Blockchain Technology in Healthcare

Dean Rakic

Enterprise Application Development (EAD),

Distributed and Generative Technologies Competence Group, Stuttgart, Germany

Keywords: Blockchain, IoT, Interoperability, Patient Record, E-Health, Evidence-based, Predictive Analytics.

Abstract: A big portion of data that are produced by various digital ecosystems has met a lack of interoperability on

the line between applications, data streams and predictability in the healthcare. The new technology

approach in the distributed messaging and Blockchain became a key component of many healthcare

technology stacks and can derive real-time data streams as valuable and scalable enough to enable real-time

healthcare predictive analytics. Besides, ingesting data streams from various sources from patterns of data

can extend healthcare trend analysis to the higher level of prediction, accuracy and improve models that

suffer from complex and long-running analyses. A better response, lower availability requirements and

unifying predictive modelling will accelerate healthcare interoperability and thus increase the accuracy of

diagnoses, put the evidence-based medicine (EBM) in the right direction and other healthcare benefits

which increase optimum outcomes and quality.

1 INTRODUCTION

1.1 Step Forward into Healthcare

Interoperability with IoT

Distributed Data

From the very beginning of information technology

usage in healthcare, the data producing was always

in the matter. Either, the simple patient personal

records or various medical treatment descriptions, it

always needs to be a countable amount of data in

digital form.

On the other hand, overall technological

advances have made medical devices become

smarter and, therefore, the ability to produce a

higher amount of data. In addition, computer

networking and the Internet have enabled data

exchange both in the local (hospital) and in the Geo-

global environment. Besides medical devices, most

of the power supplied devices around us became

also smarter. Vehicles, trains, planes, lights,

watches, parking garages… get a common

denominator in the world of smart devices and it is

called Internet of Things (IoT) - with the basic idea

of connecting all devices to each other. The IoT can

be understood as the natural evolution of the web as

it merges information technology and many other

operational technologies. It links more than ordinary

life devices – it connects all that devices containing

such a sensors collection. By connecting and

networking a common thread is IoT based

machinery that uses data streams as its fuel.

The digital revolution led by IoT (i4.0) has not

bypassed the sphere of the healthcare.

Considering all the verticals in healthcare,

regardless of whether new technologies are applied -

in a hospital environment or in personal use by

patients, it is evident that they are the part of the

change in the healthcare industry at all – from the

much based IoT eHealth wearable devices up to

sophisticated medical sensors.

Leveraging by new trends, the healthcare is

going to be revolutionized in methods where every

patient comes to the ability to interact with any

subject of new technology and also to each other.

From that point of view, the healthcare institutions

are already suffering on how to share data between

different platforms. Another weak point is an

inability to hold a secure data at the physical and

logical level. Blockchain appears as a promising -

near future answer to this data integrity dilemma. It

allows better collaboration on data level between

payers and providers adopting the principle of secure

store of electronic medical records. If it is true, the

providers can count of a higher probability in

Rakic, D.

Blockchain Technology in Healthcare.

DOI: 10.5220/0006531600130020

In Proceedings of the 4th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2018), pages 13-20

ISBN: 978-989-758-299-8

diagnosis accuracy by feeding healthcare

information systems with tons of data.

However, all of us who are participants in the

newly created technological era sometimes wonder

what is actually happening, where is all this leading?

Is there a particular benefit that is focused on

increasing the quality of health services and patients

themselves will become mere consumers of

innovative achievements?

Seen from the side of the patient, who is

participating in the innovative world and the

primarily intended benefit is enormous.

Availability of various sensors and diagnostic

elements integrated into mobile communication

devices to quickly and simplified patient contact

your physician and clinical centers. This mode has

shortened the path to obtaining a timely diagnosis

and simultaneously helps the patient.

