time data is added to the chain it is timestamped, and the
location and entity making the addition are included.
Distributed Network: As with many industries, healthcare has traditionally maintained a strong central authority to safeguard identities of participants, ensure
transactions occur safely and securely, and establish
trust with the users. A centralized infrastructure can be
costly to support, as well as vulnerable to attack and failure. Blockchain technology replaces this centralized approach with one that is distributed across the network
with potentially thousands of participants that are represented by nodes. Completing a transaction requires all
nodes to verify and reach consensus to accept the new
transaction in the ledger. Because all members of the
network have a complete copy of the blockchain, no one
member can modify the data once it has been added.
Private Key Cryptography: All transactions are signed
with a private key which in turn establishes participants’
identities. Though transactions are openly stored on the
network, information can only be accessed via a private/
public key. Caregivers, clinicians, and other intended users who are authorized may also gain access to a patient’s
As health information becomes more digitized, fragmented,
nonstandard, and siloed within a variety of sources, blockchain
technology has the ability to alleviate these challenges and improve efficiencies.
Interoperability, Accessibility, and Data Integrity Issues
The healthcare pain points of interoperability, accessibility,
and data integrity present challenges such as lack of clear
data sharing and ownership. Blockchain reduces data siloes
and aggregates EHR clinical data and thereby supports interoperability between healthcare systems. Patients have the
ability to better control who has access to what data, which
can also support personalized medicine.
Privacy and Security Issues
Healthcare faces increasing cyberattacks which in turn make
providers and hospitals more vulnerable to data breaches,
trust and access control issues, and diminished confidence
in the integrity of health information. Because of its peer-to-peer network (distributed ledger), blockchain enhances security against direct attacks on a centralized repository and
supports data encryption and the management and enforcement of complex permission settings for third parties through
the use of smart contracts. Because the blocks remain immutable, it is nearly impossible to modify data as there are multiple checkpoints through the distributed network.
Compliance with Regulations
With a patchwork of privacy and security laws across the
United States, compliance with HIPAA, and other regulatory
requirements, blockchain introduces efficiencies and trans-
parency through the use of smart contracts that automate the
maze of permissions and other requirements with complex
logic and rules that are built into the system.
Fraud and Abuse
The healthcare industry is fraught with false claims, corruption, improper billing, illegal prescriptions, and unnecessary care. With smart contracts, blockchain simplifies
subrogation and fraud is reduced through traceability and
accountability. External auditing is made easier and each
block that is added is timestamped and data rendered immutable. 3
Despite its promise of application, several issues must be
addressed before the healthcare industry can realize blockchain’s full potential and ensure wider adoption of the technology. The regulatory environment has traditionally been
slow to catch up with technology and right now healthcare
professionals are in the midst of implementing provisions
from the 21st Century Cures Act to address interoperability,
information blocking, and other issues. 4 Regulatory uncertainty will contribute to the slow adoption, but once a regulatory framework that supports blockchain applications is
developed, the healthcare industry will likely embrace it
and boost implementation.
Currently there is an absence of standards and best practices to support developing blockchain technology, which
can hinder usability and consistent implementation. As
with health information technology, it is imperative for
industry stakeholders to collaborate and work together to
develop uniform standards and protocols. Lack of awareness and understanding also slows growth and acceptance,
therefore industry leaders and federal agencies can take the
helm at educating and engaging industry players during
this nascent stage.
Healthcare continues to transition from a paper-based system to one that captures electronic health information, and
blockchain technology can serve as the catalyst to explore the
promise and opportunities of this technology. Blockchain will
have an increasing role in health IT with its ability to engage
and securely connect providers, patients, and researchers with
social determinants of health, genetic data, patient-generated
data, and other sources of health data. It will be interesting
to watch where innovation, coupled with policy, will take the
healthcare industry. HIM professionals have the opportunity to
sit front and center and be part of the change. ¢
1. Ivan, Drew. “Moving Toward a Blockchain-based Method
for Secure Storage of Patient Records.” Office of the National Coordinator for Health IT. August 2016. www.healthit.
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