Discovering the potential of Blockchain development; pursuing
advantages of creating decentralised architectures
This article presents an abstract concept and predictive benefit of applying Blockchain
technology in the healthcare ecosystem. Some current working use cases show the potential
short-term benefits of Blockchain database replacement.
Data sensitiveness by nature and by law prevents
it to be shared freely among institutionsa
silent obstacle- building barriers we find
surrounding each of the clinical operations. Interoperability
is a necessary element to enable the seamless
distribution of medical data in order to provide patients
with efficient treatment and eliminate miscommunication.
From a medical viewpoint, Blockchain technology
originally embraces some deployment features,
in addition to, propelling digital-driven healthcare
Who owns medical data?
Medical information is respectively administrated
within the specific healthcare institutions, derived
from a patient’s data and diagnosis and is kept in its
original format regardless of the standard within which
similar categorised operations share it. It burdens the
patients and healthcare providers, when they wish to
visit other facilities, as data which can not be evaluated
or analysed through consecutive formats is of
no use or value. The Electric Data Interchange has
revealed critical issues among different services that
are harnessing information on a medical database
with limited interoperation and a ‘connected’ environment.
From a business point of view, this is a
nasty arrangement that leads the customer/patient
to reject their services and never come back again as
Furthermore, what is worse, the data had been
sold to third parties without the permission or agreement
of patients and without ensuring any data safety
provisions in some cases. Medical data is one of the
most sensitive assets for an individual. From Pew
Research analysis, “Americans Consider Certain Kinds
of Data to be More Sensitive than Others” in 2014
(Madden 2014), over half of American respondents
said they consider private health and medical information
to have the highest sensitivity level among
all their data.
Exponentially, with the enormous amount of data
in healthcare, both the administration of this data and
patient usability becomes significant. Blockchain technology
is expected to disrupt the concept of privacy
settlement from centralised ownership to empowering
the individual management of personal data.
The asset in the case of Blockchain is that once
you have received any medical information in the clinic
and are diagnosed with a specific symptom, your
medical record inherits a personal database and is
encrypted in real time. As this output is not governed
by any third party, it will be able to submit unbiased or
altered information within the available environment.
The government has tried individual data authorities;
My Health My Data (www.myhealthmydata.eu/)
for example is a European project, aiming to create
a transmittable medical information transaction by
storing data on Blockchain.
From the operational point, a Blockchain database
is capable of retaining multiple adaptions in
parallel among some medical institutions, by all
means increasing effective access while releasing
data management from centralised ownerships.
Who covers security costs?
The onslaught of data theft further burdens healthcare
providers with issues of liability concerning information
ownership, the constant need to strengthen
security teams and the increasing cost of compensation.
This will continue to put great pressure on
institutions that have large centralised data pools.
In 2015, the Japanese Pension Service was hacked
and 1.25 million files of personal data were leaked
instantly, including sensitive personal information like
people’s pension IDs, names, addresses and birth
dates, according to a report published in the Japan
This incident happened as a result of an agency
officer opening a suspicious file which then instantly
infected the PC. All emails sent from there contained
the virus and helped it spread infecting the entire
administration core storage files simultaneously.
When it comes to preventing a data hacking invasion
from outside threats, it is not easy to predict; education
and anti-virus software alone are not enough, a
comprehensive safety plan requires serious scrutiny
inside the management process. In accordance with
the set protocols in any operation structure and the
relevant data sharing regulations put in place, the
owner of the information is held accountable and
forced to pay attention and do the utmost to predict
and protect the network against potential unknown
attacks. In particular, medical data is one of the
most valuable and sensitive sets of information and
contains varieties of tangled asset records. Patients
and healthcare providers are becoming more anxious
demanding that their security service is perfect, in an effort to prove the best safety capabilities against a
hacking incident and potential targeting, otherwise
risking to lose customer trust and ultimately any
profits to their bottom line. Evaluating the security
costs of implementing adequate measures strong
enough to avoid critical assaults requires expertise
and additional cost.
Recently, Korea’s Myongji Hospital announced
they signed an agreement with BICube, to collaborate
on the development of a Blockchain-based
medical information exchange system. In the recent
announcement by the hospital, the main purpose
of the agreement is to “build a hybrid cloud that
combines public and private clouds, and to secure
the safety of online medical information exchange
system by combining blockchain technology in the
process of exchanging medical data through the
cloud”, essentially to combine Blockchain technology
and a cloud database (Myongji Hospital News 2014).
