Great progress is made as health care works to reach the potential for blockchain


While health care is in the early stages of blockchain testing, followed by other sectors such as the financial services industry, healthcare systems are starting to explore technology despite slower adoption due to regulations, security problems and lack of standardization of data.

Asked when the blockchain is expected to be integrated into the systems of its organization, 32% of the providers and 48% of the health plans have been declared in one or two years, according to a survey conducted by the consulting firm and professional services Accenture.

In addition, 91% of health care managers surveyed indicated that blockchains and smart contracts will be critical to their organizations over the next three years, according to Accenture's Digital Health Technology Vision 2018 Report.

Studying options [19659002] Despite those optimistic expectations for the future of the blockchain, a lot of work is before the technology is ready for use by suppliers. However, research is ongoing.

The Mount Sinai Health System in New York launched the Center for Biomedical Blockchain Research to address health problems using the technology underlying Bitcoin's cryptocurrency and provides a data structure that can be stamped and signed using a private key.

In particular, the center will focus on app development by evaluating blockchain-enabled solutions, collaborating with suppliers who are working on technology, as well as building and testing the systems within Mount Sinai.

Managed by the Mount Sinai Icahn School of Medicine and the Institute for the Next Generation of Health Services, it is the first of its kind in an academic medical center, its leaders say.

"We are very early in the cycle of hype blockchain and there are many promises made about how we will save health care," says Noah Zimmerman, assistant professor of genetics and genomics sciences and director of health data and design center of innovation. "Basically, for us, blockchain is about creating large-scale open networks and encouraging people to take part in it." This is what really excites us. "

" We expect some cases of early use to emerge from areas where existing systems and approaches are insufficient, "adds Joel Dudley, executive vice president of precision health at Mount Sinai and director of the Institute for Next Generation Healthcare.

"The fragmented nature of regional and global health systems prevents the flow of vital information and creates barriers to access for under-served groups," says Dudley. We see the potential of blockchain and related technologies to enable applications that support more unified health ecosystems and serve the major goals of building national and global precision health networks. "

Making the case

By 2020, the IDC research company predicts that 20% of health organizations will have passed the pilot projects and will use the blockchain to manage operations and 39. Patient Identity

Blockchain is seen by advocates as fundamental to building trust in the authenticity and accuracy of shared data.In particular, they see the potential for blockchain in IT health interoperability as a case # 39; Emerging Use.

"While interoperability and HIE structures evolve to address a number of challenges in health, blockchain could provide an alternative for where these technologies could fall In short, "says Mutaz Shegewi, director of research for the transformation strategies of the IT provider to IDC." The possibility of exchanging data in a feasible way beyond and beyond the company level with levels of far greater distribution, distribution and immutability makes the blockchain a noteworthy proposition to explore new ways of shaping the future of health informatics interoperability. "

Toward this end, the engineers at Vanderbilt University claim to have developed and successfully validated the feasibility of a blockchain architecture that exploits HL7's Fast Healthcare Interoperability Resources (FHIR) standard for the safe and confidential sharing of patient records.

Called FHIRChain, technology meets the Office of the National Coordinator for Health Technical IT requirements for sharing clinical data among distributed providers, according to Vanderbilt researchers, who developed it in collaboration with Oncology radiotherapy and software manufacturer Varian Medical Systems.

In particular, FHIRChain uses FHIR data elements together with a token-based project to exchange data resources in a decentralized and verifiable manner without actually moving data.

"We demonstrate a decentralized application based on FHIRChain (DApp) that uses digital identities to easily authenticate participants and manage data access permissions in a case study on sharing clinical data," say researchers from Vanderbilt and Varian in a pre-printed document that was presented for publication. "This DApp allows users to share specific and structured information (rather than an entire document), thus increasing the readability of data and the flexibility of sharing."

