Engineers at the Nashville-based Vanderbilt University attest that they have successfully developed and validated the feasibility of blockchain-based technologies for secure and confidential sharing of patient medical records.
The engineers laid out their work in a recent case study that demonstrates how blockchain could solve a huge healthcare challenge—improving interoperability and removing data silos that currently exist between hospitals, clinics, pharmacies, and payers.
The case study, which involved a rural hospital tumor board, as well as the blockchain architecture supporting that secure information exchange are discussed in the team’s paper, “FHIRChain: Applying Blockchain to Securely and Scalably Share Clinical Data,” which is currently available as a preprint and has been submitted to the Computational and Structural Biotechnology Journal.
Researchers from Vanderbilt and California-based Varian Medical Systems evaluated FHIRChain, as they dubbed the technology. Their goal was to design a blockchain-based system that complied with standards established by the Office of the National Coordinator for Health Information Technology (ONC)—called the Shared Nationwide Interoperability Roadmap.
While Dana Zhang, one of the study’s co-authors, noted that healthcare companies typically contract with third parties to exchange patient medical information securely, FHIRChain “is a trustless exchange with no centralized third party. The Vanderbilt/Varian team envisions a system of public and private keys that allow an identified physician or clinic access to health information at Hospital A for a specific period of time. Think of password reset emails that require action within 24 hours,” as outlined in a Vanderbilt University press release. As such, the data will never leave Hospital A; whereas currently under the third-party scenario, Hospital A sends health information to a trusted agent, which sends it to a cancer specialist at Clinic B, for example.
Indeed, researchers had the goal of wanting to use blockchain as a decentralized access mechanism to facilitate permissioned medical record exchange. The case study is not unlike a patient wanting a second opinion on a medical issue from an outside specialist because board members are spread out geographically, officials noted. “The problem always is getting data to another doctor,” Zhang said. “In this approach, the data is opened up for a temporary period of time (with a decryption key), but the original facility or doctor is still the data owner.”
What’s more, although blockchain technologies provide a decentralized peer-to-peer network, this does involve some tradeoffs. Researchers at Vanderbilt and elsewhere are focusing their efforts on applications in domains where disintermediation (having no central authority) is more important than strict confidentiality, Schmidt said.
“The idea is there is strength in numbers,” he said. “Because you don’t want anyone in charge, you are willing to give up some confidentiality. You may know Party A sold something to Party B and although you don’t know who they are, you know some transaction took place.”
The broader effort at Vanderbilt involves tackling blockchain fundamentals. That includes developing more secure “smart contracts” that are a foundation of the technology. Jules White, an associate professor of computer science, said a meta-analysis of 20,000 smart contracts found 8,000 with security issues.“ The major bugs actually came from the creators of blockchain platforms,” he said. As such, experts at Vanderbilt are attacking that problem from multiple fronts, including developing a secure test bed where researchers and developers can try out their ideas, according to officials.
