At the end of last year, 2019, I took an extension course about Blockchain1 at PUC-Campinas. I participated as a total layperson on the subject. To me, Blockchain was the same thing as bitcoin (a digital currency). In the first class, the professor explained all of the basics of Blockchain and gave some examples of possible applications for this new technology — among them, applications in the health services field, which motivated me to write this article.
What is Blockchain?
Roughly speaking, Blockchain technology is nothing more than a database that is stored in a decentralized way. However, this base is composed of a set of immutable blocks, linked in a chain and time-stamped. A block can contain both data and transactions. Each block on a Blockchain can only be written once. When it is necessary to make a change to a block, a new block must be generated and, then, linked to the original block.
In a Blockchain, all blocks are only added after being validated by other computers in the network. This validation is done through consensus algorithms, which must be solved by a certain number of computers. Once the block is validated, it is signed with a hash8 code — a fixed-length word generated from a hash mapping function applied to the block information, such as the block transaction, the date and time and which are the linked blocks to this particular block.
The purpose of the Hash code is to ensure that the data cannot be modified. If changes are made to the block data, the Hash code is also modified, so it is no longer the one generated in the creation of the block, which turns the block invalid. In addition, the confidential information in the block is protected through asymmetric key cryptography, using the public key of the information owner, which ensures that no one, except the owner or someone authorized by them, can access the confidential information in the block.
There are two types of Blockchain2: public and private. In a public Blockchain, the network is open to the public, which means any computer that wants to be part of the chain can join. An example of this Blockchain type is bitcoin, in which anyone with an interest can be part of the Blockchain network, be it as a bitcoin trader or as a miner (miners are the computers that intend to solve the consensus algorithm and, for that, are rewarded with bitcoins).
On the other hand, a private Blockchain is controlled by only one entity and only users within this network can manipulate it. This type of network can be used, for example, to control production processes within an industry.
Within a private Blockchain, we could still classify two more types: the Blockchain consortium and the semi-private Blockchain. In the first case, the network would be controlled by a predetermined consortium of companies, such as a set of hospitals. In the second case, a Blockchain would be controlled by one entity. However, other entities could be part of the network, if the network controller authorized their membership. An example would be a health insurance plan, which would have its Blockchain and would allow doctors and patients to access this network.
Blockchain in Health Services
So let’s talk about the applications of this technology in the health services field.
Electronic health records
One of the main Blockchain applications in health services currently being studied is the development of Electronic Health Records (EHRs) 4. EHRs are a digital network for storing patient medical information.
The medical records must be easily accessible among various entities — such as hospitals, clinics, laboratories and patients —, but, on the other hand, they must be extremely secure networks with controlled-access, in order to guarantee the privacy of patient data.
Thus, EHRs should only be accessed by authorized persons, since a patient’s medical records cannot be changed arbitrarily. Any type of modification must be carefully recorded, as any type of incorrect information can generate many losses, both monetary and to people’s lives.
Some large companies are already investing in this area, such as Philips, Gem Health, Google and IBM.
Medication and medical supply management
With Blockchain, it is possible to manage medication and medical supplies, both for manufacturing purposes and for their sale, distribution and use.
In manufacturing, it can be used to track the entire production chain. Starting with the raw materials that will be used in the manufacture of medication — Blockchain allows their origin can be tracked and ensured. Then, during the manufacturing process itself, it is possible to ensure that all steps have been performed correctly. Finally, it can be used during the distribution of the medication — with data of the locations and time-stamps of transportation.
Within clinics and hospitals, Blockchain can assist in tracking all supplies available in theirs stocks; control the expiration date of medication; the quantities of drugs available in stock; which professional prescribed a given medication or requested some type of supply; which professional used the supply or delivered a given medication; and, also, which patient received the medication.
As explained above, Blockchain can also be applied in pharmacies. Some companies already have some solutions for health services based on Blockchain, like Chronicled, Blockpharma and Tierion.
With the use of Blockchain in health insurance plans, the main objective is to prevent fraud in the system as a whole. For example, a patient goes to the doctor and has his or her consultation record stored. If the doctor requests tests, they will be inserted into the network. Once the exam is done, the results must also be inserted into the records and, finally, the medication requested by the doctor will also be in the file. The health insurance plan can, then, safely monitor all stages and, with the use of Blockchain, it would be practically impossible for doctors, clinics and patients to circumvent steps during the process as a whole.
The health services field, as it is a very delicate segment, needs a system with transparency for its high reliability data. Blockchain, with its immutable system, decentralization and information transparency, fits perfectly into the solution of this problem.
Blockchain technology is still very new. Many bureaucratic adjustments need to be made before there is a consensus among all of the stakeholders, but in the very near future, I believe that we will be using this technology on a larger scale.