Blockchain is the hot new technology topic in the financial world, the health sector, and the supply chain industry. The idea, first applied by the virtual “cryptocurrency” Bitcoin, combines the security of cryptography with the safety of distributed data. This combination results in distributed ledger technology (DLT) that is highly secure and very difficult to hack because there is no central server containing all data that needs to be protected; everyone with rights to access the blockchain has visibility into the transactions that affect them.
Blockchain technology has a variety of applications in health, not least of which are medicine traceability and patient data management. This is just as true for the US domestic health sector as it is for health systems in low- and middle-income countries (LMICs).
This infographic provides an easy to understand illustration of some of the possible applications in the health sector.
Ensuring product provenance
Counterfeit drugs are a scourge in virtually every country, but nowhere is the problem more acute than in LMICs where regulatory agencies are poorly financed and under equipped to police the market. Pharmaceutical manufacturers are concerned about lost revenue but also about reputational risk when counterfeits are used and cause spikes in adverse reactions or poor treatment outcomes. Suppliers can’t trace their products beyond the primary purchaser (typically a wholesaler), small retailers can’t be sure of the integrity of their suppliers, and people who buy medicines on the retail market cannot be certain if they are getting the real thing.
Pharmaceutical supply chains are complex systems with many players, fragmented oversight and accountability, and limited visibility into chain of custody. Digital information systems have only recently been introduced in LMIC supply chains to improve visibility, and few extend to the last mile. But that situation is changing fast, offering real opportunity for end-to-end track and trace. Building into this increasingly digital environment, blockchain technology can provide the transparency and accountability needed to ensure the integrity of every medicine and every transaction that moves it from where it’s manufactured to where it’s dispensed to the patient.
Improving health outcomes through better data exchange
As treatment for disease and genetic conditions becomes increasingly individualized and as data collection from digital devices generates ever more data, health providers, researchers, insurers, and public health agencies need to access and share patient-level data as never before. This requires robust health information exchanges (HIE) that use common standards and provide strong protection of patient privacy. Distributed ledger technologies like blockchain are based on open standards and provide the necessary data security, while also assuring patient identity and verification of services covered by insurance and rendered by providers.
In developing countries, paper records predominate and digital information is fragmented and siloed. Nascent HIEs are only just beginning to emerge, giving rise to security and privacy concerns in an environment where there is limited ICT skills and capacity for protecting central databases. Blockchains offer a solution that not only enables secure data exchange but that gathers/places a person’s health records more within their reach and control, rather than being fragmented and oftentimes inaccessible to the patient in some far-removed central database. Continuity of care can be improved as blockchains record encounter-level data wherever services are provided, and that medical history cannot be lost or altered without the patient’s permission. Because the record—the ledger—is distributed, the patient has a copy or access to a copy (perhaps via a mobile app), the providers each have access to a copy, and every new encounter is updated to each instance of the ledger whenever the parties have internet access. Service providers will be able to write the health records of patients, but they would be writing an encrypted version of the health records that can only be unlocked using the patients’ private key. As a result, service providers can trust they have a more complete picture of the patient’s health history, arming them with the information needed to make the right medical decisions.
As with all digital health technologies, blockchain is not a panacea, but it offers a promising solution to some of the most vexing problems in public health today.