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White Paper

Blockchain for
Healthcare
An opportunity to address many
complex challenges in healthcare

May 2018
OVERVIEW OF BLOCKCHAIN TECHNOLOGY
In today’s digital world, different systems interact with The private key. A message which is encrypted using a
each other for data and information exchange. We private key can only be read by any node with a public
expect each interaction / transaction between the key which is linked to the private key, thus limiting the
systems to be secure and reliable. Blockchain is a new number of users to access or read an encrypted
technology that promises an efficient, cost-effective, message or data.
reliable, and secure system for conducting and
recording any transaction without the need of Any action on blockchain is a function of network, so to
middleman. alter any transaction data the hacker should modify the
same data in all the nodes in the network. It basically
A Blockchain database is a distributed database that means hacking into all the systems in the network at a
records and stores transaction data in the form of time time, which is practically impossible to do. Blockchain is
stamped “Blocks” linked to each other in such a way consensus- based; every transaction needs approval
that no one can alter any transaction data. Members of from more than half of the participants or nodes before
the Blockchain network who validate the transactions execution. Every transaction in blockchain is public but
are called nodes. Blockchain technology allows access to content of each transaction can be limited or
different types of nodes to enter Blockchain Network restricted based on the sensitivity of the transaction.
using specialized software such as Ethereum Today blockchain is finding applications in every field.
performing different functions 1] Mining nodes in the like finance, healthcare, economics, legal, etc. Some
blockchain network will be assigned a secret private examples from healthcare sector use cases where
key and a public key pair. Public key acts as “Public blockchain can be used are: EHRs, drug traceability from
Address” which is visible to all participants. Private and manufacturer to consumer, clinical trials to eliminate
Public key pair is cryptographically linked such that fraudulent data modifications and interoperability
identification is possible in only one direction using

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HOW BLOCKCHAIN ADDRESSES CURRENT HEALTHCARE CHALLENGES
Blockchain provides us with a tremendous opportunity Interoperability
to overcome challenges that exist in the healthcare Today healthcare organizations are at different
industry today, including interoperability, security, maturity levels as far as interoperability of healthcare
integrity, traceability and universal access. data is concerned. There are some organizations who
are exploring use of FHIR, while several organizations
Blockchain addresses current challenge for syncing
are using the CDA standard for data exchange and
patient data between multiple disparate HIS while
some share data using HL7 2.X standard Varying data
ensuring patient data security and privacy by adopting
standards across organizations is another challenge
a distributed framework for managing patient identity.
which reduces which hamper Quality scores
Some of the healthcare challenges that blockchain
interoperability Blockchain helps overcome this
addresses includes
challenge by accessing data through APIs. With
transfer of data through APIs, blockchain achieves
standardization of data format, which is used to
transmit data irrespective of the capabilities of EHRs
to communicate different HL7 versions.

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Security Universal Access
Security in healthcare industry encompasses various Managing access to patient data across healthcare
aspects based on integrity of data maintained in an entities is a challenge where Blockchain can help.
organization. Tampering and security breach of Blockchain ensures that required data is present at
healthcare data is a growing concern for many every node and is available for use to the authorized
healthcare organizations. It is difficult to tamper with entities based on the access rights provided through
data present in blockchain as it requires validation from smart contracts or other mechanisms.
different nodes in the chain. Blockchain offers inbuilt
security features as the data in blockchain is encrypted Cost of Maintenance
with private key of the sender and only intended
Maintenance of a typical healthcare information
recipient can decrypt data using key from the sender. system involves various operations including but not
limited to performing backup storage services, having
Integrity
recovery mechanisms in place and ensuring up to
Blockchain’s distributed ledger and immutable date fields. In case of blockchain, data is distributed
transactions helps ensure data integrity while across the network and there is no single point of
encryption of data enhances data security across the failure leading to inherent backup mechanism.
network. With the implementation of Blockchain
technology, multiple instances of obsolete patient data Also, a single version of data is copied on every node
with various stakeholders are replaced with single of the blockchain. This reduces transaction volume
source of up-to-date information of patient that occurs between each information system
information. Patient is the custodial owner of data reducing the burden on the healthcare ecosystem
controlling who has access to PHI information.
.

