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BLOCKCHAIN IN HEALTHCARE

HOW TECHNOLOGY CAN IMPROVE MEDICAL TREATMENTS AND RESEARCH



1. OVERVIEW: WHAT IS BLOCKCHAIN AND BIG DATA IN HEALTHCARE


The average human lifespan is increasing across the world population, which poses new challenges to today’s treatment delivery methods. Healthcare analytics has the potential to reduce costs of treatment, predict outbreaks of epidemics, avoid preventable diseases, and improve the quality of life in general.

By utilizing key performance indicators in healthcare and healthcare data analytics, prevention is better than cure, and managing to draw a comprehensive picture of a patient will let insurance provide a tailored package. This is the industry’s attempt to tackle the siloes problems a patient’s data has: everywhere are collected bits and bites of it and archived in hospitals, clinics, surgeries, etc., with the impossibility to communicate properly. Indeed, for years gathering huge amounts of data for medical use has been costly and time-consuming.


Figure 1. [Workflow of Big data Analytics. Data warehouses store massive amounts of data generated from various sources. This data is processed using analytic pipelines to obtain smarter and affordable healthcare options]


One of the biggest hurdles to using big data in medicine is how medical data is spread across many sources governed by different states, hospitals, and administrative departments. The integration of these data sources would require developing a new infrastructure where all data providers collaborate with each other.



HOW CAN BLOCKCHAIN HELP?

A blockchain is a distributed system that generates and stores data records. It maintains a digital ledger of connected “blocks” of information that represent how data is shared, changed, or accessed on its peer-to-peer network.

All devices on the same blockchain system will generate identical blocks when a connected device is involved in any kind of transaction. If one computer’s data is accessed, changed, shared, or otherwise manipulated in any way, a block is generated to locally record that information on every device. This way, changes to data can be easily identified. It's a decentralized approach that allows data parity to be achieved by comparing every connected device's blocks.

On top of simply recording and comparing data is the utilization of “hashing.” Hashing gives every block a unique identifier that changes based on its contents. This is important because blocks are stored together in chronological order and also directly reference the preceding block’s hash. Therefore, trying to change the data of one block would immediately cause a succeeding block to identify a hash change. It is for this reason that connected blocks form a “chain” securely wrought in an immutable, reliable, decentralized manner.

Blockchain will facilitate finely customizable openness while upholding only the best security standards for true interoperability. In turn, this will allow health information systems to work within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities.



Figure 2. Applications of blockchain in healthcare


2. MAIN FEATURES OF THE BLOCKCHAIN TECHNOLOGY HELPING THE HEALTHCARE INDUSTRY


Blockchain has a wide range of applications and uses in healthcare. The ledger technology facilitates the secure transfer of patient medical records, manages the medicine supply chain, and helps healthcare researchers unlock genetic code.



  • DATA SECURITY: Keeping our important medical data safe and secure is the most popular blockchain healthcare application at the moment, which isn't surprising. Security is a major issue in the healthcare industry.

  • PRIVACY ENFORCEMENT: Additionally, while blockchain is transparent it is also private, concealing the identity of any individual with complex and secure codes that can protect the sensitivity of medical data.

  • INFORMATION SHARING AND PERSONALIZATION PLANS: The decentralized nature of the technology also allows patients, doctors, and healthcare providers to share the same information quickly and safely. The decentralized nature of the technology creates one ecosystem of patient data that can be quickly and efficiently referenced by doctors, hospitals, pharmacists, and anyone else involved in treatment. In this way, the blockchain can lead to faster diagnoses and personalized care plans.



Figure 3. Medical errors as percentage of annual deaths (US 2016). Preventing them through a more efficient sharing of data is of paramount importance for a substantial improvement in medical treatments outcomes.


  • SUPPLY CHAINS CONTROL: How much do we really know about our medicine? Can we be sure it hasn't been tampered with? Is it coming from a legitimate supplier? These questions are the primary concerns of the medical supply chain or the link between the lab and the marketplace. The decentralization feature of Blockchain has serious implications for pharmaceutical supply chain management, granting full transparency in the shipping process. Once a ledger for a drug is created, it will mark the point of origin (ie. a laboratory). The ledger will then continue to record data every step of the way, including who handled it and where it has been until it reaches the consumer. The process can even monitor labor costs and waste emissions.

  • INSURANCE: Smart contracts for insurance: This type of environment goes a step beyond supply chain management to also enable trading partners and insurance providers in the healthcare sector to operate based on fully digital and in some cases automated contract terms. By having shared digital contracts between manufacturers, distributors, and healthcare organizations logged on a blockchain ledger, rather than each player having their own version of contracts, they can significantly reduce disputes over payment chargeback claims for prescription medicines and other goods.

