by Peter B. Nichol

Blockchain health record bank replaces EHRs and EMRs

Apr 27, 2016
Electronic Health RecordsEmerging TechnologyHealth and Fitness Software

Blockchain consensus and chain-of-custody for the healthcare supply chain are coming to your neighborhood.

User facing applications, purchase decisions, and infrastructure never have aligned for healthcare. The patient is still waiting, and the experience of care is disjoint. Sure, many of us dreamers have tried to achieve alignment, but ultimately, the seamless integration of health has yet to be fully discovered. Interoperability, audibility, cost-efficiency, real-time and agile enrollments, public transparency and guaranteed continuity (removal of the central operator) is what blockchain offers healthcare.

Trust in product supply chains

Nike, Coca-Cola, and Apple are brands we trust. What if every corporation had the same opportunity to build confidence in their company and their products? They do with blockchain.  Large transnational corporations are top of mind when we think of trust. Turn the spotlight onto healthcare. What comes to mind when you think about your healthcare insurer? Is trust the first thing you imagine when you hear United Health, Aetna, Cigna, or Blue Cross? It’s unlikely. They also aren’t solely to blame for the lack of trust in the healthcare system. Insurers are only a spoke in the broken wheel of healthcare, subject to the same dysfunction as the other healthcare actors. 

Health care delivery systems also hold accountability for the disintegration of the United States healthcare system. Healthcare delivery systems include:

  • Hospitals and acute care facilities
  • Healthcare networks
  • Ambulatory/outpatient provider practices (individual, group and clinic)
  • Health plans
  • Payers (insurers)
  • Ancillary service providers (laboratory, radiology)
  • Pharmacy/PBMs
  • Health information organizations (HIO)
  • Health information exchanges (HIE)
  • Critical access or rural hospitals
  • Health insurance exchanges (HIX)
  • Public sector agencies (public health departments)
  • Clearing houses and others

Do you trust the products you consume? What do you know about products you use every day? What was the supply-chain of your toothbrush? How about the chain-of-custody of your medical record for the most recent diagnosis? The appointment could have been to treat the common cold or something more serious. Who has seen the diagnosis? Does your electronic toothbrush deplete natural resources? Is the meat and seafood you eat contaminated? Berks Parking recalled 1,320 pounds of beer products in January 2016, and Hormel Foods had a beef recall in February 2016, according to Consumer Affairs. At least, we know about these. What about future contaminations?

John West, a fish supplier out of the U.K., provides canned tuna and salmon, allowing consumers to track their fish from the boat to the can. This additional standard on the John West product resulted in $24.2 million of increased sales. Consumers care about the supply chain; the value of transparency is real, and it can be applied to healthcare.

Medical record chain-of-custody

With centralized chain-of-custody fraud can easily occur. We have to look no further than the timber industry and Chain of Custody (CoC) certification to understand why former Forest Stewardship Council (FSC) General Director André de Freitas recently called CoC certification a myth. Forest Stewardship Council, Programme for the Endorsement of Forest Certification (PEFC), and agricultural schemes such as Fairtrade, SAN/Rainforest Alliance all evolve adding risk to their primary mission or eco-labelled products.

Blockchain allows organizations to operate and conduct commerce in a trustless and permissionless ecosystem and discover the full supply chain of your toothbrush, food products, and even your medical records.

Blockchain’s transactional process for health

Distributed ledgers, mining, and nonce make blockchain more confusing and harder to explain. Articulating the value of blockchain becomes even more challenging when applying the technology to healthcare. Welcome to the modern and fashionable electronic medical record (EMR).

Allow me to expand; the doctor would confirm the diagnosis, the provider would confirm treatment was performed, and the payer would establish that insurance coverage was valid. The peer review is also where consensus occurs. It could be as simple as requiring your doctor and provider public keys to create consensus or agreement could be based on a threshold cryptosystem (mainly for the military prior to 2012, subsequent versions include: RSA, Paillier cryptosystem, Damgård–Jurik cryptosystem, ElGamal) or ring signatures (a message signed with a ring signature is endorsed by someone in a particular group of people e.g. your family doctor’s health practice), or even other cryptographic techniques that could be implemented.

The next explanatory steps update an EMR from the perspective of the blockchain, illuminating the roles between the patient, doctor payer (insurer), and the provider.

1. Receive token – a healthcare transaction is received by the blockchain as a set of actions grouped in the form of tokens

2. Pull base block – a historical block will be pulled (the last block confirmed) including an identifier for the block, which is used to create the new block

3. Peer review – the token is validated (the set of health care actions, enrollment information, proof-of-insurance, diagnosis and procedure codes for treatment) and broadcasted to named peers for review. 

4. Validation of block– at this point the digital signature of the validators is added to the block (hashed)

5. Token extended – the initial health token (the set of actions) is extended to include the validity token from the confirm health actions

6. Block creation – based on the validity token, historical block identifier, digital signatures, peer reviews and the set of healthcare tokens. Then miners calculate and generate the new block

7. Block broadcast – using the blockchain Health Record Bank (bcHRB) and the peer-reviewed token(s) these combined blocks (sets of healthcare actions) are then broadcast to peers.

Note: Nik Custodio did a great job explaining, at a high level, how this process works on Medium if there is any confusion.

To summarize a token is received containing healthcare transactions (medical, dental, pharmacy, or ancillary services) and a historical block identifier is used as the start of the base new block. The token, a set of healthcare transactions, is peer reviewed and validated once the peer review is completed. Digital signatures are added to the block, extending the token. The healthcare token, historical identifiers (previous block), peer reviewed validated token, and with digital signatures complete, then the miners create a new block reflecting the recently received healthcare transactions. Miners then broadcast to peers on the bcHRB.

Instead of medical data sitting across silos with limited interoperability, with blockchain we now have the ability move the information in a secure, auditable, and shared data layer. Transparency isn’t only about the supply of goods; it also involves services – healthcare services.