Page 193 - ITU KALEIDOSCOPE, ATLANTA 2019

TECHNICAL AND LEGAL CHALLENGES FOR HEALTHCARE BLOCKCHAINS
AND SMART CONTRACTS

Steven A. Wright 1
1 Georgia State University

ABSTRACT [5] are computerized transaction protocols executing
contractual terms on top of the blockchain as code to
The paper considers the technical and legal challenges minimize risk [6]. Digital Autonomous Organizations
impacting recent proposals for healthcare applications of (DAOs) have been proposed as legal entities based on
blockchain and smart contracts. Healthcare blockchain data blockchains. Blockchain technology is evolving rapidly and
and actors are rather different to cryptocurrency data and some [7] refer to generations of blockchain, with Blockchain
actors, resulting in a different emphasis on blockchain 1.0 associated with cryptocurrency, Blockchain 2.0
features. Technical issues with healthcare blockchain associated with smart contracts and Blockchain 3.0 including
implementation and trust are considered, as well as a variety other application areas like health and IoT.
of potential legal issues. Conclusions and recommendations
are proposed for open source and standardization efforts to Blockchains are increasingly proposed as solutions in
reduce technical and legal risks for healthcare blockchains healthcare; however, technical and legal issues remain as
and smart contracts. risks for design and deployment of healthcare blockchains.
One way to reduce risk and build trust in a software system
Keywords – blockchain, healthcare, legal, smart contract is through the use of standards [8]. Though not specifically
in the healthcare area, a number of standards development
1. INTRODUCTION organizations have started work in the area of distributed
1
ledger technologies including IEEE, ISO ITU-T, W3C.
Blockchain’s rise in popularity is usually traced from bitcoin Standards typically promote interoperability between
though some antecedents exist [1]. Blockchains provide a complex systems. Open source software projects are also
distributed, peer-peer, linked data structure; a distributed emerging that reduce risk as a complement to some
ledger that can be used to maintain transaction order and traditional standardization activities [9]. Open source
consistency. A ledger is a book of accounts or transaction software can also increase the trust in a software system
history that could be implemented in a number of ways. A because the code is publicly available for inspection [10].
blockchain can also be considered as a distributed database Open source implementations enable rapid evolution of
organized as a list of ordered, immutable blocks, where the technologies to adapt to uncertain and evolving requirements.
entries in those blocks are not always transactions. The A number of blockchain projects have open source code
computing nodes (miners) of the blockchain sequence the available and some have initiatives focused on healthcare.
2
blocks with timestamps and maintain integrity with each Development of open source or standards takes time, but
block containing a hash of the previous block. The uncertainty around treatment of legal issues from
blockchain structure maintains properties such as accumulating legal precedent and evolution of laws and
transparency, robustness, auditability and security [2]. While regulations in diverse jurisdictions may take longer.
the initial bitcoin application was 'permissionless', recently
applications have featured authorized use of the blockchain The scope of healthcare blockchains is reviewed in section 2
by trusted users. Beyond cryptocurrencies, blockchains have to illustrate the variety of proposals and contrast these with
been proposed for applications in a number of different fields cryptocurrency applications. Technical issues of particular
including financial, integrity verification, governance, relevance to healthcare blockchains are considered in section
Internet of things (IoT), health, education, privacy and 3. A variety of general potential legal issues of healthcare
security, business and industry [3]. The United Nations is blockchain operations are discussed in section 4.
also exploring options for blockchains [4]. Smart contracts Conclusions and recommendations to reduce the technical

1 ISO/TC 307 has a number of specifications under development 2 e.g. https://www.hyperledger.org/resources/industries/healthcare
including a Reference Architecture (ISO/CD 23257),
Terminology (ISO/DIS 2739) and work on Smart Contract
interactions (ISO/TR 23455).

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