he buzz about opportunities for blockchains in the health care and pharmaceutical industries continues to ramp up. This technology can give us new tools to secure medical information, track pharmaceutical supply chains, and more. While blockchains have promise, they are not a panacea for health care.
Make no mistake: We are excited about the opportunity to use blockchains in our industry. Earlier this year, we launched Elektra Labs, a venture backed by a National Science Foundation I-Corps grant to develop a more secure system to share and verify health information. To build our first prototype, our team worked with the MIT Media Lab and Ethereum, a blockchain-based platform that was barely a year old.
Although there are many potential applications for health care blockchains, we worry that the heavy jargon and media hype has caused a lot of confusion about how and when to use this technology
At its core, a blockchain is a digital ledger in which transactions are recorded chronologically and openly. The ledger is decentralized, with multiple copies stored across a wide network; it does not rely upon a central intermediary, like a bank or broker, to verify transactions. Participants who update the ledger are paid for their work using a digital currency or “token,” like bitcoin. Launched in 2009, bitcoin was the first widely adopted digital asset; others have since launched. The bitcoin market cap when we wrote this was $316 billion, three times larger than GlaxoSmithKline.
A large number of blockchain-based projects have launched in the past few years. To keep track, our team created the open-source map of health care-related projects below.
To dive deeper into the potential for health care blockchains, we’ll explore what this technology can and can’t do.
The promise of blockchains
Blockchains in health care can improve coordination challenges and incentive systems.
The past year has seen a wide adoption of new digital assets, like Ethereum, which incorporate features like smart contracts. These contracts make money “programmable” by predefining the rules and agreements between parties. For example, say a hospital’s inventory of blood pressure cuffs or insulin decreases to a certain level. A smart contract can automatically reorder the product, pay for the shipment, and record the transaction in a distributed ledger which multiple parties can review.
Programmable money also makes it possible to create powerful, real-time incentive systems that extend well beyond the supply chain. Some of these can influence behavior. For example, a company could set up a smart contract to release funds as soon as an employee walks a certain number of miles per week, passively tracked via a wearable. A smart contract could also speed up outcome-based reimbursement by releasing bonuses to hospitals that lower their readmissions by a predetermined percentage.
Another opportunity for the use of blockchains in health care revolves around data integrity. The health care industry spends a lot of time talking about the Health Insurance Portability and Accountability Act, encryption, and other aspects of data confidentiality. We strive to make it difficult for adversaries to access protected data. While data confidentiality is essential, data integrity — maintaining the accuracy and consistency of data — is becoming increasingly important.
Put another way: A patient might not care if everyone knows that her blood type is O-positive. But she’d care a lot if someone could go into her health record the day before her surgery, change her blood type to B-negative, and leave no trace. That’s data integrity.
By design, blockchain-based technologies preserve data integrity. These systems are tamper-resistant because multiple, verified copies of the ledger exist in the decentralized network, and participants can compare changes chronologically against their own copies.