8 ms·

Blockchain Healthcare 2016 Report – Promise and Pitfalls

78 points by kysar_tom 10y ago

dvcc 10y ago
I read through this and I still have no idea what they actually applied the idea of the blockchain to within healthcare. To an HIE? Does each patient receive their own "wallet" that is their patient record? This just seems to be a generic overview of EHRs/Blockchains within the same page.
- waynevaughan 10y ago
  Thanks for reading the report. This last weekend there was the first Blockchain Healthcare conference where blockchain was pitched as a panacea for a wide spectrum of healthcare problems. https://godistributed.com/health/ https://godistributed.com/health/ Our report was targeted at a non-technical audience. Printed copies were distributed to about 500 attendees. We wanted to make them aware that while there may some opportunities for using blockchain technology also comes with substantial risks. We want to help them cut through the hype and maintain a healthy dose of skepticism. Gartner recently placed blockchain technology at the beginning of their hype cycle. https://pbs.twimg.com/media/CtxEq0MWAAA3EQe.jpg https://pbs.twimg.com/media/CtxEq0MWAAA3EQe.jpg
  - RyJones 10y ago
    Not coincidentally, Hyperledger just started a working group for healthcare. [0] Coincidentally, a healthcare application won this week's Hackathon in Amsterdam [1] https://www.finextra.com/pressarticle/66385/medical-data-application-wins-abn-amro-hyperledger-hackathon https://www.finextra.com/pressarticle/66385/medical-data-app... [0] https://lists.hyperledger.org/pipermail/healthcare-wg/2016-October/000001.html https://lists.hyperledger.org/pipermail/healthcare-wg/2016-O... [1] https://www.finextra.com/pressarticle/66385/medical-data-application-wins-abn-amro-hyperledger-hackathon https://www.finextra.com/pressarticle/66385/medical-data-app...
- asciihacker 10y ago
  I dont see the application myself either. Why not leverage existing robust technologies like a relational database?
  - kysar_tom 10y ago
    You could, but a relational database isn't distributed upon 5,000+ worldwide nodes in an immutable data ledger. That's the value the Bitcoin blockchain provides, it allows you to stick data into a transaction that will be there forever. The Bitcoin blockchain provides an economic incentive to keep the data accurate and accessible, as it would be (near) impossible to pull off a 51% attack in todays day and age. Many databases can be modified by the ones who centrally operate it. The Bitcoin blockchain is the worlds first distributed global database that takes the burden of trust off your internal systems and records.
    - feral 10y ago
      No; using the Bitcoin blockchain to store medical records is a terrible idea. Yes, they are robustly distributed on each of 5,000 worldwide nodes. But, think about that! How's that going to work for 10 million patients' MRI records? Each MRI being a series of high res images? That's not possible with Bitcoin - its not designed to store near that quantity of data - its not even desirable. I don't know what the advantage of Blockchain is with healthcare, but its certainly not storing your medical records on the Bitcoin blockchain. [Standard disclaimers about predicting the future apply.] Maybe a hash of them, so you know they aren't tampered with, or that sort of thing - but that seems like a second order problem.
      - waynevaughan 10y ago
        No one is advocating putting medical records on the blockchain. That's crazy. He's talking about using a technology like Tierion or Chainpoint to anchor a hash of the data in the blockchain. This can be used to verify the integrity and approximate timestamp of the data. http://tierion.com http://tierion.com http://chainpoint.org http://chainpoint.org
doctoring 10y ago
As a clinician, I'd love a way to see all the past health records of any patient that walked in the door. They usually would love for me to as well. I'm not sure how blockchain as a technology necessarily moves us forward to get there. The vendors have a stranglehold on medical record software and have no incentive to work together, share data, or agree to any standards -- I mean, it wasn't until last year that the two hospitals I work at (owned by the same umbrella hospital, using software from the same vendor, and 3 miles apart from each other) could electronically access records from each other. We had to fill out paper forms, make phone calls, and send faxes to get access. It's not for want of a technological breakthrough that we've been struggling so much...
- mcculley 10y ago
  Agreed. I carry all of my health records on a very small USB flash drive in my pocket. Every time I show it to a doctor, they are scared to plug it into their desktop for fear of malware.
  - ramidarigaz 10y ago
    And that seems like a totally rational fear too.
    - ChoHag 10y ago
      It totally is, and the computers they use should not have working USB ports on them.
      - mcculley 10y ago
        This was the point of my reply. There's no technological fix when clinicians can't even safely open a read-only file.
      - mcculley 10y ago
        Amusingly, I work with a rather large organization which still buys machines with PS/2 keyboards and fills the USB ports with epoxy. This is the state of security.
aub3bhat 10y ago
I am pretty sure that Gmail database is 1000x times larger than all non-imaging healthcare data for entire population of the world. There are instances where blockchain type technology is useful such as transactions between multiple parties with lack of trust. This isn't true in healthcare and surely not for EMR/EHR data.
bduerst 10y ago
I've had someone pitch the same blockchains-as-EMR to me, and they made the same mistake of construing data integrity with data security. Blockchains are public record, which you do not want your health data stored in. Even this article acknowledges that and recommends using private blockchains, which offers no competitive benefit over other decentralized databases. This just seems like another hammer looking for a nail.
- sit12 10y ago
  hammer looking for a nail in terms of healthcare applications yes but I am sure finance or government are better nails for the hammer.
- kysar_tom 10y ago
  The Bitcoin blockchain is really great for value transfer and data integrity. You want a hash of your data stored in the Bitcoin blockchain, that can referenced at a later point in time to validate the accuracy of the data.
  - zaphar 10y ago
    You are describing the Merkle Tree which is not unique to the blockchain and existed some time before bitcoin. This isn't an argument for bitcoin it's an argument for the Merkle Tree.
    - kysar_tom 10y ago
      Tierion anchors the root of a Merkle Tree made up of all inbound records every 10 minutes into a Bitcoin transaction. With that root in a Bitcoin transaction, you can use a portable cryptographic proof (Tierion calls them blockchain receipts) to validate the integrity of each record at a later point in time. The Bitcoin blockchain is a global immutable data ledger that makes for a great place to anchor hashes to.
      - bduerst 10y ago
natrius 10y ago
Blockchains are like scrolls: you can write information on them that a society can use to coordinate current actions based on the past. You don't want a scroll for your medical records. You want a journal that can't lose data and can safely give access to any app you want to install without losing privacy. That sounds more like Urbit than a blockchain.
waynevaughan 10y ago
Part of the challenge is that the word blockchain is misused. Here's a quote from the first page: “…the term ‘blockchain’ has been so misappropriated that no one knows what it means anymore.” – Elaine Ou, Bloomberg People are using blockchain to describe Bitcoin, private ledgers, the public Ethereum network, private Ethereum forks, and other tech that shares design characteristics with Bitcoin.

