[{"innerBlocks":[],"name":"core\/freeform","postId":1849,"blockType":{"name":"core\/freeform","keywords":[],"attributes":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"providesContext":[],"usesContext":[],"selectors":[],"supports":{"className":false,"customClassName":false,"reusable":false},"styles":[],"variations":[],"apiVersion":3,"title":"Classic","description":"Use the classic WordPress editor.","category":"text"},"originalContent":"While healthcare is in the early phases of experimenting with blockchain, trailing behind other industries such as the financial services sector, health systems are beginning to explore the technology despite slower adoption because of regulations, security concerns and a lack of data standardization.

Asked when they expect blockchain will be integrated into their organization\u2019s systems, 32 percent of providers and 48 percent of health plans said in one to two years, according to a survey by consulting and professional services firm Accenture.

In addition, 91 percent of health executives who were surveyed indicated that blockchain and smart contracts will be critical for their organizations over the next three years, according to Accenture\u2019s Digital Health Technology Vision 2018 report.

Studying options<\/b>

Despite those optimistic expectations for the future of blockchain, much work lies ahead before the technology is ready for use by providers. However, research is underway.

Mount Sinai Health System in New York has launched the Center for Biomedical Blockchain Research to solve healthcare challenges using technology that underlies the Bitcoin cryptocurrency and provides a data structure that can be timed-stamped and signed using a private key.

In particular, the center will focus on developing apps by evaluating blockchain-enabled solutions, partnering with vendors that are working on the technology, as well as building and testing systems within Mount Sinai.

The venture\u2014managed by the Icahn School of Medicine at Mount Sinai and the Institute for Next Generation Healthcare\u2014is the first of its kind at an academic medical center, its executives say.

\u201cWe\u2019re very early in the blockchain hype cycle and there are a lot of promises being made about how it will save healthcare,\u201d says Noah Zimmerman, assistant professor of genetics and genomic sciences and director of the Health Data and Design Innovation Center. \u201cFundamentally, for us, blockchain is about building large-scale open networks and incentivizing people to participate in them. That\u2019s what really excites us.\u201d

\u201cWe expect that some early use cases could emerge from areas where existing systems and approaches fall short,\u201d adds Joel Dudley, executive vice president of precision health at Mount Sinai and director of the Institute for Next Generation Healthcare.

\u201cThe fragmented nature of regional and global healthcare systems prevents the flow of vital information and creates barriers to access for underserved groups,\u201d Dudley says. We see the potential for blockchain and related technologies to enable applications that support more unified healthcare ecosystems and serve the greater goals of realizing national and global precision health networks.\u201d

Making the case<\/b>

By 2020, research firm IDC predicts that 20 percent of healthcare organizations will have moved beyond pilot projects and will be using blockchain for operations management and patient identity.

Blockchain is seen by advocates as critical to creating trust in the authenticity and accuracy of shared data. In particular, they see the potential for blockchain in health IT interoperability as an emerging use case.

\u201cWhile interoperability and HIE frameworks evolve to address a range of challenges in health IT, blockchain could deliver an alternative for where these technologies may fall short,\u201d says Mutaz Shegewi, research director for provider IT transformation strategies at IDC. \u201cThe ability to feasibly exchange data across and beyond the enterprise level with far greater degrees of decentralization, distribution, and immutability makes blockchain a noteworthy proposition for exploring new ways of shaping the future of health IT interoperability.\u201d

Towards that end, engineers at Vanderbilt University say they have successfully developed and validated the feasibility of a blockchain-based architecture that leverages HL7\u2019s Fast Healthcare Interoperability Resources (FHIR) standard for secure and confidential sharing of patient medical records.

Called FHIRChain, the technology meets the Office of the National Coordinator for Health IT\u2019s technical requirements for sharing clinical data between distributed providers, according to Vanderbilt researchers, who developed it in collaboration with radiation oncology treatments and software maker Varian Medical Systems.

Specifically, FHIRChain uses FHIR data elements in conjunction with a token-based design to exchange data resources in a decentralized and verifiable manner without actually moving the data.

\u201cWe demonstrate a FHIRChain-based decentralized app (DApp) that uses digital health identities to easily authenticate participants and manage data access authorizations in a case study of clinical data sharing,\u201d state Vanderbilt and Varian researchers in a pre-print paper that has been submitted for publication. \u201cThis DApp enables users to share specific and structured pieces of information (rather than an entire document), thereby increasing the readability of data and flexibility of sharing.\u201d

According to Dana Zhang, a Vanderbilt computer science PhD candidate and lead author of the paper, FHIR standards use a popular form of data structure\u2014called JSON (JavaScript Object Notation)\u2014for exchanging clinical information, which is more compact and readable compared to XML used by other data formatting standards and enables more efficient transmission.