  • MEDICAL STAFF CREDENTIAL VERIFICATION: Like tracking the provenance of a medical good, blockchain technology can be used to track the experience of medical professionals, where trusted medical institutions and healthcare organizations can log the credentials of their staff, in turn helping to streamline the hiring process for healthcare organizations.

  • ·IOT SECURITY FOR REMOTE MONITORING: One of the biggest trends in digital health is the adoption of remote monitoring solutions, where all kinds of sensors measuring patients’ vital signs are being used to help give healthcare practitioners more visibility into patients’ health, enabling more proactive and preventative care. The decentralized nature of blockchain means that IoT devices can interact directly with each other, without going through a centralized server (as most IoT connections do today), making it very difficult to launch DDoS and man-in-the-middle attacks.


Figure 4. Blockchain-based healthcare data management system between multiple stakeholders (nodes) within a healthcare ecosystem



Frontline companies for the implementation of blockchain in healthcare:

applying blockchain to security:

  • · Akiri

  • · BurstIQ

  • · Factom: Factom creates products that help the healthcare industry securely store digital records on the company’s blockchain platform that's accessible only by hospitals and healthcare administrators. Physical papers can be equipped with special Factom security chips that hold information about a patient and stored as private data that is accessible only by authorized people. In June of 2018, Factom got a grant of nearly $200,000 from the U.S. Department of Homeland Security to beta-test a platform aimed at integrating secure data from Border Patrol cameras and sensors in order to better understand the impacts of blockchain

  • · MedicalChain



applying blockchain medical records to create shared databases and personalized health plans:

  • · ProCredEx

  • · Avaneer

  • · SimplyVital Health

  • · RoboMed

  • · Coral Health: By inserting patient information into distributed ledger technology, the company connects doctors, scientists, lab technicians, and public health authorities quicker than ever. Coral Health also implements smart contracts between patients and healthcare professionals to ensure data and treatments are accurate.


using blockchain to rethink the medical supply chain:


  • · Embleema

  • · Chronicled



3. BLOCKCHAIN AND GENOMICS


One of the big barriers holding back precision medicine (based on patients’ genetic content) is the health systems’ inability to store and access large amounts of data, safely and securely. While data storage technology, such as the cloud, offers solutions to access such data from any place and device, the security and data integrity, have not yet been addressed.

As precision medicine becomes increasingly integral to our healthcare system, the industry will no doubt face a number of technical and ethical challenges; how can we ensure the privacy of genetic data? How can we be trusted to share this data safely? And ultimately who owns this data?

Any long-term genomic data storage solution will need to guarantee individuals have control and protection of their data, whilst at the same time provide access to clinicians and biomedical researchers.

This is where blockchain comes in.

The core function of genomics big data platforms is to collect personal genetic data for application and sharing. What makes blockchain an ideal solution is it addresses both the patients’ needs – a secure and transparent way to store their data – and also the data-sharing requirements of healthcare and pharma professionals.

Blockchain facilitates direct interaction between data providers (users) and buyers (pharma companies, research institutes), without the need for a trusted third party.

Meanwhile, cryptographic keys maintain the anonymity of users during the data exchange. This means buyers can utilize the information to study genetic patterns in a given population without compromising the privacy of the individual. This open, but secure, transfer of data is crucial in enabling the development of drugs and other therapies based on genomic profiles.


The Global Blockchain in Genomics Market is expected to grow at a significant CAGR during the upcoming decade, although high maintenance costs of the blockchain technology may slow down this trend.

The market for global blockchain in genomics is segmented based on type, application, models, targets, end-user, and region. The end-user segment is bifurcated into pharmaceutical companies and research institutes. Among these, pharmaceutical companies held the dominant market share in 2019 and the trend is likely to continue in the coming years as well. Additionally, pharma companies are mainly the ones carrying out the transaction of genomic data contributing to its leading position in the market.

In terms of regional analysis, North America held the dominant share in the market because of its rich economy and the presence of numerous research companies in the region. Asia-Pacific is anticipated to witness the fastest growth until 2025 as developing economies like India and China are now adopting blockchain in genomics.



Some active companies in genomics and blockchain:


  • · Nebula Genomics is using distributed ledger technology to eliminate unnecessary spending and middlemen in the genetic studying process. Pharmaceutical and biotech companies spend billions of dollars each year acquiring genetic data from third parties. Nebula Genomics is helping to build a giant genetic database by eliminating expensive middlemen and incentivizing users to safely sell their encrypted genetic data.

