Work beginning on blockchain, needs good healthcare use case

On the infamous curve of the Gartner Hype Cycle, blockchain has crested the first hill.

That’s not always good—it means the technology has been overhyped, and the rush of euphoria is diminishing. The Trough of Disillusionment awaits.

But that’s not all bad, contends key movers at the Convege2Xcelerate healthcare modernization conference, held Wednesday at Columbia University in New York. Now, the hard work begins, primarily to find use cases that will demonstrate the value of distributed ledger technology.

It’s those use cases that show how the technology can solve a vexing problem in healthcare that will validate the technology, which is being tested in other industries but only in the early stages of research in healthcare, says Brian Behlendorf, executive director of Hyperledger, an umbrella project of open source blockchains and related tools.

“When you talk about patient-centric information and data-driven health research, insurance determination, reduction in drug discovery costs or the supply chain, we need blockchain technology,” he says. “With the two components—distributed ledgers and smart contracts—you can build on top of those.”

More clarity is needed to communicate the fact that blockchain technology will facilitate a network of ledgers, “so we’re not talking about putting patient data on blockchains,” Behlendorf added. “We can use ledgers to verify the integrity of this data.”

For now, however, healthcare organizations are sifting through a lot of proposals and propositions that are far from ready for prime time, says Florence Hudson, special adviser to the Northeast Big Data Innovation Hub for Next Generation Internet at Columbia University.

“You get told that all this data is going to be on the blockchain,” says Hudson, a former IBM vice president and chief technology officer. In healthcare, distributed ledger technology is more likely to hold “data about data—why can’t they be clear about that? The way that they say they’re going, they’re going to run into a regulatory buzzsaw.”

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“People see a new tool and they’re looking for a nail to hit,” said Gil Alterovitz, who’s on the faculty of Harvard Medical School specializing in biomedical informatics, and is with the Computational Health Informatics Program at Boston Children's Hospital. “That may not be the ideal use of it.”

“The technology needs a use case, and the adoption of it will flow from there, says John Halamka, MD, CIO of Beth Israel Deaconess Medical Center, and chairman of the New England Healthcare Exchange Network (NEHEN).

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However, the technology must be fully buttoned down and completely reliable, says Hudson, who draws a line between uses in other industries versus the use of it in healthcare.

She had a recent conversation with two longshoremen who could explain how blockchain technology was applicable to shipping; but she believes the technology is a long way from being trusted in healthcare.

“If there’s misinformation in shipping, that’s one thing. In healthcare, that’s completely different,” she said. “Providers have to be sure that the information contained in a blockchain is immutable.”

Patient privacy also may be at risk on current iterations of blockchain, even if only metadata may be stored on it, Halamka says. For example, a patient might have metadata on a blockchain only indicating which provider provided treatment, but if that provider specializes in addiction treatment or behavioral treatment, then protected patient health information could be deduced from that, he noted.

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