Every physician has been there. We’re entrusted to making medical decisions for patients in the clinic or hospital setting and having access to medical records from outside facilities would have significant ramifications on the care we provide. Sometimes, such as in the emergency department, physicians must make quick decisions, and access to this information may have life or death consequences.
Electronic health records (EHR) have streamlined physicians’ access to patient data over the last two decades, and have significantly cut the cost of providing patient care. However, the way in which we obtain health information from a different facility with which we do not share health records, is extremely archaic. Believe it or not, to obtain records, a physician must consent a patient to acquire those records, at which point the consent form is faxed to an outside facility from which we are requesting certain records. At that point, it is the responsibility of the receiving facility to send the records back the individual requesting. I can recall several times during my residency training during which I had to wait several days prior to obtaining those records. The cost incurred by repeating diagnostic testing performed because of lack of access to these records, is likely significant.
In addition to its strain on our healthcare system, the difficulty of accessing information from a different facility has implications on the well-being of the patient as well. Often times, medical decisions need to be made in a timely manner, and not having point-of-care access to health information negatively affects the care we provide our patients. Sometimes physicians are faced with the challenge of looking through health records, necessitating us to make decisions based on information that may be fragmented or outdated. In addition, the centralized electronic health record systems in which patient records are housed, are often vulnerable to data breaching. 2017 saw an increase in the number of such breaches, with 477 total breaches compromising 5.6 million patient records. Lastly, obtaining medical records for patients can often be a cumbersome task. It requires the patient to request their personal health information from a provider or facility, which then provides them with this data.
Blockchain technology may be the solution to many, if not all, of these issues. For those of us living under a rock, the “blockchain” was initially designed as a ledger to decentralize financial transactions. A financial institution or individual can create a cryptic secured list of transaction, and this data that can be accessed with a public key. The data of the blockchain is distributed on each “node” participating in the network. While initially conceived for the financial world, the implications of such technology have been applied to various industries, with the common aim of decentralizing data.
Theoretically, applying blockchain technology to our electronic health data has the potential to revolutionize healthcare information technology. Similar to its use in financial transactions, a blockchain would essentially eliminate the need for a “middle man,” allowing patients to remain in control of their own health data, with easier access of this data to healthcare providers. In a hypothetical scenario, a patient would consent to having their health data placed on the blockchain. If she is hospitalized or seen at a clinic in a facility where they do not routinely receive care, they would be able to provide their physician with a key that would allow them to access their health data. Outside of the implications on the patient-provider relationship, blockchain technology applied to EHR has the potential to revolutionize data analysis for research purposes as well.
Application of blockchain technology to EHR is not necessarily a new concept. In 2016, Lippman et al., a group at Harvard’s Beth Israel Deaconess Medical Center, developed a platform called MedRec using Ethereum smart contracts, to provide patients and providers with easier access to medical records. Academic institutions are catching onto the utility of the blockchain as well. Mayo Clinic recently partnered with a London-based startup called Medicalchain to integrate various blockchain ledger systems at their health system. In June of this year, Walmart won a patent application for a wearable device storing healthcare data on a blockchain. This device would store the patient’s data and may be accessed with an RFID scanner. Used in conjunction with a biometric scanner to identify the individual, this would allow first responders and physicians to have point-of-care access to medical data in emergency situations.
Development of a universally-accessible blockchain for EHR would be no easy task. First, getting EHR software vendors, hospitals, outpatient clinics, and other organizations to be on board would require integration of thousands of systems and thus would require a significantly challenging concerted effort. It would require an interface capable of integrating significant amounts of patient data. In addition, blockchain technology requires “miners” to validate new data and record it on the public ledger by solving problems based on cryptographic hash algorithms. So who would be responsible for mining all of this data? Lippman et al., in their MedRec platform, incentivize medical researchers and healthcare practitioners to mine on the platform, which in return would release access to medical data as a mining reward. This may provide a reasonable solution to this question.
Implementation of APIs that adapt blockchain technology to electronic health record have the theoretical implications of solving many of the issues we see today with sharing health data. This may make health data more accessible to physicians, allowing us to provide better care, while making this data more secure and less prone to breaches. It’s clear that getting to this point would require aligning the goals of both public and private entities. While the adoption of blockchain technology is seemingly on the crux of changing the financial industry, only time will tell whether it may be capable of revolutionizing the way we access our health data.