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I've seen Blockchain use case in healthcare but it doesn't quite answer my question.

I would like to know if there is a real use case for blockchain in healthcare or if it is just a buzzword that they are trying to incorporate to impress people who don't know better.

The general problem in healthcare appears to be that data is stored in various siloed locations and has multiple formats. The other key concern is patient anonymity but at the same time, if the data is fully anonymized and aggregated, researchers would like to use it for their work.

I have seen some proposals to use blockchains to solve these issues but I can't yet clearly see how or why it has to be blockchains. Does anyone see why traditional distributed databases with standardized data formats are insufficient for the things I've mentioned?

TL;DR How can one really use blockchains in healthcare applications, if at all?

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    One advantage in a decentralized settings is each person will be the real owner of their data. Now in siloed databases you are no the owner of your own data, if you want to change health service provider may not be as easy as you want. Your data can be sell to a third party without your consent. But AFAIK it is a topic under research. – Ismael Aug 8 '17 at 3:49
  • This seems on-topic and interesting, but a bit broad/opinion-based. Not sure what the appropriate place for this is. – lungj Aug 8 '17 at 4:33
  • I know what you mean - it isn't a specific question but there have been similar questions on the bitcoin stackexchange but even broader. See for example bitcoin.stackexchange.com/questions/9067/…. Things have moved on since but googling healthcare and blockchains yields several specific proposals, yet none of them seem to really need blockchains. Please let me know if it's still okay to leave this question open. – user1936752 Aug 8 '17 at 7:57
  • While I appreciate the answers, the real sense I'm getting is that no one really has a good use case in healthcare. Should I conclude that this is yet another case of trying to jump on a buzzword bandwagon? – user1936752 Aug 14 '17 at 6:20
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Proposed solutions

To my knowledge, there have been two proposals of systems which use blockchains to remedy current problems in healthcare:

  • MedRec, proposed by some people at MIT;
  • Patientory, a start-up based on MedRec's proposal;

Why blockchain and not a traditional ledger?

In MedRec's case, there is one particular feature which I could relate to blockchain use which is "comprehensive, immutable log of authentication permissions for ease of data access and auditing". In my opinion, this is where a blockchain can be potentially interesting to solve current healthcare problems.

To add to the current healthcare problems you mentioned in your question, there are other important ones: it's currently impossible to see who accessed your data, when, etc. This information could be useful to remedy cases of non-authorised access or abuse of privileges. Also, it is becoming more important as the E.U. pushes more laws towards transparency in how companies use your data (in what will certainly influence other data legislation). The creation of a tamper-proof access log to record access to patient data could be the interesting use case of blockchain, namely Ethereum.

For extra clarity: "tamper-proof" or "immutable" is what leads to the idea of a blockchain. In a traditional database, there is one point of control which makes it more susceptible to problems such as attacks and manipulation of data. In a blockchain, if a doctor tries to access something he's not supposed to, that transaction hash will be there in a way that can (potentially) be traced back to him, without any option of deleting that record.

How?

You can use smart contracts to regulate access to data in a public manner. The data itself could never be stored on the blockchain for several reasons (costs, publicly available sensitive information). However, one could manage permissions to offchain data in the blockchain. This way, whenever someone wanted to access your data they could be forced in some way to generate a transaction, which would essentially create the above mentioned log.

Extra

Even though you can see this as examples of the "buzzword" being thrown around, they may have interesting information.

https://hbr.org/2017/03/the-potential-for-blockchain-to-transform-electronic-health-records; https://www.wired.com/2017/02/moving-patient-data-messy-blockchain-help/

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  • You do make a good point regarding tamper proof access logs. I would imagine that something like a blockchain could be used but perhaps mining and hash functions would be replaced by a different mechanism. – user1936752 Aug 17 '17 at 6:28
  • Yes, it creates a trail which is easy to audit. By the way, this needn't just apply to healthcare. You would be interested in having a trail of data access from companies who hold your data. Why do you say the mining and hash functions would need to be changed? – mcansado Aug 17 '17 at 7:41
  • When it's a currency, there is some financial incentive to solve PoW hash problems to add a new block of transactions. An audit trail is different, it's smaller and less regularly updated and will most likely not be public. There's no reason to have PoW and hashes in this case (in fact, there is a high risk of someone doing a 51% attack on a small blockchain network like this to try to modify the log) - You simply want a distributed database of immutable records. Rather than a hash, you could have, say, sequential blocks where all previous blocks are digitally signed in each new block. – user1936752 Aug 17 '17 at 8:45
  • I see. I'm not sufficiently familiar with the blockchain tech to know about that, tbh. But from what I understand, it could be important to have some underlying token to the system to prevent users from making endless transactions for which the computational power would be provided by everyone else: gas, for instance, and therefore of a currency seems to make sense to me. This would obviously depend on many factors though (e.g. healthcare being public/free (E.U.) vs. private/paid (U.S) model). Finally, the 51% attack you mention makes sense. I have no response to that but am curious as well! – mcansado Aug 17 '17 at 10:04
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I am agree with you what blockchain in healthcare is not very useful to store full medical data. But there are cases where it can helps. Most of problems of course can be solved another way. But. It's always a question of costs, flexibility and reliability. For example: country-wide medical booking system can be easyly build atop of etherium smart-contracts. Independent health facilities can dispatch patients to one another for consultations by calling methods of each other smart-contracts. and give a booking-token to patient to let him book an apointment himself ...again ..by calling smart-contract methods and choising time from aviable.