Not taking into account all the technological and

technical obstacles such as lack of interoperability

and different standards in terms of integration, we

come back to the starting point of view of that

unique element which is concomitantly building

block or the end product and that's the - data. In our

case, these are the data of the patient. Whether this is

just a basis for the identification of a patient in the

system (EHR) or used as an expanded set of data in

the analysis and prediction of disease and diagnosis,

the data is potential, high risk factor. Seen from the

patient as a consumer, if its data is vulnerable - and

he himself is at risk.

In the process of data collection from points of

origin to its final destination, securing the data is

required under the HIPAA compliance. But in

practice, it turned out that due to deficiencies in the

security standards should lead to greater

involvement of the IT sector in the field of data

protection and increased interoperability.

A new technology such as Blockchain is very

promising in terms of increasing interoperability,

security transfer and exchange of information. As

the information is distributed over the network(s),

Blockchain especially has become as a solution to

establish the trust of all the factors in the world of

digital healthcare. Also, all challenges addressing

the security of protected health information (PHI)

and HIPAA compliance has an opportunity as a

solver tech by using Blockchain encrypted data and

its validated replication over the network.

From another standpoint, the healthcare data are

very complex. They are built of various data

formats, images and videos, sometimes non –

structured data.

All that is the representation of a single health

record of the patient. Such patient records, time-

stamped and signed by using a private key under the

Blockchain can be distributed without losing data

integrity and make the stairway to deep learning, a

new technology based approach in healthcare data

analysis and prediction.

Putting them together, the principle of secure,

valid and distributed health information is likely to

be closer to goal of the healthcare interoperability

and precision medicine with promise to unlock

access to all population health data.

In addition, the caregivers, community of people,

doctors, patients, insurances and all other health

information consumers, by being a part of

Blockchain reduces a fraud in healthcare payments.

2 CONCEPT

2.1 Blockchain Itself

There are various definitions that try to explain the

background of Blockchain technology in a simple

way. One of the most commonly used definition

states that a Blockchain is a distributed system

(distributed ledger) divided or in other words,

decentralized into blocks which are connected with

nodes. Blockchain uses mathematical models for the

distribution of encrypted information through the

chain of blocks, making them safe and transacted at

the real time. Some of the basic terms should be

considered at first to be able to understand the

definition.

Distributed system is for a long time already in

the computer terminology and represents an earlier

definition of the computer network where they are

separate individuals, i.e. computers spread on a

geographical area. Nowadays, is now much more

used as a system of multiple autonomous processes,

i.e. computers (nodes) that communicate with each

other by passing messages.

Decentralized means that there is no central

point or entity that takes care about of transactions,

identities and no data are held centrally.

The Block itself simply represents a file and it

could be a text file (like book chapter), image, video

sample, spreadsheet or any kind of structured data

that consists records which are storable and readable

by the machine.

The blocks are interconnected with nodes (hubs)

creating a chain like a process and govern the

transmission of information.

ICT4AWE 2018 - 4th International Conference on Information and Communication Technologies for Ageing Well and e-Health

Transactions are actually information, i.e. data

transmission that referred to one block. They are

message broadcasting based system. By the simple

meaning, the transaction is single operation over one

node and as the nodes is able to communicate and

transfer the data from one node to another across the

network.

During this transmission process, each node acts

as a central point and is able to generate and

digitally sign the transaction. Then, as the nodes

connect each other in a peer-to-peer network, each

node has to verify incoming transaction

independently for its validity, compliance and

conflicts with peers. All these need to be digitally

signed and tested so the transactions that passed the

verification process enters the memory pool, a local

list of the node’s that are still provisionally marked

as unconfirmed transactions. Later, they are

forwarded on to its peers. All those transactions that

are rejected are placed in the orphan pool - a

temporary holding area.

One more rule that makes data transmission or

transaction successful is described as cryptographic

hashing. Each block of data has to be

cryptographically hashed using the SHA-256

cryptographic hash algorithm on the header of the

block. The header also contains the hash of the

parent block. To complete the linear list of blocks

and to establish a sequence, each block contains the

hash of its parent and this way, creating the chain

backing all the way up to the first block ever created.

