Could blockchain help cure health IT's security woes?

Blockchain is the newest buzzword in healthcare information technology. It's also one worth remembering.

The encryption-enabled data exchange system holds great promise in simplifying an array of healthcare data transactions on both the business and clinical sides of healthcare—from claims adjudication to precision medicine.

A key feature of blockchain technology is what's called its “distributed ledger,” a shared, immutable record of a series of time- and date-stamped transactions organized in data blocks and electronically chained together in chronological order.

There are a few early adopters using it in healthcare, but also many hopeful believers.

“It's hard to imagine a more effective lubricant for innovation in our complex, privatized healthcare system,” said Dr. Adrian Gropper, a physician informaticist who serves as the chief technology officer for the Patient Privacy Rights Foundation. A series of blockchains using open data standards could create a truly patient-centric medical record exchange system, he wrote in a white paper for HHS.

Hospitals glimpsed the dark side of the technology in February when electronic health records at Hollywood Presbyterian Health Center in Los Angeles were encrypted by hackers and held hostage until $17,000 in ransom was paid in bitcoins, a digital currency based on blockchain.

But it could have positive and far-reaching applications in healthcare transactions and information exchange.

“I think people are still trying to wade through it,” said Chuck Christian, vice president of technology and engagement at the Indiana Health Information Exchange in Indianapolis. But, he said, “You've got a lot of very high-powered minds looking at this.”

The global financial services industry has taken notice. Last year, it formed an international coalition, now including 70 of the world's largest banks and insurance companies, which is seeking $200 million in research and development funds to adapt blockchain to members' needs. IT giants the Linux Foundation, IBM and Microsoft are also doing R&D on the technology.

Chris Kay, chief innovation officer at health insurer Humana, said “there is tremendous potential” for applying the technology in healthcare. “For us, this itch is about simplifying the customer experience in getting care—having (an electronic) handshake with a doctor so they take pre-authorization out of it. Wouldn't it be great if that went away? If there's a smart system that could do that, that would be amazing.”

In late August, the Office of the National Coordinator for Health Information Technology at HHS released the results of a “white paper challenge” on blockchain and last month co-hosted a conference on it at the National Institute of Standards and Technology at Gaithersburg, Md. There were 77 papers submitted and 15 winners.

The submissions “went across an entire range of topics, from privacy and security to fraud to health information exchange, Medicaid, identity (verification) and authorization and credentialing,” said Steve Posnack, director of the ONC's Office of Standards and Technology.

A team from Beth Israel Deaconess Medical Center, Boston, and the MIT Media Lab at the Massachusetts Institute of Technology submitted a winning entry, a blueprint for a decentralized “interoperability layer” using blockchain.

Called MedRec, their system would carry “pointers” to patient records stored with providers or other data repositories, offering “an accessible breadcrumb trail for medical history,” according to their paper. Permission to access data on the private network would be controlled by blockchain encryption keys. So-called “smart contracts,” triggered by events, could perform standardized tasks, such as automatically notifying a patient or a provider when a transaction appends a new block to the chain.

PokitDok, developer of a platform for healthcare data services, has built a blockchain platform dubbed DokChain specifically for the healthcare industry. This summer the company demonstrated “a full production-ready” application for checking patients' insurance using blockchain and Microsoft's Azure stable of web services, according to Ted Tanner, PokitDok co-founder and chief technology officer. A demo with health insurer Cigna Corp. included bitcoin accounts called “wallets” for the provider and customer to handle records of their transactions.

Tanner said his customers, which include many telehealth providers, will have access to blockchain-enabled services by the end of this year. “Telehealth could be the killer app on blockchain.”

Correction, Nov. 8, 2016:

Cigna's "wallets" allow providers and costumers to keep records of transactions. A previous version of this story incorrectly reported that they handle payments.