Blockchain in Healthcare - Part Two

This blog is a continuation of the previous blog titled 'Blockchain in Healthcare - Part One'. We will look further at the applications of blockchain technology in the healthcare space.

Privacy 

We will shift our emphasis to privacy; Zhang and Lin [83] propose a blockchain-based secure and privacy-preserving EMR scheme which uses private and consortium blockchains to store the actual EMR and the pointers to the EMR respectively. This scheme also relies on asymmetric encryption but also implements mechanisms for conformance testing to ensure the system’s availability. 

In [65], the authors propose a privacy-preserving platform, MediBchain that employs cryptographic functions to de-identify patients’ data in blockchain-based EMR systems. 

Yeu et al. in [58] also propose an architecture called Healthcare Data Gateway (HDG) for blockchain-based EMR application which allows patients to own, control and choose how to share their data in a privacy-preserving manner. A related architecture is proposed for the management and sharing of medical data of diabetes patients using multi-signature blockchain contracts to achieve access control and data privacy [59]. 

Drug/Pharmaceutical Supply Chain

One other identified use case of blockchain is in health supply chain management, particularly in the drug/pharmaceutical industry. The delivery of counterfeit or substandard medications can have dire consequences for the patients, yet this is a common problem faced in the pharmaceutical industry. Blockchain technology has been identified as having the capability to address this problem [13,15,55,56,74].

Engelhardt, in his survey, mentions some companies that are working on how blockchain can be used to detect prescription drug fraud. The companies mentioned include Nuco, HealthChainRx and Scalamed [14]. The general idea is to record every transaction relating to the prescription of drugs on the blockchain network to which all the stakeholders (manufacturers, distributors, doctors, patients and pharmacists) are connected. This way, any alteration or malicious modification of the prescription by any of the parties can be detected. Mettler also mentions the Counterfeit Medicines Project that is launched by Hyperledger (the developers of Hyperledger Fabric [12]) to combat drug counterfeiting. 

Here is an implementation of an example blockchain-based application for pharmaceutical supply chain management. Modum.io AG is a startup that uses blockchain to achieve data immutability while creating public accessibility of the temperature records of pharmaceutical products during their transportation so that their compliance to quality control temperature requirements can be verified [47]. Mackey and Nayyar, however, report that they found from grey literature many examples of prototypes and research initiatives related to the application of blockchain in the area of pharmaceutical supply chain management [31]. This indicates that industrial players may have released many commercial blockchain-based products to combat the fake medicine trade even when there are still limited academic publications on the subject.

Biomedical Research and Education

Blockchain has an interesting use case in biomedical research and education. In clinical trials, blockchain can help to eliminate falsification of data and the under-reporting or exclusion of undesirable results of clinical research [41,73,74,82]. Blockchain makes it easier for patients to grant permission for their data to be used for clinical trials because of the anonymisation that is inherently encoded in the data [55]. Additionally, the immutability property of blockchain certifies the integrity of data collected through blockchain for clinical study. The transparent and public nature of blockchain also make it easier to replicate research from blockchain-based data. 

All these are some of the reasons blockchain is expected to revolutionise biomedical research [14,17]. Blockchain has also been noted to have the potential to revolutionise the peer-review process for clinical research publications based on its decentralised, immutable and transparent properties [17]. 

Another potential application of blockchain to health professions education (HPE) is presented in [43] where Funk et al. make a case for using blockchain to build an HPE system that will be value-based, competency-based and offer credentialing services without relying on a third-party. A proof of concept implementation of consent traceability in clinical trial using blockchain protocol is presented in [38]. 

Similarly, Nugent et al. present their research in [60] in which they demonstrate how smart contracts on Ethereum blockchain platform can be used to improve data transparency in clinical trials. The Ethereum platform is also used to implement another blockchain-based solution that is proposed to notarize documents retrieved from biomedical databases [71]. 

Remote Patient Monitoring (RPM)

In this Section, we look at how blockchain technology facilitates remote patient monitoring (RPM). Remote patient monitoring involves the collection of biomedical data through body area sensors (or IoT devices) and mobile devices to be able to remotely monitor the status of the patient outside traditional healthcare environments such as the hospital. Blockchain has been proposed as a means for storing, sharing and retrieving the remotely-collected biomedical data [29,32,37].

In [57], Griggs et al. demonstrate how smart contracts on the Ethereum blockchain platform can support real-time patient monitoring application with capability to provide automated interventions in a secure environment. Liang et al. [61] present a Hyperledger-based implementation of blockchain-enabled data collection and sharing among healthcare stakeholders in a mobile healthcare environment. Similarly, blockchain is employed to develop SMEAD, mobile-enabled assisting device for monitoring diabetes patients [79]. 

Another example application is presented in [81] where mobile devices (smartphones) were successfully used to transmit data to a blockchain-based application on Hyperledger Fabric. Ashraf Uddin et al. also developed a blockchain-based patient centric agent (PCA) to achieve end-to-end data security and privacy in a continuous remote patient monitoring application [50]. 

In [75], practical swarm optimization (PSO) is used for root exploit detection and feature optimization in blockchain-based mobile device medical data management. Lastly, Ji et al. proposed a scheme known as BMPLS (Blockchain-based Multi-level Privacy-preserving Location Sharing) for realizing privacy-preserving location sharing for remote monitoring applications.

Health Insurance Claims

Insurance claims processing in healthcare can benefit from blockchain’s transparency, decentralisation, immutability and audit-ability of records stored on it [55]. A number of papers identify insurance claim processing as a very promising area for the application of blockchain in healthcare [13,17,40,55,86]. However, examples of prototype implementations of such systems are very limited. 

One good example we can find is the MIStore (a blockchain-based medical insurance storage system) which is deployed on the Ethereum blockchain platform [70]. Additionally, [14] talks about an initiative by a company named Pokitdok that aims to partner with Intel to build a blockchain-based system that will facilitate insurance claim resolution in healthcare. 

Health Data Analytics (HDA)

Blockchain provides also a unique opportunity to harness the power of other emerging technologies such as deep learning and transfer learning techniques to realise predictive analytics of healthcare data and advance the research in the area of precision medicine [85]. This blockchain use case is also mentioned in [55] and [17], while [51] provides a comprehensive roadmap on how this can be realised. Juneja and Marefat conducted an experimental research in which blockchain is used in a deep-learning architecture for arrhythmia classification [62].

Others

There are other potential areas of application of blockchain in healthcare, including areas such as the dental industry, legal medicine and meaningful use [14,17]. One sets out to identify the metrics for evaluating blockchain-based healthcare applications [69] while the other [80] studies the socio-technical implications of using blockchain technology in healthcare.