Recently we came to know about an interesting incident at a corporate wellness camp. The health workers recording the vital statistics of the participants were making key mistakes in recording the observations. A good example was the height of one of the participants was recorded wrongly as 147 centimeters instead of 157. Immediately the participant became obese as per the record. Similarly, BP was recorded wrongly for another participant. Though both mistakes were eventually rectified, we were left wondering how many such errors happen in the healthcare ecosystem daily and what the consequences of these errors would have been.
Also In our opinion having historical medical data would have given some guidance to the health workers collecting data. For example, the height of an adult would not change. Similarly looking at the pattern of previous Blood Pressure readings would have given the health workers an indication of whether they would need to take that reading again. Collecting, managing and storing healthcare information is the key to maintaining quality and improving care outcomes.
The experience from other countries is not very different. US-based healthcare organizations have spent around $ 93 Billion over the last five years in just data sharing costs? Surprised? Healthcare data can be complex – in part due to the non-linear nature of diagnosis and treatment, and also due to differing healthcare standards across regions in the world. Additionally, data privacy and other related laws can make healthcare information difficult to access and share. So much so that in many countries, including India, a patient may not have complete access to his/her medical record!
Considering that the next paradigm shift in healthcare is expected to come from the adoption of digital technologies – whether for patient experience or improved efficiency of hospital tasks – it is important to address current challenges around data sharing and access, lest they become hurdles to progress. In that context, blockchain could be a savior for the industry.
Blockchain is a continuously growing list of records, called blocks, which are linked and secured using cryptography. Each block contains, typically, a link to a previous block, a timestamp and transaction data. Transactions have to be approved by all users of the blockchain to be stored and modifying an older block of data is impossible. Only updating of future records is permissible making the system secure (relatively speaking) and therefore reliable. This also means an entire blockchain can serve as a secure ledger that records transactions, negating the need for multiple disparate trails of information.
We believe Indian healthcare has most to gain from the adoption of blockchain technology. For starters, blockchain allows all types of data to be integrated into the chain. This means one can add not just doctor prescriptions and treatment records but also nutrition information, fitness data, and recordings from medical devices (such as for blood pressure and diabetes patients) by patients themselves. Over time the presence of such longitudinal patient data means caregivers can better interpret disease symptoms and prescribe effective treatment that is customized to work for the patient. Currently, doctors rely on data from treating different patients to prescribe medication. The chances of success for such medication are about 50%. In many cases, doctors wait for feedback from patients to change the medication. With the availability of longitudinal patient data, doctors would know in advance what treatments are more likely to suit a patient in line with his/her health history.
If implemented over a large scale, blockchain could help significantly lower healthcare costs in India. In addition, it can give multiple parties selective access to patient records ensuring data is not compromised. A survey report by IBM outlines the following healthcare areas benefiting from blockchain: clinical trial records, patient health records, regulatory compliance, medical device data integration, treatment records, billing and claims, asset management (for hospital assets such as beds/ equipment available), and contract management (for hospitals).
In India we are proposing a new model for sharing and accessing Healthcare records over Blockchain. We are calling it Healthchain.
Healthchain is decentralized, distributed and anonymous platform which brings security, transparency, accessibility, and speed in EHR. Healthchain stored the EHR and the immutable ledger maintain makes it the single source of truth. All the records cryptographically secured and need owner’s permission. Same way, it’s distributed and decentralized so as a patient you need not rely on a single entity. It allows different participants like doctors, hospitals, Labs, insurance company, and research agency to be part of Consortium. The patient is a base and key player of this solution makes him the owner of his records. He can access his records instantly across the globe; he can share or give timely permission to other participants to access his medical records and/or history for medical use. In fact, by sharing personal health records patient may get some discount from the insurance agency and also get a reward from health researcher.
In short, Healthchain gives rights and freedom to patients with their EHR by the power of Blockchain. Below is a representative diagram of how Healthchain would work in the Indian set up.
Currently, there are a few pilots running on Blockchain in Healthcare. Interestingly Estonia is already one of the most advanced nations when it comes to Blockchain implementation and has already been using Blockchain to deliver citizen and government services. They are planning to enable healthcare records of all their citizens on Blockchain. In 2016 Estonia digitized all health records and this is a critical first step towards the success of a future Blockchain implementation. Currently, all citizens in Estonia already carry a card with a unique id, similar to the Aadhar card in India. It will be interesting to see the results once all health records in Estonia are Blockchain enabled.
Traditionally, healthcare has been a laggard when it comes to embracing new technologies. However, the interest and exploration of blockchain among other industries – finance and pharmaceuticals – may fuel blockchain adoption in the healthcare industry in the coming years.
Coauthored with Priyank Jani a technologist and innovator who came up with the concept of Healthchain