This week I’ve been reading up on uses of the Blockchain in healthcare and I’ve come across some interesting applications of this fledgling technology that may be of interest to you, my gentle reader.

First, let’s talk about the technology at a fairly high level.

If you’ve read about the Blockchain before there’s a good chance it’s been in the context of the Bitcoin digital currency. While the Blockchain is a core enabling technology for Bitcoin it is a more fundamental concept that can be used in a wider context.

The Blockchain itself can be compared to a ledger of time stamped transactions; though not necessarily monetary transactions. Every block on the chain has a cryptographic “signature” or “hash” that guarantees the authenticity of the transactions the block carries. Any party can verify the content of the block by recomputing the hash, and if the modified data has different hash values it has been tampered with.

blockchain.png
A simple representation of the blockchain

The Blockchain uses an inherently distributed architecture where any individual running the right software can obtain a new block from an individual called a “Miner”, a company or person who specializes in solving certain complex cryptographic problems used to find blocks that can then be bought and used for transactions. This ensures Miners are paid for their expense in hardware and electricity and provides an incentive for them to continue to find new blocks.

Once a block has been found, an individual adds their transaction as a hashed piece of data and the broadcasts the block to the entire network where other nodes can verify it.  The block is then added to the end of the blockchain.  Note that any interested party can now verify the entire chain by walking back through the signatures. If two inconsistent chains are broadcast at the same time the longer one is accepted on the grounds that more computational power was needed to create it.

The blockchain as described does not allow for data storage other than the transactions themselves which have a very tightly prescribed format, but this can be fixed through the use of protocols such as namecoin that can store small amounts of data within the actual transactions themselves.

One interesting approach to the use of Blockchain is claims processing. According to Bryan Smith, CSO at PokitDok, roughly 20-40% of medical expenses are spent on resolving disputes and inconsistencies in medical billing. If all parties can agree that the entries in the claim information are correct through the use of Blockchain then the potential exists to speed up the process resulting in significant cost reductions across the industry as a whole.

Blockchain technology shows promise for audit trails where the immutability of data and ability to prove provenance are crucial features. Companies such as Factom take data such as patient records and compute the hash which is stored. The actual records are left in place, and if there is suspicion of modification of data the hash can be recomputed. The really important part of this process is that only the institution that owns the records ever sees the data.

Various approaches have been proposed to use the Blockchain to actually hold patient records. In these situations the patient data can be stored within the block along with the hash that proves it’s authenticity. It’s not at all clear how practical it is to query such records and the size of data that can be placed into each block is extremely limited but the idea remains interesting as a long term archive of patient data.

Blockchain also has a role to play in Population Health.  On simple example is that certain types of population health data such as cancer or transplant registries must verify a tremendous number of patient records. Block chain technology provides a relatively simple way to provide consistency amongst these records.

For applications where the veracity of data is key, the block chain offers a new way to cryptographically verify data without all parties having to maintain a complex public key infrastructure. This is particularly apropos in HealthCare and new applications are appearing daily.

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