According to Dana Zhang, a doctoral candidate in computer science from Vanderbilt and lead author of the paper, FHIR standards use a popular form of data structure called JSON (JavaScript Object Notation) for the exchange of clinical information, which it is more compact and readable than XML used by other data formatting standards and enables more efficient transmission. [19659002] "The design of FHIRChain applies a smart contract to maintain the identifiability of health users without exposing personal information on the blockchain," says the document. "It also replaces the need for a traditional username / password authentication scheme with the use of a pair of public / private cryptographic keys for authentication, in a general clinical context, these digital health identities – private keys – they would be difficult to manage for patients.FHIRChain, however, only creates these identities for physicians to facilitate data sharing, which consequently enables more effective collaborative decision-making for patients. "

The potential by Blockchain

Because blockchain has a data structure that can be stamped and signed using a key to prevent tampering, technology is seen as a natural choice for managing responsibility, authentication, confidentiality and sharing information.

"Our DAH based on FHIRChain demonstrates the potential of the blockchain to foster an effective sharing of health data while maintaining the security of the original data sources", concludes the document. "The design of FHIRChain can be further extended to address other health interoperability issues, such as the coordination of other stakeholders (eg insurance companies) across the industry and provide patients with easier (and secure) access to their medical records . "

However, Zhang points out that so far FHIRChain has been implemented as a prototype in the laboratory and has not yet been implemented in the clinical setting.

"It requires a careful reflection on architecture and design," says Jules White, associate professor of computer science at the Vanderbilt School of Engineering. "When you're moving into a world where you have to do things right the first time, it keeps you going cautiously, and that's obviously true with anything with blockchain, but I think particularly about health data."

IDC states that with the advent of FHIR and the opening of programming interfaces (APIs), blockchain could provide a "lattice" to accelerate the distribution of clinical data. "However, the research firm concludes that "if the blockchain really gives the industry new ways to make interoperability or is just a buzz in the market, for the most part, remains to be seen. "

For his part, Kaveh Safavi, MD, responsible for Accenture's global health practice, does not see the blockchain as a health care" panacea. "We believe it is unrealistic to use blockchain as a means to carry protected health information, "he says." The delivery of PHI into a blockchain is unlikely. It will have some uses largely around the identity but less as a primary transport mechanism. "

Similarly, Chris Jaikaran, an IT security analyst in the Government and Finance Division at the Congressional Research Service, believes that the blockchain is not particularly suitable for electronic health records management because EHRs are stored on provider systems and are still potentially vulnerable to cyberattacks.

"Blockchain is currently being tested by the industry but currently does not seem to be a complete replacement for existing systems," Jaikaran testified to an Audit of the Chamber subcommittee on # 39; Beginning of this year. "One of these examples is the management of electronic medical records. In this example, the actual medical records are kept on the provider systems, but a record of that record is published on the blockchain. "

In this scenario, patients can use the blockchain to authorize those who have access to those records, according to Jaikaran." What the blockchain can publish is the permissions to that record, so rather than a patient who has to cross the city ​​to take a record of that record to take control of another provider, those providers could talk to each other to transfer that record. "

Roadblock forward

Although technically feasible, at the same time, he claims that this blockchain-EHR solution has pitfalls. "All providers must be on the same blockchain so that everyone has some kind of identity – a public and private key – and users need to take a more active role in managing of that record for themselves. "

In addition, Jaikaran notes that providers must maintain the electronic medical record" in a manner consistent with federal and state laws " , including HIPAA and the HITECH law. The application of the blockchain to the EHRs would "still address" both federal and state privacy laws "as well as the lack of standards, data processing and retention – that could inhibit its adoption," he adds.

In addition, because the EHRs would be stored on provider systems, Jaikaran states that "the record itself is still based on the security measures" of those health organizations. "So if the provider is not implementing in-depth defense strategies or other IT security strategies, an attacker would instead attack the blockchain, attack the provider's data store and the record would still be vulnerable," he concluded. [19659002] IDC's Shegewi agrees with Jaikaran that blockchain technology, by itself, "does not apply any type of security, privacy or default compliance measures," such as HIPAA and GDPR.

Furthermore, he observes that "The first testers of the blockchain are realizing that it may not be a good idea to go on a public blockchain network, and some may want to test with private limited access blockchain networks.

Shegewi also stresses that another blockchain limitation is that it is largely an incentive-based architecture that is the sum of its parts, its users. "As a result, he warns that" harmful activities could arise if incentives for participants to act badly Curiously on a blockchain are more incentives not to do so. "

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