Managing medical information will require a great
deal of expenses on behalf of the data holder, it is
therefore preferable to adopt a decentralised operation
system cutting cost in the long-run of all future
Who trusts the information?
Pharmaceutical supply chains are faced with
immeasurable issues, in the meanwhile, from the
top to bottom of their distribution, to take measures
that will prevent contaminated drugs and errors in the
mixture of drugs until they are ready and placed for
sale in retail drug stores and pharmacies. According
to a recent World Health Organization report, counterfeit
drug production has been increasing; the top
three countries where threats originate are India at
31%, UAE at 31% and China at 20% (Robles et al. nd).
A few years ago, there were serious incidents
in Paraguay and Pakistan when a large number of
patients were administered cough syrups containing
contaminated agents while they were in the hospital.
Although these incidents affected many people,
manufactures and the hospitals were unaware and
unable to provide tracking to the original sources
of this supply chain. Despite the severity of the
contamination, the complicated routes of the data
could not allow officials to locate the precise factor
of infections in order to provide timely treatment to
the infected patients. Information asymmetry leads
to ubiquitous consumption ratios and inescapable
influences due to unknown nature of the structure,
so that traceability is recognised as an imminent requirement in order to recall and clear the tainted
drugs from the entire distribution channels.
Pharmaceutical giant, Novartis has started to
experiment with the use of Blockchain technology
since 2016, even at the early stages of Proof of
Concept, in an effort to demonstrate an imagined
future with IoT harnessing services, storing temperatures
and the ability to locate and identify counterfeit
ingredients inside supply chain provisions.
Having the data to track elements of the distribution
chain like the spots where the delivery truck
has been routed through for example, or how and
when the products are delivered to the final vendor
will help to increase the accuracy and minimise the
margin for outside tampering of products. Besides,
the tamper-proof Blockchain database guarantees
increased quality of trust compared to the current
mostly handwritten documentation records while
securing preventive storage against intentionally
Who insures your healthcare security?
Medical insurance provides access for financial
support while you are making payment with negotiating
discounted prices and in some cases supported
from third party payers and government healthcare
systems. However, the insurance process gets
more complicated through a series of identification
and assessment requirements within each specific
payment coverage and the potential of accepting or
denying a patients claim. Currently, most insurance
contractors spend significant time intervals, even
when the patient has been diagnosed with a clear
and acceptable healthcare symptom, because of
congested administrative processes; and the patient
is left to wait until the needed verification in order to
Healthcare data is continuously being refined
through beneficiaries to be able to provide more
accurate information yet needs to be rethought by
minimising the effect of human error. This entire verification system costs both in financial and human
resources capital to complete, maintain and manage.
Blockchain technology provides the tools to help
decompose these complex procedures, improving the
shortage of information and data, replacing them to
integrate data flow in a single operation.
Actually, new healthcare organisation alliances have
started out between groups of insurance providers.
UnitedHealthcare and Humana, Optum, Quest Diagnostics
and MultiPlan are now launching Blockchain
pilot programmes, helping out payers to tackle complex
bureaucracies within their organisations. These
programmes focus on improving data quality and eliminating
the administration procedures, to pursue cost
According to healthcare IT news, insurance providers
have received similar requests from dozens of payers. It
takes a lot of time and money to reach out to providers
on each 90-day cycle. Congested calls and emails delay
those inquiries, heavy access traffic jams.
In this pilot, alliance members curated information
to be shared, confirming the overlapping with other
provider’s data and highlighting the need to prevent
the duplication of processes within each of them.
How to deal with patient images?
Medical imaging information is sensitive and crucial
for both diagnosis and treatment. The patient retains
ownership of the imaging data, and has secure individual
rights against any service provider failing to
protect the data from risk of leaking or malicious
manipulation. In the US, the Health Insurance Portability
and Accountability Act (HIPPA) defines the rule of
privacy and medical data security; respectively enterprises
need to follow this enforcement, in terms of
administrate privacy and medical data (Edemekong
et al. 2018).
In 2015, there was a massive hacking incident
that leaked more than 3.9 million patients’ medical
information nationwide by EHR vendor Medical Informatics
Engineering. In this case, the electronic healthcare
record vendor was suspected to be in violation
of HIPPA rules and other state regulations, and held
accountable for the breach of records including radiology
In this case, the electronic medical record vendor
was in direct violation of the process of operation to
store information, and handle sensitive patient data.
