By Juliana Bain
The Embarrassing State of EHRs
Congressional advocates intended the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 to be a catalyst to bring health records into the digital age. While it succeeded in helping many hospitals upgrade from paper records to electronic health records (EHRs), it seriously fragmented the network used to access and transfer health data. While the current system is flawed, blockchain offers an opportunity to repair the EHR sector.
Healthcare providers across the country have dedicated time and effort to input patient information into digital databases to electronically store records, but many doctors and healthcare providers continue to fax and snail-mail their medical records to recipients outside of their office walls. In 2015, only had successfully merged information from another practice into their own database. The numbers are worse for patients. Even though we live in a connected, internet-driven society, just 16 percent of patients can download, view, or send their medical records electronically. Barriers to interoperability between hospital systems remains a critical culprit for these challenges, and it’s no surprise that a recent study by the American Medical Association and American EHR Partners found that 43 percent of physicians believed EHR software made their jobs more difficult.
Despite these challenges, patients are churning out more digital health data than ever before. Roughly 60 percent of Americans uses mobile apps to track medical conditions and make informed choices about their health, and by 2020, between 20 to 30 billion internet of things connected health devices will be used globally. These shifts are important to note, especially as full genome sequencing has become more popular and affordable. However, if the data cannot be integrated into existing systems, doctors are unable to take full advantage of innovations in health data to make the best decisions about a patient’s health.
The availability and ability to digitize health data are important factors in the success of electronic health records. Moreover, it is paramount to patients, doctors, and healthcare providers that digitized health records be both private and secure. EHRs should be private in that only authorized parties that have received permission, by the law and the parties involved, may access health records, in various levels of detail. They must also be secure to ensure health records are protected from tampering, as incorrect data can make the difference between life and death.
The Promise of Blockchain
Here’s where blockchain comes into play. Blockchain is a database that leverages cloud storage infrastructure to maintain a secure list of data records or transactions. Although it is a technology often associated with cryptocurrencies like Bitcoin and Ether, it has been used for applications like land title registration in the Republic of Georgia and secure digital ID cards in Estonia. Smart contracts within the blockchain platform allow logic to be programmed into the blockchain and executed when a transaction is made.
Within the EHR industry, blockchain presents a much-needed avenue to upload, store, and transfer files securely and cost-effectively. Rather than requiring health data to be stored in a centralized database, blockchain utilizes secure cloud technologies enabling data to be seamlessly shared and accessed from multiple sources. For example, during annual check-ups, physicians and healthcare providers could review data synced from apps and wearable devices like the Apple Watch or Fitbit, instead of relying on patients to accurately, and honestly, divulge their health and exercise habits. In more urgent situations, a doctor may access blockchain-sourced data to decipher whether the patient is allergic to certain medicines, or gather other critical information necessary for treatment.
Despite the efficiencies blockchain provides, the concerns for maintaining the integrity of healthcare data is legitimate. In the first half of 2017, there were 233 health data breaches, affecting more than 3 million people, reported in the United States. Over 41 percent of the breaches were insider-caused.
However, the services provided by blockchain help assuage the anxieties of bringing valuable, personal healthcare data into the digital world. Blockchain offers particularly strong benefits in three areas: integrity, permission, and decentralization.
- Blockchain ensures information on the chain is verified by requiring users to provide a signature and time-stamp with a private key to access the data.
- Blockchain can trace successful, or attempted, hacks and falsified records to an exact user to mitigate data breaches and insurance fraud.
- Blockchain maintains a permanent ledger, making it much more difficult for records to be lost or misplaced. Instead of relying on photocopies from their doctor’s office or third-party provider, patients have control over their data.
- Blockchain uses logic that powers smart contracts, allowing users to give permissions, and control with whom their data is shared. Consider consumer genetic testing. Insights about patients’ DNA could help physicians make life-saving decisions, but they could also be used to raise the costs of life insurance. While the Genetic Information Nondiscrimination Act of 2008 protects consumers from genetic-based discrimination in health insurance and employment decisions, it does not cover actions of actuaries or decision-makers in other fields. Therefore, the logic built into blockchain allows consumers to have the best of both worlds, providing access to doctors when they need it, while simultaneously protecting data from unauthorized users.
- Blockchain does not require data to be centrally maintained. Healthcare information can be stored in cloud databases and devices around the globe, ultimately providing patients with the power to control and share their data. By removing the requirement for doctors, hospitals, and other care providers to be siloed into a single health data system, patients are empowered to decide when, how, and to what extent their information may be shared with those who provide care.
Private, public, and government agencies are all looking towards the potential uses and innovations for blockchain. In 2016, the U.S. Department of Health and Human Services sponsored a competition on the intersection of health and blockchain, resulting in several promising white papers from researchers at MIT, Deloitte, and IBM. While the opportunity exists, it is difficult to shift the health record paradigm after billions of dollars have been invested into a “modernized” EHR system. Moreover, legacy information technology providers may be unwilling to give up their strangleholds on the EHR industry, lobbying for provisions that effectively slow or block progress toward a more open, competitive sector. In the absence of stronger consideration of the opportunities blockchain provides, countries like Estonia will lead the way in utilizing blockchain in innovative ways to manage health records and mitigate fraud. Hopefully the United States will catch up and become a leader in safe, private, and secure storage and distribution of health records.