Can Blockchain Fix What Ails Electronic Medical Records – EMR and Electronic Health Records – EHR?
Our medical histories are vital to us as patients, to the physicians who treat us, and to the insurance companies that cover us. This data needs to be managed under a mandate of control, privacy and accountability. The framework we’ve built around this undertaking here in the U.S. is the Health Insurance Portability and Accountability Act. HIPAA sets standards for the protection of health information. However, from a security perspective it is arduous and cumbersome.
Accessing medical data is clunky, requires a high overhead, and is prone to human error. That’s because information is typically not located in a single database but rather distributed among many actors who own and exchange the data for each patient as required. The data model is fragmented and vulnerable, since basic computer security protocols are often lacking. For example, the Department of Health and Human Services does not require universal encryption but rather orders institutions to use a level of security that is merely “reasonable and appropriate.”
Blockchain Technology could be the 21st Century answer.
Blockchain technology, which is more often associated with cryptocurrencies such as bitcoin, is literally what it says — a chain of data blocks, each of which contains transactions that are encoded for security, and linked or chained to their predecessor and successor blocks by a mathematically derived and unique “address” or public key.
This approach comes with some very powerful advantages over existing approaches to data storage, distribution and use in health care.
First, unlike the ad hoc system in place today in health care, blockchain is designed to be distributed. By storing data across a network, it avoids the perils of data being stored in one location. That’s what we usually (and sometime mistakenly) think of as a trusted third party, such as a title company holding your land ownership data or a health insurance company holding your transactional history. Should that third party suffer a catastrophic data problem, or even a minor one such as a data corruption brought about by a hacker, it may be difficult if not impossible to prove or disprove you own your home or performed a transaction. These problems are avoided with the distributed ledger because when one data block is changed or modified then not only does it becomes invalid, but the entire subsequent set of chained blocks become invalid. This is due to the fact that the content of each block is used in the math function to generate the link in the chain to the next block. As such, changes are impossible to fabricate, or hide.
Second, blockchain is highly secure. The data in a block, namely our electronic patient record, can easily be stored in an encrypted form using public key cryptography and can be unlocked using a private key (password) that we as patients, owners of the transaction, possess. This key would make it impossible for unauthorized access to our data. The question of what happens in the case of emergency when we may be incapacitated and unable to provide the key, is often posed. Several potential options exist, including emergency third-party advocates with access to private keys whose very use would also be tracked via a blockchain authority; and embeddable RFID devices under the skin.
Third, trust. In order to create the links in the chain, so-called data miners perform mathematical calculations to find the addresses of the next link; this requires that all the miners (in this case potentially the health-care companies; as well as private entities) would have replicas of the blockchain also ensuring data quality across all the copies of the blockchain.
Overall, these factors will combine to not only increase the security of the electronic patient record but to also ensure the data quality, and ultimately create a standard data entity for health care, so unified clinical and back-office systems can be created with greater two-way transparency and lower operating costs.
By: Robert Plant (@drrobertplant) is an associate professor at the School of Business Administration, University of Miami in Coral Gables, Florida.
Source: Wall Street Journal
Source URL: https://blogs.wsj.com/experts/2017/04/27/can-blockchain-fix-what-ails-electronic-medical-records/
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