Health records increase situational awareness by providing an in-depth history of patients. Medical personnel operate at the highest capacity when they are able to securely disburse and source health information. The current centralized health record system is predominantly digitized and remains insecure as organizations transmit data between incompatible platforms. Veteran Affairs maintains a corporate data warehouse where data is secured by one centralized entity (Saleem et al., 2013). This data pile is not only inefficient, but vulnerable to attack in the brutal internet of things environment. The equipment and applications used to store patient information remain susceptible to breaches and feature an extremely low level of interoperability. The current centralized ecosystem disregards the user as the driver of the process. Providing patients with validation credentials creates informative access to personal health information and the possibility of preventative medicine through user empowerment. This alteration to connectivity could spur the incorporation of reactionary medicine. In a realm where immediacy and efficiency are crucial, the current electronic health record system must be altered.
The digital revolution has given birth to an environment of interconnectedness. The shift from offline to online has brought about a new era of engagement and liberation. Information sent and received in the current age of computers is highly susceptible to security breaches. Credit card information is stolen every day through the infiltration of the commonplace centralized systems currently in place. Trusted third party entities have failed in their ability to protect sensitive user information. Decentralization can protect this information in a world where the internet of things continues to grow. Alongside security, a movement towards efficiency and user empowerment continues to grow, leaving centralized entities stirring. Interoperability streamlines processes, giving the user overall control of the data they create.
The vulnerability associated with trusted third-party management has prompted the increasing research and application of Blockchain technology. It seeks to solve the structural problems evident in a digital world. The Blockchain is a distributed public ledger, spread across a network of computers, that can properly record and store transactions in an unalterable and verifiable way (Iansiti & Lakhani, 2017). Any entries unverifiable by the network are not included, providing an unalterable method for data exchange. Through this, the Blockchain is able to dramatically alter the efficiency, speed and safety of transactions and storage spanning numerous industries.
Security breaches, abuse of power by centralized authorities, widespread socioeconomic divide and a shift in human interactions have prompted change. The blockchain movement was born from a vision to correctly harness computing power to create an efficient and secure decentralized environment for exchange. In 2017, the largest credit bureau, Equifax, was hacked and the personal data of nearly 145 million people was stolen (Larson, 2017). In the hands of unscrupulous entities, this information may lead to stolen identities and financial ruin. The call for a new system grows louder. As connectivity continues to increase, a decentralized environment has become the solution to ensure health care records are secure and easily accessible to validated parties.
Benefits
When first introduced, trust of computers and mobile technology was in short supply. Through continued use and application, it has become an integral part of everyday life. The adoption of blockchain technology hinges on resounding understanding and satisfaction. Emerging complexity discourages users from learning through an investment of time and effort (Smith-Atakan, 2006). The new and unknown nature of Blockchain technology has curbed its speed of adoption. Individuals continue to disregard this movement on the basis of difficulty and disbelief. Mental models remain fixed as individuals continue to utilize the technology they are most accustomed to. Actual implementation of a universal EHR system on the Blockchain will result in a mental model shift and increase in speed of adoption through improvements to the chain of data exchange. Transitioning electronic health records to the Blockchain will result in a user-intuitive platform to effectively source and exchange medical information in a secure way, leading to growth in user data empowerment.
Security
Situational awareness is essential to effective communication and treatment in the medical realm. Health information is continually logged and stored in order to be transmitted and accessed when necessary. The information stored and exchanged in health records is extremely sensitive. Protection of this information remains a core principle to the chain of trust. The HIPPA law was established in order to ensure the privacy and security of this information (Zhang & Zhang, 2011). A centralized environment with vulnerabilities voids the trusting relationship created between patient and medical personnel. The transmission and ownership of health information should be transparent while maintaining content privacy. The modern EHR system makes this impossible, preventing a high level of transparency and creating specific targets for attack. A system that ensures the secure exchange of health information between numerous parties must be created in order to fulfill the desires of privacy and transparency. Overall, Blockchain has the potential to transform electronic health records through a secure, decentralized system.
