Blockchain: the trust solution for healthcare?
The facts behind the hype
Blockchain is the technology powering many of the innovative trends that are making headlines the world over; with cryptocurrencies, and bitcoin in particular as recent examples. With its great added value in terms of privacy, interoperability and real-time data management, it has certainly got our attention at Bax & Company.
Many new start-ups have already grown out of blockchain, with promising applications and the potential to impact efficiency and security. Europe is an important player in the global field of blockchain. Housing 8,265 ongoing blockchain projects, compared to the 9,565 in the US . Alongside logistics, we see healthcare as the most relevant sector for blockchain applications. This article focuses on the potential of blockchain within healthcare – the possible applications, the hurdles it currently faces and our vision for the future of blockchain in healthcare.
What is happening now?
Traditionally, the healthcare sector has followed, rather than led, in the digital revolution of computerisation. However, new legislation has greatly encouraged IT development in healthcare, with the European Union’s approval of the General Data Protection Regulation (GDPR). Following years of debate, the GDPR will be in effect as of May 2018. The GDPR requires improved levels of security across the healthcare sector. While providers have previously been free to dictate the terms of their cyber-security and protection, organisations will now have to comply with standard privacy and data requirements. If you or your family have your files stolen, healthcare institutions will no longer be able to avoid taking counteraction.
The financial sector took the lead in the development process following the appearance of blockchain within the sector, supporting bitcoin. The concept of decentralising a database – along with the automated/real-time validation processes and considerable contributions to developments in both security and privacy – soon sparked interest in other sectors. The IBM Institute for Business Value conducted a blockchain survey on 200 healthcare executives in 16 countries, stating: “16 percent aren’t just experimenting with blockchain technology; they expect to have a commercial blockchain solution at scale in 2017. 180 respondents are planning to invest in blockchain technology by 2018.” 
These market leaders really have only one question: can blockchain be the solution to the trust issues in healthcare?
A lack of trust
Data security is one of the building blocks for trust in healthcare. Unfortunately, the healthcare sector is having to cope with significant problems in data security.
Around 1.13 million patient records were compromised in 110 healthcare data breaches in the first quarter of 2018, according to data released May 3 in the Protenus Breach Barometer . The total number of individuals impacted by breaches last year was 14,679,461. The average global cost of data breach per lost or stolen record lies around the $380 in healthcare organizations, without taking into account the negative impact on the consumer’s trust in the organisation. The cost of data breaches in the healthcare sector in the United States alone, is estimated at $6.2 billion annually .
For the future, it is expected that global healthcare cybersecurity spending will exceed $65 billion cumulatively over the next five years, from 2017 to 2021. Ponemon Institute chairman and founder Dr. Larry Ponemon said in a statement. “While employee negligence and lost/stolen devices continue to be primary causes of data breaches, criminal attacks are now the number one cause. Cyber criminals recognize two critical facts of the healthcare industry: 1) healthcare organizations manage a treasure trove of financially lucrative personal information and 2) healthcare organizations do not have the resources, processes, and technologies to prevent and detect attacks and adequately protect patient data,” the report states .
Patient records and data
Blockchain is essential to creating and operating a decentralised model for electronic health records (EHRs). One of its biggest contributions is avoiding a considerable number of privacy and security issues that arise when storing data in one large pool (data silos).
In addition to improving security, blockchain also targets the interoperability of data between different providers. By standardising healthcare data, it will be far easier to transfer and access data between different systems and providers. This could mean sharing information with your wearable heart rate watch, your general practitioner and even the hospital you need to visit while on holiday. Blockchain can protect patient records even while facilitating interoperability.
The next big development in IT and healthcare is likely to be focused on the data that is gathered, but barely used, from wearable medical devices. Patient generated health data (PGHD) is streamed to our smartphones and cloud services, but only one-fifth of hospitals currently incorporate this patient generated data from wearables or home devices into their diagnosis or care routine decision-making. Patients who are part of the blockchain would then be able to approve or deny any sharing or changes to their data, helping to ensure a higher level of privacy and greater consumer control. Capturing and evaluating this PGHD could lead to a significant improvement in treatments.