78 points by kysar_tom 10y ago

dvcc 10y ago

I read through this and I still have no idea what they actually applied the idea of the blockchain to within healthcare. To an HIE? Does each patient receive their own "wallet" that is their patient record? This just seems to be a generic overview of EHRs/Blockchains within the same page.

waynevaughan 10y ago
Thanks for reading the report. This last weekend there was the first Blockchain Healthcare conference where blockchain was pitched as a panacea for a wide spectrum of healthcare problems. https://godistributed.com/health/ https://godistributed.com/health/ Our report was targeted at a non-technical audience. Printed copies were distributed to about 500 attendees. We wanted to make them aware that while there may some opportunities for using blockchain technology also comes with substantial risks. We want to help them cut through the hype and maintain a healthy dose of skepticism. Gartner recently placed blockchain technology at the beginning of their hype cycle. https://pbs.twimg.com/media/CtxEq0MWAAA3EQe.jpg https://pbs.twimg.com/media/CtxEq0MWAAA3EQe.jpg
- RyJones 10y ago
  Not coincidentally, Hyperledger just started a working group for healthcare. [0] Coincidentally, a healthcare application won this week's Hackathon in Amsterdam [1] https://www.finextra.com/pressarticle/66385/medical-data-application-wins-abn-amro-hyperledger-hackathon https://www.finextra.com/pressarticle/66385/medical-data-app... [0] https://lists.hyperledger.org/pipermail/healthcare-wg/2016-October/000001.html https://lists.hyperledger.org/pipermail/healthcare-wg/2016-O... [1] https://www.finextra.com/pressarticle/66385/medical-data-application-wins-abn-amro-hyperledger-hackathon https://www.finextra.com/pressarticle/66385/medical-data-app...
asciihacker 10y ago
I dont see the application myself either. Why not leverage existing robust technologies like a relational database?
- kysar_tom 10y ago
  You could, but a relational database isn't distributed upon 5,000+ worldwide nodes in an immutable data ledger. That's the value the Bitcoin blockchain provides, it allows you to stick data into a transaction that will be there forever. The Bitcoin blockchain provides an economic incentive to keep the data accurate and accessible, as it would be (near) impossible to pull off a 51% attack in todays day and age. Many databases can be modified by the ones who centrally operate it. The Bitcoin blockchain is the worlds first distributed global database that takes the burden of trust off your internal systems and records.
  - feral 10y ago
    No; using the Bitcoin blockchain to store medical records is a terrible idea. Yes, they are robustly distributed on each of 5,000 worldwide nodes. But, think about that! How's that going to work for 10 million patients' MRI records? Each MRI being a series of high res images? That's not possible with Bitcoin - its not designed to store near that quantity of data - its not even desirable. I don't know what the advantage of Blockchain is with healthcare, but its certainly not storing your medical records on the Bitcoin blockchain. [Standard disclaimers about predicting the future apply.] Maybe a hash of them, so you know they aren't tampered with, or that sort of thing - but that seems like a second order problem.
    - waynevaughan 10y ago
      No one is advocating putting medical records on the blockchain. That's crazy. He's talking about using a technology like Tierion or Chainpoint to anchor a hash of the data in the blockchain. This can be used to verify the integrity and approximate timestamp of the data. http://tierion.com http://tierion.com http://chainpoint.org http://chainpoint.org