A health record system based on the Blockchain provides a universal interest gathering without a ruling central authority. Decentralization allows for authorized parties to have access to the entire health data set and its lengthy history (Halamka, Lippman & Ekblaw, 2017). This creates at atmosphere of reliability as health data must proceed through multiple check points for validation instead of a single gateway. The current electronic health record system involves submission and retrieval from a single, vulnerable portal with no multi-party validation framework. When a health record on the Blockchain is altered, the patient is notified of the change and their validation is requested. The component of awareness that stems from decentralized verifications heightens the associated level of security. The time-stamped and customizable Blockchain can only be accessed and altered by identity verified parties through a multi-step validation system.
The healthcare system consistently creates and churns information due to the plethora of people. Patient information is compiled and sent through centralized nodes that are not outfitted to properly organize and protect the private data. Present auditing tactics are minimal and inefficient. The transition of health records to the Blockchain allows for a high level of reliability and autonomy. Any alterations to the medical record is visible to the community associated with the ledger and leaves an auditable trail (Halamka et al., 2017). An overwhelming level of transparency ensures consistent clarity and reliability, essential for all sensitive information. The decentralization of electronic health care records allows for the removal of vulnerable single pathways and an easily auditable platform. Minimizing the frequency of human arbitration through the programmable, autonomous comparison of health information decreases the level of error associated with human interaction. The extremely high level of integrity at every point of use creates a nearly autonomous system that harnesses computing power and community transparency to validate the exchange of health information.
Consistent auditing is essential in order to maintain accuracy and integrity. It is essential that sensitive health information is exchanged and modified in a verifiable and traceable manner. Auditing must be performed correctly for it to serve its purpose. A study was conducted by NC State University to determine the efficacy of current health care record audit mechanisms. Three open-source electronic health record systems were investigated to determine if they contain any of sixteen important auditable events. It was found that the systems logged only 12.5% of event types (King, Smith & Williams, 2012). Nearly every event of modification occurred without any detection. The present EHR system allows changes to be performed in a carefree and untraceable manner without informing the user or other medical personnel. A system based upon accuracy and reliability cannot have these security vulnerabilities. If based on the Blockchain, auditing can occur in a consistently efficient and autonomous manner.
Security is at the foundation of electronic health records. With no central entity, data remains safe from disaster and tarnish (Linn & Koo, 2016). The ease of access for internal and external parties prevents the current system from being a reliable resource. A decentralized Blockchain environment allows for multiple stages of validation and high level of transparency, safeguarding data and improving the overall user experience. Encrypted data only viewable by verified entities is the most secure way to store and transmit electronic health records. The rise in accountability and autonomy greatly increases system efficiency. The shared database can be accessed and modified by verified personnel only after universal validation, leaving an auditable and permanent trail.
Interoperability
The exchange of information on a consistent basis requires a shared network that allows for ease of understanding and operation. The medical system is composed of a complex network of organizations working towards a common goal of improving overall quality of life. Patient information is shared in order to increase situational awareness and allow for proper treatment. This medium of exchange is one of the most important components to the healthcare industry. Ease of access to the entire accurate history of a patient prompts exceptional insight and care. Currently, humans attempt to manually rectify data amongst these organizations (Halamka at al., 2017). Each organization inputs and stores information in a different manner. This versatility can be maintained with the creation of a shared Blockchain foundation. Maintaining the unique data-entry software present while altering the infrastructure will allow for seamless exchange of complete patient history amongst health organizations of various scale and capability.
Interoperability remains a priority for organizations seeking to function in the digital world. The desire to exchange information in privacy has continued to grow. The current health IT realm is not suitable for exchange across platforms. A health blockchain prevents the need to develop a complex data integration component to allow systems to communicate (Linn & Koo, 2016). Instead, open-source software would communicate directly with the Blockchain in a secure and autonomous manner. This allows each organization to have their own unique programming method while transmission and recording occurs with the foundational Blockchain. A complete shared data source enhances the relationship shared by medical personnel, researchers and users.
