Blockchain technology has made a splash in the world of cryptocurrency but its capabilities could revolutionize healthcare.

Editor's Note: This article was written by Anne Marie Collins, who was part of DeciBio's summer 2018 intern class. She will graduate in Spring 2019 with a degree in Human Development and Aging, with a minor in Business.

What is blockchain?

Blockchain is a decentralized, digital ledger that keeps a permanent, unalterable record of transactions between users. One of the greatest benefits of this technology is that it is significantly more secure than other data storage platforms, a characteristic making it especially appealing to store and share personal health information (PHI). Because of this and because of reasons outlined below, blockchain is beginning to showcase itself as a potentially game-changing technology in healthcare.

How is the technology used in healthcare today?

Healthcare today has only seen a small early minority piloting blockchain technology. In January of 2017 the US FDA partnered with IBM Watson to develop a secure exchange of health data using blockchain technology1. In July 2018 Mount Sinai opened a Center for Biomedical Blockchain research to evaluate current solutions, provide partnerships, and build its own blockchain system2. Most recently, eMQT, a nonprofit organization, will be sequencing 1,000 sub-Saharan African’s with sickle cell disease and store the information on Shivom’s decentralized blockchain-based genomic storage hub to provide security and data-sharing capabilities3. Other applications being piloted include storing consent forms for clinical trials using the immutable ledger and tracking progress in pharmaceutical supply chains4. Most efforts to employ blockchain in healthcare are in their infancy but the technology shows promise for high desirability and adoption in the near future.

How does it fit into the health landscape and why should I care?

There are many reasons that blockchain has such a bright future in healthcare. Here are a few of the most important according to our healthcare technology consulting experts:

Since blockchain is a decentralized network across geographies, it could help alleviate the challenge of interoperability by allowing the share of data across institutions to whoever is granted access.

Data sharing across health institutions and even within health organizations is currently fragmented and inefficient. Medical records often become inaccurate as they are passed between providers, potentially leading to duplicate or unnecessary treatment. Enabling interoperability would allow information from appointments, wearable devices, and demographics to be shared among providers, giving them a more comprehensive patient medical history and allowing them to provide a higher quality of care.Why it matters: The lack of interoperability in healthcare is one of the most common pain points that providers report. Thus far, no company has been able to develop software to broadly assuage this key issue.

Blockchain facilitates the instantaneous exchange of information, money, contracts, etc. according to pre-established smart contracts and without a middleman.

This could be especially useful for insurance claims that could be filed and filled instantaneously according to payor-provider smart contracts4.Why it matters: Billing and insurance represent about 18% of U.S. healthcare expenditures7. A blockchain-based software that could use smart contracts to eliminate most of this burden would likely be of serious interest to many healthcare organizations according to our health technology consulting experts.

Blockchain could significantly improve data security because it has no centralized point of failure, all users are held accountable for edits and exchanges of data, and data cannot be accessed without a highly specific digital access key.

More secure data would mean substantial savings for the healthcare industry. In 2017, on average, one data breach a day occurred to a health organization and costed an average of $3.62 million to the afflicted organization6.Why it matters: Cyber-attacks, such as WannaCry in the UK, are becoming more prevalent in healthcare. Governments and healthcare executives are already investing in technologies such as blockchain to help secure PHI and stop these attacks.

Blockchain could enable patient control of PHI, granting each patient a personal digital “key” that they would be free to share with their providers8.

People could also grant big data companies or R&D departments access to their health, genetic, or demographic information in exchange for payment8. This would simplify big data aggregation by creating one centralized location for all life science research data while initiating transparency about the usage of patients’ PHI and compensating them for their contributions.Why it matters: In the wake of controversy over Facebook’s privacy policy and the EU’s new GDPR, it is evident that people want control over how their personal information is shared. This public scrutiny will likely stimulate new governmental policy on how people’s PHI can be exchanged and utilized.

What are drawbacks?

While blockchain seems promising for healthcare, some pitfalls must be acknowledged. Giving patients autonomy over their data may create further complications for doctors trying to get access to patient PHI they need for successful diagnosis and treatment. In addition, it will be challenging to move this new technology past regulatory restrictions and convince health organizations to adopt it. Furthermore, blockchain technology struggles to exchange and store large volumes of data. This is an especially big issue when it comes to large imaging files and whole genome sequences. Lastly, blockchain in healthcare is rather young, posing unknown integration/startup costs and risks.

Will it take off in healthcare soon?

The blockchain industry has taken off in China, with 456 Chinese blockchain companies and additional foreign companies entering the market by partnering with Chinese companies like Australia’s Genetic Technologies did with Beijing Zishan Health Consultancy. China’s government has stated plans to integrate their wealth of blockchain technology into healthcare within the next three years5. On a broader scope, Deloitte projects that blockchain will be adopted by the early majority of healthcare organizations in 5-10 years6. By the end of 2018, blockchain in healthcare is estimated to be worth ~$180 million globally, with that number expected to grow to over ~$5.6 billion by the end of 20254. This rapid growth warrants keeping a close eye on blockchain in healthcare and the opportunities it will bring.

Who are the current players?

