Does Blockchain Tech Have a Future in Health Care?

By Stephen P. Williams

Proponents of blockchain expertise say we’re on the cusp of a revolution in well being care. They envision a future the place medical doctors and establishments share medical data simply, and sufferers management their private information moderately than letting tech corporations harvest our information without spending a dime and promote it for revenue. If the idea of Web3 — a blockchain and cryptocurrency-based web that grows to naturally displace our present World Wide Web — proves out, it might make their visions actuality.

But others within the well being care business, even when they see the necessity for a revolution, worry that blockchain presently has too many blindspots to be efficient. “In my opinion, although I think the impact of blockchain technology will be huge in the health care system in the future, a successful and scaling solution is likely to be years ahead of us,” says Lukas S. Vogel, MD and blockchain skilled in Baden-Baden, Germany.

What Is a Blockchain?

Blockchain got here into the favored consciousness when it served as the muse for Bitcoin, the cryptocurrency that was invented in 2008. Ever since, the expertise has been misunderstood, each by the cult-like fanatics who imagine it’s the cure-all for each drawback the world faces, and the narrow-minded cranks who say it serves solely to assist pyramid schemes, gangsters, and tyrants.

Let’s go away these fanatics and cranks to their Twitter wars, and method blockchain and well being care from the center floor. First, a blockchain primer:

Blockchain is software program, it’s so simple as that. This software program is a digital model of the previous inexperienced account books your grandparents may need used to trace cents spent and cents earned. Except that as a substitute of simply two columns — debit and credit score — blockchains (there are a lot of blockchains, with many extra to return) have three: debit, credit score, and verification. This triple entry accounting system requires no auditors, verifiers, or gatekeepers. Because each transaction is public and immutable, nobody can change the information with out triggering alarms all through the system. Once a transaction is registered on a blockchain, that reality stays there endlessly. It is related to a particular blockchain handle, however these addresses can stay nameless.The precise information — equivalent to written paperwork, movies, or take a look at outcomes — are saved “off chain,” in information banks, as a result of blockchains are designed to report possession, moderately than retailer information.

No one owns these public blockchains; one innovation is that they’re managed by individuals within the chain. Private, or enterprise, blockchains are owned by consortiums or corporations, equivalent to IBM, and they’re extra centralized.

To use private and non-private blockchains creatively, corporations construct apps (known as dApps in blockchain lingo). The dApps typically monitor possession of digital property, equivalent to cryptocurrency tokens or well being data.

 

Health Care Companies’ Interest in Blockchain

At the second, quite a lot of well being care corporations, together with IBM, SAP, Centers for Disease Control and Prevention, Patientory, and Nebula Genomics are utilizing enterprise blockchains for targeted duties equivalent to:

• Verification of credentials
• Sharing medical data
• Tracking prices and funds
• Tracking organs and transplants
• Following the pharmaceutical provide chain

According to some business specialists, it’s potential (although not assured) that some very helpful functions will turn out to be broadly used within the subsequent 5 years. There’s a giant push to provide sufferers and medical doctors sovereign ID’s, in order that they’ll management their id, popularity, data, and different information. Right now, we medical customers give our information away.

“Now, the records are owned by the hospital or other corporation, which can sell the data — you still have to ask for permission to access your own data,” says Jose Morey, the North Carolina-based chief medical officer for a medical expertise firm.

Giving sufferers management over their very own information received’t be a straightforward process. Even placing apart technical points, it will require an enormous quantity of cooperation between corporations that don’t have a lot of an incentive to cooperate. “It’s very hard to solve the health care problems,” says John Bass, founder and CEO of Hash Health, a Nashville-based enterprise studio that’s constructing new digital well being startups. “That takes enterprises that are willing to work together. It takes new management techniques. It takes systems change.”

 

The Challenges of Blockchain for Health Care

Widespread adoption for this expertise received’t be straightforward, and it’d even be dangerous. Here are an important potential drawbacks:

Cryptocurrency

A cryptocurrency is a digital coin, equivalent to Bitcoin, that’s tracked and licensed by a blockchain. There aren’t any precise bodily cash. Rather, the digital cash are saved, as strains of code, in digital wallets that may solely be unlocked in your laptop or system with a non-public digital key. Bitcoin and ether are the 2 most used cryptocurrencies. The price of every is extremely risky, rising or dropping in worth by hundreds of % in a yr.

Many enterprise innovators, together with in well being care, imagine that crypto cash could possibly be used to incentivize behaviors — in well being care, maybe, you’d obtain the hospital’s branded cryptocurrency for those who confirmed that you just exercised thrice per week, as your physician instructed. This idea isn’t far-fetched or technically tough, although no hospitals are but utilizing it.

“There are regulatory questions around the normal crypto stuff, outside of health care. The coins that would be used in health care are even more complex without having to worry about that,” Bass says.

Web3 believers wish to incentivize sufferers to be wholesome, share their data, and do different issues by paying them with cryptocurrency. But there’s probability that speculators would enter that ecosystem and presumably manipulate the worth of the cash. Plus, the IRS and the SEC haven’t but settled on particular guidelines about cash, tokens, and NFTs. There is an actual danger that new rules will severely hamper corporations’ skill to make use of these incentives.

