A lack of accessibility
It’s a common occurrence that when a patient visits the clinic for a consultation, they may be seen by someone who is not their regular physician. Yet too often, that clinician cannot access the full medical history of the individual, despite them having been in the same healthcare system for decades. Doctors and patients alike are faced with the challenge of electronic health record (EHR) inaccessibility. This has the potential effect of instilling a sense of doubt in patients and can mean that physicians are unaware of vital information such as allergies to medication and previous treatment recommendations. This can subsequently result in poor referral management to specialists, preventable hospital readmissions, and longer in-patient stays when hospitalised.1
Appallingly, mismatched patient EHRs is also a prevalent issue, as there remains no nationally recognised patient identifier.2 “Statistics show that up to one in five patient records are not accurately matched even within the same health care system” commented Director of Regenstrief Institute’s Centre for Biomedical Informatics, Shaun Grannis. “As many as half of patient records are mismatched when data is transferred between healthcare systems.” Unsurprisingly, a misidentified patient can lead to serious clinical error and increases the likelihood of harming the individual.2,3 So how can healthcare systems counteract this problem in care? Improving access to EHRs within healthcare systems could help to ensure clinical and financial data interoperability of patient populations.1
What is blockchain, and can we utilise it in healthcare?
Blockchain has become an increasingly popular topic of conversation and debate in the technology space in recent years. Fundamentally, blockchain is a time-stamped collection of an immutable record of data that is handled by a series of computers, not owned by any single entity. Each of these individual pieces of data are then secured and associated with each other using cryptographic principles. Its decentralised, unalterable, transparent nature has led to its admiration within the technology field, after its first notable manifestation as the powering technology behind Bitcoin.2
If interoperability is such a critical issue in healthcare systems, could we integrate blockchain into EHRs to prevent information blocking and misidentification of patients? Blockchain could aid the creation of a patient information sharing marketplace, where individuals’ data are readily accessible and transferrable due to decentralisation. “Most healthcare data are centralised at the level of a corporation, healthcare facility or government registry,” comments John Halamka, Chief Information Officer of Beth Israel Deaconess Medical Center in Boston and Editor-in-Chief of ‘Blockchain in Healthcare Today’. “Blockchain is decentralised and therefore not impacted by the behavior of any one organisation. In the future we might see blockchain as a component of a system in which patients serve as stewards of their own data, rather than relying on any central source”.4
As an example, Health Wizz has begun piloting a blockchain-enabled app whereby individual’s health data are tokenised. This allows patients to organise, share, donate and/or trade their medical records. In doing so, the goal is that health data will be able to be managed in the same way as one might manage their bank account, giving control to patients and improving communication between healthcare organisations.5
Is blockchain the future of healthcare?
Some believe that in conjunction with artificial intelligence and machine learning, blockchain can be used to solve the challenges of EHR interoperability and promote the shift towards personalised medicine. By linking data types and using them to identify patterns across large quantities of data, blockchain could aid big data analytics to form insights on an individual basis, with the patient having complete control over their data.4
However, others remain cautious about its use and integration in healthcare, as a variety of technical factors present barriers to its adoption. Its slow pace, complexity, and the multiple steps required to collect and enter data thwart easy utilisation in healthcare systems. Regulation, policy and legal challenges are similarly preventing uptake, and many believe that without policy changes at the highest level of government, the adoption of blockchain in healthcare will remain scarce.4