Global Disasters, Mobile Health and Blockchain (PART II)
By Marc Wine, MHA
Part One of this Article focused on the underutilization of existing technologies to improve disaster relief in the field of healthcare. Now we turn to another relatively new technology that has already been applied to the personal health arena; although, there has been considerable discussion as to its merits generally and in healthcare in particular: blockchain. And, for the record, blockchain will not be the only or last technological advance to infiltrate healthcare.
And, to be clear, many people think the beginning and end of blockchain is tied to and centers around bitcoin and cryptocurrency, a vastly too narrow a perspective on this technology as it currently exists and it may exist a decade or two from now.
By way of background, much of the world has already taken steps to encourage and promote the use of personal and population health data and tools to “liberate” data (with key security protections in place) to advance research and innovation. There is a place, as developed here, for these innovations to be extended to our response to disasters if we expand how we think about and manage data.
Since 2011, the Open Government Partnership (OGP), an international partnership currently encompassing 69 countries, has been working to “promote transparency, empower citizens, fight corruption, and harness new technologies.” OGP was established with eight countries -- Brazil Indonesia, Mexico, Norway, the Philippines, South Africa, the United Kingdom, and the United States.
The increased focus on data transparency has helped to create what is often referred to as a “Big Data Revolution,” with promises slowly being realized of dramatic breakthroughs in population health, disease management, and personalized medicine. How we apply these data as a personal service for consumers is a topic that is growing in importance and being recognized as a critical new focus for Big Data usage.
But, as evidenced by recent challenges, more can be done within existing contexts and for disaster management. One pathway toward improvement is through blockchain. Investing in this technology can, if done well and with an eye to costs, be deployed to overcome the complex hurdles that currently prevent health IT, data and information systems sharing.
Step One is Using Blockchain to Improve Healthcare
Different definitions of blockchain have floated across the literature and landscape. Let’s consider it in general as “a series of connected machines for creating trust.” With that in mind, we need to ask how blockchain’s benefits can be leveraged to connect health IT exchanges and information systems during a natural disaster and in so doing, provide access, security, scalability and privacy.
To that end, we need to focus first on blockchain’s use in healthcare and then apply the best aspects to disaster relief. This analysis is deeply informed by the work of Peter Nichol and Jeffrey Brandt. To be clear, blockchain’s benefits in disasters presuppose the use of blockchain, and that is a challenge in and of itself.
Patients in a blockchain environment are provided with a code in the form of a private key and a cryptographic or distributed hash with an address. These are what enable individuals to unlock their personal patient data. While the patient data is not literally stored in the blockchain, the blockchain provides the authentication or required hashes to enable access.
The contributors to patients’ medical records (e.g. medical providers and we can debate who qualifies as such given the wide array of providers and the deep silos in healthcare delivery) are provided a separate means of access (codes, hashes, or multi-sigs). These medical providers’ access codes when combined with the patient’s access codes enable the data to be unlocked. The patients control both the content of their profile (although the effectuation of that seems difficult given that the data are provided by third parties) and unlocking requirements.
To be sure, the challenges of this almost leap off the page, even absent a natural disaster. If dual authentication is required, then there are two separate computer systems that are implicated. The good news is that both would need to be compromised for unauthorized access. And there is authentication that is recorded so one can follow both access and efforts to access that fail. Hash algorithms and public key infrastructure (PKI) guarantee the records’ validity and enable documents that are authentic and certified.
Blockchain allows patients and providers to share health information in a trusted ecosystem in which the provenance of the product, service, or interaction can be uncovered. Provenance creates the opportunity for an historic record of the full supply chain of food products (allergies), prescriptions, and even medical records.
Blockchain’s characteristics (which can be refined over time as the technology matures and perhaps morphs) can free health IT open solutions and devices from closed proprietary revenue strong holds and strangleholds. This will enable health data with privatized identify control and consumer empowerment of the individual, and create better management of unclassified controlled information that is causing exposure to liability and risk adversity across governments and institutions.
The Challenges and Benefits of Blockchain in Disasters
The benefits of blockchain in a disaster situation are not the hard part and they can be envisioned with relative ease. The true, accurate medical histories of a devastated population could be accessed so that providers in other regions (and rescuers) could provide seamless care with interventions and medicines that are tailored to each and every patient (assuming there is blockchain in place pre-disaster, another challenge to be sure, particularly in third world nations and in situations where there is only partial provider compliance).
If blockchain were in place and operable during disasters, this would enable remarkably improved healthcare delivery to the affected populations: there would be access to health data; the data would be timely enabling on-the-spot intervention and responsiveness; there would be proof of identity, trust and accountability (and auditing post event) and the deep challenges to current situations where health records are not readily available or transferable.