Whether it’s obtained from medical devices, wearables, or internal hospital procedures, all of this collected patient data is going to need to be stored. Over the past few years, healthcare organisations have shifted from the traditional local storage of patient records to hybrid systems. With blockchain, it’s possible to both streamline and target the cost efficiency of these “old-fashioned’ data storages. Looking beyond that, it could potentially contribute to either hybrid or possible future decentralised systems. “Blockchain becomes the unifying glue that holds together a highly fragmented healthcare record world.”  It is increasingly clear that blockchain can deliver when it comes to the secure sharing of EHRs, personal health records and health information exchange (HIE).
Trust isn’t only a key issue in the data management of health files. Its impact on the validation of medicines is more direct and potentially even more serious.
According to research undertaken by the World Health Organisation (WHO), “more than 120,000 people a year die in Africa as a result of fake antimalarial drugs alone, either because the drugs were substandard or simply contained no active ingredients at all”. An estimated one in ten medical products circulating in low- and middle-income countries is either substandard or falsified.
The estimated value of this counterfeit drug market, ranges from €150 to 200 billion globally .
Blockchain supports the documentation of each step the pharmaceutical product takes on its journey to the store shelf and the end consumer. The source can be validated, the testing procedures and precise content can be tracked and checked. A blockchain-powered prototype has been made and is already being tested in a lab simulation. It shows the technology can handle volumes of up to 7 billion unique pharmaceutical product numbers, at a rate of nearly 1,500 transactions per second. Patients are given insights into what they are actually buying, and the pharmacists learn more about the quality/content of the medicines they are selling. It’s a development of value for both consumer and seller.
Clinical trial records
Clinical trial records could be described as the internet cache, or cookies, of the medical world. Over the course of their lives, patients build up data that is collected in EHRs, stored in big data silos with different structures. It is not uncommon for people to switch general practitioner or healthcare provider. This makes it difficult to share the stored data. In the process of changing provider, data can often be lost. As a result, its value and usability decrease fast.
Creating new medicine needs many years of research. This research can include experiments and observation done through clinical trials. These experiments are designed to answer specific questions on treatments and patient behaviour. The data required comes from individual EHRs.
Blockchain provides more transparent and interoperable solutions for patient data. The data that is so crucial for clinical trials can be scattered across multiple systems that are often incompatible, due to differences either in the structure of the data itself or the architecture of the system. With blockchain technology, data can be decentralised and distributed to other entities in the healthcare ecosystem, while, most importantly, protecting certain aspects of the patients’ privacy. This empowers the patient to decide how much of the data from their EHR they are willing to share and with whom.
A brief summary of the added value of blockchain in healthcare
– Establishing a trust network: giving patients an overview of what data is being shared, while empowering them to decide who they share their health data with – smart contracts.
– Reduced transaction costs: the cost effectiveness of data storage. In cloud computing, the use of blockchain can be an important tool for data transaction.
– Standardised data fields: a lot of data varies in format and is therefore not easily compatible between different systems. Blockchain standardises the format and stimulates interoperability.
– Real-time data management: through the use of blockchain, data can be analysed in real time, which can have many uses – such as tracking medicines, personal subscriptions, etc.
Why isn’t it happening now?
Blockchain is still a relatively new technology and, as such, is still facing some teething problems. It is currently still too complex to scale up to the size needed. There are blockchain-based pilots and cases up and running, but more ‘muscle’ and development is needed to power the large data sets of patient records. Blockchain solutions aren’t yet optimised to handle such large volumes of data. Experts agree that the scalability issue is one of the biggest obstacles for this promising new technology.
