The health care industry faces a plethora of complex challenges, from creating treatments to optimizing the drug supply chain. Innovators are tackling many of these using new technologies.
Trainee surgeons can practice their craft using virtual reality. Artificial intelligence can help doctors detect lung cancers. And 3D printing can be used to make custom-fit prosthetic limbs.
Blockchain is another technological frontier. While it might be known as the machinery behind cryptocurrencies like Bitcoin or even Justin Bieber’s $1.3m NFT, the blockchain has many possible applications.
Startups are pioneering new use cases with the goal of advancing the business of health care, improving patient outcomes, and, ultimately, saving lives.
What is blockchain in health care?
Blockchain is a digital, unalterable ledger that uses an open, distributed system to record data and keep track of assets. Those assets could be:
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Cryptocurrency
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NFTs
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A doctor’s credentials
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A drug moving through a supply chain
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A patient’s medical records
Each transaction is a block on the chain.
The reason blockchain is described as a “distributed record” is because it exists on a peer-to-peer network — a network of individual computers known as nodes — rather than on a centralized server owned by, for example, a hospital or a pharmaceutical company.
There are two kinds of blockchain when it comes to health care: public networks and private networks.
Public networks are completely decentralized. Anyone can join the network, and they do not need permission to do so. Users typically operate under pseudonyms.
You might not want to store private information like medical data on a public blockchain because anyone on the network could view it — although they wouldn’t be able to connect it with your name or other identifying details.
Bitcoin, Ethereum, and Solana — all of which have their own cryptocurrency — are examples of public blockchains.
Private networks are partly controlled by a single organization that decides who has access. Users need permission to join the network. These are smaller, more exclusive networks, and they are only partially decentralized.
Examples include RippleNet, which is used in the banking industry, and Hyperledger Fabric, which is used by Walmart and other companies for internal applications.
Benefits of blockchain in health care
The technology offers a number of advantages over systems like cloud computing when it comes to storing or tracking data.
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Tamper proof
Records on the blockchain cannot be changed, deleted, or corrupted. This adds a layer of built-in trust. When data is stored on a system controlled by a single organization, like a hospital, users must take that organization’s word that the data will not be lost or altered.
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Security
The blockchain offers end-to-end encryption, which means extra security for sensitive data like medical records. Its decentralized nature means there is no single point of failure. Although data stored on the blockchain is visible to the whole network, users are able to remain anonymous to protect their privacy.
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Speed and collaboration
Data on the blockchain is accessible in real time to all users. Records are streamlined, doing away with paperwork and duplication of records on different users’ systems. This can cut through the bureaucracy of typical health care providers and medical supply chains.
Blockchain use cases in health care
Patient data
Patients are likely to interact with a variety of health care providers in their lifetime, including family doctors, hospitals, and specialists like physiotherapists. Each of those providers have their own record-keeping system, and those systems usually don’t talk to each other.
This causes problems in three areas.
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Patient Access
If a patient is brought to the ER in the middle of the night and can’t recall which medications they are allergic to, they can’t access records stored by their family doctor, which means ER doctors have to put the patient at risk when prescribing medication.
Similarly, if a patient visits a specialist, travels to another country, or decides to change doctors, their medical records do not move with them, and doctors are left to rely only on what the patient remembers and tells them.
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Patient Consent
Patients are not fully in control of how their data is used. Currently, medical data can legally be shared or sold by health care providers to third-party organizations without patient consent as long as it is anonymized. Patients don’t get any direct financial benefit from these transactions.
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Medical Research
Researchers who want access to data for clinical trials and studies have to negotiate with individual health care providers or brokers. This limits the sample size of the data and takes time and money.
Adding patient records to the blockchain tackles all these problems.
Patients, doctors, and medical professionals are able to log records onto the blockchain via a website or an app, much like an online banking platform. These records are either:
a) Stored under a pseudonym on a private blockchain or
b) Stored off-chain (on the cloud or a hospital server) and linked to a private blockchain which “points to” where the data is stored.
