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Blockchain Eyed for Boosting Data Security, Trust in Precision Medicine

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CHICAGO (GenomeWeb) – Mention "blockchain" to someone in healthcare or life sciences and expect one of a handful of responses: a blank stare, a remark about the controversial cryptocurrency Bitcoin, an assertion about how it could solve this industry's data exchange and security problems, or a quick dismissal of what might be another passing fancy.

So what exactly is this blockchain people keep talking about?

"A blockchain is just a protocol. It's a data design platform," said Emily Vaughan, head of accounts at Gem Health, the healthcare division of enterprise blockchain software company Gem.

"Blockchains don't store data," Vaughan explained. "I'm just proving that my data exists and then you can request access." A blockchain also creates pathways for data exchange.

Vaughan called blockchain "fundamentally different" than other security protocols and models, in terms of format and structure. "It represents a paradigm shift in the way we manage data," she said.

"What it does is add additional layers of security and trust," said Kamaljit Behera, an India-based industry analyst in the Visionary Healthcare Program at consulting and research firm Frost & Sullivan.

Blockchain technology works like peer-to-peer file sharing — think the BitTorrent file-distribution protocol or the original incarnation of Napster that drew the ire of the music industry — but adds security and immutability, according to Behara. Each group of online transactions over any given 10-minute period gets recorded as a "block," and the blocks line up to form a blockchain that cannot be changed or controlled by any single entity.

"It has the potential to disintermediate" data from proprietary hosts and silos, including electronic health records, by facilitating peer-to-peer data exchange, said Behara, who tracks technologies that threaten to disrupt current business models. "EHR vendors still have interest in working in silos," Behara said, echoing a common sentiment in the health IT industry.

In June, Frost & Sullivan published a report — primarily authored by Behara — on blockchain technology in healthcare over the 10-year period ending in 2025. As is company policy, Frost & Sullivan did not make the full report or specific data points available to the media.

However, a summary of the report said, "At its core, blockchain offers the potential of a shared platform that decentralizes health data, ensuring access control, authenticity, and integrity of protected health information." That protected health information is data subject to HIPAA privacy and security regulations.

"Further, the blockchain-based distributed network consensus with cryptography techniques provides an additional layer of trust to minimize cybersecurity threats for healthcare IT systems. This never-before blockchain-based trusted workflow with a 'single source of truth' presents the healthcare industry with radical new possibilities for outcome-based care delivery and reimbursement models," the summary continued.

The Frost & Sullivan report added that "the blockchain concept remains difficult to grasp." But for the healthcare industry, in particular, "it holds the potential to save billions of dollars by optimizing current workflows and the disintermediation of some high-cost gatekeepers."

Indeed, Vaughan noted that healthcare has become the largest vertical for Gem, the business name of a Venice, California-based software startup called BitVault, which initially offered security software for Bitcoin transactions and other cryptocurrencies. "Our hypothesis is that cryptocurrency is just a data asset," said Vaughan, who joined Gem to help the company broaden its operations from Bitcoin-only applications.

A commonality between the healthcare and financial industries is that security is paramount. That, according to Behara, makes blockchain technology suitable for both.

"It is immutable," he said. "Everything recorded in blockchain is impossible to change or manipulate," since blockchains create automatic audit trails, he said.

According to Frost & Sullivan, precision medicine is among six major potential applications for blockchain in healthcare. "Patients can permit access to their anonymized personal health information for research commons and remunerative models," Behara explained.

Precision medicine requires data from many sources, including clinical records, clinical trials, omics-based studies, daily observations of living, and lifestyle information, and blockchain technology helps aggregate such information securely. Blockchain also supports electronic consent forms, according to Behara.

Blockchain may be a key in overcoming shortfalls in widely used health IT as the healthcare industry adapts to precision medicine, explained Ron Ribitzky, a Newton, Massachusetts-based physician who consults in precision medicine and health informatics. "Healthcare systems are not scalable for reaping the benefits of precision medicine," Ribitzky said.

Ribitzky believes that three things are necessary for any technology to enable precision medicine: a genomic ecosystem, the ability for computer systems to talk to each other, and a suitable user experience (UX) to encourage adoption.

"Ecosystem formation is inherent," Ribitzky said. "If you don't have an ecosystem, you just have lines of code that don't do anything."

In the interoperability realm, Ribitzky referenced a talk he heard Beth Israel Deaconess Medical Center Chief Information Officer John Halamka give at a June conference on precision medicine. Halamka, a well-known health IT policy expert, said then that precision medicine requires "evolutionary leaps of interoperability" over today's reality.

Halamka did strike an upbeat note, though. "I am meeting with more and more entrepreneurial 26-year-olds who are creating modules of functionality that are layering on top of electronic health records and will fundamentally provide more agility and more innovation than the EHR vendors themselves," he said, according to Healthcare IT News.

Ribitzky said that startups working with blockchain need to convince buyers of their software's worth, and then the CIOs of health systems need to see value in implementing blockchain technology. Ultimately, though, consumers need a reason to use such a system. "This is where UX is important," Ribitzky said. "Otherwise, it becomes a scientific exercise."

The user experience is where many EHRs have failed, causing pushback by clinicians that occasionally lead to dangerous workarounds or the ignoring of alerts.

Still, Ribitzky expects to see "serious adoption at scale in genomics" in the next couple of years, though he does not see blockchain becoming commonplace in this field for at least five years.

What will push the issue, he said, is the combination of data volume that genomic studies generate, the velocity at which data hits a health system, and the rate of change in understanding genomic data itself. This is leading to what Ribitzky has dubbed the "paradox" of precision medicine: "The rate of discovering new precision medicine 'dots' overwhelms our ability to connect them," he said.

The healthcare industry, in his estimation, has a scaling problem today because it lacks the personnel to reap the full benefits of genomic medicine. "EHRs were not designed for the problems we have today," Ribitzky said.

"We [as a society] are overwhelmed," Ribitzky explained. "The rate of discovery of new information in genomics and precision medicine is almost too fast to manage."

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