“The healthcare industry is experiencing rapid change resulting from evolving consumer and employer demands, regulatory requirements, and technological disruption, as well as the rapid evolution in technologies. Traditional healthcare organisations have generally struggled to keep pace with this change—many have been unable to develop the capabilities, acquire the talent, and transform their organisations at the pace required.” – Mckinsey 
User satisfaction has long been a stumbling block for healthcare IT. The physicians and staff at many health systems continue to express dissatisfaction with the electronic health records and other IT tools they are asked to use. Although this may simply reflect resistance to change in some cases, there are many instances in which systems and processes have not been optimised for clinicians. This must change if greater value is to be captured . Scalability and funding are technical problems. The internal trust of companies is rather more abstract, but still needs to be solved. Satisfaction through trust is key to encouraging the uptake of new tools, powered by blockchain technology.
There are serious hurdles blockchain must overcome to meet its great potential. To successfully start implementing the technology, trust and satisfaction is required of the users. As previously mentioned, many healthcare organisations are interested in using blockchain. It has the potential to improve data security, privacy and interoperability between different stakeholders, although it is unlikely to replace the entire enterprise database. Meanwhile, the costs of running a data framework which enables real time transactions and monitoring powered by blockchain are, as yet, unknown.
At Bax & Company, we believe blockchain’s potential and the impact it could have on the healthcare sector strongly outweigh the challenges. We’re certain that it’s only a matter of time before we encounter blockchain-based applications first-hand in our local hospitals.
Here at Bax & Company, we are developing a trans-national project to support SMEs in their blockchain development called Blockstart. We will be creating a framework to help SMEs develop, test, and implement their blockchain solutions. These solutions will tackle both internal and external issues. Blockchain technology can help SMEs reduce operational costs and target external problems and use cases. One of Blockstart’s three focus areas will be the healthcare sector. We will bring together governments, business networks, incubators/accelerators, and knowledge institutes. And so, we will create a framework for business development and real-world implementation around blockchain. Blockstart addresses the need for a supportive SME ecosystem, specifically within the healthcare sector. These organisations and SMEs produce information that can be easily accessible. Our goal is to identify the knowledge gaps efficiently and tackling these through the capacities of the network.
We see a lively ecosystem in the NWE region, which should prove an effective breeding and testing ground for any emerging blockchain projects. The availability of real life testing grounds is crucial to successful application of solutions. Currently there are very few up and running use-cases which are tested in real life situations. Blockstart will change this. For Bax and Company it is a great motivation to work on a project facilitating an emerging technology with such vast potential.
Where will the future take us?
This new technology and its potential in future applications is intriguing. Maintaining a sober and analytical attitude is essential. On its own, we don’t predict blockchain will be the biggest disruptive technology from this decennium. However, in combination with other developments in technology, such as cloud computing and artificial intelligence, it has an excellent opportunity to become the ultimate supportive tool to tackle security and privacy issues.
The technology itself is still in an early phase, up against challenges such as scalability, funding, and trust. It will take time for blockchain to spread across the healthcare market. Once the technology has sufficiently progressed, there will be many possibilities to reduce the costs and efficiency of data operations in healthcare. The healthcare industry should first focus on tackling the smaller applications, before trying to revolutionise the main pillars of electronic health care. Step by step, we will see blockchain applications entering our daily lives. The future looks very bright, considering all the possibilities of blockchain, which would allow for the safe and efficient exchange of data across organisations. “25% of life sciences organisations surveyed have already started. And 70% expect to have blockchain production in progress by 2020.”  One thing we can say for sure: blockchain technology is a big innovation driver for IT in the healthcare industry.
 The State of European Tech 2017 report: https://2017.stateofeuropeantech.com/
 1.13M Records Exposed by 110 Healthcare Data Breaches in Q1 2018, HealthIT Security; https://healthitsecurity.com/news/1.13m-records-exposed-by-110-healthcare-data-breaches-in-q1-2018