The National Institute of Standards and Technology (NIST), in partnership with the Office of the National Coordinator for Health Information Technology (ONC), recently launched an initiative called the ONC Blockchain Challenge and invited healthcare and technology leaders to submit research papers to explore the "use of blockchain in Health IT and Health-released Research."
I am participating in the challenge, having submitted a paper I co-authored with Jeff Brandt, an expert in mobility, security and healthcare. Our paper, titled "Co-Creation of Trust for Healthcare: The Cryptocitizen Framework for Interoperability With Blockchain," addresses future research propositions. Brandt and I submit that there are three primary areas in need of further research, including the monitoring of medical devices.
Autonomous monitoring of ubiquitous medical devices
The immutability of blockchain can improve access to medical information. How will care change over the next three to 10 years? Will the definition of treatment change? Today, when we think of preventive medicine, thoughts of face-to-face appointments with doctors rise to the top of our minds. Tomorrow, robotics, nanobots and nanomachines may be a common part of the new definition of preventive care.
In our paper, Brandt and I present the concept of blockchain being leveraged for healthcare device maintenance, where nanomachines will autonomously communicate device-to-device:
"Device-to-device distributed sharing will create a new market for semi-autonomous devices. These devices — such as delivery robots providing medical goods throughout a hospital autonomously or disinfection robots that interact with people with known infectious diseases such as healthcare-associated infections or HAIs — will be reporting information not to a central authority but to other devices. Medical nanotechnology is expected to employ nanorobots that will be injected into the patient to perform work at a cellular level. Ingestibles and internables bring forward the introduction of broadband-enabled digital tools that are eaten and "smart" pills that use wireless technology to help monitor internal reactions to medications. Medical nanotechnology is just the beginning."
Monitoring atrial fibrillation with the blockchain
Adding color to the research proposition, we offer this example of how medical device maintenance is possible with blockchain:
"The following is an example of how blockchain technologies could manage medical devices. A patient named John, with atrial fibrillation, is having an atrial defibrillation device implanted: commonly known as an Afib device. This implantable defibrillator allows quick restoration of the sinus rhythm by administering a low-energy shock. The Afib device was manufactured by company "X" with a serial number "Y." During manufacturing, a blockchain was created to track this device. The US Food and Drug Administration (FDA) mandated that a hash of the unique device identifier (UDI) be stored in the blockchain along with other pertinent information. The hash of the device information is stored and verifiable in an immutable digital ledger. The implanted Afib device is assigned to John (patient), and the device's blockchain is updated with information such as the hospital, doctor, emergency contacts, and advance directives around care for patient John. The Afib device is supported by a series of smart contracts that can autonomously notify John (patient) and providers when the device needs service, e.g., battery expiration, or when health irregularities are detected.
Today, device preventive maintenance is rudimentary at best. For example, when an Afib device requires maintenance, the device starts to audibly alarm Jon (patient), [in his chest] which can be disturbing. A smart contract could also send preventative maintenance information to the patient and provider, reducing the chance of a catastrophic failure."
Brandt and I present arguments offering new exploratory propositions that require more research. These research propositions identify three areas as requiring more in-depth research:
- Proposition 1: Healthcare device maintenance ranging from medical devices to nanomachines will autonomously communicate device-to-device.
- Proposition 2: Personal and public self-sovereign will place identity ownership in the hands of the patient.
- Proposition 3: Electronic health information exchanges (HIE) and all-payer claims databases (APCD) will establish trust using blockchain technologies.
Blockchain technologies do offer answers to healthcare's interoperability struggle. The solution to this national crisis won't, however, be purely solved by adding yet another layer of technology. The underlying broken payer and provider processes need to be addressed in parallel for a complete patient-centric solution.
The patient ownership of data accelerates health data transparency. Blockchain technologies can observe what data is being accessed, who can access the data, and for what period. Self-sovereign identity provides sovereignty, security and privacy to promote benefits for the patient and the organization or agency by reducing risk, strengthening security, improving accuracy, deepening permission control and decreasing the time required for regulatory oversight.
Our paper, "Co-Creation of Trust for Healthcare: The Cryptocitizen Framework for Interoperability With Blockchain," can be downloaded at ResearchGate.net.
NIST and the ONC will publish the results of the Blockchain Challenge competition on Aug. 29. Blockchain technologies can spark the co-creation of trust in healthcare.
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