This first block in the chronology is also called

genesis block. The simplified Blockchain is

represented in Figure 1.

Figure 1: Simplified Blockchain.

Each block in the Blockchain is linked with the

parent (previous) block of data stored in the header:

timestamp (date-time) and origin.

2.2 Public vs Private Blockchain

The Blockchain is a public ledger. From that view of

the authority, as there are many parties involved in

transactions sharing the data headed by

cryptographic keys, Blockchain can be public or a

private. There is a big difference depending on

which technology you need. It is also depending on

the principle: Do not allow anyone to write to your

Blockchain or to someone known and thoroughly

tested participant.

The first one, public, is the one about the people

always meaning by talking about Blockchain and

means actually that anyone, without permission

which is granted by another authority, can read or

write data. This one is also known as permission-less

Blockchain. It has a greater possibility of

compromising security while permission to

Blockchain can be controlled easily.

The private Blockchain is the second one and

obviously most popular. It is a permission based

Blockchain where participants are known. They are

trusted across their industry group or for example

group of company and many of the permission

mechanisms are not needed. In some cases, they are

replaced by using legal contracts.

The issue of private versus public Blockchain

leads to another moment of concern in the

implementation of this new technology. First of

them is criticism on top of vulnerability. Soon or

later someone will find a hole in the coding loop of

smart contracts. Such already happens in June 2016.

This or similar should be overridden if a majority of

validators follows the rules and produce stronger

(also cheaper) immutability such one is resulted by

using the private Blockchain. Besides, use of a

private Blockchain shall become a more accessible

to the general public. As far as the both or one

satisfies main principles of data immutability,

preserving smart contracts vulnerability and

anonymous information during the transactions by

agreement with authentication, it will be useful and

acceptable.

2.3 Smart Contracts

Since we are talking about transactions between two

entities it is necessary to have a simple rule that will

establish the trust among them. As the transaction is

digitally signed, the trust rule should also be in a

digitally trusted form. Then, we have a smart

contract – a form of the computer program (pre-

written logic) that helps us to convert certain

conditions in the valuable outcome. Outcomes are

able to be stored and replicated across distributed

system, executed over nodes and result in a change /

update the state of digital asset.

Simple words description, smart contracts are

little computer programs that execute in way

represented in Figure 2.

From the current level of technology, smart

contracts are programmed to perform simple

functions and thus create agreements between

Blockchain Technology in Healthcare

Figure 2: Smart contract.

parties. They can be peer-to-peer (P2P), person-to-

organization (P2O) and person-to-machine (P2M).

2.4 Decentralized Database Consensus

Helping with the unique feature and the principles of

the cryptography, the Blockchain has the potential to

develop a database application consensus which is

primarily decentralized. Besides, the secure

authentication of transactions which is achieved by

using hash codes in the record headers means of no

possibility of the transaction duplication and thus no

need of a central middleman/intermediary. This is

the main point which breaks a centralized consensus

paradigm. Avoiding the necessity of the central

mediator there is no recorded replication of the

previous transaction.

By using a decentralized scheme transactions got

an ability to transfer authority as trusted across the

network. This happens during transactions over the

public block and its nodes by taking records

regularly and sequentially – peculiarly creates a

unique chain or Blockchain.

The consensus is more actively explained by the

fact that only the header is available to the public.

Only the creator has access to a private key (a

distinctive fingerprint) and this is the only way how

anyone can access the complete data.

Consensus shall be accepted as the starting layer

of a decentralized architecture, foundation and as a

prime rule protocol that drives the operation inside

the Blockchain.

2.5 The Immutability

Basically, the principle of immutability is a

something that could not be changed over time or it

is unable to be changed. From the context of the

security of the information / data that are stored on

Blockchain, this is the topic of high importance.

Using simple words of explanation: once written

data to Blockchain, no one, also not even system /

data administrator has no possibility to change it

whatsoever.

