Chain reaction: How blockchain helps health systems boost security, cut costs

Blockchain technology can play a key role in the management of medical records, according to a new commentary published in npj Digital Medicine. This can help health systems increase security and cut costs at the same time—and it ultimately leads to better patient outcomes.

“In order to ensure that healthcare systems do not remain an accessible target for hackers, sufficient precautions must be put in place to protect patients’ sensitive data,” wrote lead author Anuraag A. Vazirani, University of Oxford in the UK, and colleagues. “Blockchain uses public-key cryptography to secure data: a public and a private key are generated for each user using a one-way encryption function (hash). These may be used by both parties in a transaction: the sender signs, and the receiver verifies, using their own private key, and public keys are used to send transactions to a recipient. This allows the recipient to verify the validity of the chain of information.”

By using blockchain to manage health records, providers can gain more than just improved security—they also look to gain a reliable way to cut down on unnecessary studies. When a patient’s prior results are unavailable, exams are often ordered that could have simply been avoided altogether. With blockchain in place, however, a system’s interoperability will be so strong that “unavailable results” can become a thing of the past. And, the authors added, the “authorized sharing of data comes at no extra cost.”

So how is it done?

Vazirani et al. noted that prior studies have shown just how much of an impact blockchain can make on a health system, giving us effective examples as the technology continues to evolve. For example, MedRec, a system developed in 2016 by researchers in Boston, uses a cloud-based medical record and blockchain to “record patient-provider interactions via smart contracts.” This, the authors explained, “not only allows data to be accessed with consent by a patient’s multiple healthcare providers, but also accommodates access for epidemiological researchers.”

However, blockchain doesn’t magically solve all security concerns going forward. Even an advanced setup can be hit with a “51% attack,” which involves attackers completely rewriting the chain structure. Fortunately, there are ways to guard against such a scenario.

“The use of a ‘permissioned’ (as opposed to permissionless) blockchain … can allow a healthcare system to rule out any possibility of this style of attack,” the authors wrote. “This method limits those who can run full nodes, issue transactions, execute smart contracts and read transaction history to approved computers and users. This feature therefore increases the integrity of the system, as well as guarding against hackers, and strengthens the system beyond its robust foundation of public-key cryptography.”

The most effective method for blockchain-based medical record management, according to the researchers, may be for outside parties to manage the health system’s records. This allows patients to be empowered “in a way that has not previously been possible” and keeps patient data quite secure. There are other benefits as well for providers as well. Blockchain-based medical record management makes it easy to analyze statistics using AI, for example, and it can “contribute important information to the system,” leading to improved patient-centered care across the board.

“Blockchain represents an innovative vehicle to manage medical records, ensuring interoperability but without compromising security,” the authors concluded. “It also protects patient privacy, allowing patients to choose who can view their data. Investments into this technology would be outweighed by returns as the interfacing of systems leads to increased collaboration between patients and healthcare providers, and improved healthcare outcomes."