Patients can access and download their medical history any time from the online platform. They can also grant permissions to doctors or others to access their data (a little bit like you do with a Google Doc).
Every time anyone accesses a patient’s data, that transaction will be logged on the blockchain so the patient will never be in the dark about what is happening to their data.
In the future, it may be possible for patients to sell or share their data to researchers, insurers, and pharmaceutical companies directly via the blockchain — giving them the opportunity to benefit financially from their data.
In return, researchers will have access to a much wider sample size, which will help advance the field of medicine.
Credentialing
When a medical professional starts a new role or works with a new provider, they have to go through a credentialing process to prove to employers, insurers, and regulators that they are trained, licensed, and experienced.
Credentials includes things like:
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University degrees
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Identity documents
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Medical licenses
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Certifications
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Work visas
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Vaccine certificates
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Letters from previous employers
To ensure that a qualification document is not forged or falsified, employers reach out to multiple organizations like hospitals, medical boards, and universities to verify. This process can take months and has to be repeated for every job change.
Adding credentials to a blockchain streamlines the process. The immutable nature of the blockchain means that credentials only need to be verified once (when they are added to the chain) and can forever be considered trustworthy.
As everything is stored in one place, employers can view credentials instantly without worrying about whether it is authentic.
Supply chains
Counterfeit drugs
An estimated 10% of medical supplies sold in the developing world are substandard or counterfeit, resulting in tens of thousands of deaths every year.
Counterfeit products usually find their way into the supply chain somewhere in the middle of the journey from manufacturer to retailer. Often a duplicate product will be added to the system so that two indistinguishable items come out at the end. Unexplained delays are one indication that something fishy is happening.
Using a private blockchain, made up of users who are part of the supply chain (e.g., manufacturers, retailers, and logistics agents), companies can track medications as they travel around the world.
A product is logged on the blockchain at the start of its journey. The medication goes into a sealed container with a QR code and every point of contact — from the person who packs the container to the person who puts the product on the pharmacy shelf — is logged and time-stamped.
Sensors can be added to make the containers tamper-proof. Any suspicious activity can be cross-checked against who has been in contact with the product. It is clear where delays have occurred and who had custody of the product at the time.
Since you can’t duplicate an asset in the blockchain, duplicate products will not be logged and will therefore be easier to root out.
Cold chain monitoring
Some medications, like insulin and certain covid vaccines, need to be kept at a specific temperature. Thermometers in vehicles and storage facilities could be set up to automatically upload readings to the blockchain. This would make it easy to check if medications are safe for use and identify where problems in the cold chain arise.
Efficiency
Storing supply chain data on the blockchain allows for real time updates and coordination between parties, making it easier to identify bottlenecks. For example, if there is a delay at the dock, all parties will have visibility into the new delivery time.
Another common bottleneck is the customs process. Customs officials need to review paperwork that tells them where a container originated, its monetary value, and that the importer has a permit to import controlled substances. Sometimes they need to conduct an inspection.
Logging the movements of containers on a blockchain-based system would allow customs officials to quickly view verified information without conducting a search or contacting anyone else.
Compliance
The pharmaceutical industry is heavily regulated by two main government agencies.
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The Drug Enforcement Administration is concerned with smuggling and the black market. They need detailed information about drug transactions like the date that a drug was released by a customs officer or the quantity in each delivery.
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The Food and Drug Administration is concerned with counterfeit and poor-quality drugs as well as inaccurate or misleading labeling. They are interested in the integrity of the supply chain and the standards of the manufacturer.
Blockchain ensures that companies have a clear audit trail with evidence of who did what when. If regulators call for data about the supply chain or the origin of a drug, or if there are any civil legal disputes about the authenticity or quality of a drug, those records can prove that everything was done by the book.
Smart contracts
Smart contracts are lines of code that contain the terms of an agreement, and are automatically verified and executed via the blockchain. For instance, a smart contract could be used to make an automatic insurance payout when a patient makes a claim that meets the right criteria.