Implementing a shared data source amongst health organizations greatly enhances the level of access and sharing. In addition, it provides a foundation for IoT devices to effectively communicate in a secure manner. Another layer of interoperability allows the health blockchain to scale and interact with the wearable market. Affordable health wearables are utilized by the general public, but without a high level of interoperability. Securely linking wearables with the Blockchain would allow for the logging of real-time health data and enhance the realm of preventative medicine (Linn & Koo, 2016). This creates an unprecedented level of care and data analysis. The addition of wearables must be performed in a decentralized environment in order to uphold a high level of security and privacy. Blockchain technology is currently being developed to secure physical IoT devices and their wireless transmissions. The power of the digital world can be correctly leveraged if the proper technology is utilized. The current health record system can be transformed into a user-driven process, leveraging the power of personal data to monitor and make insights.
Beyond in-person treatment, health research is an important component of the medical field. This area leads to advancements in medications, treatments and processes that ultimately saves lives. The integration of an IoT component of a health blockchain would not only ensure security but provide a plethora of real-time health information pertinent to making new discoveries. Increased understanding of diseases translates into new medical discoveries and the implementation of newly-designed treatment plans (Linn & Koo, 2016). Researchers continue to seek a diverse data set in order to ensure fair data analysis. The conversion of electronic health records to the Blockchain would provide user-approved access to nearly exponential data as the wearables market continues to grow in affordability. The medical community would be able to expand into underserved populations, obtaining data that can provide an accurate representation of the entire human condition (Linn & Koo, 2016). The extension, security and efficiency that comes with blockchain-based electronic health records is exceptionally high and would result in a community-based effort for improved health.
User Empowerment
A digital world produces an overabundance of data. It is the most prized possession of the modern day. Businesses insecurely store and freely sell data created by their user base. The model for the exchange of data between business and user provides the customer with very little clarity and no ownership of the data they create. This data is consistently added to a data profile and shared with partnering analytics companies. The user is not provided clarity on the exchange of their data that is stored in a centralized method. The final product of any process should be controlled at the discretion of the original creator. Without ownership or clarity, a user is unable to be situationally aware of their current state. Electronic health records are rarely accessible to patients. They have little to no control over what information is shared between personnel and where it is located. A decentralized environment would provide the patient with full access and control for the health information that is prized for privacy.
The security that comes with electronic health records on the Blockchain allows for permissions to be set and data to be traded when approved. Patients would be the exclusive owners of their health information with full control over how and with whom it is shared. The patient is provided the power to grant access for searches and confirm alterations. Patients determine what medical personnel can access and edit their medical history, assigning them a unique identifier (Linn & Koo, 2016). Every alteration is routed through the owner, creating an effective stage for audit and an increase in user empowerment. This sense of ownership and attachment is a stark change from the detached relationship of the current system. This change in hierarchy engages the patient, creating awareness of their current health condition and providing peace of mind through identity verification procedures. Complete control over digitally signed and encrypted transactions would allow the role of the patient to grow and enhance. Greater awareness of the current condition of their health can lead to a rise in preventative medicine techniques.
The medical realm is exceptionally reactionary. Concern is raised and treatment is initiated only after the problem has been uncovered. Preventative health care techniques are rarely implemented to decrease the chance of health problems. This stems from hierarchal detachment, creating a dysfunctional realm of unawareness. A potential solution stems from user empowerment. A high level of user empowerment provides motivation to be invested (Leung, 2009). A user in full control of health information ensures a sufficient level of engagement is present. Preventative medicine is most effectively implemented by an aware patient. Providing the user with complete control over their health information increases overall awareness. This awareness alters human behavior to drive determination towards action for a positive health image.
The level of connectivity continues to rise as the number of devices connected to the internet grows. This has created a complex network known as the Internet of Things. Without viable security protocols, this network remains extremely susceptible to hack (Said & Masud, 2013). Blockchain technology is continually being developed to secure communication between devices. This development is happening alongside a growing wearables market. The affordability of aesthetic biomedical wearables has increased their popularity and allowed wearable companies to scale exceptionally well. An electronic health record system based on the Blockchain would ensure accountability for data management between user, company and health professionals. The growth of the wearables market showcases the desire of the general public to be aware of health information. The Blockchain-connected wearables would be able to securely communicate with electronic health records to consistently provide real time data, generating a new internet of things (Hashemi, Faghri, Rausch & Campbell, 2016). These devices heighten the level of engagement experienced by the user, providing them with a sense of authority of their data. Users would experience empowerment through the tangible use of wearables and direct access to their entire medical history. Overall, a secure IoT network and complete access to this data can be facilitated with Blockchain technology and will encourage users to utilize wearables in the pursuit of preventative medicine.