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APPLICATIONS OF BLOCKCHAIN IN HEALTHCARE
Blockchain with its distributed ledger technology has problems, diagnosis are recorded by the physicians
captured the markets attention for its data handling and they continue to retain stewardship of those
capabilities with respect to decentralization and sections after a patient’s treatment. In a blockchain
security. With its relatively successful implementation implementation, a patient holds the stewardship of
in the financial domain, various industries are now medical record and physicians will be given access on
realizing its benefits and are exploring the potential of a need basis through “smart contracts”.
blockchain in their respective domains. Healthcare is
one such industry looking at unlocking the benefits of One of the issues EHRs face currently is maintenance
blockchain. Several opportunities exist in healthcare of records accurately involving correction of any
wherein blockchain can help improve interoperability erroneously recorded data. Apart from ensuring data
and privacy of patient health data. Some of the integrity, different providers and hospitals system face
important healthcare applications are discussed in this interoperability challenges leading to ineffective data
article. sharing, if any at all. The lack of coordination in data
management and exchange leads to health records
Blockchain for EHRs being fragmented.[2] Blockchain framework can help
alleviate data fragmentation issues across healthcare
The ideal scenario with EHRs is to maintain a life time entities. With blockchain implementations for EHRs,
medical record and be accessible to care team members of a private, peer-to peer network can share
including physicians, lab technicians etc. at the point the block content with appropriate viewership
of care and on time. In current implementations of permissions, while the original member maintains
EHRs, patient data is stored across different ownership of the data shared. In addition, blockchain
organizations throughout the patient’s lifetime. Few supports “smart contracts which are basically self-
sections of a patient’s medical record like medication executing contracts with the terms of agreement

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coded in them. Smart contracts allow automation and their own storage structure and semantics. This leads
tracking of state transitions like viewership rights or to hurdles when it comes to sharing of the data.
new record creation in a system. To guarantee data These hurdles are partly due to nature of the data in
integrity, blockchain includes cryptographic hashing of question (Protected Health Information) or to prevent
records. The care team can add new records to a information blocking during exchange. This not only
patient's profile, while the patient decides which has an implication on treating patients efficiently
provider views the information by authorizing them. across multiple organizations, but also hampers the
This ensures patient and provider engagement and field of clinical research, which requires real life
helps in the evolution of patient records. Blockchain medical data to conduct research and test their
architecture is built on principles of decentralization hypothesis in real world scenarios with real world
and cryptography, which could contribute to more data. Clinical trials need patient data which is de-
secure and highly interoperable EHR systems. identified. Consolidating and de-identifying patient
data takes significant time and effort, which leads to a
Blockchain in Clinical Research considerable cost.

While there has been a considerable advancement in A critical factor in attaining higher accuracy in outputs
moving medical data from paper to digital records, of clinical research and trials is the availability of large
healthcare industry is still working its way through sets of real life de-identified raw data, analyzable
issues regarding sharing of patient data across datasets for secondary analysis and meta-analysis
providers and organizations. Throughout their lives, Polls show that majority of consumers are open to
patients may move cities, change health plans, switch sharing their medical records for analysis and research
their healthcare providers for their treatments. Most of on the assurance that their privacy is maintained, and
their detailed medical records tend to remain in silo the data is secured.
with the individual facility or provider. Furthermore,
each medical entity would have saved patient data in

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APPLICATIONS OF BLOCKCHAIN IN HEALTHCARE
With trust is built into Blockchain database, there is a efficacy and safety of product is paramount. The
high degree of transparency. Records are publicly journey of the product from manufacturer to
writable by anyone and owned (stored) by no one, consumer has multiple stages: transportation,
with security of data being provided through handling, storage, redistribution, retail. Things can go
encryption. Using private and public key cryptography, wrong during these stages, from simple human error
a shared ledger can facilitate information sharing and to malicious intent (fraud). In a conventional system, it
community driven clinical study. Patients can directly can get difficult to identify the problem as participants
control their medical data and rights to grant or in the supply chain may usually maintain their own
withdraw data access to care givers and organizations. records and may share their information usually just
Such a platform would be a vital in helping research one level up and one level down the chain.
organizations get direct and secure access to a vast Furthermore, if these records are paper-based, they
repository of holistic and accurate clinical data. are more prone to errors. These factors further delay
investigations to identify the issues with drug supply
Blockchain in Drug Supply Chain chain.
Management Additionally, with governments and consumers
One of the main challenges in the pharmaceutical demanding transparency in the supply chain for such
industry is the transparency and security aspect of products, companies have worked towards
supply chain management. Pharma companies incur maintaining an open or transparent supply chain
losses in millions annually due to counterfeit drugs. system. Depending on one organization to track
Pharma companies deal with products that directly irregularities still isn't fool proof.
impact the lives of their consumers,[3] which is why