The problem becomes worse since there is already
a shortage of radiology subspecialists in the US to
maintain sufficient services. According to the Merritt
Hawkins figure the number varies from the 2016 ACR
Commission on Human Resources Workforce Survey
in the article published in Diagnostic Imaging showing
28% of the radiology workforce is 56 or older (Kaplan
2016). In both cases, though, a significant number of
radiologists are nearing retirement age. It is evident
that there is a need for more resources to improve
In order to solve this issue, the MDW project, a
decentralised Blockchain platform that connects
healthcare facilities, radiologists and AI algorithms,
enables radiologists to preview and purchase verifiable
algorithms to enhance their practice. Radiologists
gain compensation once their report is accepted. This
results in lower costs giving radiologists the ability to
access high quality expertise
There is a lack of talent to manage the current
medical system structure. As such, it is unable to
sustain the needs of healthcare overall and imaging
in particular. These issues can be resolved with new
technology like Blockchain. Blockchain databases can
help secure the environment by following the regulatory
requirements and by only distributing encrypted
information more efficiently.
Who is aggressively betting on healthcare
From PwC’s 2018 Global Blockchain survey, 49% of
global healthcare companies have started Blockchain
pilot programmes (PwC Global Blockchain Survey
2018). Even though this survey was conducted within
a limit of 74 healthcare enterprises, other evidence
suggests there is an increase in healthcare trials using
Blockchain pilot programmes.
From the healthcare perspective, it tends to
combine health privacy data with payment or other
financial access. Some companies explore the technology as an alternative to the traditional process
that requires endless paperwork and human centric
enforcement. Blockchain companies are making
a move to explore the potential of the healthcare
market, adding significant value by cost cutting and
providing simplified overall management.
How to build a decentralised operation
system in healthcare?
In terms of healthcare areas, a decentralised network
facilitates private data transformation from a centralised
database to the individual end user or owner of
the data, the patient. In accordance with the growth
of health-tech and medical-tech innovation, data
ownership has certainly come on the table, and solutions
to tackle the sovereignty issues of ownership
and privacy will ultimately be provided by new platforms.
As a result, architectural concepts will have
to be changed while information ownership and individual
control will rely on the effective operation of
Basically, when it comes to the application of
Blockchain, it is important to involve all the stakeholders,
visualise a consensus algorithm and incentive
structure, and choose an appropriate governance
and maintenance model. It is also important to
consider some risks in advance that could possibly
have an impact on governance or breach the rules.
However, the entire mechanism differs from the
number of audiences and stakeholders; moreover,
consensus algorithms influence the management
block scales in consequences. Regardless of the
technical aspects, government regulation is going
to enforce Blockchain modeling unless it conflicts
with enacted items on existing laws. Data privacy is
controversial and on the table in a constant attempt
to ‘synchronise’ governance and technology innovation.
Ultimately, Blockchain systems will be utilised as
certification credits in order to prove data accuracy.
For example, the American Drug Supply Chain
Security Act (DSCSA) outlines the steps required to
build an electronic and interoperable system, capable
of identifying and tracing prescription drugs distributed
in the US market (Drug Supply Chain Security Act
FDA). In order to protect consumers from contaminated
products and otherwise harmful incidents,
companies need to adhere to legal frameworks set
in place for distribution. However, regulatory requirements
are not the same between multilateral nations,
so that it is now necessary to develop solutions such
as Blockchain pipelines with the potential to securely
service international healthcare delivery systems.
In conclusion, Blockchain is a decentralised database,
potentially a tool that will be widely implemented
in the next generation of our society to
disrupt traditional healthcare ecosystems. However,
we still have to fill knowledge and experience gaps
by empirical operation and trials in various areas to
determine how this technology can be further applied
in healthcare and imaging as a natural extension.
From industry and government viewpoints, the
inclusion of multiple stakeholders is the key element,
even at the stage of discussion because Blockchain
solutions must combine each player of the healthcare
continuum if they are to produce meaningful value.
- Data ownership discussion becomes more serious by harnessing Blockchain-based operations
- Accurate traced information secures customer protection under the regulations
- Single pipelines are more cost effective than congested current operations
- First experiment, second create the standard,third follow with operation