Blockchain already earned the buzzword of the year award, so it is high time to address the elephant in the room. Is it really there? If it is, will it really change everything? How will it impact healthcare?
Don Tapscott, author of the book entitled Blockchain Revolution said in his superb, no-frills TED Talk that blockchain is the technology that is likely to have the greatest impact on the next few decades. No, it's not social media. No, it's not big data, not robotics, not even artificial intelligence. It's the technology behind the cryptocurrency, Bitcoin.
Stop there for a moment. So, blockchain will have more transformative power on our lives than Facebook, Instagram and Donald Trump using Twitter for diplomacy? How? Why? When? Is that true or is it another bubble shaping up in front of our eyes?
When looking at how fast companies in various industries are adopting blockchain, the latter question is certainly worth considering. According to Transparency Market Research, the global blockchain technology market is expected to be worth $20 billion(!!) by the end of 2024 as compared to $315.9 million in 2015. The overall market is anticipated to exhibit a 58.7 percent annual growth between 2016 and 2024. Moving faster than Elon Musk's red Tesla Roadster in space. And the drivers of this massive expansion are innovators, start-ups, bold companies in finance, retail and manufacturing, government – and healthcare.
Due to blockchain's ties to cryptocurrencies, most people believe that the financial system will adopt the technology soonest, but healthcare's speed of leveraging blockchain seems to actually surpass it. A new IBM Institute for Business Value blockchain study, Healthcare Rallies for Blockchain, surveyed 200 healthcare executives in 16 countries. They found that 16 percent aren't just experimenting; they expect to have a commercial blockchain solution at scale in 2017. Moreover, according to IBM's estimation, another 56 percent will follow the first adopters until 2020. That means within 2 years!
Thus, it is high time to have a look at how and why the technology behind Bitcoin, the cryptocurrency in a great part powering criminals trading on the darknet could become the cornerstone of future healthcare. More briefly, let's see what the hell blockchain is!
Blockchain is the new word for trust online.
On the Internet, nobody knows that you're a dog. Although Peter Steiner's cartoon drawn for The New Yorker in 1993 is mostly associated with the issue of anonymity on the Internet, it highlights deeper problems in relation to trust, credibility, security, and privacy. In the era of fake news and online scam, it does not come as a surprise to anyone that it is difficult to secure information, communication processes or trade online. And it is especially important in case of such sensitive information as money or healthcare data.
In case of money, trust and credibility have long been established by central intermediaries, such as banks, and other types of middlemen. You transfer money via your online bank account knowing its safe and secure because you trust the financial institution behind it. And in the case of online transactions, there has been another problem for which trustworthy intermediaries have meant the solution for years. The problem of duplications. When you send an e-mail with an attached cat photo, the image will automatically be copied. So, how do you make sure that doesn't happen with your money? That the well-earned dollars that you spend on books will actually disappear from your bank account and appear on Amazon's. In the case of digital assets like money, stocks or intellectual property, not to speak about electronic health records, authentication and accountability are key elements.
Still, middlemen such as banks are too slow. And too expensive. While an e-mail arrives in seconds in another person's mailbox, an international transfer could take several days, even weeks. And it is not even that secure, as it could be hacked more easily due to the banks' centralized nature. As a response to all these issues, Satoshi Nakamoto, a mysterious Japanese programmer or a group, worked out the world's first digital currency, Bitcoin and its underlying, supporting system, the blockchain. Since then, several types and modified versions of the technology appeared. As The Economist explained, blockchain enables an economy where trust is established not by central intermediaries but through consensus and complex computer code. It lets people who have no particular confidence in each other collaborate without having to go through a neutral central authority. Simply put, it is a machine for creating trust.
Blockchain is like a scarf knitted by your grandmother.
The concept and the operation of the technology are rather difficult, but it is perhaps easier to imagine with a nicely-put metaphor by The New Yorker's Nathan Heller. In his article about Estonia as a digital republic, he said that a blockchain is like the digital version of a scarf knitted by your grandmother. She uses one ball of yarn, and the result is continuous. Each stitch depends on the one just before it. It's impossible to remove part of the fabric, or to substitute a swatch, without leaving some trace: a few telling knots, or a change in the knit.
When The Medical Futurist asked Ivo Lohmus from Guardtime, an Estonian company developing K.S.I. blockchain technology, he said it to imagine as a shared book of records, or in more technical terms, a distributed database, that's designed in such a smart way that whatever is added to this database, that's immutable. As if it's carved into stone. Any change becomes immediately evident. Another aspect of the system is that there is no central authority to decide what's right or wrong. The participants need to come to a consensus, to articulate some shared view of the world.