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Blockchain helps in addressing the supply chain issues for patient medical condition, misrepresenting non-
by providing a distributed ledger which is shared covered medical services as services which are
among all the stakeholders within the supply chain. covered for obtaining claims money and covering
The records entered in the blockchain at each stage in financialand
efficacy loses.
safety of product is paramount. The
the supply chain are immutable, permanent and journey of the product from manufacturer to
decentralized. This in turn removes the vulnerability of There are many intermediaries involved to verify and
consumer has multiple stages: transportation,
introducing errors or fraud. Counterfeit drugs are adjudicate the claim information, to ensure there is
handling, storage, redistribution, retail. Things can go
reduced by maintaining a chain of custody log that very less time lag for claim processing and reduce the
wrong during these stages, from simple human error
lets organizations track each step of the supply chain administrative cost for providers and payers. A typical
to malicious intent (fraud). In a conventional system, it
at an individual drug or product level. With blockchain process of claim adjudication involves lot of back and
can get difficult to identify the problem as participants
system in place, even the end consumer now has all forth of communication between parties involved for
in the supply chain may usually maintain their own
the information regarding the product right from claims processing. Blockchain system helps reduce
records and may share their information usually just
creation to consumption. most of these challenges faced during claim
one level up and one level down the chain.
adjudication and payment processing activities. The
Furthermore, if these records are paper-based, they
Blockchain in Claim and Billing blockchain solution can automate the required
are more prone to errors. These factors further delay
workflows and then all the parties involved can share
Management investigations to identify the issues with drug supply
single copy of the contracts and billing related
chain.
information.
One of the losses in healthcare which needs to be
eliminated and avoided is fraudulent claims and Additionally, with governments and consumers
billing. Medical billing-related fraud is still very demanding transparency in the supply chain for such
common in the healthcare space. Some of the very products, companies have worked towards
common healthcare frauds are providers claiming maintaining an open or transparent supply chain
charges for the non-performed services, overcharging system. Depending on one organization to track
the actual services, performing unnecessary services irregularities still isn't fool proof.

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Blockchain Application in HIE
HIE’s primary objective is to transmit healthcare data In a traditional set up of HIE, data from different users
beyond geographical and institutional boundaries to in the network
efficacy is stored
and safety in theirispersonal
of product paramount. storage
The
provide an effective and secure delivery mechanism. systems
journey of the product from manufacturer tobasis. It
as well as sent to HIEs on a periodic
With a universal sharing mechanism in place, lot of is a centralized
consumer storage system,
has multiple where failing of the
stages: transportation,
factors need to be considered, like: central storage
handling, would
storage, put the updates
redistribution, retail.of several
Things can go
patient
wrong during these stages, from simple human data
medical records at risk. With increase in error
 Security: Data privacy is of utmost importance, for each patient from various sources such as
to malicious intent (fraud). In a conventional system, it
failure to secure patient data has financial as well as wearables, physicians,
can get difficult lab reports,
to identify HIEs are
the problem under
as participants
legal implications. pressure to scale
in the supply chainthemay
infrastructure and support
usually maintain their own
variety of data sources.
records and may share their information usually just
 Infrastructure: Sharing data traditionally requires
a centralized data source which increases the one level up and one level down the chain.
In a blockchain technology architecture, each patient
security risk foot print and requires trust to a single Furthermore, if these records are paper-based, they
controls ownership of the medical record, as against
are more prone to errors. These factors further delay
centralized authority. traditional architecture, where a central authority
investigations to identify the issues with drug supply
controls accesses and distributes data across network.
 Interoperability: Data should be shared in such a chain.
way that all the required parties can understand the Medical record access is permitted to only limited
structure and meaning Additionally, with governments and consumers
healthcare entities (people or organizations). Shared
demanding transparency in the supply chain for such
data across the blockchain network enables near real
On a blockchain, all data is encrypted with the private products, companies have worked towards
time updates across all healthcare entities. Secure
key of participants in the network. Only few nodes or maintaining an open or transparent supply chain
access to patient 360 data is possible through the
participants are given access to information by sharing system. Depending on one organization to track
distributed ledger. Data duplicity is reduced as the
the public key of a sending participant, thereby irregularities still isn't fool proof.
same copy of data is available to all.
ensuring confidentiality and privacy.