This is beneficial. From one side, the data

provider can prove that there is no data alteration

from the data provider, the recipient can be sure that

the data has not altered – the audits successful.

The immutability could also be relative in some

specific use cases. For example: if someone sends a

bulk email (the large list of recipients), from its

perspective, the data are pretty immutable because if

provider intends to change something or to delete an

email, possible, but at the same time it is very hard

as he needs to persuade everyone from the bulk list.

2.6 The Blockchain Proof of Work

Principle

The proof of work is about a computational puzzle

or hashing problems. Parties in a process of

validating electronic transactions are repeatedly

asked to solve-rerun hashing algorithm. Resolving

the puzzle among hushing algorithm is very hard

and estimates computational power but validating its

solutions and also the block content is easy. This is

the computational asymmetry which makes fraud so

hard or better to say impossible.

This method is used for achieving a secure

method of the value exchange. The result is no needs

for a single – trusted authority in a process to clear

and manage transactions as they are validated by

individual nodes.

2.7 Interoperability Dilemma

A big portion of data that are produced by various

digital ecosystems has met a lack of interoperability

on the line between applications, data streams and

predictability in the healthcare. The new technology

approach in the distributed messaging and

Blockchain became a key component of many

healthcare technology stacks and can derive real-

time data streams as valuable and scalable enough to

enable real-time healthcare predictive analytics.

Besides, ingesting data streams from various sources

from patterns of data can extend healthcare trend

analysis to the higher level of prediction, accuracy

and improve models that suffer from complex and

long-running analyses.

Figure 3: Interoperability dilemma on relation patient-

physician.

ICT4AWE 2018 - 4th International Conference on Information and Communication Technologies for Ageing Well and e-Health

A better response, lower availability

requirements and unifying predictive modelling will

accelerate healthcare interoperability (i14y) and thus

increase the accuracy of diagnoses, put the evidence-

based medicine (EBM) in the right direction and

other healthcare benefits which increase optimum

outcomes and quality.

2.8 The “Things” Collect & Exchange

Data

The Internet of Things (IoT) is a system of

interrelated computing devices, mechanical and

digital machines, objects, animals or people that are

provided with unique identifiers and the ability to

transfer data over a network without requiring

human-to-human or human-to-computer interaction.

IoMT (Internet of Medical Things) - healthcare

IoT - the collection of medical devices and

applications that connect to healthcare IT systems

through online computer networking.

Figure 4: Simplified IoT description.

Looking from the healthcare perspective, listed

are some of the healthcare areas that can rely on IoT:

 Secured & Smart Healthcare Monitoring

 Remote patient (self) monitoring (RPM)

 Wearable health monitors (near future)

 Clinical decision support system (CDSS)

 Telematics & wireless medical telemetry

services (WMTS)

 Telepathology

 Telepresence robotics

 Emergency notification system

2.9 Blockchain Use Cases for

Healthcare

Nowadays, the information exchange is huge but the

current infrastructures of healthcare information

systems at all are inadequate to handle. Too many

challenges around such as multiprocessor units,

cloud technology and mobile application

development are expressed by difficulties in

handling on top of the DevOps & DEV CI and

especially vulnerability. Blockchain comes into the

story as promising technology and has opportunity

to do an impact on those challenges.

In the healthcare, usage of large files is part of

almost each healthcare data transaction. Such files as

imaging scans (PDF, TIFF…) estimates limitations.

Where to store files, how to transfer and avoid

changes or any kind of alteration by third parties.

Blockchain solve this by using its distributed

technology. With it, there is no need to store data on

entirely chain. They have just to link with its hash or

cryptographic numeric fingerprint. The transfer

between parties can start without to alter anything in

the source data or moving content to some central

point to be accessible from other parties. The

validation logic of Blockchain, the smart contracts

on the Blockchain ledger deploy shared control so

the transfer or blocks could not be duplicated or

replicated from anyone across the network except

the authorized nodes.

