I would like to apologize to the readers of this site for the long hiatus. I have been spending time as cardiologist, consultant, and caregiver for a seriously ill family member.  My goal is to continue writing as it is something I truly love to do. I hope and believe that all of the above roles I engage in add to the quality of this blog.

A good definition of blockchain is: “A blockchain,^[1][2][3] originally block chain,^[4][5] is a continuously growing list of records, called blocks, which are linked and secured using cryptography.^[1][6] Each block typically contains a cryptographic hash of the previous block,^[6] a timestamp and transaction data.^[7] By design, a blockchain is inherently resistant to modification of the data. It is “an open, distributed ledger that can record transactions between two parties efficiently and in a verifiable and permanent way”.^[8] 

Blockchain was first developed as a means of transaction for the digital currency Bitcoin.  The transparency, accuracy and efficiency of blockchain technology have made it attractive for its adoption by Wall Street.  The blockchain rubber meeting Wall Street’s road is already here. Many of the attributes of blockchain have made it a natural topic of discussion in taking healthcare to its own version 2.0 now that it has entered the digital world (albeit tepidly) via EHRs and IT support. Interestingly, an IBM survey of 200 healthcare executives in 16 countries focused on interest in adopting blockchain technology revealed that this is a very rapidly evolving area.

One of the most obvious benefits of blockchain resides in improving privacy of electronic health records. In this scenario, a patient can digitally determine who should have access to the medical record (and which portion), which person(s) or entities saw or modified the record (and what portion) and when.

Herding a patient’s data from many sources into a single record has always been a lofty goal of digital health.  According to an excellent whitepaper describing a case study of Medrec, a platform utilizing blockchain technology, health information interoperability is facilitated with the use of blockchain.  However, interestingly, interoperability of blockchain itself remains as much a Holy Grail as interoperability of digital healthcare data. One may also imagine the implications for healthcare data security. Blockchain can potentially significantly reduce security breaches and track more accurately the exchange and integrity of healthcare data.  Blockchain can also ensure the accuracy of the data exchanged among entities, something a HIE (health information exchange) cannot do.
Blockchain technology’s potential impact on the life sciences industry (drug development, distribution and prescribing) is significant.  It can impact the opioid crisis and improve tracking drugs in the supply chain.  One can envision how blockchain might also stop drug counterfeiting thereby improving patient safety.

Medical devices are the subjects of recalls due to manufacturing issues, alerts regarding vulnerability to cyber attack, and device failures or suboptimal performance.  Historically there is a paper trail from the device vendor to the implanting physician.   However, the physician who is following the patient after implant is often different from the implanting physician, resulting in that paper trail becomes a dead-end.  In addition, the real-time tracking of the location of individual devices, whether already implanted, in a hospital’s inventory, or out in the sales field presents a challenge.  If there is a life and death issue involved, one can only imagine the imperative of obtaining the device location and/or patient. As an implanting and following physician who weathered multiple large and clinically critical recalls and alerts over decades (including ones which changed FDA compliance regulations related to them), I can attest to my own records having been more accurate than those of  vendors.  Patients relocating also present an obstacle to tracking devices already implanted.  Blockchain technology can track devices via vendor records and patient clinical records.  Medical devices frequently have multiple digital technology components from third party manufactureres.  Blockchain can track eaxch component from manufacturing to the point of care. The service records of the device and its components may also be tracked via blockchain technology.

The potential benefits of blockchain certainly need proven in any arena in which it is adopted.  As is often the case when it comes to digital technologies, other sectors (in this case finance) have been first adopters preceding healthcare.  I must submit however that in this author’s view blockchain has been discussed in healthcare circles significantly earlier with respect to its adoption in other fields than other digital technologies. Perhaps this is because of heightened awareness of the pitfalls of digital technologies which are now widely adopted in healthcare, namely security and interoperability.  It was interesting that at the 2017 HIMSS Conference on IT Privacy and Security, blockchain was brought up by an audience participant and was met with “This is too far in the future to discuss now” by the moderator. We are now at that point and I welcome in-depth discussion as well as adoption.