The number of companies / platforms aiming to bring blockchain to healthcare has skyrocketed in the past couple of years. Here are a few to watch out for:DNATix is the first company to transfer a genetic sequence and a Y chromosome over blockchain, demonstrating their ability to solve blockchain’s issues with large data volume. They also partnered with Mapmygenome with goals of entering the Indian genetic services market.Luna DNA pays people in their cryptocurrency, Luna Coin, to contribute their genomic data to Luna’s blockchain-based database. Illumina Ventures and Arch Ventures have both invested in this company.Guardtime is a global Estonia-based company that started using blockchain to secure Estonian governmental data from Russian cyber-attacks. They partnered with Estonian e-Health Authority to accelerate the adoption of their technology for security of health data. Their platform is also being piloted by United Arab Emirates’ largest private healthcare provider, NMC Health, to secure its health data.Nebula Genomics is using blockchain to securely store and sell genomic data while attempting to address the challenges of genomic big data. They partnered with China’s Longenesis to add AI into their technology mix.Wuxi NextCODE launched LifeCode.ai, a blockchain enabled data bank to manage and analyze health data. Their robust AI / big data capabilities will add further value to LifeCode.ai.SimplyVital Health’s HIPAA-compliant Health Nexus uses open source blockchain for streamlined sharing of patient data between organizations and incorporates AI / machine learning to improve accuracy over time. The technology is being used by The Cool Kids on an initiative working to identify the highest healthcare impact opportunities in the Philippines.IBM Watson partnered with the FDA to develop a solution for secure, efficient, scalable exchange of health data utilizing blockchain technology.PokiDok’s HIPPA compliant block-chain based platform for the exchange of healthcare data, DokChain, highlights a patient’s autonomy to access and control her data. VSP Global has invested in PokiDok and partnering to test their platform.Hex made a splash at the 2018 Hybrid Summit in Bangkok when it released its blockchain-based platform for integrating all a patient’s health data. The company already manages large volumes of medical information and has struck several partnerships, including with ASHTON and TPLUS.Patientory’s blockchain-based platform doctors, care providers, and patients can communicate and access the patient’s health data. It interconnects with any EMR and is HIPPA-compliant.

Where are future markets?

Since integrating blockchain into healthcare would be complicated, existing networks, such as drug supply chains or health information exchanges, will be viable initial targets. For instance, Guardtime, Instant Access Medical, and Healthcare Gateway launched a blockchain-based health records platform (MyPCR) that takes advantage of the NHS’s interoperability to make this personal health data sharing technology available to the 30 million patients in the NHS9. In the next three years, blockchain is expected to be used to store and integrate health information from disparate medical devices, to manage contracts via smart contracts, and to provide health tokens as wellness incentive or research participation10. Attractive markets further down the line include data exchange, aggregation, and security in large hospital networks; consent form collection in clinical trials; and the execution of collaborations in R&D.

Where are there opportunities?

One possible opportunity outside of the actual blockchain platform would be a technology to condense health data files so that over-storage on the blockchain does not slow down its performance. For example, DNAtix released a tool on May 10 that shrinks DNA data down to 25% of its size, making DNAtix the first company to transfer a DNA sequence over a blockchain11. An additional prospect is blockchain in combination with secure cloud computing technology6. The cloud would provide off-site data storage while blockchain would ensure security by creating complete traceability of data within the cloud.

What’s on the horizon?

There will not necessarily be a complete overhaul of the healthcare data infrastructure by blockchain. It is more likely that bits and pieces of this technology will be utilized and incorporated into existing technology. Biotech companies developing healthcare data products would be wise to consider incorporating blockchain into their platforms. This technology brings hope for revolutionary changes to the health industry, incentivizing expectations of rapid adoption close on the horizon.

References

1. IBM Watson Health Announces Collaboration to Study the Use of Blockchain Technology for Secure Exchange of Healthcare Data. GlobalData, 2018. https://medical.globaldata.com/NewsDetails.aspx?ArticleID=5715089&Type=N
2. Mount Sinai Launches Center for Biomedical Blockchain Research. Global Data, 2018. https://medical.globaldata.com/NewsDetails.aspx?ArticleID=6265352&Type=N
3. Shivom, eMQT Partner on Sickle-Cell Disease Sequencing in Sub-Saharan Africa. August, 7 2018.
4. Credence Research. Global Blockchain in Healthcare Market-Analysis and Forecast, 2017-2025. 2018.
5. 2018 China Blockchain Industry White Paper. 2018.
6. 2018 Global Health Care Outlook: The Evolution of Smart Health Care. 2018. https://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/gx-lshc-hc-outlook-2018.pdf
7. Jiwani, A., Himmeltein, D., Woolhandler, S., & Kahn, J. Billing and insurance-related administrative costs in the United States’ health care: synthesis of micro-costing evidence. BioMed Central, 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283267/
8. Mamoshina, P., et. Al. Converging Blockchain and Next-Generation Artificial Intelligence Technologies to Decentralize and Accelerate Biomedical Research and Healthcare. Oncotarget 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5814166/
9. First Blockchain-supported Personal care Record Platform Launched. GlobalData, 2018. https://medical.globaldata.com/NewsDetails.aspx?ArticleID=6217970&Type=N
10. Matlow, D. Healthcare and Blockchain Deck. VitalHub 2018. http://vitalhub.com/wp-content/uploads/2018/03/application/pdf/vitalhub-healthcare-and-blockchain-deck-march-29-2018.pdf
11. DNAtix Releases an Open Source DNA Compression Tool. PR Newswire, 2018. https://www.prnewswire.com/news-releases/dnatix-releases-an-open-source-dna-compression-tool-300646468.html