Downfalls
Electronic health records based on the Blockchain allows for secure, efficient and private exchange of sensitive health information. Regardless of the system in place, human error will always be present. Any system involving human-computer interaction incorporates a high level of error. Humans are naturally imperfect leading to the potential for manual error at any stage of a process. Additionally, the scale of this transition is monumental. A slow-moving regulatory and political environment could hinder the innovation process. A government-led push would be needed to spur integration and adoption.
Human Error
A portion of electronic health records involve automatically logged data transmitted between devices. Health information stems far beyond vital readings, incorporating an entire qualitative side that provides exceptional clarity on patient history. Medical personnel enter patient information into an electronic interface to be accessed and reviewed at a future date. The process of manual entry can experience error at any point. For example, a nurse may easily mark the wrong amount of medication injected leading to the doctor believing the patient needs an additional dose. Simple errors can have dire circumstances in the medical setting.
A secure system for the exchange and storage of health records does not prevent the entry of incorrect health information. Specific design features can be implemented to ensure multiple checkpoints before data entry, but every error cannot be caught. Once the wrong information is input, a chain reaction occurs resulting in the dispersion of the information. Although not a complete fix, a health blockchain provides another checkpoint layer to the electronic health record system to ensure data entry is precise. By incorporating the user as a stage of validation and increasing the reliability of the overall system, human error can be minimized. This should also prompt research into design techniques for data entry interfaces that ensure precision. This could potentially involve color recognition and multi-stage confirmation notifications that encourage the employee to recheck the data. Creating a health blockchain is the first step in securing sensitive health information through a layered and consistent validation process.
Complexity
The medical system is an extremely complex network of organizations, people and research entities with the common goal of improving overall quality of life. The Food and Drug Administration (FDA) ensures there are strict guidelines for creation in the medical realm in order to protect the well-being of patients worldwide. This high level of protection establishes the patient as the priority in all areas. Although proper, the medical realm does not always function at peak efficiency. System changes and new devices take years to pass regulatory tests and validation checkpoints. The entire medical system is consistently described as being slow-moving and difficult to enter for startups looking to make an impact.
A large overhaul of the current electronic medical record system would be extremely complex and lengthy, even if done at a stage where Blockchain was more widely accepted. At the foundation, the creation of a securely shared data system would face similar regulatory hoops before it could be implemented. Road blocks could extend beyond necessary testing procedures due to the scale of this movement, resulting in little to no progress. Additionally, extensive training in order to implement the consistent use of a Blockchain-based EHR system would be necessary. The complex network of medical personnel would need to be efficiently trained on use of the data system, requiring additional time and expertise. The transition to Blockchain technology must be done in a manner that requires little additional training and can be understood by existing employees. Overall, a government entity is needed to facilitate the creation of new laws relating to the implementation of this technology to create a foundation of belief that the medical system can support.
Conclusion
The age of the internet has created an online ecosystem that has altered the way interactions are made and data is exchanged. Research and events have uncovered the dangerous inefficiencies associated with the centralized atmosphere in place. The desire for the integration of Blockchain technology grows stronger every day. Blockchain is a decentralized ecosystem where transactions can be performed in a secure, reliable and user-centric way. The transition of medical records to the blockchain can facilitate exceptional improvement in the exchange and storage of sensitive health information. The distribution of health information across a distributed network, containing multiple gateways of system and user validation, will allow for a high level of security and user empowerment. This transition will ensure a high level of privacy and increase patient awareness for a potential movement towards preventative medicine.
Beyond the user-focus, Blockchain-based medical records will allow for one shared data source. Differing platforms spread across the complex health network will remain personalized while sharing the same foundation for information storage. A high level of interoperability will increase the capability of medical organizations in their interactions and exchange of pertinent health information. This will lead to more immediate care, a valuable ability in the medical realm. The transition of electronic health records to the Blockchain is the next step towards a decentralized system that prioritizes the patient, security and assembly.
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