The Blockchain networks, i.e. private and

permissioned such as Ethereum, can be maintained

by official regulators (MHRA, FDA, CROs) and

used by traditional clinical data management

systems (CDMS). Cryptography and smart contracts

allows trust in data integrity which allows medical

professionals to make better decisions and have the

potential to reduce patients risk from one side and

efforts to reduce the data manipulation in the

financial health services.

Master patient index (MPI) is a medical

database. It holds electronic records from each

patient registered at healthcare organization and

includes information like patient name, DOB, race,

gender, security number, place of residence…and

another content that belongs to patient medical

history. Besides, may include data on physicians and

/ or other medical stuff. MPI ensure the every patient

is represented only once. This means also a constant

demographic identification across the systems of

hospital data. If the MPI is well organized, the

institution that holds the data can ensure more

accurate care for their patients.

Medical patient index is often created within

electronic health systems (EHR). Usually the EHR

has different vendors and its cause an irregularity of

MPIs by accessing them from EHRs. Introducing an

industry driven national patient identifier problem

looks like a solved. But, not only EHRs access and

use MPIs. There are also other healthcare systems

that contain MPI, such a lab information systems,

radiology and many vendor free computerized

patient order entry software applications.

In many cases data between mentioned

healthcare systems are mismatched or records are

Blockchain Technology in Healthcare

duplicated – multiplied. Mismatches can be e.g. in

the date of birth (DOB) as there can be as many

different ways of DOBs as many systems are opting

with MPI. Besides, the MPI data are centralized and

verifying the data is mission impossible if there are

many systems involved.

The Blockchain with its nature of

decentralization has a possibility to solve this. If the

Blockchain network incorporates MPI, the patient

identification data were hashed to the ledger and

content will remain unique, un-altered based on

immutability of block contents inside the chain. All

parties will deal only with header to access the MPIs

but only authorized nodes (e.g. physician, lab

technician) can view patient data and add content

but only the owner has possibility to make any

changes in hashed header. The mismatch or

multiplied records could not be possible anymore as

the smart contract do not allow that.

2.10 Potential Use Cases for Healthcare

Blockchain by its nature opens up an infinite number

of possibilities for application in particular in the

field of health care. The following topics are just an

indication of those opportunities that are partially or

fully implemented on the basis of the Blockchain

health care.

- Fully privacy (100 %) peer to peer

Blockchain network with possibilities to store and

analyze patient health data. Possible are of use:

clinical trials, precision medicine and research.

- Blockchain based patient tracking and

identity assurance. This should include improved

information exchange and validation. It is a strong

healthcare interoperability issue.

- Healthcare objectives information exchange.

Possible are of use: National healthcare initiatives to

fulfill wide area health data interoperability.

- IoT Blockchain patient recorded outcomes

measurement technology. Possible are of use:

various area of medical diagnostics, patient

management, clinical trials, pharma data

management.

- Blockchain PHI – linkage protected health

information with identities from verified credentials

providers. Shall lower healthcare transactional costs

and improve security.

- Blockchain pre-authorized payment. Possible

are of use: clinical trials and prevention of

counterfeit drug production.

- Blockchain predictive modeling. Possible are

of use: improve health data interoperability across

network of health institutions.

- Alternative payment models based on

Blockchain by linking quality and value.

This clip is only the beginning of the

development and application of technology that

Blockchain is already showing remarkable for

results in improving health care at the level of

application of digital and innovative technologies.

The development strategy is certainly on the side of

these technologies in the near future.

3 CONCLUSION

3.1 Putting All Together – The

Healthcare Interoperability

The purpose of this research was to determine if

there is possible bridge solutions or such a

technology platform that can put Blockchain and

Deep Learning together in purpose of faster, more

secure and reliable transfer of data between

healthcare institutions and the human population in

general as well as improving the preconditions that

would lead to more reliable data analysis and

thereby prediction in healthcare.

