Blockchain in Healthcare (Part III)

If Blockchain has potential to add value in Healthcare, What is stopping?

As we have been exchanging over the past few days on ideas and controversies, the general feeling is that blockchain could offer a technological creating advantage in transforming how Healthcare ecosystems manage information and deliver services to patients. That being said the Healthcare companies considering to participate in this transformation should start thinking on some of the challenges on the ground. Here are few comes to immediate attention and you are welcome to add to the list.

1. How do you evaluate blockchain fit for purpose?
2. How to create a business case and come up with ROI? The cost of establishing and maintaining a healthcare blockchain is unknown yet and no one can seriously consider this technology without knowing about its expenses ahead of time.
3. How can we make it easy for legacy systems to feed a blockchain?
4. What are the applications that can support the delivery of blockchain data into legacy systems?
5. Who will own the healthcare data? Who will grant permission to share it? That kind of structured department or process hasn’t been established yet.
6. What are the services needed to support authentication and smart contract creation across parties?
   What are the business process tools that can leverage the blockchain?
7. Finally, Blockchain within the healthcare industry will be comprised of medical records, images, documents and lab reports which require a significant amount of storage space. Conceptually, every member included in the chain would have a complete copy of the full medical record of every individual in the U.S. and this volume could potentially exceed the storage capacity of current blockchain technology.

What really are the challenges to overcome for blockchain (BC) to be successful in healthcare (HC)?

While BC technology is changing rapidly, with protocols suited to HC, the technology has to address and overcome a few more challenges. Let us take a widely accepted area like clinical trials and examine few details as the challenges around blockchain are surmountable.

1. Ability to handle the sheer volume of clinical data: BC scalability has to be addressed on priority. Blockchains, as they exist today, are not designed for storing large amounts of data, such as would be generated during a clinical encounter.
2. The crux of HC puzzle revolves around patient data - Is BC close to tackling it? Blockchain relies on some form of a unique identifier to link records across individuals, which means identity will have to be managed somewhere to de-duplicate patient IDs
3. Anonymity vs privacy of data - decision between public vs private vs hybrid BC: Next comes privacy. Identity on blockchain tends to be anonymous but not private. What this means is that while transactions are anonymous, they are publicly recorded. Once an individual’s identity is linked to a blockchain identifier, their entire history of transactions is available – which could be catastrophic for clinical data. There are mechanisms to mitigate these issues – for example, 'private' blockchains that aren’t public, or storing data 'off-chain' – these issues need to be addressed more fully before we see widespread EHR data sharing via blockchain.