- More than 40,000 healthcare stakeholders gather at the HIMSS Convention and Exhibition every year to get a good look at some of the most advanced and intriguing health IT tools on offer from hundreds of vendors, big and small, seeking to hawk their wares to an evolving industry.
Companies offering the latest and greatest in machine learning, precision medicine, big data analytics, and population health management crowded the exhibition halls, attracting throngs of visitors to demo stations, coffee bars, and marketing presentations throughout the nearly week-long conference.
But in one small corner of the Innovation Zone, a showcase for promising start-ups and eager young companies on the cusp of greatness, a unique industry voice called Hyperledger held court to discuss the merits of blockchain, the technology that could fundamentally disrupt how health data is created, protected, stored, and shared.
Hyperledger isn’t a startup, and it is not a vendor looking to sell anything other than ideas to the healthcare community. Instead, it’s an open source collaborative effort supported by more than 120 contributors from multiple sectors looking to apply blockchain principles to more than just cryptocurrency.
“We want blockchain to become integrated into the very fabric of the internet,” said Brian Behlendorf, Hyperledger’s Executive Director, to HealthITAnalytics.com at HIMSS17.
“We think coalition building is the way to do that. Blockchain allows us to change the physics of data sharing by allowing us to expand secure, private access to data in a decentralized, equitable way.”
Equal control means equal access for providers and patients
Blockchain is still a new concept for healthcare, and the data sharing and storage methodology is still very closely associated with BitCoin, the notorious internet-based monetary system that often crops up in discussions of ransomware and illicit “dark web” activities.
But far from being nothing more than a tool for shady characters, blockchain holds the potential to significantly increase data privacy and security while boosting accuracy and integrity – all while giving patients the ability to control their information more completely than current methodologies.
In essence, a blockchain is a defined series of identical copies of information held locally by every member of the chain, instead of in a single, central repository. When one entity within the community wants to make a change or addition to the data set, every other participant must agree, cryptographically or otherwise, that the change is valid.
Once the action is approved by a majority of the community, every locally-held copy of the data reflects that the edit took place. This ensures that everyone stays informed of all changes and has a chance to dispute an edit or block access if an unauthorized entity tries to tamper with the data.
“In most high-value data networks, you need to record when, where, and how transactions take place in addition to publishing information,” Behlendorf explained. “You want to record that a certain event happened at a certain time, and everyone who is party to that needs to know that it happened, needs to be able to prove it, and has to be unable to deny it.”
“Most of the time, we depend upon a central provider to keep those things consistent for us. But that puts the organization in a position that gives them a tremendous amount of power, and there are plenty of incentives in the healthcare industry for them to keep that data private. Blockchain solves those problems by letting organizations complete those tasks without relying on a centralized entity.”
Equal access means equal control, Behlendorf said, and equal responsibility shared with patients and their caregivers.
“There’s an opportunity to capture the holy grail of health IT, which is to put the patient back in the center of their care. We can provide much more transparency balanced against confidentiality. We can change the landscape of that by adopting blockchain – and hopefully cut the costs of bureaucracy and overhead that make healthcare so expensive.”
From consent to clarity, blockchain can break down data silos
Blockchain has numerous potential applications in the healthcare space, starting, of course, with the development of personal health records that give patients unprecedented control over sharing, collaboration, and privacy.
When the Office of the National Coordinator asked the industry for white papers describing blockchain-based applications in healthcare, the flood of entries from stakeholders all stressed the technology’s ability to create shared decision-making communities and develop truly longitudinal health records for patients.
IBM, a Hyperledger consortium member and strong advocate for blockchain in healthcare, calls the methodology “the chain of trust,” emphasizing its potential role in breaking down siloes between organizations with strong incentives to keep their data close to the vest.
Clarifying data ownership and improving integrity as data spreads from organization to organization are among the many benefits blockchain could bring, IBM said in its discussion paper.
Behlendorf agrees that the healthcare is in sore need of better ways to track information, patients, products, and services across an extremely fragmented environment.
“If you could chart the pharmaceutical supply chain from the drug’s batch number and factory of origin all the way to sale and storage and adherence, you could identify issues much more granularly,” he said.