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REGULATIONS AROUND BLOCKCHAIN
There are no regulations as of today around Challenges in Implementing
efficacy and safety of product is paramount. The
blockchain in the healthcare domain. The US Blockchain Technology
journey of the product from manufacturer to
healthcare department has started to take interest in
understanding the use cases and applications of consumer has multiple stages: transportation,
Blockchain technology has been widely adopted in
blockchain in healthcare. ONC is also actively handling, storage, redistribution, retail. Things can go
the banking industry over the last decade. However,
considering the proposals submitted in a competition wrong during these stages, from simple human error
the awareness and adoption of this technology in
arranged by US government. Plan is to evaluate the to malicious intent (fraud). In a conventional system, it
healthcare domain is yet to materialize. Organizations
proposals which include peer to peer network for can get difficult to identify the problem as participants
face challenges in understanding how blockchain
analysis of patient health data with focus on security in the supply chain may usually maintain their own
works and the benefits associated with it. Enterprise
and privacy aspects, enhancing interoperability records and may share their information usually just
systems are still centralized, and organizations are not
solutions for information exchange, patient tracking, one level up and one level down the chain.
ready to adopt the new distributed data culture
improving healthcare claims processing and Furthermore, if these records are paper-based, they
completely by implementing blockchain. Another
decentralized record management system for are more prone to errors. These factors further delay
challenge that the companies face in implementing
electronic health records. ONC plans to introduce a investigations to identify the issues with drug supply
blockchain is around investments. The cost of
Blockchain-based infrastructure which healthcare chain.
executing peer-to-peer transactions on blockchain
companies in the US can leverage to create their network is huge forgovernments
ensuring speed
Additionally, with andand effectiveness.
consumers
unique private systems.
demanding transparency in the supply chain for such
While blockchain technology has its own set of
products, companies have worked towards
challenges, it can play a significant role in addressing
maintaining an open or transparent supply chain
existing interoperability and security challenges of the
system. Depending on one organization to track
healthcare industry.
irregularities still isn't fool proof.

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CONCLUSION
Blockchain technology is an emerging technology and has a
huge potential not just to impact few industries but it can efficacy and safety of product is paramount. The
change the way businesses are done. The adoption of journey of the product from manufacturer to
blockchain technology in healthcare has started and we can consumer has multiple stages: transportation,
expect to have commercial blockchain solutions in the market handling, storage, redistribution, retail. Things can go
in near future. Most of the healthcare use cases for blockchainwrong during these stages, from simple human error
are intended to provide secure and integrated care to the to malicious intent (fraud). In a conventional system, it
patients can get difficult to identify the problem as participants
in the supply chain may usually maintain their own
records and may share their information usually just
REFERENCES one level up and one level down the chain.
Furthermore, if these records are paper-based, they
are more prone to errors. These factors further delay
 http://blog.appliedinformaticsinc.com/blockchain-
investigations to identify the issues with drug supply
transparency-integrity-and-clarity-to-the-healthcare-system/
chain.

 https://www.healthit.gov/sites/default/files/14-38- Additionally, with governments and consumers


blockchain_medicaid_solution.8.8.15.pdf demanding transparency in the supply chain for such
products, companies have worked towards
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4105729/ maintaining an open or transparent supply chain
system. Depending on one organization to track
irregularities still isn't fool proof.

