How Blockchain Can Improve The Health Information Exchange
This article originally appeared on Forbes.com.
POST WRITTEN BY Boris Shiklo, CTO at ScienceSoft, a software development and consulting company headquartered in McKinney, Texas.
Health information exchange is probably that one thing that keeps hindering healthcare IT. The challenges are in data security and privacy, as well as in multiple operational inefficiencies, which inevitably concern those partaking in sensitive interactions.
There are multiple reasons why assuring PHI (protected health information) privacy remains challenging, but the major one is that there are no uniform architectures and standards to ensure trusted access to PHI and PII (personally identifiable information) and safe data exchange between all stakeholders, including patients.
It hinders patient engagement due to patients’ limited ownership of their health data, hurts care cooperation between providers from different networks, and also back-pedals population health management since caregivers can’t effectively exchange their insights in a secure way.
However, there can be one technology to create a new health information exchange framework and solve related problems: the blockchain technology.
The Chain Of Trust
We can define blockchain as a distributed record of peer-to-peer transactions composed of interlinked transaction blocks in a digital ledger. It is a system with no central authority, where each participant can store, exchange and view information without pre-existing trust. Speaking of access to sensitive information, blockchain protects data through the public/private key access.
Blockchain promises to ensure cost efficiency and accountability in sensitive health data transactions via its key concepts, as identified by IBM (full disclosure: IBM is an official partner with my company):
- Bit-string cryptography secures data integrity without violating HIPAA (the Health Insurance Portability and Accountability Act), continuously limiting real-time use and analysis of health data.
- The majority of chain nodes confirm transaction validity through consensus.
- Smart contracts authorize and notarize each transaction.
Each time caregivers provide patients with a medical service, they track and update their patient’s health data, including clinical notes, care plan, lab results, procedures performed, etc. In a finite network of providers, it leads to issues with security and patient engagement.
Privacy And Security Pains
Major issues related to privacy and security include:
- Hacking attacks
- Data integrity and availability
- Trust and access control
- Confidentiality of PHI and PII
- Compliance with HIPAA and other privacy regulations
Each blockchain network participant has a secret private key and a public key that acts as a visible identifier. This pair of keys is cryptographically linked so that identification is possible only in one direction by using the private key that unlocks a participant’s profile.
Due to identity permission layers, patients can limit data access and then share relevant parts of their personal information with particular providers within their care network. This way, a potential attacker can’t just crack a single patient’s private key to access PHI. Instead, the hacker would need to steal each user’s private key to obtain valuable identifiable information. But that’s not easy either.
All providers within one blockchain can keep their own copy of the health care ledger. If the block is to be adjusted, 51% of network participants have to approve the change, as every copy of this blockchain should be updated to reflect the change. This feature improves security and helps to limit the risk of a malicious activity since all changes are broadcasted within the network and distributed ledgers provide safeguard copies against harmful hacks.
Blockchain also helps with frictionless connectivity since it's supported by smart contracts and consistent authorization to access health data. Smart contracts serve as a gateway to store standardized information, which all network participants can immediately access thanks to API-oriented architecture. This architecture allows for seamless integration with each organization’s existing systems, so providers can focus on their internal systems.
Patient Engagement Pains
On the patient engagement side, the major issues today include:
- Poorly trackable clinical outcomes
- Fragmented efforts in population health management
- Inconsistent disease management
Patients get suspicious about recording and sharing their social and health data. Be it identity, genetic or biometric data accumulated from various settings, patients need to feel they own their data.
A blockchain network with smart contracts can help providers to gain patients’ trust since individuals will be able to track everything that happens with their information. Here, trust means better visibility in a patient’s health status outside the clinical setting and between appointments.
In population health management, providers can use blockchain to progress in clinical research, patient safety event reporting, adverse event identification, public health reporting and precision medicine. Through the blockchain transaction layer, organizations can access sets of standardized, non-patient identifiable data. These data sets can be then analyzed with cognitive computing, machine learning and analytics.
Healthcare is getting ready for blockchain. According to IBM, about 16% of payers and providers are ready to “adopt, implement and commercialize blockchain.” IBM itself along with Accenture, Hashed Health and Kaiser Permanente take part in the Hyperledger Healthcare Working Group to ensure steady evolution of blockchain platforms.
But there are not only big players in the game. Startups are on the market as well. Gem, another member of the HLHC Working Group, is a startup that launched the Gem Health Network in partnership with Philips to offer providers shared and secure data infrastructure. Tierion, also a partner with Philips, provides caregivers with a platform for data storage and verification.
Even if we can’t call blockchain a panacea for health information exchange yet, it still addresses critical pain points and brings greater transparency and trust. This is a chance to introduce a health-based data-sharing system that supports secure integration of care information across a range of stakeholders while protecting patients’ identity and giving insights on population health.
Other HIE Trends
Blockchain is a popular trend in regard to HIE and data interoperability, but there are more. Last month, the Colorado Regional Health Information Organization (CORHIO) announced the FHIR standards framework for user-configurable access to view and retrieve the patient health data within the CORHIO HIE.
Regulation-wise, the ONC is seeking feedback (download required) on a framework for measuring and implementing interoperability standards. The ONC wants to determine widely adopted standards and identify any pitfalls in enabling a widespread data exchange. Hopefully, the updated framework will become the guiding light for achieving uniformity in HIE.