\u201cFHIRChain\u2019s design applies a smart contract to maintain health users\u2019 identifiability without exposing personal information on the blockchain,\u201d states the paper. \u201cIt also replaces the need for a traditional username\/password authentication scheme with the use of a public\/private cryptographic key pair for authentication. In a general clinical setting, these digital health identities\u2014private keys\u2014would be hard to manage for patients. FHIRChain, however, only creates these identities for clinicians to facilitate data sharing, which consequently enables more effective collaborative decision making for patients.\u201d

Blockchain\u2019s potential<\/b>

Because blockchain has a data structure that can be timed-stamped and signed using a key to prevent tampering, the technology is seen as a natural fit for managing the accountability, authentication, confidentiality, and sharing of information.

\u201cOur FHIRChain-based DApp demonstrates the potential of blockchain to foster effective healthcare data sharing while maintaining the security of original data sources,\u201d concludes the paper. \u201cThe design of FHIRChain can be further extended to address other healthcare interoperability issues, such as coordinating other stakeholders (e.g., insurance companies) across the industry and providing patients with easier (and secure) access to their own medical records.\u201d

However, Zhang emphasizes that so far FHIRChain has only been implemented as a prototype in the lab and has not yet been implemented in a clinical setting.

\u201cIt requires careful thought about architectures and design,\u201d says Jules White, an associate professor of computer science in the Vanderbilt School of Engineering. \u201cWhen you\u2019re moving into a world where you have to get things right the first time, it makes you cautious moving forward. And, this is of course true with anything with blockchain\u2014but I think particularly for healthcare data.\u201d

IDC makes the case that with the advent of FHIR and open application programming interfaces (APIs), blockchain could provide a \u201clattice to accelerate clinical data distribution.\u201d However, the research firm concludes that \u201cwhether blockchain will truly empower the industry with new ways of doing interoperability or is just market buzz, for the most part, remains to be seen.\u201d

For his part, Kaveh Safavi, MD, head of Accenture\u2019s global health practice, doesn\u2019t see blockchain as a \u201cpanacea\u201d for healthcare. \u201cWe think it\u2019s unrealistic to use the blockchain as a way to transport protected health information,\u201d he contends. \u201cDelivering PHI in a blockchain is unlikely. It will have some uses largely around identity but less as a primary transport mechanism.\u201d

Likewise, Chris Jaikaran, a cybersecurity policy analyst in the Government and Finance Division at the Congressional Research Service, believes blockchain is not particularly well suited for managing electronic health records because EHRs are retained on provider systems and are still potentially vulnerable to cyberattacks.

\u201cBlockchain is currently being tested by industry but at this time does not appear to be a complete replacement for existing systems,\u201d testified Jaikaran at a House subcommittee hearing earlier this year. \u201cOne such example is to manage electronic health records. In this example, actual medical records are retained on provider systems but a record of that record is published to the blockchain.\u201d

In this scenario, patients may use the blockchain to authorize who has access to those records, according to Jaikaran. \u201cWhat the blockchain may publish are permissions to that record, so\u2014rather than a patient having to drive across town to pick up a disk of that record to take over to another provider\u2014 those providers could talk amongst themselves to transfer that record.\u201d

Roadblocks ahead<\/b>

Although technically feasible, at the same time, he contends that this blockchain-EHR solution has pitfalls. \u201cAll the providers have to be on the same blockchain so they all have some kind of identity\u2014a public and private key\u2014and users have to take a more active role in managing that record for themselves.\u201d

In addition, Jaikaran notes that providers must maintain the electronic health record \u201cin a manner that is consistent with federal and state laws\u201d including HIPAA and the HITECH Act. The application of blockchain to EHRs would \u201cstill face\u201d both federal and state privacy laws \u201cas well as a lack of standards, data processing, and storage\u2014which may inhibit its adoption,\u201d he adds.

Further, because EHRs would be retained on provider systems, Jaikaran makes the case that \u201cthe record itself is still relying on the security measures\u201d of those healthcare organizations. \u201cSo, if the provider is not implementing defense-in-depth or some other cybersecurity strategies, an attacker\u2014instead of attacking the blockchain\u2014would attack the data store of the provider and the record would still be vulnerable,\u201d he concluded.

IDC\u2019s Shegewi concurs with Jaikaran that blockchain technology, in and of itself, \u201cdoes not enforce any sort of security, privacy, or compliance measures by default,\u201d such as HIPAA and the GDPR.

Further, he observes that \u201cearly testers of blockchain are realizing that it might not be a good idea to go on to a public blockchain network just yet\u2014and some may want to look at testing with private, restricted-access blockchain networks.\u201d

Shegewi also points out that another limitation of blockchain is that it\u2019s largely an \u201cincentive-based architecture that is the sum of its parts\u2014its users.\u201d As a result, he warns that \u201cmalicious activities could arise if incentives for participants to act maliciously on a blockchain are greater than incentives not to.\u201d","saveContent":"While healthcare is in the early phases of experimenting with blockchain, trailing behind other industries such as the financial services sector, health systems are beginning to explore the technology despite slower adoption because of regulations, security concerns and a lack of data standardization.

