Blockchain. A day doesn’t seem to go by without seeing articles and discussions about the technology. According to PwC executive Seamus Cushley, approximately $1.4B has been invested in blockchain just last year. In Gartner’s recent hype cycle for emerging technologies, blockchain is approaching the peak. It is considered by Gartner as one of the ‘Key platform-enabling technologies to track.’ While there is a lot of ‘hype vs reality’ discussions going on, there is no arguing that blockchain is being taken very seriously across industries and cannot be ignored.
A large percentage of the discussion does seem to focus in the financial services industry. This is not surprising given blockchain’s historic legacy (I know, a disruptive technology already has a legacy) with Bitcoin and crypto currencies. In my article, last year, Blockchain – Its So Much More Than Bitcoin, I discussed that while given that legacy, there are so many other potential areas and use cases outside that arena. Yes, the financial services industry is investing heavily in research on blockchain, as it could have fundamental impact on how they do business. Even given that, the potential use cases for the technology outside that industry are what I find much more interesting. One vertical that is particularly intriguing is healthcare.
The business challenge in the healthcare industry
The healthcare industry has been full of disruptions in the last decade. Ranging from the double digit explosive growth of medical devices in the world of the Internet of Things, to the incredible advances in machine learning that could reshape diagnostic medicine. The medical devices are generating huge volumes of data about patients, and the machine learning technologies are the consumers of that data. This highlights a common focus for these disruptive technologies, and one of the industry’s biggest challenges, patient data. Or put another way, the proverbial holy grail of the medical industry, the elusive Electronic Health Record (EHR).
EHRs have been a topic of conversation and goal in the healthcare industry for over a decade. Conceptually it sounds simple enough. A consolidated medical history of a patient that ‘may include all of the key administrative clinical data relevant to that persons care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports.’ (Center for Medicare & Medicaid Services). The challenge is this information comes from a variety of sources, providers, laboratories, hospitals each with their own patient records systems. Add to that complexity, ownership, HIPPA regulations on access control and sharing of the information, trust between systems, and the associated costs of storage and replication of potentially huge volumes of data and you begin to appreciate why 10 years later, the industry is still struggling with EHR.
This has happened before, it will happen again
The failure to achieve the goal laid out 10 years ago for EHRs is not for want of trying. There have been some fairly large and high profile attempts
- Google Health – Google Health was launched in 2008 with much fanfare. Many thought with Google behind it, the concept of a consolidated EHR would be achieved. Four years later, Google shut it down. There was a variety of analysis of why it failed including trust, willingness of insurance companies and providers to share data, and lack of perceived benefit to the consumer.
- Microsoft HealthVault – Launched in 2007 and still appears to be up and running, though there has been little press or focus on the system. Recently Microsoft seems to be trying to re-start interest, but evaluations of the current state of the system, as well as actual usage do not bode well for it.
- VISTA (Veterans Information System & Technology Architecture) – VISTA was an initiative by the Veteran’s Administration to achieve a common EHR that traces its origins back to the 1970s. Over 60% of U.S. physicians rotate through the VHA system, so it is probably the most visible effort in the EHR space. Even with that, the VA announced in March that it will be moving away for VistA towards a commercial EHR. Then in June of this year, it was announced that VistA will migrate to the DoD’s EHR system (AHLTA – Armed Forces Health Longitudinal Technology Application, say that three times fast!).
Blockchain to the rescue?
Blockchain has become a big topic of conversation as the potential ecosystem that could help achieve the goals of EHRs. Conceptually, think of a ledger of your health care information and treatments. A fully traceable chain of information and activities that you as a patient have access to and control over who has access to that information. A chain that cannot be modified or tampered with. This is the kind of use case scenario that is being seriously looked at in the industry.
- Last year, Estonia (the tiny little country that lives on the bleeding edge of technology) announced they were using blockchain to secure over one million medical records.
- It was reported recently that Amazon has a stealth research project looking at developing a patient-centric EHR model based on blockchain technology.
- A group of researchers from MIT Media Labs working with Beth Israel Deaconess Medical Center tested out the concept of using blockchain to handle medical records earlier this year.
We have miles to go, and promises to keep
While there is a lot of activity and buzz around blockchain and its potential in the healthcare industry, it is far from a certainty that blockchain will be the savior that many hope for to solve their challenges. David Chou, CIO at Children’s Mercy Hospital in Kansas, wrote a recent blog (6 Challenges to Healthcare Adoption of Blockchain) that highlights the challenges facing the use of blockchain in the healthcare industry. Key among the challenges are a cultural shift (including an innate resistance to sharing of information in the industry) and the technology challenges of all the distributed information across disparate systems.
Are we there yet? No. Using blockchain to help solve some of the challenges in the healthcare industry still has a long way to go to being a viable, productive solution. Even so, there is a lot of potential and bears watching as it progresses. As technologists, we always have a responsibility to help business and industry solve their business challenges, identifying the tools that can help achieve those goals. We should never fall victim to ‘shiny toy’ syndrome. Blockchain is a tool in the toolbox. I for one am happy to have it available, and look forward to seeing the benefits it can bring to solving business problems and challenges.