Technology may finally overcome the resistance within Ontario’s health-care system to changing how health data is shared and interacted with.
While patient electronic medical records (EMRs) are widely used by clinicians, they usually remain tied to the health provider’s practice. However, blockchain technology can securely store and manage these EMRs by encrypting and linking each block in a decentralized and distributed ledger to create EMRs that can move with patients. Blockchain provides a high level of security and privacy, enabling patients to control their own medical records and share them securely with health-care providers. Additionally, blockchain can facilitate the efficient sharing of medical records between providers, reducing duplication of tests and procedures and improving care coordination.
Okey Igboeli, a Waterloo professor of Science and Business and senior author of a 2020 paper proposing blockchain as a solution to managing health data in British Columbia, explains that blockchain technology can be integrated with existing application interfaces (software communication) and platforms, eliminating the need for a complete system overhaul and facilitating seamless data sharing between health-care providers and researchers, a significant inefficiency in our current health-care system.
“We started our research trying to identify how to improve the Canadian system,” says Igboeli. “We used B.C. as a snapshot of how the rest of the country looks like in terms of health-care data management. Our paper provided a reimagined version of what the solution should look like after speaking to experts about the provincial health service.”
Blockchain technology is a work in progress, with ongoing developments aimed at enhancing its efficiency. And as with all new technologies, there are some kinks that need to be ironed out, says Igboeli, including transparency and anonymity that could negatively impact the security and confidentiality of personal health information. Of chief concern is designing a “built-in key retrieval process” so that if patients misplace or forget their “key” (password) there is a retrieval process. This is especially important in cases where someone may forget due to a medical condition or a health issue (e.g., Alzheimer’s, dementia, traumatic brain injury, stroke or certain medications that affect cognitive function). While this key-retrieval solution would need to be built into the infrastructure itself, Igboeli is convinced that it is a solvable problem.
Another issue is that blockchain has high energy needs that require smart architectural and governance design choices. Ultimately, the decision to use blockchain or an alternative distributed database will depend on the specific requirements of the particular use case.
But the biggest hurdle to implementation has nothing to do with the technology itself. Obstacles include the challenge of digitizing medical records, slow adoption of new methods by the medical profession and concerns around interoperability, which refers to the ability of different systems to share and use data with each other.
Interoperability is a particular issue in health care, where lab results and health data from one provider may not be easily read and used in another system. While other industries have found ways to overcome interoperability challenges, the health-care sector still needs to do more work in this area.
Security, confidentiality and ethics
Given that EMRs contain personal and identifiable information about a patient’s medical history such as diagnoses, medication and laboratory results, it is essential to maintain privacy and confidentiality.
And blockchain does just that, strengthening EMR security through its immutability, transparency and decentralization: immutable since data is unalterable once it is accepted into the chain; transparent because it provides a history of all transactions; decentralized because it allows access to the data across multiple independent systems that have been given privileges. Secure data sharing between health systems and health-care providers is a challenge that currently exists between disparate EMR systems.
Blockchain improves integrity and accountability by creating a tamper-resistant historical record.
Blockchain also improves integrity and accountability by creating a tamper-resistant historical record that facilitates auditing. An audit log serves as a form of security since it holds users accountable if they misuse their access privileges. In addition, patients will be able to identify who accessed their data compared to EMR systems in which patients are unaware of this information.
While there are concerns over commercialization of patient data, blockchain gives patients ownership over the data and authority over who can access it. Commercialization is not inherently negative; it should only be viewed as such when patients’ data is commercialized without their knowledge.
However, patients’ abilities to make these informed decisions is dependent upon their digital literacy and health literacy. Thus, they must possess both the cognitive and technical skills required to use and access the information, in addition to the ability to interpret and understand the health information.
Policy implications
The recent Canadian health-funding agreement presents a policy window of opportunity for blockchain technology. The funding package comes with four goals in mind – two of which could be facilitated by blockchain technology: patients’ access to their own electronic health information and a resilient and supported health workforce. On the first point, the vast majority of patients (88 per cent) who have accessed their own personal health information said they felt more informed about their health but only 32 per cent have accessed their health data electronically. Blockchain’s ability to centralize a patient’s data holds promise that patients could access their data frequently and easily.
On the second point, the current exchange of health information is a time consuming and repetitive task; the lack of patient’s complete health information can cause physicians and clinics to take additional time and resources on locating information, leading to more delays and redundancies. Blockchain could facilitate better administrative workflows by enabling patients to share their health data with authorized individuals seamlessly.
However, there are still a number of needed policy reforms. For one thing, the government of Ontario would need to create a legal procedure for blockchain key retrieval. Furthermore, existing privacy laws and data governance may need to be revised. The Ontario Personal Health Information Protection Act (PHIPA) stipulates that Ontarians can request that corrections be made to one’s health record, but data stored on the blockchain cannot be deleted.
These governance issues mean more research is needed before blockchain can be fully implemented. Igboeli recommends that policymakers identify all the key players – health-care workers, patients, tech developers, etc. – and engage them in the development and adoption of blockchain applications.
“Not all concerns are unfounded,” he says, “and these challenges must be confronted head-on.”
In the near future, Igboeli says the integration of blockchain technology and artificial intelligence could revolutionize the health-care sector, especially in the efficiency and effectiveness of diagnosis. Add in extended reality that researchers are working on, and doctors could interact with patients in real-time through remote technologies.
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Reading this article, I can’t see that it actually makes a case for the use of blockchain technology in healthcare that doesn’t apply at least as well to conventional databases. There is the claim that it will increase accessibility for patients, but how is that different from the patient portal apps that current EMRs already have? There are also claims about ease of sharing data, but I can only see that being true if every hospital, clinic and office adopted EMR systems that are operable with the same blockchain. If we had the power to implement that, we could just standardize them all on the same conventional EMR system, or build a database that could link all the EMRs.
Meanwhile, the issues with technological literacy, the right to alter records, and the difficulty of replacing lost keys without ultimately relying on an old fashioned centralized database are noted but not really pursued. The position seems to be “blockchain is coming to healthcare with major benefits, and we need to tackle these hurdles to enable it”, but that’s begging the question.
Thus far, in its first 15 years of existence, blockchain technology has mostly managed to impost a massive environmental burden for little practical benefit and to facilitate financial fraud. It may eventually have practical uses superior to other database technologies, but I wouldn’t assume that to be the case, and I’d caution journalists about the risks of inflating yet another hype cycle around the concept.