Asked when they expect blockchain will be integrated into their organization\u2019s systems, 32 percent of providers and 48 percent of health plans said in one to two years, according to a survey by consulting and professional services firm Accenture.

In addition, 91 percent of health executives who were surveyed indicated that blockchain and smart contracts will be critical for their organizations over the next three years, according to Accenture\u2019s Digital Health Technology Vision 2018 report.

Studying options<\/b>

Despite those optimistic expectations for the future of blockchain, much work lies ahead before the technology is ready for use by providers. However, research is underway.

Mount Sinai Health System in New York has launched the Center for Biomedical Blockchain Research to solve healthcare challenges using technology that underlies the Bitcoin cryptocurrency and provides a data structure that can be timed-stamped and signed using a private key.

In particular, the center will focus on developing apps by evaluating blockchain-enabled solutions, partnering with vendors that are working on the technology, as well as building and testing systems within Mount Sinai.

The venture\u2014managed by the Icahn School of Medicine at Mount Sinai and the Institute for Next Generation Healthcare\u2014is the first of its kind at an academic medical center, its executives say.

\u201cWe\u2019re very early in the blockchain hype cycle and there are a lot of promises being made about how it will save healthcare,\u201d says Noah Zimmerman, assistant professor of genetics and genomic sciences and director of the Health Data and Design Innovation Center. \u201cFundamentally, for us, blockchain is about building large-scale open networks and incentivizing people to participate in them. That\u2019s what really excites us.\u201d

\u201cWe expect that some early use cases could emerge from areas where existing systems and approaches fall short,\u201d adds Joel Dudley, executive vice president of precision health at Mount Sinai and director of the Institute for Next Generation Healthcare.

\u201cThe fragmented nature of regional and global healthcare systems prevents the flow of vital information and creates barriers to access for underserved groups,\u201d Dudley says. We see the potential for blockchain and related technologies to enable applications that support more unified healthcare ecosystems and serve the greater goals of realizing national and global precision health networks.\u201d

Making the case<\/b>

By 2020, research firm IDC predicts that 20 percent of healthcare organizations will have moved beyond pilot projects and will be using blockchain for operations management and patient identity.

Blockchain is seen by advocates as critical to creating trust in the authenticity and accuracy of shared data. In particular, they see the potential for blockchain in health IT interoperability as an emerging use case.

\u201cWhile interoperability and HIE frameworks evolve to address a range of challenges in health IT, blockchain could deliver an alternative for where these technologies may fall short,\u201d says Mutaz Shegewi, research director for provider IT transformation strategies at IDC. \u201cThe ability to feasibly exchange data across and beyond the enterprise level with far greater degrees of decentralization, distribution, and immutability makes blockchain a noteworthy proposition for exploring new ways of shaping the future of health IT interoperability.\u201d

Towards that end, engineers at Vanderbilt University say they have successfully developed and validated the feasibility of a blockchain-based architecture that leverages HL7\u2019s Fast Healthcare Interoperability Resources (FHIR) standard for secure and confidential sharing of patient medical records.

Called FHIRChain, the technology meets the Office of the National Coordinator for Health IT\u2019s technical requirements for sharing clinical data between distributed providers, according to Vanderbilt researchers, who developed it in collaboration with radiation oncology treatments and software maker Varian Medical Systems.

Specifically, FHIRChain uses FHIR data elements in conjunction with a token-based design to exchange data resources in a decentralized and verifiable manner without actually moving the data.

\u201cWe demonstrate a FHIRChain-based decentralized app (DApp) that uses digital health identities to easily authenticate participants and manage data access authorizations in a case study of clinical data sharing,\u201d state Vanderbilt and Varian researchers in a pre-print paper that has been submitted for publication. \u201cThis DApp enables users to share specific and structured pieces of information (rather than an entire document), thereby increasing the readability of data and flexibility of sharing.\u201d

According to Dana Zhang, a Vanderbilt computer science PhD candidate and lead author of the paper, FHIR standards use a popular form of data structure\u2014called JSON (JavaScript Object Notation)\u2014for exchanging clinical information, which is more compact and readable compared to XML used by other data formatting standards and enables more efficient transmission.

