Review in English： Blessing
The concept of centralization creates a model of governance that demands a hierarchical consensus of various people in the decision-making process. Alternatively, decentralization distributes control and decision-making to a more autonomous structure. Decentralization is at the heart of blockchain technology. Blockchain technology (BCT) is a distributed ledger system that verifies transactions by a peer-to-peer network consensus, and its applications are expanding to different sectors like healthcare1. This article outlines the prospect of blockchain technology in solving some healthcare problems.
Healthcare problems and blockchain solutions.
Patient electronic health records.
Electronic health records (EHR) typically contain sensitive patient data such as billing, social security numbers, and diagnostic and treatment information. Health data breaches can occur in various ways as hacking incidents and unauthorized or improper disclosure. Out of all industries, the healthcare industry loses the most money to data breaches2. Data breaches cost to society is high and results in eroded consumer trust. Blockchain technology has the potential to improve EHR security through decentralized storage.
Patient safety events.
Sentinel events are patient safety events that result in death or temporary or permanent harm. Retained surgical items (RSIs) and wrong site surgery (WSS) are sentinel events. RSIs are any unintended items (e.g., surgical blades or cotton) left inside the patient after skin closure. They contribute significantly to medical errors that cause mortality or morbidity among patients. RSIs occur mainly due to the absence of or noncompliance with preventive policies and procedures. The medical and liability costs associated with each RSI incident are high3.
WSS is a surgery performed on the wrong body side, anatomy, wrong patient, or with the incorrect procedure. For instance, a kidney transplant on the wrong patient at a hospital in Cleveland, Ohio4. Incidences of WSS occur despite efforts to implement protocols and checklists to reduce them5. Surgeons, other staff, or team members can equally cause sentinel events in the operating room.
Blockchain technology can provide solutions for patient safety event tracking. Incorporating BCT into the safety verification process can lead to greater transparency and accountability. BCT can also encourage operating room teams to comply with preventive policies and procedures6.
Patient data access and interchange.
Players in the healthcare ecosystem include patients, healthcare institutions, educational institutions, research institutions, and funding bodies. The activities among these stakeholders require effective data interchange across institutional boundaries. Nations with national health insurance (NHI) systems have centralized population-level databases7 with restricted access due to data protection laws. Alternatively, countries with private health insurance (PHI) systems are troubled with data silos. Both NHI and PHI have access control and interoperability problems. For example, patients cannot access their entire medical records.
Some experts believe the health sector can benefit when ownership of data shifts to patients. Establishing a universal patient record number could be a basis for medical record integration and exchange across providers8. Blockchain solutions can solve access control and interoperability problems the present healthcare ecosystem is facing.
Professional certification and licensing.
The medical profession is susceptible to fraudulent persons pretending to be its members due to the lucrative career opportunities it offers. Fraudulent health practitioners can cause public harm9. Currently, there is no framework to confirm the professional certification or licensing. Blockchain technology can solve the medical profession credentialing problem using its immutability property. Blockchain technology can achieve this by extending the national certification and licensing systems globally6.
Pharmaceutical product authentication.
Electronic commerce revolutionized the way people buy and sell products. A significant proportion of pharmaceuticals sold online are counterfeit. ‘Over-the-counter’ medication is sold directly to the consumers, while ‘prescription only’ medication requires the approval of a healthcare practitioner. Counterfeit medication poses a very high threat to public health and is estimated to cause hundreds of thousands of deaths every year10. Pharmaceutical products such as vaccines require stringent transportation conditions to remain viable and effective. Blockchain technology can solve the pharmaceutical product authentication problem by tracking each transaction across the supply chain to ensure authenticity (provenance).
This article highlights several healthcare problems and their potential blockchain solutions. Although BCT holds so much potential in solving the healthcare problems outlined in this article, there are limitations worth noting. Scalability issues, high implementation costs, unclear regulations, and privacy issues limit the widespread adoption of blockchain technology solutions6.
Innovators are advancing the limits of blockchain technology, and blockchain solutions will soon find adoption. Some within the short term and others in the medium to long term. Two dimensions could impact the blockchain technology adoption timeframe: technological complexity and coordination8. Technologically less-complex solutions requiring simple stakeholder coordination have short-term adoption timelines. In contrast, technologically more-complex solutions requiring a high level of stakeholder coordination have long-term adoption timelines.
Blockchain technology exhibits a lot of prospects in solving healthcare problems. It is essential for healthcare enterprises and governments to deliberately and immediately start exploring how blockchain could help them leap ahead in delivering healthcare solutions. Estonia, a Baltic country making considerable strides in digital technology innovation, offers valuable lessons for blockchain technology adoption. The time to start is now!
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- Sandle, T. The true costs of data breaches revealed. Digital Journal (2023).
- DeWane, M. P. & Kaafarani, H. M. Retained Surgical Items: How Do We Get to Zero? The Joint Commission Journal on Quality and Patient Safety (2022).
- Pitofsky, M. Two employees on leave after Ohio hospital gives kidney to wrong patient. USA TODAY (2021).
- Gloystein, D. M., Heiges, B. A., Schwartz, D. G., DeVine, J. G. & Spratt, D. Innovative Technology System to Prevent Wrong Site Surgery and Capture Near Misses: A Multi-Center Review of 487 Cases. Front Surg 7, (2020).
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- Hsieh, C. Y. et al. Taiwan’s national health insurance research database: Past and future. Clinical Epidemiology vol. 11 349–358.
- Sharma, L., Olson, J., Guha, A. & McDougal, L. How blockchain will transform the healthcare ecosystem. Bus Horiz 64, 673–682 (2021).
- Seggie, J. Trust me, I am a ‘doctor’: Of bogus doctors, medical impostors, and medical fraudsters. South African Medical Journal 101, (2011).
- Lavorgna, A. The online trade in counterfeit pharmaceuticals: New criminal opportunities, trends, and challenges. Eur J Criminol 12, 226–241 (2015).