“If you start seeing a hotspot of patients taking that drug having some sort of problem, you can easily see if it’s traced back to just that batch or if there’s a problem with the drug as a whole, or if a certain provider needs to improve the way they help patients stick with their regimens.”
It could also reduce duplicated effort when acquiring consent to use data in a certain way, he added. “You could cut hundreds of hours of manual labor just by reducing the need to get permission to reuse clinical trial data for subsequent projects.”
“And you can set different sharing parameters for different types of data,” he continued. “Something like someone’s blood type might be shared with every organization, so that when that patient shows up unconscious while they’re on vacation at some hospital they don’t have a previous relationship with, they can receive the emergency care they need.”
“But something like HIV status – you might not even want the network to know that there was an HIV test performed, let alone post the result in clear text to every member of the chain. The patient can play a role in defining when certain elements get shared and how widely that sharing goes.”
Defining the scope of blockchain in the healthcare industry
Blockchain is still finding its way into the consciousness of the healthcare industry, and Behlendorf is keenly aware that organizations like Hyperledger have their work cut out for them over the next few years.
“It’s still a very young space,” he acknowledged. “It’s kind of like 1995 in the World Wide Web, where people are just starting to put high-value things on the internet. There are still some critical pieces missing, like a really high performance web browser was at the time.”
“But there are lots of companies here working to solve the hard problems, and there are some very interesting pilots starting to spring up. It’s really fun to see, and it’s why we’re here.”
Helping healthcare vendors understand what they can and cannot do with blockchain is one of Hyperledger’s goals, he continued. Perhaps more importantly, the collaboration would like to see the industry avoid some of the pitfalls of traditional data sharing strategies, such as locking users in to a specific platform or service and generating opportunities for data blocking.
“A lot of these companies want to be Google,” he explained. “They want to be the one portal you use to do everything. It’s a lot easier to create that sort of thing than it is to be completely vendor agnostic, but it also binds you to a specific provider very tightly.”
“And it doesn’t seem like many of these centralized portals want to make it easy for you to leave them, because clearly there’s an economic incentive to keep customers bound to them as much as possible. It would be better from a systemic point of view – not from the perspective as a shareholder in one of these companies – to have different front-ends pulling data from one shared database, like a private blockchain.”
That way, customers could choose which front-end best suited their usability needs or offered certain features that met their requirements, but they would not be locked in to a single entity that could hold their data hostage, as has happened in the past with some electronic health record vendors.
It could also make big data analytics easier for researchers and as-a-service companies looking to deliver insights to providers at the point of care. As machine learning and artificial intelligence tools become increasingly popular for predictive analytics and population health management, seamless access to data stores is turning into a high priority for stakeholders.
“Machine learning and AI depend on having a big data set, building a model, and applying that model while trying to predict the future, but we’re still learning how to do that right in healthcare,” said Behlendorf.
“A lot of today’s machine learning applications presume big data exists. They presume that we’re hoovering in all the data available from anywhere. And that’s hard to do, especially with healthcare data, because we’re never going to see one big database with everyone’s private health records.”
Artificial intelligence vendors haven’t yet struck the balance between promoting privacy and ensuring premium data quality, he added. The integrity and usefulness of patient data can sometimes decrease when blurred by anonymization, but protecting patient privacy is still paramount.
“I suspect will happen is that we’ll have training sets that are quasi-anonymized so we can develop models that can be run at the patient’s home organization, so that their data never has to leave their provider,” he said.
The industry will need vendor-neutral coordinators and collaborative organizers like Hyperledger to help stakeholders transcend traditional boundaries that prioritize centralized repositories and incentivize proprietary development without eliminating all the economic rewards for creating blockchain-based technologies.
“This is going to take us ten or twenty years for us to figure out, just like the web did,” Behlendorf predicted.
“It’s not going to work if it’s just one company saying that we should all get on board. But if it’s a collection of companies brought together by a consortium, a professional society that embraces blockchain as a standard, or a shared pilot project across the whole continuum, then it could really gain some traction. I’m optimistic that we’ll see that very soon.”