07 September 2017

Blockchain Approaches to EMR Security

My previous two geek.ly articles explored some of the innovations I'm seeing in the healthcare field, with an emphasis on technologies that could actually help improve the U.S.'s broken healthcare system. This article provides some example healthcare cases that should be possible in the near future.

But first, a review of what I’ve discussed so far:

  • In “Healthcare, Innovation, Technological Advances: Are There Really Medical Unicorns?”, I surveyed some of the latest apps and gadgets that are currently impressing me. In particular, I looked at technologies that empower the patient; that allow 3-D printing to create inexpensive, bespoke body parts; and that provide robotic assistance to surgeons. I cautioned, however, that not all gee-whiz technologies survive the hype cycle and that they alone cannot cure everything that’s wrong with our healthcare system.
  • In “How Predictive Analytics and Machine Learning are Changing Healthcare,” I discussed technologies that might help us avoid injury or the need for intervention. For example, researchers are using predictive analytics for injury prediction, with the hope that prediction can lead to prevention. Meanwhile, various healthcare-related IoT devices (and their machine learning algorithms) are helping medical professionals in several ways: establishing a prognosis, taking over the work of radiologist and anatomical pathologists, and improving diagnostic accuracy. I concluded the article with a look at national patient outcome registries, and how these accessible big data repositories can aid researchers, and even help insurers keep their costs down. Again, none of these advances are cure-alls on their own, and each has its detractors and/or issues to overcome.

All these apps, gadgets, algorithms, and registries are great, and provide hope for the future of healthcare. But what about security, especially of EMRs (electronic medical records)?

Blockchain Approaches to EMR Security

With the need to integrate healthcare records from multiple providers, registries, and pharmacies (including data on diet and supplements), patient record security is a growing challenge. Will a blockchain approach keep a patient’s EMR data safe? I published an article on LinkedIn about blockchain and EMRs that Peter Nichol argues that blockchain technology (which is most famously used as the Bitcoin ledger) will revolutionize healthcare and provide the security necessary to prevent record breaches and data hostage situations.

Blockchain technology as described by Nichol would improve security in at least two major ways. First, patients would be able to allow access to their medical records on a conditional basis, depending on a situation’s context. For example, perhaps a patient would only share information in an emergency instead of having it available to providers at all times. Currently, computerized systems cannot easily account for conditional consent—patients usually have to authorize complete access at all times or provide no access at all.

Second, through the use of keys and codes, multiple computers would need to be compromised for a hacker to gain access to information. In at least three recent large-scale breaches ranging in size from 850,000 to 25.7 million records, the breaches were successful because only one computer needed to be compromised.

Blockchain technology would improve EMR security in at least two major ways
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Of course, there are challenges facing the development of blockchain for healthcare, including selection of a protocol, creation of blockchain regulation, unknown costs, and limitations of the technology itself. Whether blockchain technology is the solution to EHR breaches or not, it is clear that a solution must be found and implemented quickly. As things currently stand, there is no assurance that our medical records are secure, and the repercussions of a breach could wreak havoc on patients' lives.

Healthcare Case Studies

Let’s pull together the technologies I've discussed in my three articles into some example healthcare cases. Some of these are already possible; others could be commonplace in the near future.

Case #1

A 46-year-old woman with rheumatoid arthritis is in need of finger splints to relieve the ache in her joints and to have better functional use of her hands. Currently, she must make an appointment for three weeks from now, get to her physician’s office, find and pay for parking, lose a half-day’s work, get measured, receive another referral or appointment, and spend $35 on a co-pay. It will be more efficient and less expensive when she can download open-source maker software, pick out a design and color she likes, tweak the software to her hand size, send the file to her local library, and 3-D print her own custom set that afternoon for about $3 worth of material.

Case #2

An 84-year-old man with ambulation problems due to osteoarthritis in his right knee cannot drive to his physical therapy appointments. Instead of a medi-car, which is very expensive and hard to schedule for the times of his weekly rehab appointments, he instead opens up the Uber or Lyft app on his phone and books round-trip appointments. Soon his insurance will pick up the tab, as both services are reliable, safe, and much less expensive for their enrollees.


The owner of a large orthopedic rehabilitation practice has won a capitated contract (flat fee per patient) with a major insurer in her area. She needs to know how her clinicians' expertise match which patient needs, in the context of comorbidities, ethnicity, genomic data, and so on. She has a sophisticated EMR that tracks such information. It can produce clinical performance and outcome analytics with granularity down to the individual patient or clinician, and aggregate the data to inform her differential referrals to her most appropriately suited staff members. A convenient app allows for immediate patient satisfaction and Net Promotor Scoring, clinical self-reporting of range of motion and pain score improvements, compliance to home exercise programs, scheduling, co-pays, and HIPAA secure reporting to other involved healthcare providers and the contracted payer. She also uses the app to determine bonus-incentives based on the quantified value of the care her team members have delivered.

Whether blockchain technology is the solution to EHR breaches or not, it is clear that a solution must be found and implemented quickly
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Case #4

The owner of a large orthopedic rehabilitation practice wants to bring all his clinical staff up to a basic standard of care that reflects a state-of-the-art, evidence-based practice, but he knows none of his staff has the time or resources to read the literature and keep up to date. He knows that global scientific output doubles every nine years and that in 2010 there were “… 25,400 journals in science, technology, and medicine, and their number is increasing by 3.5% a year… [and] PubMed now cites more than 20 million papers,” further exacerbating the impossibility of keeping up with advances and the published clinical literature.

In response, he co-develops an EMR empowered with machine learning that automatically considers the patient’s presenting symptoms or injury; current functional status, pain, and range of motion; demographics (age, sex, body mass, and so on); and comorbidities (diabetes, hypertension, and so on). It then looks to the scientific literature's evidence-base for appropriate treatment guidelines befitting the presenting circumstances. The AI of the EMR probabilistically considers which course of treatment (including likely medication response based on genomic data) might yield the optimal clinical outcome, and offers it to the therapist to inform his/her treatment planning process and augment his/her clinical judgment. 


My answer to the question, “healthcare in technology: hype, hope, or both?” is an enthusiastic yes!

Of course new technologies and products are being hyped; whether they are being over-hyped can only be known as they become available in the market, get any kinks ironed out of them, and mature.

But I think that even the products that don’t survive still inspire hope. It means that we humans are still willing to bring our creativity and tenacity to bear on some very serious problems. If these solutions don’t work (and even if they do!), there will be other solutions to examine, test, and yes, even hype.

That said, some of the problems we see in healthcare cannot be solved by technology alone. As I said in the first article of this series, there are competing interests, disconnected payment schemes, rival financial motives, poor visibility of costs, massive amounts of regulatory rules and requirements, complex layering of protocol and training, and more. We need to bring our creativity and tenacity to bear on all levels of the healthcare dilemma, so that we can introduce efficiencies, save money, and yes, improve and save lives.

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