\u201cFHIRChain\u2019s design applies a smart contract to maintain health users\u2019 identifiability without exposing personal information on the blockchain,\u201d states the paper. \u201cIt also replaces the need for a traditional username\/password authentication scheme with the use of a public\/private cryptographic key pair for authentication. In a general clinical setting, these digital health identities\u2014private keys\u2014would be hard to manage for patients. FHIRChain, however, only creates these identities for clinicians to facilitate data sharing, which consequently enables more effective collaborative decision making for patients.\u201d

Blockchain\u2019s potential<\/b>

Because blockchain has a data structure that can be timed-stamped and signed using a key to prevent tampering, the technology is seen as a natural fit for managing the accountability, authentication, confidentiality, and sharing of information.

\u201cOur FHIRChain-based DApp demonstrates the potential of blockchain to foster effective healthcare data sharing while maintaining the security of original data sources,\u201d concludes the paper. \u201cThe design of FHIRChain can be further extended to address other healthcare interoperability issues, such as coordinating other stakeholders (e.g., insurance companies) across the industry and providing patients with easier (and secure) access to their own medical records.\u201d

However, Zhang emphasizes that so far FHIRChain has only been implemented as a prototype in the lab and has not yet been implemented in a clinical setting.

\u201cIt requires careful thought about architectures and design,\u201d says Jules White, an associate professor of computer science in the Vanderbilt School of Engineering. \u201cWhen you\u2019re moving into a world where you have to get things right the first time, it makes you cautious moving forward. And, this is of course true with anything with blockchain\u2014but I think particularly for healthcare data.\u201d

IDC makes the case that with the advent of FHIR and open application programming interfaces (APIs), blockchain could provide a \u201clattice to accelerate clinical data distribution.\u201d However, the research firm concludes that \u201cwhether blockchain will truly empower the industry with new ways of doing interoperability or is just market buzz, for the most part, remains to be seen.\u201d

For his part, Kaveh Safavi, MD, head of Accenture\u2019s global health practice, doesn\u2019t see blockchain as a \u201cpanacea\u201d for healthcare. \u201cWe think it\u2019s unrealistic to use the blockchain as a way to transport protected health information,\u201d he contends. \u201cDelivering PHI in a blockchain is unlikely. It will have some uses largely around identity but less as a primary transport mechanism.\u201d

Likewise, Chris Jaikaran, a cybersecurity policy analyst in the Government and Finance Division at the Congressional Research Service, believes blockchain is not particularly well suited for managing electronic health records because EHRs are retained on provider systems and are still potentially vulnerable to cyberattacks.

\u201cBlockchain is currently being tested by industry but at this time does not appear to be a complete replacement for existing systems,\u201d testified Jaikaran at a House subcommittee hearing earlier this year. \u201cOne such example is to manage electronic health records. In this example, actual medical records are retained on provider systems but a record of that record is published to the blockchain.\u201d

In this scenario, patients may use the blockchain to authorize who has access to those records, according to Jaikaran. \u201cWhat the blockchain may publish are permissions to that record, so\u2014rather than a patient having to drive across town to pick up a disk of that record to take over to another provider\u2014 those providers could talk amongst themselves to transfer that record.\u201d

Roadblocks ahead<\/b>

Although technically feasible, at the same time, he contends that this blockchain-EHR solution has pitfalls. \u201cAll the providers have to be on the same blockchain so they all have some kind of identity\u2014a public and private key\u2014and users have to take a more active role in managing that record for themselves.\u201d

In addition, Jaikaran notes that providers must maintain the electronic health record \u201cin a manner that is consistent with federal and state laws\u201d including HIPAA and the HITECH Act. The application of blockchain to EHRs would \u201cstill face\u201d both federal and state privacy laws \u201cas well as a lack of standards, data processing, and storage\u2014which may inhibit its adoption,\u201d he adds.

Further, because EHRs would be retained on provider systems, Jaikaran makes the case that \u201cthe record itself is still relying on the security measures\u201d of those healthcare organizations. \u201cSo, if the provider is not implementing defense-in-depth or some other cybersecurity strategies, an attacker\u2014instead of attacking the blockchain\u2014would attack the data store of the provider and the record would still be vulnerable,\u201d he concluded.

IDC\u2019s Shegewi concurs with Jaikaran that blockchain technology, in and of itself, \u201cdoes not enforce any sort of security, privacy, or compliance measures by default,\u201d such as HIPAA and the GDPR.

Further, he observes that \u201cearly testers of blockchain are realizing that it might not be a good idea to go on to a public blockchain network just yet\u2014and some may want to look at testing with private, restricted-access blockchain networks.\u201d

Shegewi also points out that another limitation of blockchain is that it\u2019s largely an \u201cincentive-based architecture that is the sum of its parts\u2014its users.\u201d As a result, he warns that \u201cmalicious activities could arise if incentives for participants to act maliciously on a blockchain are greater than incentives not to.\u201d","order":0,"get_parent":{},"attributes":[],"attributesType":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"dynamicContent":""}]

Heavy lifting ahead as healthcare works to achieve blockchain’s potential

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