Page 194 - ITU KALEIDOSCOPE, ATLANTA 2019

2019 ITU Kaleidoscope Academic Conference

and legal risks of healthcare blockchains are then presented and operations of the blockchain are truly immutable, then it
in section 5. cannot evolve to reflect the changing needs from its users
and the commercial / legal environment. A blockchain is
2. HEALTHCARE BLOCKCHAINS simply a distributed data structure that does not create value
until it is applied in a particular economic context. In their
A variety of healthcare applications have been proposed survey, [17] categorized the health data referenced by the
3
[3],[11],[12],[13] including drug counterfeiting prevention , blockchain as financial, database queries, transaction records,
clinical trials, public healthcare management, longitudinal ambient temperature, consent forms, clinical trial records,
healthcare records, automated health claims adjudication, personal records, medical records, sensor data and/ or
online patient access, sharing patients’ medical data, user- location data. Medical records, sensor data and personal
oriented medical research, precision medicine and smart records were the most frequently identified data categories.
contracts to improve the credibility of medical research. From 19 companies, [18] identified healthcare data being
Healthcare applications are being created; [14] identified managed as electronic medical records, electronic health
nine different healthcare applications on Ethereum and two records, and personal health records. electronic medical
applications on Hyperledger. [15] points out that healthcare records (EMRs) contain clinical data related to a specific
applications must balance patient care with information patient stored by the responsible healthcare provider [19].
privacy, access, completeness and cost. The designers of Personal health records (PHR), store data collected by
healthcare information systems may have a number of patients monitoring their health conditions, using their smart
different requirements associated with the systems they are phones or wearable devices [20]. Electronic health records
designing, and the criteria for applying blockchain are not (EHRs), for example, are designed to allow patient medical
always clear [16]. Applications may be a good fit for history to move with the patient or be made available to
blockchain according to [15] if: multiple stakeholders are multiple healthcare providers [21]. [22] proposed a
contributing; more trust is required between parties than blockchain-based EHR as a mechanism to share data
currently exists; an intermediary could be removed or between PHRs and EHRs; but it did not resolve the trust and
omitted to increase trust or efficiency; there is a need for access control mechanisms required. The blockchain PHR
reliable tracking of activity and there is a need for data to be feasibility study in [23] revealed some challenges due to the
reliable over time. In their survey, [17] categorized size of the data records (which impacted both the
healthcare blockchain application areas as clinical trials, performance of the system and operational costs) as well as
biomedical databases, health records, medicines supply, privacy aspects. A blockchain as a database of personalized
medical insurance, wearables and embedded or mhealth, records is likely structured significantly differently than a
with the majority of papers on health records. [14] also noted cryptocurrency blockchain (e.g. separate blockchains for
electronic medical records as the most common area with an personal records c.f. common blockchains for fungible
increasing numbers of papers. In their survey, [17] identified currencies of commodities). The data lifecycle in the
the following rationales for using blockchains in healthcare healthcare blockchain would depend on the use cases that are
applications: access control, non-repudiation, data needed to support the healthcare actors.
versioning, logging, data provenance, data auditing and data
integrity. Access control, data integrity and logging were the 2.2 Actors in healthcare blockchains
most prevalent rationales. [14] identified the benefits of
blockchains for healthcare applications as decentralization, In considering the role of blockchain in a value chain, [24]
improved data security and privacy, health data ownership, identified the need to decide not just what valuable
availability/robustness, transparency and trust, and data information to be captured in the blockchain, or what
verifiability. The data stored in and the actors operating on a operations need to be performed by the blockchain, but also
healthcare blockchain lead to some differences (c.f. for whom the blockchain should be accruing this value. In
cryptocurrencies) in required blockchain features. EMR applications of blockchains, as an example, the value
of the recorded data in the blockchain is not intrinsic; rather
2.1 Data in healthcare blockchains it comes from the association with a particular user e.g. a
patient or a medical practitioner. As a result, the transactions
Blockchains maintain timestamped and cryptographically adding data to the blockchain are most likely not anonymous
signed blocks of transaction data. The data integrity transactions as in bitcoin; rather using the hash as an
mechanisms of the blockchain provide limitations in electronic signature to establish the provenance of the data.
operational flexibility and governance. If the data structures While medical actors may have need of the broader range of

3 The Drug Supply Chain Act (DSCSA) of 2013 requires the
Food and Drug Administration (FDA) to develop standards and
regulations for an interoperable electronic system to identify
and trace medications. A number of pilot projects for this
purpose have been developed using blockchain technologies
(https://www.drstevenawright.com/pharmaceutical-supply-
blockchains/).

– 174 –