Distributed ledger use cases in healthcare

I was asked by Malcolm to post my use cases for distributed ledger tech within healthcare. I hope this can be of use to the community.

Within the UK, I foresee healthcare benefitting from DL technologies in the following ways:

  1. Patient record sharing

This is a tricky use case because of GDPR compliance and as it requires the wider public being comfortable with the word blockchain. This may be some way off, but for sure the benefits are there.

1a. In the last year in the private sector I have experienced the disparity of patient record sharing compared to the NHS. In the NHS, all test results are published on an electronic record. This is localised to the specific NHS Trust the patient is being treated at, i.e. one NHS Trust hospital cannot login to the electronic records of a different NHS Trust. This is not actually too problematic, as once referred for treatment, the patient will inevitably remain at that hospital for their ongoing follow ups that, in my specialist area, tend to continue for life. If a patient is seen for whatever reason at a different hospital, there is a means of record sharing via secure “nhs.net” email, although this often doesn’t happen.

This is very different in the private sector. Patients will be seen sporadically in the NHS, then private, then NHS, and records are not shared across email, as there is no widely used secure process for doing this. Consequently, patients will regularly show up for treatments on their heart with no record of what implantable device they have had implanted, or importantly why the implanted device is programmed the way that it is. This results in costly delays (time is money in the private sector) and potentially dangerous programming changes made on the device settings. Of course the patient should carry with them a physical device ID card, on it very limited information that is not updated as things change, which very rarely happens in practice.

All of these problems can be avoided with patient record sharing on the appropriate blockchain.

1b. Clinical trials. With the necessary consent, patient records can be shared securely with pharmaceutical and other medical industries to maximise the potential for evidence based medicine. Patients may even be incentivized in the future with crypto tokens. Smart contracts set up in line with the relevant regulators ensure that data is not used in unintended ways.

  1. Supply chain

2a. All cardiac devices - as with all electronic devices - can fail. When they do, which is not an uncommon occurrence, the worst case scenario is death, the best is continual remote monitoring. Often, whole “batches” of devices have to be explanted and replaced, putting the patient through a risky procedure on their heart. If the process from mining of the precious metals that make up the battery and circuitry, through production, to supply, were itemised on a blockchain, any device failure could instantly be traced back to the source of where the error occurred and not involve the lengthy process of each individual manufacturer carrying out audits, then contacting every implicated follow up centre, who in turn contact every implicated patient. This would save time and prevent affected devices from being implanted in the first place.

This blockchain could connect multiple industries that all share the same mined precious metal, that if contaminated, may result in failures of many electronic products across many industries.

2b. Additionally, medical equipment has a limited shelf life, during which time the manufacturer can guarantee the sterility and performance of a product. Hospitals must locally control the expiry dates of their thousands of products. As you can imagine, this often results in the unnecessary throwing away of kit. In my experience I have not seen a digital record of expiry dates for an equipment catalogue. Regardless, a national blockchain of medical equipment expiry dates coupled with an efficient process for transporting short dated kit to where it is to be used in a shorter time frame than the origin hospital, would drastically reduce waste and save the NHS a great deal of money.

  1. Additional use cases exist in the US heathcare model:

The process of clearing insurance claims via “claims clearing houses” would be made significantly more efficient with smart contracts on a blockchain. There are also directories that determine if a patient is covered by their insurance for a particular test / operation, a process that would be made automatic by the use of smart contracts.

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On use of DL and related technologies in healthcare:

When comparing current public cryptocurrencies to future distributed ledger applications it is important to realize that for a distributed ledger system that seeks to interface with a known authority, like the NHS, permission-less is not a requirement (and is very expensive to implement for little to no gain).

For patient record sharing, the difficulty is twofold: authentication and interfacing. Authentication could be hypothetically handled by the patient (and a set of trusted authorities, friends, current primary doctor, etc for the inevitable case where the patient loses the key) holding their own private encryption key for their data which is held in a public repository. This way the patient always has access to the data and can give it to whoever they want with little. The interfacing problem is that every provider the patient needs to access must be able to accept their data from the DL repository. If their systems are incompatible, the data is useless.
How this interfaces with GDPR is complicated, and well outside my area of expertise. but I can’t see a method like this being less secure and private then the current system.

On the supply chain point: You might want to look into the Mattereum project, as they’re trying to solve a lot of these issues. You can read their slide deck, which is still under development but contains a lot of interesting stuff.

As for Causevest, we want to create robust, verifiable data stores supported by distributed funding with our archive node system. Once this exists it can be used for both scaling and storage and its robust venerability and low cost can be used by other projects.

Thanks for your reply @MrWahala.

Yes I agree; I only see private blockchains working in this specific use case due to an institution wanting more control over their data. This of course goes against decentralisation but I think it would be a nicer pill to swallow for those involved, including and most importantly the patients.

You said you “can’t see a method being less secure…”, but can you see DL tech being used widespread across healthcare in the future?

How do you see DL technologies making their way into the healthcare space initially? Do you think there has to be a more widespread use of this tech elsewhere in society, for example crypto-payments, before people will understand the appreciate and accept the benefits of the tech wrt their healthcare data?

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