March 5, 2017


The Potential for Blockchain to Transform Electronic Health Records (John D. Halamka, MD, Andrew Lippman, Ariel Ekblaw, MARCH 03, 2017, Harvard Business Review)

Here's the idea:

Blockchain was originally conceived of as a ledger for financial transactions. Every financial institution creates a cryptographically secured list of all deposits and withdrawals. Blockchain uses public key cryptographic techniques to create an append-only, immutable, time-stamped chain of content. Copies of the blockchain are distributed on each participating node in the network.

Today humans manually attempt to reconcile medical data among clinics, hospitals, labs, pharmacies, and insurance companies. It does not work well because there is no single list of all the places data can be found or the order in which it was entered. We may know every medication ever prescribed, but it can be unclear which medications the patient is actually taking now. Further, although data standards are better than ever, each electronic health record (EHR) stores data using different workflows, so it is not obvious who recorded what, and when.

Imagine that every EHR sent updates about medications, problems, and allergy lists to an open-source, community-wide trusted ledger, so additions and subtractions to the medical record were well understood and auditable across organizations. Instead of just displaying data from a single database, the EHR could display data from every database referenced in the ledger. The end result would be perfectly reconciled community-wide information about you, with guaranteed integrity from the point of data generation to the point of use, without manual human intervention.

My colleagues at the MIT Media Lab and Beth Israel Deaconess Medical Center tested this concept with medications, proving the viability of such an approach. In our white paper, "A Case Study for Blockchain in Healthcare," we proposed a novel, decentralized record management system to handle EHRs using blockchain technology, which we called MedRec.

MedRec doesn't store health records or require a change in practice. It stores a signature of the record on a blockchain and notifies the patient, who is ultimately in control of where that record can travel. The signature assures that an unaltered copy of the record is obtained. It also shifts the locus of control from the institution to the patient, and in return both burdens and enables the patient to take charge of management. For those patients who do not want to manage their data, I imagine that service organizations will evolve to serve as patient delegates for this task. One challenge of the project and the idea is building an interface that can make this responsibility palatable for patients. Most of the individual patient portals that people use today have cumbersome designs, create more work, and have different user interfaces at every institution. A deployed MedRec system would feature a user interface to simplify patient interaction with health care records that bridge multiple institutions.

Posted by at March 5, 2017 8:08 AM


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