There are several methods for making a decision about a new entry based on the particular consensus, Medium's Collin Thompson explains the proof of work process used by Bitcoin as the following: when a digital transaction is carried out, it is grouped together in a cryptographically protected block with other transactions that have occurred in the last 10 minutes and sent out to the entire network. Miners (members in the network with high levels of computing power) then compete to validate the transactions by solving complex coded problems. The first miner to solve the problems and validate the block receives a reward. The validated block of transactions is then timestamped and added to a chain in a chronological order.
New blocks of validated transactions are linked to older blocks, making a chain or blocks that show every transaction made in the history of that blockchain. The entire chain is continually updated so that every database in the network is the same, giving each member the ability to prove who owns what at any given time.
The benefits of blockchain.
The technology has numerous benefits for online transactions, especially in the field of digital assets, such as health data. Blockchain's time-sensitive nature allows any data to move around in that particular format only once in the network. The blocks are impossible to change; only new entries can be added to the network. This is critical in case of health data. Just imagine what might happen if someone could change a patient's blood type in the health record system without anyone noticing it.
Moreover, Ivo Lohmus said that many times, as in the case of the K.S.I blockchain which is used for the Estonian medical records system, the blockchain does not directly deal with the data. Through the cryptographic process, a unique identifier of the data, a hash, is created, which functions similarly to the biological fingerprint. While you can identify anyone based on his or her fingerprint, you cannot “reconstruct” the whole person. And finally, as the blockchain is based on the consensus of network participants, access to data can be linked to permission.
Beyond ensuring authentication and credibility, blockchain also brings unprecedented security benefits. Hacking attacks that commonly impact large, centralized intermediaries like banks would be virtually impossible to pull off on the blockchain. For example — if someone wanted to hack into a particular block in a blockchain, a hacker would not only need to hack into that specific block, but all of the proceeding blocks going back the entire history of that blockchain. And they would need to do it on every ledger in the network, which could be millions, simultaneously.
Blockchain in healthcare – Long instead of big data.
Blockchain has immense potential in healthcare. According to the IBM Institute for Business Value blockchain study, new adopters of the technology expect the greatest blockchain benefits across time, cost, and risk in three areas: clinical trial records, regulatory compliance, and medical/health records.
It is capable of transforming the entire system of medical records, just as Estonia already did. In March 2017, the Baltic country's eHealth Authority has signed a deal with Guardtime to secure the health records of over a million Estonians. Patientory, a start-up helping hospitals to secure their patient data while enabling patients to follow the fate of their own data, has urged the British government “to get behind a blockchain-enabled national IT health system” at the time of the NHS ransomware attack. If there were political will and comprehensive financial support, other countries could also Estonia's as well as Dubai's lead. The latter has also started to test blockchain technology for securing its electronic medical records.
Due to its time-sensitive nature, blockchains shift the lens from disparate bits of information held by a single owner, to the lifetime history of an asset. Instead of big data, capturing long-term data becomes more easily possible. And that's exactly why it is the perfect solution when we need to document a patient's health record, to set up reliable vaccine registries or to secure the movement of drugs through the supply chain.
Blockchain in pharma.
The issue of counterfeit medicines, as the dark side of networked markets and globalization, has become increasingly pressing, both in terms of the economic cost of this global black market and the risk to human life that comes from taking counterfeit drugs. In many developing countries in Asia, Africa, and South America, counterfeit drugs comprise between 10 percent and 30 percent of the total medicines on sale.
Cindy Greatrex, Vice President of The National Alliance of Research Associates Programs remarked that for combatting fake pharmaceuticals a solution needs to be employed that stops the counterfeits from contaminating the supply chain. The best solution is to track pharmaceuticals so that digital systems linked to medication moving in the physical world are established. This is important because when you have a unique digital reference to a drug and a physical copy of that drug, it is much harder to erase or duplicate one without the other.
Blockchain offers security through transparency. It might work as follows: barcode-tagged drugs could be scanned and entered into secure digital blocks whenever they change hands. This ongoing real-time record could be viewed anytime by authorized parties and even patients at the far end of the supply chain. This would make it much more difficult for criminal networks to sell their counterfeit drugs on the market.
However, the advantages of blockchain for pharma does not stop there. Drug developers running clinical trials might be able to share clinical data and medical samples more securely. And while blockchain underpins the digital currencies demanded in ransomware attacks, the technology could also play a role in securing sensitive industry data from malicious attack.
It's clear that blockchain will have a massive impact on dealing with healthcare data. It's also worth looking at news about blockchain differently than those related to Bitcoin. The blockchain is a technology, Bitcoin is a product of it. As it is going to be more and more widespread in the future, we'll keep on writing about the many ways blockchain can support healthcare and pharma.
Dr. Bertalan Mesko, PhD is The Medical Futurist and Director of The Medical Futurist Institute analyzing how science fiction technologies can become reality in medicine and healthcare. As a geek physician with a PhD in genomics, he is a keynote speaker and an Amazon Top 100 author.
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