With its principle of non-centralized data

collection and non-central database, but sharing and

distributing data across networks by credentialed

users with possibility to add and in the same time

avoiding data alteration, Blockchain becomes a

player in the information industry and in digital

healthcare. From the early buzz of the healthcare it

becomes lately a promising technology that is able

to jump into healthcare interoperability story.

Many hopes and dreams about how and what this

novel technology can accomplish to the healthcare

data and its interoperability. Few of them are very

important to basically push healthcare

interoperability to next level:

Master Patient Index (MPI). Last year in a

presentation at HIMSS17, stated by Tamara St.

Claire that the very nature of Blockchain “actually

incorporate MPI”. She said, “One way to think about

it is the fact that not your identification but your data

is hashed to the ledger. It’s an address you’re

looking for. And there can be multiple addresses.

And a patient can hold multiple keys to those

addresses in their electronic wallet.”

This means that the Blockchain is able to fit into

healthcare interoperability as right player. Besides,

all data with clear MPI are prepared data set for deep

learning trainings algorithm. Any neural network

can easy overtake all MPIs that are securely hashed

by Blockchain and place their blocks into

ICT4AWE 2018 - 4th International Conference on Information and Communication Technologies for Ageing Well and e-Health

predictable algorithms for population health,

optimizing and reducing clinical costs.

Eliminating Middleman. It is already described in

the previous chapter, but once again to recapitulate

in one sentence: with possibility to eliminate

middleman (central data control entity) Blockchain

enabled access to data on large scale. This lead also

to engage it in a population health. With this the

population data are decentralized and accessible

directly for deep learning training data sets in the

purpose of prediction. This method fulfills one the

interoperable gap between interoperability and

predictability.

Multiple Source Data Combination. This is one of

the basic interoperability requests. Blockchain can

overtake a main role as problem solver. It has ability

to combine data from various sources of medical

devices (or originating devices) and also from

mobile and wearable devices sources. Any of the

existing EHR or home health device is directly

impacted in the data source combination and directly

is referred to semantic interoperability.

If the data fit into semantic interoperability they

are also easy conversable into machine learning data

record set and no need additional adjustments for

any predictability methodology.

Blockchain-based technologies will become the

foundation for digital innovation that can reach

millions of lives. A unique combination of artificial

intelligence, smart contracts and the Blockchain will

become the nervous system of our society, helping

us live longer and healthier lives.

Blockchain has an ability to fill the

interoperability gap but still not fulfill it. Hospitals

need more infrastructure improvement all over the

world so they are technologically based ready and

also more healthcare personal resources. Only with

that they were be ready to communicate with same

language – to be operable.

The aim of predictability is a story mostly hangs

around behavioral model, lack of implementation by

healthcare innovation leadership and many

healthcare utilization patterns, risk adjustments and

complexity of healthcare systems. The machine

learning with its subset deep learning is on the right

way to put predictability in the course of healthcare

data interoperability.

Basic efforts and most of the energy in

implementation of these technologies will be on the

theme of Protected Health Information (PHI) or

Personally Identifiable Information (PII). Satisfy a

sufficient amount of architectural standards and

support systems, this will lead to stability and

reliable usability of EHRs.

Pioneering in those two new technologies will

help in better understanding and creating new Rolle

inside the management of the digital healthcare.

Finding a holy grail to fill the gap is very hard

but it is certain in the near future but with noting that

the basic postulate the implementing new

technologies is improving the conditions of human

life in its entirety.

REFERENCES

William, Jacob. Blockchain: The Simple Guide To

Everything You Need To Know (William, 2016).

Mitnick, Gary. BLOCKCHAIN: Learn Blockchain

Technology FAST! (Mitnick, 2016).

(http://searchcio.techtarget.com/feature/How-blockchain-

works-An-infographic-explainer).

Blockchain Technology in Healthcare

APPENDIX

Blockchain in Healthcare – Interoperability Flow

ICT4AWE 2018 - 4th International Conference on Information and Communication Technologies for Ageing Well and e-Health