NFTs

Nonfungible tokens, or NFTs, are just like crypto cash, besides that every NFT is considered one of a form. So far, NFTs have been used as artwork objects: you purchase a token that claims you personal an image, and the funding can admire identical to an precise image (Except you possibly can’t cling it in your home).

But the tokens can serve nicely to register everlasting data of your id, medical data, and different well being care information. The info is sharable, as you want. You might personal the NFT that has your entire train information, as an illustration, and use it to share related info along with your bodily therapist, or promote your information to a analysis firm. The greatest drawback now could be that buying and storing NFTs requires some technical abilities, and the person expertise proper now could be too cumbersome to onboard lots of people.

Security

Blockchains are almost inconceivable to hack. The Bitcoin blockchain has by no means been hacked, and the Ethereum chain was solely hacked as soon as, quickly after its inception. Given its present dimension, it is extraordinarily unlikely that it might occur once more. However, the dApps constructed on prime of blockchains to handle information, IP, ID, and different features are typically weak to stylish hacking. And when, if ever, quantum computing turns into frequent, that expertise can be highly effective sufficient to crack the cryptologic codes on blockchains.

Until that point, customers are fairly prone to hackers working phishing schemes. While blockchains themselves can’t be hacked, folks may be tricked into surrendering the key phrase that provides them entry to their personal wallets. Sharing these phrases is like sharing the code to your safe vault. Once somebody has that, they’ll steal any cash or NFTs in your digital pockets, and likewise steal your well being data and different information. Given the character of the expertise, the thefts can be registered immutably on the blockchain. But since blockchains are amoral, the blockchain would not do something about it.

Distributed Autonomous Organizations (DAOs)

DAOs are teams of individuals organized on the blockchain who use cryptocurrency as a funding mechanism, and make most huge selections by voting. They haven’t any central chief or authority. These organizations with minimal hierarchy have solely been round for a decade or so, however lately DAO’s have exploded in recognition amongst startups in all sectors. Some well being care innovators now are excited by funding their ventures with DAOs, or organizing sufferers with uncommon ailments to lift funds to analysis medicines for his or her illness. This is necessary as a result of many much less frequent remedies and sicknesses aren’t of curiosity to enterprise capitalists and others who need big returns from big merchandise. Yet most everyone seems to be ready till DAOs are much less dangerous, and simpler to clarify to stakeholders. No one has actually nailed the person expertise of DAO’s but. They are like Nineteen Seventies communes, however with numerous cash and a concentrate on enterprise. They talk by chat rooms in an internet platform known as Discord.

“The Discord servers are pure chaos,” Bass says. “Asking a health care provider to join Discord would be sort of a joke.”

Cross Chain Portability

While there are dApps that assist transmit information from one chain to a different, the extent of interoperability between chains that might be essential for reworking the American well being system merely doesn’t but exist. For instance, it’s necessary {that a} hospital that makes use of one chain be capable of share information with a health care provider who makes use of one other. At the second, that’s typically tough. The well being care system won’t be unified till that is extra potential.

Credentialing

Blockchain appears to supply the proper resolution to a credentialing, which is a typical well being care drawback. Every doctor has a relationship with 4 or 5 well being programs and payers. Each of these companies should certify that the doctor is who she says she is. This course of now could be largely analog and may take months, and must be reconfirmed each 2 years. No hospital shares this information, so every hospital has to do it for themselves. This is an ideal use case for the efficiencies of blockchain, and a few corporations are engaged on it. In the meantime, corporations pay tens of millions of {dollars} for extra conventional certification providers yearly.

A great way to retailer a health care provider’s credentials can be on NFTs saved in digital wallets. But that is perhaps too technologically difficult for in the present day’s medical doctors due to the technical savvy required.

“If you created a self sovereign wallet for a physician right now they wouldn’t know what to do with it,” Bass says.

The Environment

Many educated persons are involved in regards to the quantity of power the computer systems of two of the most important chains, Bitcoin and Ethereum, use to confirm and safe “blocks” of knowledge on the chain. This is presently a really actual situation. However, Bitcoin individuals are more and more switching to utilizing renewable power, as a result of it is cheaper and sustainable. And Ethereum is anticipated to start out utilizing a special blockchain expertise, known as proof of stake, this yr, which can cut back its electrical energy utilization by greater than 90%. There are quite a lot of different chains, each private and non-private, that already use this low power technique of certifying information.

It appears sure that blockchain goes to have an effect on well being care. The expertise may even result in a revolution in well being care, the place information is personal and prices are billed transparently. Where organ transplants run easily and equitably, and fee friction is decreased. It’s all potential, however the expertise positively has to leap some hurdles earlier than it could possibly occur for actual.

Editor’s Note: Stephen P. Williams is a co-founder of Evertunes Studio, which builds cash and NFTs for artwork and cash video games. In his spare time he collects and sells fine-art NFTs, utilizing ether and different currencies.