by Fifi Monahan
One Health Tech’s event: ‘Busting the Blockchain Myth in Healthcare’ has attracted a mixed crowd tonight; from business analysts and lawyers through technologists to fintech developers. Everyone presumably attracted for a similar reason to me - to cut through the hype surrounding the blockchain buzz. Can we understand its real and practical implications in the risk-averse, traditionally late-adopting industry of healthcare? There were six speakers from the healthtech industry, covering the basics of blockchain and looking at different use cases for blockchain in the health industry. My endeavour to extract the points of great interest and make sense of this technology in a health context is captured below.
So, what is blockchain?
Rhian Lewis, one of the few female blockchain developers in the UK, uses Bitcoin as the simplest example. The blockchain is a type of distributed data structure that enables the transfer of Bitcoin payments all over the world whilst guaranteeing transparency and security of the transfer. At the time of the rise in cryptocurrencies, the danger of ‘double-spending’ was the biggest challenge. How could people be certain that a digital coin hadn’t been sent to two different sources and spent twice? “[Blockchain] is a trust machine,” says Lewis. In places where you need to trust people or data with little or no social capital (as on the internet), blockchain comes into its own. The two main attributes of blockchain can help to illustrate this. Transparency and encryption.
The transparency of blockchain leads to trust
Consider a local sports club. Maybe one person is responsible for managing the club’s financial accounts. There is a great deal of trust placed in that one person to keep the books accurately. Now, what if a Google spreadsheet was used instead? Everyone in the club can see the data, and no one person has to be solely trusted. It is more difficult to cheat the numbers with a distributed database. Of course, Google spreadsheets is not a perfect analogy, surely anyone can alter the data on a Google spreadsheet?
The encryption of blockchain leads to security
Well, blockchain uses complex code to secure batches of transactions into little groups (or blocks), all of the information becoming inextricably linked together chronologically. No one can go back and re-write this – the code is blocked in these chains. And as a distributed public network, data is stored in multiple locations and there is no central point susceptible to security breaches.
It is important, Lewis says, to dispel a common myth. Describing blockchain as a ‘public’ network does not mean that all parties can see everything; a potential concern for the healthcare industry. In fact, restricted viewing can be built into the architecture where necessary, meaning information between parties can be controlled. Of course, there is a relative trade-off between privacy and trust, but certainly degrees of each can be built into a blockchain architecture depending on what is required.
Uses of blockchain in healthcare; in securing patient records, defending against counterfeit drugs and in the study of genomics.
Considering all of this, what are the potential uses within the healthcare industry? Over the course of the evening we looked at three very different use cases; a healthcare record system, a pharmaceutical supply chain, and genomic coding.
Natalie Furness, a physio with 10 years of clinical experience, had become increasingly frustrated during the course of her clinical work when she was at times unable to access her patient’s records. And in turn, she realised that there were many instances when patient’s themselves had no idea of what was in their records, nor any control over them. Her friend, for example, had been through innumerable healthcare professionals seeking a diagnosis for her chronic condition. Every single time having to repeat herself and recall her history of symptoms, only to have to repeat the same memory game for the next doctor. So, Furness founded MedicalChain which uses blockchain as a decentralised medical record ledger, where data stored in regulated data compliance nodes allows patients to communicate their records directly to their doctors. The blockchain layer tracks every change and is only readable when you hold the key. This dynamic ecosystem provides one single point of medical history that can be easily shared with any doctor anywhere in the world, as well as providing opportunities to plug in useful services and data feeds such as telehealth API plug in’s, integrated smart devices, like data from a Fitbit watch, even readings from environmental sensors.
When discussing this, several challenges become quite clear; not least what happens with access to personal information in an emergency, where a person is unable to give their permission to a doctor. Cases like emergency situations represent real user scenarios that could be life threatening.