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ABOUT THE AUTHORS
Vishal Rawal efficacy and safety of product is paramount. The
Healthcare Consultant, CitiusTech journey of the product from manufacturer to
vishal.rawal@citiustech.com consumer has multiple stages: transportation,
handling, storage, redistribution, retail. Things can go
Vishal has over 6 years of experience in information technology industry. Vishal is a healthcare technology
wrong during these stages, from simple human error
professional with strong experience in the area of healthcare provider-payor workflows, disease management, HL7
to malicious intent (fraud). In a conventional system, it
Integration and business intelligence for leading healthcare provider organizations. Vishal has worked on several
can get difficult to identify the problem as participants
healthcare projects for leading provider organizations and healthcare ISV’s. Vishal has a Masters in Information
in the supply chain may usually maintain their own
Technology Management
records and may share their information usually just
one level up and one level down the chain.
Furthermore, if these records are paper-based, they
Prashant Mascarenhas are more prone to errors. These factors further delay
Healthcare Consultant, CitiusTech investigations to identify the issues with drug supply
prashant.mascarenhas@citiustech.com chain.
Prashant has more than 8 years of experience in the information technology industry, with over 4 years of
experience in healthcare technology and consulting, primarily Additionally, with governments
focused on provider and consumers
and ISV segments. Prashant’s
demanding transparency in the supply
core area of expertise includes working with major ISVs in the US in the fields of Revenue Cycle Management chain forand
such
products,management.
Population Health Management. Prashant has a Masters in IT business companies have worked towards
maintaining an open or transparent supply chain
system. Depending on one organization to track
irregularities still isn't fool proof.

11
Manan Shah efficacy and safety of product is paramount. The
Healthcare Consultant, CitiusTech journey of the product from manufacturer to
manan.shah@citiustech.com consumer has multiple stages: transportation,
handling, storage, redistribution, retail. Things can go
Manan Shah has 6+ years of experience in healthcare technology, spanning various domains including healthcare
wrong during these stages, from simple human error
interoperability, regulations and analytics. At CitiusTech, Manan leads consulting team for Medical Technology
to malicious intent (fraud). In a conventional system, it
Market where he helps track emerging domain and technology trends impacting HIT organizations. Prior to joining
can get difficult to identify the problem as participants
CitiusTech, Manan worked extensively on delivering cloud solutions for a leading technology organization. Manan
in the supply chain may usually maintain their own
has a Masters in Information Technology Management
records and may share their information usually just
one level up and one level down the chain.
Furthermore, if these records are paper-based, they
Sai Sravan Kondaka are more prone to errors. These factors further delay
Healthcare Business Analyst, CitiusTech investigations to identify the issues with drug supply
saisravan.kondaka@citiustech.com chain.
Sai Sravan has over 5 years of experience in the Information Technology industry, including 2 years of experience in
Additionally, with governments and consumers
Healthcare technology and consulting, primarily focused on provider and ISV segments. Sai Sravan’s core area of
demanding transparency in the supply chain for such
expertise includes working with major healthcare providers, EHRs in US, and analyzing US healthcare regulations
products, companies have worked towards
such as MACRA, MU, and their impact on various stake holders. Sai Sravan has strong experience in the area of
maintaining an open or transparent supply chain
healthcare provider workflow. Sai has worked on various assignments with Healthcare ISVs, ONC certifications.
system. Depending on one organization to track
irregularities still isn't fool proof.

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CitiusTech is a specialist provider of healthcare technology services and
solutions to healthcare technology companies, providers, payers and life
sciences organizations. With over 2,900 professionals worldwide,
CitiusTech enables healthcare organizations to drive clinical value chain
excellence - across integration & interoperability, data management
(EDW, Big Data), performance management (BI / analytics), predictive
analytics & data science and digital engagement (mobile, IoT).

CitiusTech helps customers accelerate innovation in healthcare through


specialized solutions, healthcare technology platforms, proficiencies and
accelerators. With cutting-edge technology expertise, world-class service
quality and a global resource base, CitiusTech consistently delivers best-
in-class solutions and an unmatched cost advantage to healthcare
organizations worldwide.

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