do with the structure of the blockchain, allowing a new paradigm for data exchange, he said.
"Traditionally, the interoperability of medical data between institutions has followed three models: push, pull and view," said Halamka, "each of which has its own strengths and weaknesses, and Blockchain offers a fourth model, that has the potential to enable a safe life sharing of medical records among suppliers. "
The potential for the blockchain to revolutionize the exchange of data along these lines is described in detail in a 2016 case study coauthor of Halamka and colleagues of BIDMC with MIT Media Lab.
"Imagine that every EHR has sent updates on medications, problems and lists of allergies to a reliable community ledger, so the additions and subtractions to the medical records have been well understood and verified among the organizations", said Halamka.
"Instead of simply displaying data from a single database," he explained, "the EHR could display data from all databases referenced in the ledger: the final result would be the perfect reconciliation of information about you. , with integrity guaranteed from the point of view of data generation up to the point of use, without manual human intervention. "
This and other similar approaches are already at work, with start-ups such as London-based Medicalchain, which develops distributed accounting technology to store patient records as "a single version of the truth" that can be accessed through Appropriate authorization of doctors, hospitals, laboratories and insurers.
In a post on Medium, the company emphasizes the advantages of this approach: "Data is only accessible from the patient's private key, even if the database is compromised, patient data will be unreadable (it's all encrypted), patients have full control over access to healthcare data, patients monitor who sees their data and what they see, instantaneous transfer of medical data, where each member of the distributed network of health blockchain would have the same data for the patient, c & # 39; is a reduced risk of errors and better patient care. "
Medicalchain already has high-profile partners such as the NHS and the Mayo Clinic, which announced its plans to collaborate with the company on several cases of using EHR at the start of this year.
In a recent interview with HIMSS Europe, Dr. William Gordon of Harvard Medical School said that while much of the excited discussion about blockchain is "still exaggerated, particularly when it comes to clinical data," technology "is promising for EHR data in a few ways."
That said, great challenges remain, said Gordon.
"The first is the huge volume of clinical data," he explained. "Blockchains as they are today are not designed to store large amounts of data, such as those that would be generated during a clinical meeting."
Secondly, he said, "the blockchain relies on some form of a unique identifier to link records between individuals, which means that identity must be managed somewhere to deduplicate patient IDs."
And third, explains Gordon, "identity on the blockchain tends to be anonymous but not private. This means that while the transactions are anonymous (the real identity is hidden), they are publicly registered. the identity of an individual is linked to a blockchain identifier, their entire transaction history is available, which could be catastrophic for clinical data.There are mechanisms to mitigate these problems, such as "private" blockchains that do not they are public or "off-chain" data storage – these problems need to be dealt with more fully before we see the widespread sharing of EHR data via blockchain. "
Yet, he said, "the challenges around the blockchain are surmountable and there is a tremendous energy in finding the right use cases in the healthcare industry, in addition the core technology is changing rapidly, with protocols suitable for the different verticals developed ".
