Exploring Blockchain in Telemedicine

In previous years, the buzz around blockchain technology has centered mostly around cryptocurrency. As blockchain becomes a more widely understood and accepted concept, however, early adopters in other industries are beginning to envision upgrades in healthcare delivery that could result from the integration of blockchain technology—essentially, blockchain in telemedicine. Touted for its ability to decentralize control of protected health information (PHI) while maintaining trust, accountability, security, and transparency in its data transactions, blockchain can offer a reliable method for transporting and verifying sensitive information while providing clinical researchers with a wealth of anonymous data.

Blockchain technology was developed in 2008 as a platform for exchanging Bitcoin, a type of digital cryptocurrency. With blockchain, a database lists every transaction, or “block,” with a time-stamp and a connection to the preceding block, thus forming a chain. Once added, a block cannot be edited or deleted; it offers indisputable proof that the transaction occurred. With such a potential for data security and transparency, this system has drawn the attention of many in the healthcare industry.

Furthermore, the database that stores the blockchain record is not stored in one central location; instead, the record is distributed and shared across networks, but only with trusted parties. A private key must be used to access the PHI in the blockchain. Every transaction must be verified by the network, i.e., every party on the network must see, validate, and confirm the proposed block of data. Once all parties agree that the new proposed block should indeed be added, only then can the block become a permanent part of the ledger. Thus, blockchains can store large amounts of information, such as those contained within medical records, in protected, fragmented systems. No single party retains control over the PHI or flow of information, and networks have the ability to share patient or research data. Since all parties must confirm the addition of a new block, this system holds each party accountable for its role in the patient’s care; the incidence of fraud and errors should drop drastically.

Some industry enthusiasts welcome blockchain for just that reason—the current documentation-centered approach is rigid and prone to mistakes. Blockchain offers a more flexible alternative that emphasizes the transactions instead, recording hospital notes alongside vital signs gathered during a telemedicine visit.

Despite the purported advantages, several obstacles are hindering the adoption of blockchain in telemedicine:

• Complex regulations – Healthcare is rife with well-entrenched and complicated methods of managing data, all within a maze of regulations. When telemedicine is added to the mix, even more regulations must be juggled. Blockchain could offer strong security, but not before the blockchain and regulations learn to play nicely—if ever.
• Privacy – HIPAA adds to the regulatory woes with privacy rules and security rules, which challenge the way current security mechanisms can be applied to blockchain. Safeguarding PHI with a private key is helpful but does not meet all the regulatory requirements. Plus, these scenarios assume that any privacy issues regarding telemedicine have already been resolved satisfactorily—but that’s a topic for another day.
• Interoperability – Although some experts see blockchain as a possible solution for health information interoperability (standardization) issues, the reverse is more likely; different systems must be able to interface before blockchain can be implemented.
• Cost – IT systems will need to be updated or replaced, although the expense of setting up the infrastructure could be problematic in rural areas. Aside from hardware, workflows and mindsets will require adjustments, too. A lengthy transition period will likely see healthcare leaders puzzling over how to build a skilled staff for the new platform and how to adjust the existing systems to fit neatly with blockchain.

Overall, if the above obstacles can be overcome, blockchain technology could be a game changer for the healthcare industry, both by modernizing the way PHI is handled and shared, and by giving telemedicine encounters just as much legitimacy as in-office visits. After all, the patient-provider transaction and patient outcome are what matter most, not the setting. And anything that promotes a better patient outcome sounds like a win.