Adam Kassam is the chief resident in the Department of Physical Medicine & Rehabilitation at Western University
Jeremy Wasserlauf is a fellow in cardiovascular disease at Northwestern University Feinberg School of Medicine
The meteoric rise of bitcoin has fueled worldwide interest in cryptocurrencies and, more broadly, blockchain technology. The once obscure brainchild of Satoshi Nakamoto has evolved into a speculator’s paradise, rivaling the dot-com bubble of the early 2000s. While bitcoin’s future as a digital currency is a topic of debate, its underlying blockchain software has become the foundation for a technological revolution that began in finance, but is quickly transforming other industries. The application of blockchain to the world of healthcare may prove to be its most humanitarian of functions.
Acclaimed as one of the biggest innovations since the internet itself, blockchain eliminates trusted third parties such as banks from online transactions and replaces them with a decentralized database, or a ledger, of transactions. The ledger is stored across a network of computers that is visible to everybody, and a combination of cryptographic keys is used to create a secure reference of identity. Transactions are entered as “blocks” in the ledger, and once strung together as a blockchain, create a record of transactions that cannot be changed. This technology also deconstructs the current model of a vulnerable central database, meaning that the ledger spread across a vast network of nodes becomes much less attractive to hackers.
Healthcare has long had an aversion to technological change, and its reputation as a laggard has roots in the traditional, methodical and often slow practice of medicine. Recently, the medical community has warmed to innovation, with wider integration of electronic medical records (EMRs) over the past decade . The Achilles’ heel of EMRs, however, is their lack of interoperability between healthcare settings. Even the most advanced hospital emergency department may have no easy way to access your medical information from another hospital across town. In the connected world of the 21st century, patients should expect more than an open-ended request by fax when their health is at stake. The consequences of the fragmentation of EMRs include delays, medical errors and costly duplication of care.
Accessibility of patient data is also part of the larger discussion of who controls it. Since the data are not owned by any one person or entity, why should the comprehensive health information of a patient be restricted? While several forces have emerged to reduce fragmentation, such as the integration of independent practices into larger health systems, and the creation of health information exchanges, many gaps in records still exist. Ultimately, this is where blockchain technology can be leveraged to further unify the secure exchange of health information.
Using optimized blockchain technology, a patient could theoretically visit any clinic or hospital and have their complete, up-to-date medical record available to physicians. This would ideally integrate with smart devices that provide point-of-care monitoring of medical conditions. Blockchain also has the potential to harness the concept of crowdcare, where medical providers and machine learning can synergize globally using ciphered data to improve diagnostic capabilities. Patients could volunteer to share selected data from their medical record for medical research, while still maintaining control to keep other elements confidential. Encryption would also serve as strong immunity to the cyberwarfare increasingly threatening hospitals.
Blockchain’s promise as an agent for healthcare innovation should be balanced by an awareness of its potential sinister uses. This includes reports of opioid smuggling funded through bitcoin, and its value on the black-market for illicit drugs and organs. Policing this nefarious activity will be difficult and the tech community should be challenged to build safeguards into future iterations of its software.
As medicine’s relationship with technology evolves, there will be will a growing obligation to ensure the security and accessibility of patient data. The sophistication of personalized bioinformatic and genomic analysis, combined with the persistent refinement of artificial intelligence, will come to represent some of the most significant advancements in the history of the profession. Ultimately, the medical community should leverage this opportunity by building bridges with other industry leaders to safely disrupt healthcare from the boardroom to the bedside.
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