What Blockchain Should and Shouldn’t be to Healthcare: Part 1

By Connor R. Smith, Originally Published March 14th, 2019

Blockchain saw significant interest from major corporations in 2018. IBM began deploying initial proof-of-concept solutions to do things like sourcing food throughout Walmart’s supply chain. Many other enterprise use cases were speculated on and announced for Blockchain technology, and the year culminated with Amazon Web Services announcing it would be deploying business-ready blockchain solutions. While juggernauts like IBM and Amazon making strides in the space may be a strong indicator for the future of blockchain, with the “Crypto Winter” in full stride, one cannot help but look back with 2018 with some disappointment. Blockchain was supposed to change the fabric of how modern society does business, but very few proofs-of-concept actually made it past a whitepaper. Healthcare should be undergoing a total transformation because of the Blockchain, but we instead received niche, unneeded solutions, such as a cryptocurrency for dentists. People were more focused on creating a killer dApp or cryptocurrency than focusing on developing solutions for the actual problems that healthcare faces. An examination of the alignment between what the potential uses for blockchain are in healthcare versus the immediate needs healthcare has for blockchain is warranted if the technology is to see growth in this sector. Before considering what healthcare could do to healthcare, let’s look back and assess what has not worked in healthcare so far.

What Blockchain Should Not be for Healthcare:

A Cryptocurrency for Medical Professionals

New altcoins keep popping up every day. There are literally thousands of cryptocurrencies, each claiming to be “highly scalable”, “more secure”, and “the fastest”! To make matters worse many of these have very specific use cases, that are oftentimes laughable like WhopperCoin or HempCoin. Obviously, not all altcoins are created equal and many are intentionally memes or get rich quick scams that will die out over time. However, when ‘legitimate industries’ create their own cryptocurrency for a solution that doesn’t need it, it has major implications for the crypto and blockchain communities if they wish to be taken seriously and see adoption. In healthcare, the most glaring example of this is DentaCoin.

Many of DentaCoin’s goals are fantastic. They want to shift dental care to a patient-centric model and make care preventative as opposed to corrective by providing continuous care, access to a dentist, and good dental hygiene tips through a mobile platform powered by DentaCoin. If successful they could significantly drive down the cost of dentistry and maybe improve a few smiles along the way. But can someone legitimately tell me why the platform needs its own cryptocurrency associated with it? Their use of blockchain and smart contracts is to track payments and establish financial incentives for both the patient and dentist is legitimate, but there is no reason it needs its own cryptocurrency. 

Projects like DentaCoin with a native cryptocurrency will only harm blockchain-enabled healthcare solutions in the long run. It is just shortcutting systemic issues like interoperability and regulation. There are already projects that are optimized for financial transactions like Bitcoin and Stellar, as well as conventional fiat payment systems. Each service we use does not need its own cryptocurrency with it. Are consumers really going to keep track of and maintain the wallets of tens or hundreds of cryptocurrencies? I don’t think so. For a more in-depth article on blockchain projects not needing their own cryptocurrency click here.

A Way of Storing Medical Records

Does the U.S healthcare system need to continue to improve its storage and management of patients’ medical records in pace with technological growth? Absolutely. Medical records are the number one target for hackers to sell for identity theft purposes. A single medical record can go anywhere from $10 – $800/record on the black market depending on the record compared to just $1/record for stolen info from a credit card. Is storing medical records on the blockchain the way to fix this problem? Absolutely not.

Regardless of the encryption and identity protections used to preserve anonymity on the record, if so much as one item could lead to a network member to identifying a patient, Health and Human Services would be all over you for violating HIPAA privacy and security standards for handling patient information. If you live in Europe, GDPR restrictions are even more restrictive for health data, as computer IP addresses classify as health information identifiers. Just because you can do something doesn’t mean you should. Yes, HIPAA can make sharing medical records difficult, but it’s important to remember too that these regulations exist to protect and ensure the rights of the patient. Violating these isn’t only going to get you fined, but is doing a disservice to the patient’s rights to their data.

Moreover, storing medical records on a blockchain just doesn’t make sense. Blockchain was never meant to fully replace databases. Electronic medical records can range anywhere from 1 MB to over 3 GB of data depending on the file. This automatically eliminates secure, proof-of-work networks like Bitcoin with block size limitations from being contenders. Even protocols like Ethereum and Storj that don’t have any block size limitations would be impractical choices. Yes, you could theoretically do it, but the sheer computational power and operating costs to do so would be entirely impractical. The U.S Healthcare system, which costs over 18% of the United States’ GDP ($3.5 Billion), is not going to pay even more money for sophisticated mining equipment so it can hash and store medical records on a blockchain.

Improving Electronic Medical Records’ (EMR) security and access isn’t going to be done by hashing medical records to a blockchain. It’s going to be done by innovating at endpoints of the system and improving secure IT infrastructure to reduce the likelihood of a malicious actor accessing the records. Yes, improved cryptography and distributed databases may play a hand in accomplishing this, but that is distinctly different then hashing records to a blockchain.

Wrap Up:

Blockchain can really have a transformative impact on healthcare, but tokenizing medical services and storing EMRs on a blockchain are not going to be the solutions that have a lasting impact. Blockchain will revolutionize healthcare by creating things like audit trails and digital identities for credentialing and care tracking. I will be following up in a future article on these blockchain use cases and more that could provide significant value to healthcare. Thanks for reading!

(Part II Coming Soon!)