Blockchain is increasingly touted as the technology that could transform many of the challenges facing healthcare and life sciences; whether it is providing secure and interoperable electronic health records (EHR), increasing the integrity of clinical trials data or improving the transparency of life science's supply chain operations. While, the technology itself is not revolutionary, using it in the right situation, especially where trust, consensus or immutability are essential to the operations of the Life Science and Health care industries, could be transformational.
What is a Blockchain and what are its benefits?
The role of a blockchain is to serve as a distributed digital ledger in which the transactions occurring in a network can be stored, viewed, and unaltered once validated by users of the network. In the world of cryptocurrency, where the technology originated, there are a wide array of blockchains being implemented, many of which have differing protocols to ensure user anonymity, transaction transparency, data validity, network incentivisation and data immutability is maintained.1 Blockchain technology offers a number benefits for the health care and life sciences industry (See Figure 1).
Blockchain-enabled use cases in life sciences and health care
Realising these benefits and implementing the right type of blockchain will allow the life sciences and health care industries to improve multiple facets of their operations. Below is a list of the potential blockchain use cases that a recent Deloitte report, Blockchain to blockchains in life sciences and health care, identified.
- Medical records: a patient's medical history that is spread across health care stakeholders could be consolidated into a single-record using a distributed identity platform enabled by blockchain. This would give the patient visibility and control over a verifiable digital medical record and the patient would then grant permission to health care providers and payers to see the relevant health transaction information needed for enhanced patient care and experience. Sensitive personal data would be stored off-chain, linked to a unique reference or 'hash' which can be used to verify the authenticity of the off-chain patient data. Emerging prototypes include blockchain-based patient identifiers, which can be linked to hospital records and other off-chain storage systems.2
- Prescription sharing: a patient could provide audited, digital consent to have personal prescriptions tracked and operated on the blockchain to improve transparency and data validation.
- Patient wearables: a connected device that broadcasts anonymised patient information could offer a real-time, scalable solution for monitoring and treating patient outcomes.
- Supply chain: digital asset records could be linked to pharma products to track their journey through a supply chain. The record and asset history could be used to verify the integrity of deliveries and limit the risk of counterfeiting.
- Clinical trials: the risk of manipulating clinical trial protocols to match with results can be reduced. A unique, immutable reference (hash) of the trial protocol can be added to the blockchain from the outset and can later be used to validate the authenticity of the trial protocol when results are published.
- Adverse events: a blockchain solution could enable companies to share adverse events data securely, permissioned such that only contributing members could view others' data on a single, transparent platform.
- Consent management: a blockchain solution could manage and track informed consent across multiple sites, systems, and protocols in a consolidated record of events. The consent and use could be tracked forward into future research a patient may want to be involved in.
What type of blockchain is right for the life sciences and health care industries?
For both the health care and life sciences industries, incorporating the right type of blockchain is critical to ensuring its success and should be aligned to the organisation's needs for user anonymity, data security, transaction speed and cost. For use cases to become a reality, a number of factors need to be considered which I detail below.
- Public vs private blockchains: a public blockchain provides greater data integrity and security through a network-wide distribution of the chain. However, a public chain also provides an indication of the transactions to all participants in the network without revealing the details to those outside of their network. A public chain would also require validators to be incentivised to give up their own resources to ratify the transaction. A private chain is a solution that is only open to the network the organisation chooses. These may be cheaper to run as they require simpler protocols to validate transactions. However, these can also be manipulated more easily by an attack on the network, or if a network authority feels it is prudent to do so, thereby undermining the concept of data immutability in blockchains.
- Validation model: validation within blockchains is a crucial proponent that helps to ensure the integrity of the data being added to the transaction chain. In some public blockchains currently in use, transactions are validated through large amounts of computing power competing to solve mathematical problems, rewarding the validators with either digital currencies (with a value associated to fiat currencies) or transaction fees. In public chains the computing power needed to validate large volumes of transactions, as in the case of an EHR implementation, could constitute a large and costly computational burden. These models may not necessarily work for the health care and life sciences industries, but the alternative of private chains whose validators are chosen can create bias, limit transaction speeds if there are not enough to meet the transaction demand (also the case for public chains), and can serve as a single point failure should the system be compromised.
- The extent of user anonymity: not all applications of blockchain need to completely mask their users. For example, the implementation of a private chain amongst the supply chain of a life sciences company would benefit from users and their interactions being visible, as this can enable more accurate error identification and faster correction.
- Smart contracts: blockchain smart contracts can enable decentralised autonomous execution of business logic based on trigger conditions and trusted data. Applying a smart contract layered blockchain to the healthcare industry by recording transactions and transfers of care can significantly streamline the execution process and create an immutable audit trail of the journey of patient care and record ownership. This could also reduce the occurrence of lost or mismatching patients, ownership disputes, and provide authorities with transparency in respect of transactions in near-real time.
The future of blockchain in health care and life sciences
Blockchain is a novel technology that can provide a tangible solution for many of challenges the health care and life sciences industries face in terms of user anonymity, data security and interoperability. While real life use cases for blockchain in life sciences and health care are still developing, there are number of pilots expected to develop in the coming years. However, the successful implementation of blockchain will require the industry to truly understand the use cases for the technology, pick the characteristics of blockchains that meet their needs, agree on data standards and define the value its implementation will provide to both internal and external stakeholders.
Footnote
2 https://enterprise.gem.co/health/
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