Medical insurance apears immediately to track expenses + the ability of all interested parties to keep statistics

It's all is so great but why do we need all this if we can do the same the old way? To my opinion:

  1. Low development and improvment cost. Write contracts is much easy than full-scale country wide booking system.
  2. Reliability (until someone agin hack Vitalik)
  3. Flexibility: as long as medical organiztions work with common blockchain - it's easy to them to start working together by grant the opposete side right to to call methods to produce tokens-consultation-promises for their patients
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This answer is specific to the question which you have linked Blockchain use case in healthcare.

Let's check if we need blockchain to solve the above problem. I am sharing the flowchart below,which is one of resource that could help you determine if you need blockchain ?

Source : https://www.multichain.com/blog/2015/11/avoiding-pointless-blockchain-project/

enter image description here

Participants Involved in the above problem :

There are at-least 3 parties involved in the above problem who are thriving to solve fake drug issue.

a)Manufacture who produces the drug b)Wholesaller who sells the drugs to doctor. c)Doctor who buys it from wholesaller.

Without BlockChain:

Lets say you solve above problem with distributed database or centralized server. In this case there is really a necessary of third-party trustee who provides data to all 3 participants.This is necessary because assume only manufacturer owns the data and provides it to rest of two participants(wholesaler and doctor),In this case manufacturer can modify the data and claim that he has sold 2 units of drug to wholesaler even though he had sold only 1 unit. This makes all of the 3 participants to seek a third-party trustee who owns the data and provides the same to all 3 participants and they in turn pay some fees to third -party.

This is called Authority or Centralization.

With BlockChain

Blockchain helps you to de-centralize and eliminate the third party need and it opens up trust among the all of 3 participants.

In this case de-centralization refers to all of 3 participants agreeing to have a shared database and eliminate the third-party and BlockChain is one such database or a technology.(I am not gonna explain what a blockchain is ?).

These 3 participants would most probably form a private network where the data is shared among them and this is termed as De-centralization and one of core problem which a block chain solves.

Note : I am assuming the patient would get drugs from a doctor(I am assuming doctor does not endorse fake drug and not money minded,taking a piece of trust..) and have not included in the chain,if a proper trust network is established from Manufacturer to doctor,patient would not receive fake drug.

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  • Appreciate the answer but this really doesn't seem like a blockchain problem at all. Counterfeit drugs can be introduced at any stage along the supply chain to replace an actual drug (including by the manufacturer). For example, I swap a genuine drug for a fake one in your example and sell the original to someone on the black market - what will a blockchain be able to do to prevent this? – user1936752 Aug 14 '17 at 6:18
  • If Manufacturer replaces genuine drug with fake one ,then none of the technology would solve it..its not alone blockchain. Assumption is Manufacturer,wholesaller,doctor are all genuine and if some one from black market is trying to sale a fake drug to doctor or wholesaller saying its from a genuine manufacturer, he could be easily identified since his drug or drug hash would not be included in block chain. – Rangesh Aug 14 '17 at 8:42
  • @Rangesh can you add the reference to the flow diagram you have used. I went to the multichain.com/blog/2015/11/… but this diagram was not present on the webpage. Thanks – 11t Aug 17 '17 at 18:18
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I see you had the same doubts as me when I was participating in a competition, in which we had to make our product on top of the blockchain. So me and couple of my friends(also my team-mates) started brainstorming. We categorised our concepts into different sectors and then shortlisted from those ideas on board. After a lot of discussions, we decided to go with the healthcare idea. So the points on which we argued and the 'concept' we proposed in the finals are given below.

Idea

The idea was Organ transfer via blockchain. It was a very thorny problem statement, owing to the challenges that are faced (more on this below), it was worth a try. I can share the link to the concept page on the competition's website, but it's not needed.

Challenges

  • Challenge-1

In medical scenarios, the data has to be kept confidential because of numerous reasons. But this is created a whole lot of mess in the system. The hospitals were not willing to share data with other hospitals, and even the patients are reserved on this(the reason being sometimes the patient didn't even want their family members to know about their condition). Organ transfer in my country(India) doesn't have a centralised authority, what I mean by no centralised authority is each hospital is in-charge of the whole process ranging from a patient to whom the organ goes to convince the family members to donate the organs. This created a bigger problem because a patient would have to register in multiple hospitals to increase his/her chances of getting an organ.

  • challenge-2

As the data was not shared this created a duplication of data which were entirely isolated. The problem associated with this is best explained by using an example of wannacry, so this virus brought the entire medical system to a stand still for the UK more in the article.

Why Blockchain

Now as the data is distributed over the entire globe it is

  1. free from any virus attack
  2. It provides the data to be shared and more effective communication between the stakeholders. (Design the smart contracts with care)
  3. no one owns the data. We designed our smart contracts such that only hospitals were able to see the data of all the patients.
  4. The patient gets involved in the process, and if there is any cheating, any required action can be taken by retrieving the data from the older blocks.

So all the challenges which I have mentioned were told to me by hospital administration. I haven't made them up. Now answering your question directly,

How can one use blockchains in healthcare applications, if at all?

So this technology is new because people have only recently released its potential. Most of the use cases are in the financial sector, the reason being most of the investors are interested in that. Healthcare has seen some use cases in this recent past, but they are mostly prototypes and haven't seen the market, which is the reason, i think you had the question in the first place. Here I think it's the right time to introduce this article on blockchain and healtcare The data remains a problem when it comes to blockchain, but we should find solutions and solve this and not just take a u-turn and blame the technology for it.

If there is any question leave a comment I will try to answer them to the best of my knowledge.

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  • Please do add that link to your competition, if available. I would be happy to see the other ideas that were also proposed by your competitors even if it's not healthcare related, thanks! – user1936752 Aug 17 '17 at 3:44

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