  • · Encrypgen: the EncrypGen Gene-Chain is a blockchain-backed platform that facilitates the searching, sharing, storage, buying, and selling of genetic information. The company protects its users' privacy by allowing only other members to purchase genetic information using safe, traceable DNA tokens. Member companies can use the genetic information to build upon their genetic knowledge and advance the industry.

  • · Doc.ai


4. THE IMPACT OF COVID-19


As for many industries, the Covid-19 pandemic has upset the perception of the health care system. The trust in medical research and hospitals efficiency has been put under pressure like a few times back in human history.

On the one side, the pandemic has paralyzed access to global healthcare systems through unprecedented lockdowns and enforced physical distancing; on the other one, it has rapidly accelerated the adoption of digital technologies to meet various health care needs worldwide, as population-level mass screening, rapid contact tracing and supply chain management for vaccines and drugs.


The currently established database systems in the healthcare dimension have substantial limitations, such as the inability to support peer-to-peer data sharing, susceptibility to external adversaries like hacking, and the absence of an immutable audit trail.

Overcoming such barriers has become more and more necessary as the pandemic has spread. Secure, decentralized, multipurpose platforms for coordination of large-scale transfer of sensitive information are currently more a need than a dream.


Among digital technologies, the Blockchain one has numerous potential applications which could provide effective solutions to such issues. However, much of the current research remains at the technical stage, highlighting the need to turn the theory into clinical use.


Nevertheless, to achieve durable and significant effects, a stronger impetus than the one given by Covid-19 alone is needed. The healthcare community as a whole would need to develop greater understanding, literacy, and targeted research in blockchain technology and its clinical applications. Moreover, a higher general awareness of the potentiality of investments in technologies such as the Blockchain one by the community needs to be achieved.

An analysis based on reports published in MEDLINE, SpringerLink, and Institute of Electrical and Electronics Engineers Xplore found that the main COVID-19-related applications reported were the following: pandemic control and surveillance, immunity, or vaccine passport monitoring and contact tracing. Still, they were less than non-COVID-19 related ones.



Figure 5. Articles coverage on blockchain applications in healthcare


A discussion of such results can provide us with a significant overview of the current situation.

A fundamental premise here is that even though when talking about COVID-19, the data involved are usually sensitive ones, these need to be easily verifiable and managed transparently. However, transparency, in this case, may generate privacy concerns as it would imply granting full access to those data to central authorities.


To address these concerns, the research found that a blockchain-based movement pass has been developed. It relies on smart contracts and tokens that dispense the need for personal particulars for verification purposes.

In a separate study by Antal and colleagues, IoT sensor devices were combined with self-enforcing smart contracts on an Ethereum blockchain platform to achieve end-to-end tracking and visibility. The technology allows to ensure the veracity of COVID-19 vaccine distribution data. In addition, the proposed system also addressed a major concern about such vaccines, by also supporting on-chain recording of side effects.

These are just some of the examples that highlight how blockchain solutions can overcome the challenge of collating verifiable tracking data.


5. FUTURE PERSPECTIVES


As far as future expectations are concerned, there are still some points of confusion when it comes to the ways blockchain can be deployed effectively in healthcare. What we can say is that Covid-19 has played a role in lowering the barriers to the entry of new and innovative digital technologies into health care by altering mindsets in favor of such technologies.

A report released by Chilmark stated:


“Blockchain can be a superior approach to existing technologies if the business logic in the transactions can be translated into a smart contract on blockchain”.


“Where trust is lacking between parties that need to share data, blockchain can mitigate the need for parties to integrate databases.”


Such advantages suggest a shoo-in for widespread health IT infrastructure adoption exists, but actual implementation depends on what standards are produced in the coming months and years.


Standards are being developed, but there is no set standard for all healthcare organizations to use. Each component in the blockchain context is more complex than most other technologies we have seen drive innovation in healthcare over the past two decades. Standardization needs to be implemented at a high level to achieve concrete results in terms of both efficiency and effectiveness.



In conclusion, one could state that Blockchain applications in healthcare are now all set to radicalize the healthcare industry. As the healthcare sector generates vast amounts of critical data that often remain scattered and unorganized, the correct implementation of Blockchain represents an interesting growth perspective.


The key takeaway is for sure the two-level perspective in looking at this issue: on the one hand, the implementation of Blockchain could solve technical problems, resulting in more precise and efficient storage and distribution of sensitive data. On the other one, it would generate significant ethical challenges related to the sharing of sensitive information and the subsequent privacy issues. An increased awareness, as well as a constructive attitude spread across the community, constitute the only solution to strive towards innovation in both a safer and challenging way.


Writers:

Ludovico Ghitturi Alessia Carretti

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