Blockchain Technology: Still Searching for a Place in the Health Care Ecosystem

Once considered a revolutionary way to keep patient data secure and easily accessible, the technology continues to look for its sweet spot.

By John Halamka, M.D., president, Mayo Clinic Platform, and Paul Cerrato, senior research analyst and communications specialist, Mayo Clinic Platform

“Simply put, blockchain holds the potential to revolutionize healthcare.” Those words of praise from Forbes Magazine suggest that this technology is poised to have a major impact of clinicians and health care executives worldwide. Is such enthusiasm justified?

In theory, the technology could enhance security controls around health record access. To understand these potential benefits, it helps to understand the basics about the technology; it also helps to understand what it’s not. It’s not a traditional database, in which all a health record from a patient is physically located in one place—a hospital’s server for example. With blockchain, that data can be in computers scattered around an entire country, or the world if they have been treated in more than one country. The blockchain links all these computers—referred to as nodes—to create a distributed ledger, i.e., a secure, immutable record of transactions. According to the U.S. National Institute of Standards and Technology (NIST), blockchain refers to “tamper evident and tamper resistant digital ledgers implemented in a distributed fashion (i.e., without a central repository) and usually without a central authority ([e.g.,] a bank, company, or government). At [its] basic level, it enable[s] a community of users to record transactions in a shared ledger within that community, such that under normal operation of the blockchain network no transaction can be changed once published.” The chain of data or transactions are called blocks and they are linked together with encrypted signatures, called hashes. The ledger contains all the patient data that are shared by those who are given permission to see but not alter the entries.

Although blockchain technology has been available for many years and serves as the backbone of the bitcoin industry, it’s still very new to the medical world, which makes it difficult to offer a real-world assessment of its strengths and weaknesses. Estonia is the first country which uses the blockchain in health care and in 2016 it launched a blockchain technology to secure the health records of the patients. In the UK, two hospitals were the first to deploy blockchain technology to monitor the storage and supply of temperature sensitive COVID-19 vaccines. A Reuters report explains: “The tech will bolster record-keeping and data-sharing across supply chains, said Everyware, which monitors vaccines and other treatments for Britain’s National Health Service (NHS)…”

As the Reuters report points out: “Firms from finance to commodities have invested millions of dollars to develop blockchain, a digital ledger that allows the secure and real-time recording of data, in the hope of radical cost cuts and efficiency gains. Results have been mixed, though, with few projects achieving the revolutionary impact heralded by proponents.”

Such mixed results beg the question: What happened to the revolution once predicted by blockchain enthusiasts? One reason is a lack of scalability. In addition, there are already trusted agencies in the health care ecosystem. Another problem: there’s no significant incentive—financial or otherwise--to alter existing patient records. Equally important is the fact that there are other solutions to check the integrity of data and to handle database immutability. One way to address these issues is to use blockchain to doublecheck the integrity of medical records stored in more traditional databases. Such records often have different origins and provenance (from patients, from different types of laboratories, for example). Having an integrity check allows the physician and/or patient understand where the data came from with certainty and that the data has integrity.

Like many “revolutions,” blockchain continues to face problems when implemented in the real world. Its true value will take time and patience to determine.