Blockchain in Healthcare - Part One

In the earlier two blogs of Celeix Digital we have looked at the definitions and benefits of blockchain technology. In this blog we are going to look at the application of blockchain technology in healthcare.  

Electronic Medical Records 

One of the popular use cases of blockchain in healthcare is the management of electronic medical records (EMRs). EMRs, which are sometimes used interchangeably with electronic health records (EHRs) or personal health records (PHRs), have to do with the electronic creation, storage and management of patients’ personal, medical or health-related data. 

Indeed, EMR use case of blockchain is a major research topic. Blockchain’s property of decentralisation, immutability, data provenance, reliability, robustness, the smart contracts, security and privacy are being canvassed as the features that make it very suitable for storage and management of patients’ electronic medical records (EMR) [16,17,33,36,53,74]. There is also a certain degree of focus on how to facilitate patient-centric data sharing among different healthcare stakeholders, such as providers, researchers and insurers. 

Consistent with the European General Data Protection Regulation (GDPR) which prohibits the processing of sensitive personal data of patients unless explicit consent is given by the patients [26], blockchain is widely proposed as a viable technology to build the healthcare platform that can empower patients to be in control of how their data are shared, processed or used [13,14,15,24,27,40,45,72,76].

Use Cases - Part One (Currently in progress) 

Guardtime, a company that uses a blockchain-based platform to secure over 1 million patients records in Estonia is cited in other reviews as a popular example of the use of blockchain for the management of EMR [13,15]. 

Another such example is the MedRec project [67], a project of MIT Media Lab and Beth Israel Deaconess Medical Center, which aims at giving patients agency over their own data, to determine who can access them, through some fine-grained access permissions built on blockchain. 

The Gem Health Network (GHN) is yet another example, which is developed by the US startup, Gem, using the Ethereum blockchain platform. GHN allows different healthcare practitioners to have shared access to the same data [67]. 

Healthbank, a Swiss digital health company, is similarly working on empowering patients to be in full control of their data using blockchain platform [67]. 

In the Medicalchain project [14], whose blockchain-based platform will facilitate the sharing of patients’ medical records across international healthcare institutions, and the Healthcoin initiative, which aims at constructing a global EMR system. 

Other players working on different initiatives and projects based on blockchain-enabled patient-centric EMR include Factom, HealthCombix, Patientory, SimplyVital, IBM’s Watson, BurstIQ, Bowhead, QBRICS and Nuco [14].

Some of the barriers to blockchain-enabled patient-centric electronic medical records include interoperability among disparate blockchain-based EMR solutions (because of lack of standards), scalability (high volume of clinical data), patient engagement (not all patients are willing and able to manage their own data), data security and privacy, and lack of incentives [14,24,40,44,55,66,84].

Some workarounds have been proposed to tackle some of these challenges. For example, as a countermeasure to the challenge of scalability, given the large volume of clinical data involved, the trend is to store the actual healthcare data on the cloud and store only the pointers to the data on blockchain, along with their fingerprints [30,35,45].

A good number of the technical papers report on the implementation of blockchain-based EMR applications in which different approaches are adopted to address these challenges. Yet, different solutions are being proposed to improve the security and privacy of the EMR data on blockchain.

Use Cases - Part Two (Implemented and Execution in progress)

HealthChain [42] is an EMR application developed as a permission-private-blockchain network using the IBM Blockchain’s Hyperledger Fabric and deployed on Bluemix. The modular architecture of Hyperledger Fabric [12] enables HealthChain to achieve health data confidentiality, scalability and security. HealthChain also incorporates chain-codes (smart contracts) that control authorisations and access privileges on the blockchain network. 

There is also another blockchain-based framework, Ancile [34], which similarly utilizes smart contracts, but is built on Etherum blockchain platform to achieve access control, data security, privacy and interoperability of electronic medical records. 

MedRec [67] (earlier discussed) and the medical data preservation system (DPS) developed by Li et al. [46] are two other examples of blockchain implementations of EMR that utilize the Ethereum blockchain platform. Other blockchain-based EMR applications include MedBlock [64], BlockHIE [48], FHIRChain [54] and MeDShare [68]. 

Security

In the area of security and privacy of the sensitive data stored on blockchain-based EMR, some cryptographic schemes are proposed to strengthen the security and validity of the EMRs stored on the blockchain. Hussein et al. [28] propose a blockchain-based access control method to EMR that employs Discrete Wavelength Transform and Genetic Algorithm to enhance the security and optimize the performance of the system. 

An attribute-based signature scheme with multiple authorities is also proposed, in which the patient is able to endorse a message to be added to the blockchain based on attributes of the message, without disclosing any sensitive information. This protocol is shown to resist collusion attack and is demonstrated to be computationally secure [77]. 

In a similar way, an attribute-based encryption (ABE), identity-based encryption (IBE) and identity-based signature (IBS) are proposed to be used with blockchain in [78]. Other security-related proposals for blockchain-based EMR include the key management schemes by Zhao et al. [52,63]. Zhang and Poslad [39] propose an architecture called GAA-FQ (Granular Access Authorisation supporting Flexible Queries) which provides secure authorisation at different levels of granularity without requiring public key infrastructure (PKI).

Please follow this continuity to the application of blockchain in healthcare in the next blog - Blockchain in Healthcare - Part Two