Imogen Bunyard, COO of the blockchain provider company Qadre, looked at blockchain in relation to pharmaceutical distribution. Extraordinarily, 30% of drugs on the global market are estimated to be counterfeit, and over $200 billions of fake drugs are sold every year (according to a Deloitte report). Recently, there was a case where the data for an entire shipment of pharmaceutical goods went missing…. because the USB stick which stored the shipping data, taped to the side of the ship, had fallen off along the way! Blockchain’s ability to provide end-to-end tracking provides a solution to traceability in the pharma supply chain. At the point of each product transfer, the person responsible and the new party, are both accountable and trackable for the transaction. The possibilities for defending against counterfeiting and fraud and improving operational and procurement efficiencies is a fantastic use for blockchain.
Finally, Rabia Khan took a very intriguing look at a more unusual opportunity. Khan, a geneticist at BenevolentAI, an AI-enabled drug discovery company, leads drug-discovery programmes across numerous disease areas. Khan explained that in her line of work – coding the human genome has been the ‘easy’ part. The interesting insights to disease and treatments really lie in the study of multi-omics – the biological analysis of groups of data sets that include the genome, the proteome, the transcriptome, to the metabolome (the expression of genes influenced by the external environment). At a population level, as scientists start to study these data sets, we begin to get valuable insights into complex multi-factorial diseases. At an individual level, personal-omic profiling might be able to help us define disease prediction, or indeed begin to understand how an individual might respond to a certain type of treatment. Meanwhile, as genomics and growing ‘information highways’ of big data become central to disease treatments of the future, concerns for privacy around personal sensitive data is also growing. Khan believes that blockchain is truly the answer to this conflict. It represents a major opportunity to aggregate all the genetic info in one place and store it in an anonymised fashion in order to truly research within the complexity of multi-omics data.
The major challenges in using blockchain in healthcare is conflict with the new GDPR legislation.
For all these valuable attributes and uses of the blockchain, Lydia Torne and Sophie Sheldon, both associates at Simmons & Simmons with expertise in blockchain implications for GDPR, talked about some of the major risks we need to stay informed on, as an industry.
Torne first looked at the proposition of the ‘one cradle to grave’ health record – which sounds like a great proposition, but which is challenged by the new GDPR laws. The immutability of blockchain means that none of the data can be tampered with or erased over time. But with GDPR we must be able to erase someone’s data if requested. Companies can no longer hold data for longer than the purpose for which it was collected.
The second challenge of blockchain from a legal point of view is the problem of privacy. True anonymization is next to impossible from a legal standpoint. In reality, there is always a way to move back from anonymization to original identity. For true anonymisation, data would have to be moved so far from the source that it is virtually impossible to do so. From a legal perspective, blockchain is only ever pseudo-anonymising data.
The final challenge is holding data in nodes all around the world. This gets complicated when we take into consideration GDPR. When data is transferred outside of the EEA, and there are large numbers of nodes across the globe, it’s hard to know where the nodes are and when it is being transferred, in order to comply with the European and International law.
Solutions to the GDPR issue lie in building an appropriate architecture
Both Torne and Sheldon both impressed that GDPR is already behind the times. Their hope is that the European Union will realise their own regulations are not keeping pace with the technology and provide some guidance to countries. However, they provided some pragmatic workarounds in the meantime.
Firstly, a practical approach to blockchain and GDPR would be to create private blockchain networks. The fewer parties that are part of the blockchain, the easier it is to manage, so restrict the chain to only the most necessary parties. Secondly, look at EEA only blockchains, and avoid international networks where possible. Finally, taking some data off the block is another way around GDPR. Arguably these solutions do lose some of the benefits of the blockchain, but it will certainly make it easier to implement this technology within regulations.
Blockchain is “not a magic bullet”
As with any potentially transformative technology a word of caution is needed, Rhian warned. In fact, she says “there are rarely good reasons to use blockchain – it’s not a magic bullet”. It’s not the technology that is revolutionary but the way it might be used in the right situation. “It’s about mindset, just as much as the technology”. She warns against companies wanting to use blockchain for the sake of it. She advises identifying areas where trust, consensus or immutability are essential to the business, and from here you can start to consider the possibility of a blockchain potential.