Smart contracts could even replace doctors in low-risk scenarios by issuing prescriptions based on patient data.
A patient could request a repeat prescription of a contraceptive pill. If their blood pressure and weight met the programmed conditions, a prescription could be issued by smart contract.
A multi-functional solution
A blockchain platform can incorporate multiple solutions. In a clinical trial setting, for example, blockchain could be used to:
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Manage patient data
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Monitor drugs used in the trial as they move through the supply chain
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Collect records — such as patient consent forms — in compliance with regulators
Blockchain health care startups and companies
Startups using blockchain in health care include:
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Medicalchain — A solution for the storage and transfer of health records. With this platform, patients are in control of their own medical data and can grant or revoke access to others, including doctors or researchers.
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ProCredEx — A health care credentialing solution that makes it easier for medical staff to curate and share their credentials for telemedicine, contract, or temporary jobs.
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Farmatrust — A supply chain solution for the pharmaceutical and health care sector. The platform offers end-to-end visibility across the supply chain, which helps to reduce inefficiency and eliminate counterfeit products.
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Hataali — A data sharing platform for the personalized medicine sector. Personalized cell and gene therapies can cost $500k-$2m. The platform tracks these costly drugs as they move along the supply chain and also acts as a repository for patient data.
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Patientory — A marketplace for clinical trial participants. Patients can use the app to store information like allergies and vaccination status and as a tracking tool for their weight and exercise habits. Researchers can sift through that data to identify patients who are a good fit for clinical trials.
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Chronicled — A contracting solution that streamlines the relationship between pharmaceutical manufacturers and retailers by automating transactions using smart contracts and giving all parties access to the same data.
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EncrypGen — A DNA data marketplace. Once a patient tests their DNA, they can anonymously upload the data. Researchers can purchase that data using cryptocurrency.
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Blocqube — A platform for remote, decentralized clinical trials. Researchers can run a trial with patients from around the world. Patient data is logged and accessed via the blockchain. All trial-related payments are made using smart contracts.
Challenges of blockchain in health care
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Buy-in.
Blockchain is still a new technology. Health care providers, patients, and regulators may feel wary. Some fear that data on the blockchain will not be private or secure. Others don’t have the time or money to invest in overhauling their existing systems.
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Multiple chains.
One of the problems blockchain is trying to solve is that patient data is siloed within different organizations. But it is possible that providers will start to use different blockchains.
One chain of hospitals could put all their data on an Ethereum-based platform while another puts theirs on a HyperLedger Fabric platform. Patient data will still be siloed, and the old issues will continue.
However, there are now cross-chain bridges that can connect different blockchains and potentially deal with this challenge.
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Logistical issues.
Once data is on the blockchain, it is secure and immutable, but the technology doesn’t exist in a vacuum. There is a human factor.
For example, someone can miss the fact that a patient file is missing a page when they’re inputting data, or input the data incorrectly.
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Technical challenges
There are obstacles relating to the scalability of blockchain, such as energy consumption. However, some of these problems are already being solved.
For example, Ethereum, one of the blockchain networks mentioned earlier, recently moved to a model that cut its energy use by 99.99%.
How will blockchain affect health care?
First off, blockchain could create an explosion in the amount of medical data that is easily available. Patients’ records could begin as early as the first in-utero ultrasound and include detailed data from wearable tech, like your step count and how much deep sleep you get.
Blockchain could make it easier for researchers to request this data, which could in turn result in:
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Larger, more diverse sample sizes for studies
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More information about how medication impacts different people
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More information about the causes and implications of different conditions
If patients have more control over their data and physical samples, it will create a free market where researchers and companies compete to offer the most competitive rewards, whether that’s money or useful insights into a patient’s medical condition.
Blockchain will also play a role in supporting other new technologies — such as automation, artificial intelligence, and personalized medicine, all of which require accurate data inputs.