By Alex Libertas
What are Cryptocurrencies?
The term blockchain technology is synonymous with perhaps the more established phrase of ‘Cryptocurrency’. Simply put the blockchain is the technology that powers Cryptocurrencies, with Bitcoin being the most recognised and celebrated.
In 2008 Satoshi Nakamato, an unknown individual that is potentially a pseudonym for a person or group of people, introduced Bitcoin to the world.
Bitcoin can be described as a form of electronic cash. It is a decentralized digital currency without a central bank or single administrator, that can be sent from user-to-user on the peer-to-peer bitcoin network without the need for intermediaries.
In 2019, over ten years later, there are over 1990 Cryptocurrencies that are currently established and in circulation. It is important to note, however, that not all Cryptocurrencies are designed to be a form of electronic cash like Bitcoin was. Ethereum, for example, was created as a platform for developers to build distributed apps on in which there is no control or interference from a third party.
There are now Cryptocurrencies for developers, fintech, data, authenticity etc, the list is endless. Below is an infographic, courtesy of Josh Nussbaum, which gives an overview of the Blockchain Ecosystem and where we are today:
Blockchain Technology
So why are there so many different types of Cryptocurrency and why are so many well established companies exploring the potential of blockchain technology?
The technology behind Bitcoin is called ‘Distributed Ledger Technology’ or DLT for short. DLT is a way to keep records in sync with the whole network with everyone agreeing what the state of the database is — the difference with this technology as opposed to standard databases is that you can only change it if everyone agrees on the the change.
This means that once data has been agreed on the ledger it cannot be edited, lost, hacked or altered in any way and it is forever stored on the blockchain as everyone has agreed on this data being correct and accurate. It is for these reasons that many corporations and industry verticals are so intrigued with how the use of this technology can be applied to their business and the benefits that it can provide to sectors such as finance and healthcare.
Blockchain Technology within the Healthcare industry
On 22nd January I was fortunate enough to attend a fundraising event for @shaarezedekUK — an organisation dedicated to raising vital funds for the Shaare Zedek Medical Centre in Jerusalem. A 116 year old medical centre which is strictly non-political and does not discriminate on the grounds of religion, racial background or financial means. You can find more information about Shaare Zedek here.
The event was chaired by Danny Les, Blockchain Startup Mentor for @WayraUK, and comprised of the following panel:
Jeremy Bokobza — Blockchain developer, Head of Engineering for Stratis.
David Belle — Trader, Researcher and Broker in the finance sector.
Professor Roland Schlesinger — Head of Department of Health Law and Science at Sigmund Freud University, Chief Medical Officer for Lancor Scientific.
Dr A Min Tjoa — Professor Director, Vienna University of Technology. Vice-Chairman of the United Nations’ Committee of Science and Technology for Development.
The event was of an open discussion format with the audience asking questions and the panel responding and deliberating. Throughout the evening the panel provided detailed examples of the potential use cases for blockchain technology in the healthcare industry, as well as ways that are already being applied. I will discuss these below in detail:
Auditing/Data Security
Last year it was reported that NHS trusts lost almost 10,000 patient records in 2017. This prompted major concerns about patient data security and also meant that some patients data, including test results, previous procedures etc. had been irrevocably lost. Shockingly the article states that “94% of trusts continue to use handwritten notes as a method documentation”.
Furthermore it is common practice in many NHS trusts to file patient records at the end of the week or month as opposed to immediately, which becomes an inefficient and extremely manual process.
If patient data could be placed onto a blockchain within the hospital at the time of inception, then the data will be stored immediately. This data could then be accessed by every department of the hospital within seconds. Additionally, this could have a significant impact on saving the hospital money by turning a vast amount of manual processes into automated processes — allowing hospital staff to focus on much more important issues.
It is also worth noting that the blockchain does not have to be limited to just one hospital. For example, each NHS hospital in the London area could have access to the blockchain and be authorised to enter patient data. This means that when a patient moves from one area to another, or has an accident in a certain location for example, every hospital would have immediate access to the patients’ records.
During the discussion, Dr A Min Tjoa stated that “When a doctor or nurse wants to know something about a patient in Austria, it is nearly impossible to get a healthcare record from a hospital only 3 miles away. So the new hospital will have to perform all of the procedures again, which doubles up on the cost to the local healthcare system. By using the blockchain and enabling the tracking of this data you can give the data back to the patient. This can reduce costs in the healthcare system by up to 9%. So the flow of information is one of the big issues that blockchain can solve”
Anonymity
One of the largest appeals of many Cryptocurrencies is the anonymity it provides the user without any 3rd parties having access to the personal data. Personal data is an incredibly important part of one’s identity in modern society and it should therefore be made as secure as possible.
It has been widely reported that medical records are one of the most expensive items that are sold on the dark web. In 2018 it was reported that hackers are in possession of 140 million people’s personal data with medical records being the new trend.
This may seem incredible to some but there are many reasons for this — medical records contain an individual’s name, birthdate, social security number, and medical information. Some reasons why hackers find this lucrative are:
Fraud — It is possible to steal a person’s identity and bill them for a surgery or a prescription. It is also possible with this information to open a new line of credit.
Blackmail — As medical information is available, such as previous sexual or mental health issues it is possible for a hacker to use this information to extort and blackmail an individual for financial or personal gain.
