On May 12th, a virulent outbreak proliferated across the world, spanning across 150 countries in a matter of days. However, the hosts were not human. They were computers. A worldwide cyberattack successfully infiltrated over 230,000 computers ranging from everyday laptops to Britain’s behemoth National Health Services.
Although a breach of this size is rare, attacks like these are not. Health systems and hospitals face massive cybersecurity threats due to the goldmine of sensitive information they possess. Patient records, billing codes, and personal information are a few to name, which are then leveraged for purposes such as insurance fraud and identity theft. According to a recent Accenture report, cyberattacks will cost the U.S. Healthcare System a whopping $305 Billion over the next five years.
The fallout from these attacks has exposed the gaping vulnerabilities within our Electronic Health Records. EHRs are digital patient records, which have been widely adopted across all medical institutions in recent years. Although EHRs have streamlined patient information and physician workflow toward a digital platform, many problems still remain.
As mentioned above, security is a massive issue. EHR companies (and there are many) keep their databases of sensitive information within a centralized server facility. Since all the information is maintained at a single location, this becomes a prime target for malicious attacks. Think of it like this: you only need to break into one vault to steal all the gold.
Another less publicized issue is EHR’s lack of interoperability. Hospitals across the country use different EHR companies, and these different systems aren’t always compatible. We know for a fact that patients aren’t stagnant. As people move around, it can result in a fragmented version of the patient’s medical history. Since different EHRs can’t easily talk to one another, a missing piece of information such as a medication or allergy could easily slip through the cracks, resulting in serious ramifications or unpredictable outcomes.
But where exactly does Bitcoin come in? What if I were to tell you that the software behind Bitcoin has the potential to revolutionize our entire EHR industry? You might think I’m completely bonkers, but that’s quite okay. Allow me to explain.
The software underlying bitcoin, called blockchain, is a decentralized database platform that is duplicated across a peer-to-peer network through a basis of consensus. Its interdisciplinary application would therefore allow patient records to be distributed across a host of different nodes in a decentralized manner, thus ensuring both security and interoperability.
If that last bit didn’t make any sense to you, let me try it again. In English this time.
First, we need to understand the logic behind bitcoin. Many think of bitcoin as money or currency, but at the end of the day, it’s just information on a digital ledger stating ‘I possess 1 bitcoin’ or ‘I’m sending John 1 bitcoin’. This digital ledger which records all bitcoin transactions therefore requires the highest level of security in order to preserve its integrity. Otherwise, it would be meaningless if someone can hack into the network and claim all the coins for themselves. This step is achieved through a distributed database.
Rather than maintaining the database in a centralized location (ie: current EHR systems), a distributed database copies and replicates this digital ledger across the entirety of its network. Meaning that every single computer who runs the bitcoin protocol will have a copy of the database. Encryption ensures selective viewership and IP anonymity, and the authenticity of the ledger is verified by the consensus of the network. In analogous terms, every computer using bitcoin will have a copy of the bank vault, so in order to break into the vault, you will need to break into at least 51% of all computers on the network, something near impossible.
The picture should now be getting clearer. Applying this technology toward EHRs would mean that all patient records kept on a blockchain network would be unhackable, immutable, and consistently updated. Such a breakthrough would drastically improve the cybersecurity of medical records. Additionally, as different EHR databases become interconnected, every new episode of care will be updated and duplicated across the network, granting doctors the confidence in gathering a comprehensive snapshot of their patient’s medical history at any given time.
Although this technology is still considered in its infancy, the realm of possibilities are astounding. The MIT media lab and Beth Israel Deaconess Medical Center have recently partnered up to explore this technology in their proposal for “MedRec”, a blockchain health records network. Aside from finance and healthcare, a recent startup called Civic seeks to leverage blockchain to revolutionize the entire process of identity verification. Imagine not having to create different accounts for every website you visit, or having your medical records in your back pocket, or even seeing a doctor without filling out a single piece of paperwork. Such dramatic possibilities speaks to the widespread potential of blockchain technology in the near and imminent future.
We have crossed the threshold into an age of personalization. From smartphone apps to online commerce, our innovations have empowered consumers with endless choices and a unique sense of personal identity. Many of these innovations; however, have failed to penetrate the healthcare sector. Although there have been steady progress in wearable trackers, personalized medicine, and even tele-doctoring, a high ceiling still exists. This underscores blockchain’s greatest potential- the ability to bridge the gap between technology and healthcare, and to empower the patient population with the stewardship of their own medical records. Ultimately, such adoption would promote collaboration, achieve better outcomes, and foster an environment where patient autonomy remain paramount.