doctoring 10y ago

As a clinician, I'd love a way to see all the past health records of any patient that walked in the door. They usually would love for me to as well. I'm not sure how blockchain as a technology necessarily moves us forward to get there. The vendors have a stranglehold on medical record software and have no incentive to work together, share data, or agree to any standards -- I mean, it wasn't until last year that the two hospitals I work at (owned by the same umbrella hospital, using software from the same vendor, and 3 miles apart from each other) could electronically access records from each other. We had to fill out paper forms, make phone calls, and send faxes to get access. It's not for want of a technological breakthrough that we've been struggling so much...

mcculley 10y ago
Agreed. I carry all of my health records on a very small USB flash drive in my pocket. Every time I show it to a doctor, they are scared to plug it into their desktop for fear of malware.
- ramidarigaz 10y ago
  And that seems like a totally rational fear too.
  - ChoHag 10y ago
    It totally is, and the computers they use should not have working USB ports on them.
    - mcculley 10y ago
      This was the point of my reply. There's no technological fix when clinicians can't even safely open a read-only file.
    - mcculley 10y ago
      Amusingly, I work with a rather large organization which still buys machines with PS/2 keyboards and fills the USB ports with epoxy. This is the state of security.

aub3bhat 10y ago

I am pretty sure that Gmail database is 1000x times larger than all non-imaging healthcare data for entire population of the world. There are instances where blockchain type technology is useful such as transactions between multiple parties with lack of trust. This isn't true in healthcare and surely not for EMR/EHR data.

bduerst 10y ago

I've had someone pitch the same blockchains-as-EMR to me, and they made the same mistake of construing data integrity with data security. Blockchains are public record, which you do not want your health data stored in. Even this article acknowledges that and recommends using private blockchains, which offers no competitive benefit over other decentralized databases. This just seems like another hammer looking for a nail.

sit12 10y ago
hammer looking for a nail in terms of healthcare applications yes but I am sure finance or government are better nails for the hammer.
kysar_tom 10y ago
The Bitcoin blockchain is really great for value transfer and data integrity. You want a hash of your data stored in the Bitcoin blockchain, that can referenced at a later point in time to validate the accuracy of the data.
- zaphar 10y ago
  You are describing the Merkle Tree which is not unique to the blockchain and existed some time before bitcoin. This isn't an argument for bitcoin it's an argument for the Merkle Tree.
  - kysar_tom 10y ago
    Tierion anchors the root of a Merkle Tree made up of all inbound records every 10 minutes into a Bitcoin transaction. With that root in a Bitcoin transaction, you can use a portable cryptographic proof (Tierion calls them blockchain receipts) to validate the integrity of each record at a later point in time. The Bitcoin blockchain is a global immutable data ledger that makes for a great place to anchor hashes to.
    - bduerst 10y ago

natrius 10y ago

Blockchains are like scrolls: you can write information on them that a society can use to coordinate current actions based on the past. You don't want a scroll for your medical records. You want a journal that can't lose data and can safely give access to any app you want to install without losing privacy. That sounds more like Urbit than a blockchain.

waynevaughan 10y ago

Part of the challenge is that the word blockchain is misused. Here's a quote from the first page: “…the term ‘blockchain’ has been so misappropriated that no one knows what it means anymore.” – Elaine Ou, Bloomberg People are using blockchain to describe Bitcoin, private ledgers, the public Ethereum network, private Ethereum forks, and other tech that shares design characteristics with Bitcoin.