Attempted Murder — There have been cases of hackers altering medical records to remove vital information such as life threatening allergies.
Due to a large majority of hospitals still moving from written records to digital, there are inevitably going to be a number of challenges with data security moving forward.
One of the ways blockchain technology can help resolve this is for an individual to own and control their own data. Much like when you buy Bitcoin or any other Cryptocurrency you obtain your own Private Keys, you could own and control private keys that contain your medical information. A good comparison to be drawn here is how only an individual knows their own pin code to access their bank information and money; you have access to this key, or pin, to unlock your data when you are visiting a GP or hospital administrator.
Jeremy Bokobza reiterated the security of blockchain technology by confirming that “If it’s on the blockchain it’s secure and encrypted, therefore it is protected by the user and the user keys. No one else is able to access the data”.
It is important to point out that one of the potential issues that did arise around this conversation was what could potentially happen in an emergency situation.
Professor Roland Schlesinger answered this by stating “Under these circumstances the classic regulation is exercised — we don’t care about data in this case and we will run everything that we need to. We don’t ask — we act first then think about the data afterwards”.
Supply Chain
In December 2018 the PharmaTimes declared that the pharmaceutical industry is “rife with counterfeits… with estimates of €27billion revenue lost annually in Europe alone”. Additionally BusinessGhana reports that “fake malaria drugs caused 64,000 to 158,000 deaths every year in sub-Saharan Africa.” Whilst the Guardian reported in 2017 that “10% of drugs in poor countries are fake”.
These are truly frightening statistics that highlights the obvious issues around the need for transparency with pharmaceuticals.
Blockchain technology could help aid this process by recording the various stages of production of medications throughout every step of the supply chain. The distributor of the medicine would be able to see via the blockchain that each part of the process had been verified and approved by a trusted party. If any issues were to arise with any medications, then the blockchain would allow users to immediately see where these issues had occurred.
This would also help with removing any manual auditing processes, as the data would immediately be stored on the blockchain which could mean large cost savings for pharmaceutical companies.
Data Research and Simulation
Patient data is used for research and simulation which could potentially lead to the creation of preventative medicines. This data, however, could only be used with the consent of the patients.
In July last year it was revealed that “150,000 patients have been affected by an NHS data breach where confidential information only requested to be used to provide them with care was also exploited for clinical audit and research purposes without their consent or knowledge.”
Professor Roland Schlesinger explains that at the Sigmund Freud university “20% of people have already opted out of a clinical trial. Additionally they also want to have their data stored in a ledger in the way they want to disclose it. Blockchain technology could be a potential solution here.”
This shows that there is a lack of trust between the patients and the medical institutes that hold their data.
At the Vienna University of Technology, Dr A Min Tjoa explains that they are using a blockchain device for cancer screenings. He states that, “With this tech we are faster and cheaper than all other existing devices. We use the blockchain to store the data of each patient that has ever been scanned with our device. Without DLT we could not achieve this kind of data security for each person because blockchain is exceptionally secure. It’s a huge step forward in healthcare because storing patient data such as name, DOB and sex is a difficult legal challenge. Blockchain gives us a security for the first time to use personalised data that we anonymise. So we take away all personal identifiable information and then the rest of the data is then used for scientific purposes.”
Furthermore this is attracting the attention of pharmaceutical companies as he states, “The pharma industry has a very high interest to get a big amount of data from patients all over the world to start simulating. They want to know how to save costs via the blockchain and simulate the data and they have initially reported that it’s around 12% after testing through simulation.”
Setbacks
There are numerous benefits of using a blockchain in the healthcare industry that can help save lives, reduce costs and make healthcare centres more efficient. So why is there such a slow adoption with incorporating this technology?
As previously discussed in this article a significant percentage of hospitals are still using hand written records to store their data. IT systems within the industry would first need to be updated to a more secure and suitable standard before considering implementing blockchain technology on a larger scale.
Jeremy Bokozba believes that currently there are lots of blockchain projects but very few have, “Anything that the end user can see, touch or play with. Once we see tangible benefits from blockchain in everyday life — we will see blockchain everywhere.”
Blockchain is still very much in its infancy and Dr A Min Tjoa believes that, “We are just in the very beginning and it’s yet to realise its potential. We can assume that the progress will be exponential but we don’t have all the applications yet. The reason for such a hype is that people just want to be ready for it.”
Despite the potential setbacks of implementing this technology, however, it has been announced on IBM’s Newsroom that Aetna, Anthem, Health Care Service Corporation, PNC Bank and IBM will collaborate to establish a blockchain-based ecosystem for the healthcare industry.
Through these partnerships they proclaim that “The aim is to create an inclusive blockchain network that can benefit multiple members of the healthcare ecosystem in a highly secure, shared environment. The goal is to allow the blockchain network to enable healthcare companies to build, share and deploy solutions that drive digital transformation in the industry.”
They go on to state that “The collaboration members intend to use blockchain to address a range of industry challenges, including promoting efficient claims and payment processing, to enable secure and frictionless healthcare information exchanges, and to maintain current and accurate provider directories.”
This is an extremely exciting time for blockchain technology particularly in the healthcare industry. The success of this partnership is yet to be determined but one thing is for certain — Blockchain is here to stay.
Thank you for taking the time to read this article.
Alex Libertas