Meanwhile, outside the industry, bitcoin has gone mainstream, as futures for the cryptocurrency became available for the first time in a big, regulated market. A day after the Cboe Futures Exchange opened the derivatives to trading on Dec. 10, bitcoin futures were up 20%, with bitcoin itself up 1,600% in 2017. The digital currency was worth about $17,000 last week.
But the healthcare industry remains wary of the blockchain-based money, which has long been a mainstay of the dark web, the part of the internet made up of anonymously run websites not indexed by search engines and accessible only through special browsers, such as Tor. There, bitcoin is used to anonymously purchase, among other things, the very data that hackers steal for ransom payable in bitcoin.
Early in 2016, for instance, Hollywood Presbyterian Medical Center in Los Angeles paid $17,000 in bitcoin to hackers to regain access to its IT systems. And in the middle of 2017, hackers demanded $300 in bitcoin from each organization hit by the WannaCry ransomware.
Indeed, paying ransom is a key use for bitcoin, said Dr. Christopher Longhurst, chief information officer at UC San Diego Health.
Security experts recommend not paying ransom, but that's sometimes not an option for organizations crippled by lack of access to their data. "There are more than I would like to see doing it, but I understand why they're doing it—they're doing it because sometimes it's cheaper to pay the ransom than it is to deal with the days being down," said Mac McMillan, CEO of privacy and cybersecurity consulting firm CynergisTek.
To get bitcoin, affected organizations can turn to "several legitimate security firms that can purchase and transact organizations in the event of a ransomware infection," said Adam Malone, director of cybersecurity and privacy for PwC U.S.
Other than that, the currency is not yet very common in healthcare. "It's like any new technology," said Dr. John Halamka, CIO at Beth Israel Deaconess Medical Center in Boston. "There has to be an urgency to change." He wondered what, exactly, healthcare could use bitcoin for. "If we just think of bitcoin as yet another form of foreign currency, I don't think we accept any foreign currencies." But, he said, he could stretch to see bitcoin as a way to make anonymous payments to preserve patient privacy.
Some healthcare organizations already accept bitcoin as payment. A New York City cosmetic surgery practice called Bodysculpt, for instance, began accepting bitcoin in November 2017. "The goal is to provide privacy and anonymity for patients," according to a Bodysculpt news release.
But the vast majority of healthcare organizations today don't accept the cryptocurrency. While their interest in bitcoin itself may be minimal, their interest in the technology behind it, on the other hand, has been greater, as startups tout blockchain-based solutions for revenue cycle and even electronic health records.
Blockchain, the technology that supports bitcoin, is essentially a decentralized, open record of transactions. With both finances and patient records, blockchain theoretically allows for greater efficiency and security.
"When done correctly, the general safety and security of blockchain is a lot greater than any other system we have in place," said Brian Becker, an associate in Nixon Peabody's business and finance department.
For EHRs, blockchain could be used to point to all of a patient's records and to changes in those records, opening up data for greater interoperability. "There are obvious benefits to decentralized storage of health information, as long as you can be confident in the security of it," said Michael Morgan, head of McDermott Will and Emery's global privacy and cybersecurity practice. "There's an obvious value proposition in that context."
On the financial side, bitcoin might be used for claims processing and secure payment transactions, as is the case with Change Healthcare's technology, which the company says will make claims processing more efficient.
"There's all kinds of applications for blockchain in terms of providing that peer-to-peer audit that allows you to digitally track the interactions between users and devices," McMillan said. "But the coin itself—I'm not sure. … Bitcoin was created to be able to buy things, and there aren't many businesses today yet that literally buy and sell services over the web using bitcoin."
