Hospital tech officer breaks down blockchain for the layperson

By Laura Lovett
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While the term blockchain has populated numerous news feeds and executive board room conversations recently, just how the technology works and what it can do for healthcare has remained somewhat of a mystery for the layperson.

At the Digital Healthcare Innovations Congress in Boston yesterday Roger Smith, chief technology officer at Florida Hospital Nicholson Center, broke down how the technology works, what it could mean for the future of healthcare, and if the trendy technology is all that it's cracked up to be. 

“Blockchain is really hot and you are hearing a lot of hype about it for healthcare and business,” Smith said. “The hype even goes so far as to say it is going to be bigger than the internet. Well, that’s a fraud. It’s not going to be bigger than the internet. It is going to be another app on the internet. But it is really, really hot right now. And I would say that everyone who is investigating it [is] struggling with developing the vocabulary to tell other people about it.”

There are a lot of ways that the data storing technology can be deployed, but the technology is, essentially, the nuts and bolts behind transactions and data entry. To describe blockchain, Smith compared the technology to a water park; when a customer goes to a water park they see waterslides and splash pools, but underneath there are pumps and sensors. Here, blockchain is the pumps and sensors that ensure the transaction can function without a hitch. 

Importantly, the technology also makes it difficult to falsify information and cuts out the middleman in transactions, which may lead to a reduction in costs and errors. 

So how would this apply to healthcare? Smith explained that there are four major avenues where the blockchain could be used in healthcare: billing and insurance, drug verification, research distribution, and EHRs. In particularly, there has been a lot of talk around the latter of these.

“All of us walk through our lives and we leave a little disconnected trail of healthcare data,” Smith said. “So if we go to our primary care physician, who might not be associated with the hospital we go to [for] surgery, then they get data and then we go to a pharmacy and leave a drop of data at CVS. … In some cases a big system might pull some of those data points together, but in general all that data is just locked down. ... The thinking is eventually there will be a product that will be a blockchain of your health history and you will control it."

The idea is that the technology will not only unify a patient’s healthcare records, but place the user in control of their data so that they have the autonomy to share or not share their information at the time of the visit. 

“Every time you go to a healthcare provider you will give them permission to either unlock data in your chain, to read it or to create a record and add it to your chain. So all of your healthcare records are not hanging out there in space. … That place will be hosted by someone . It might be IBM, it might be Hewlett Packard, it might be Google, it might be Amazon, but you will be in control of organizing it.”

So how does it actually work in practice? 

“[The doctor] takes these transactions and says: OK, I want to put that into a block, which is going to report who I am as a patient, the doctor, what day it was done, what insurance company was involved, all of these details about this engagement with the doctor. So he is patching this all up about to record this — almost the same as you would record this in a database,” Smith explained.

In this case, Smith said that when a doctor is putting in a new block in the chain, they would go back to the previous block and take its “hash,” which works like a unique fingerprint and summarizes everything that is in that block. Each subsequent time a doctor or clinic adds a block they take the hash from the previous block which includes all of the collective hashes in the chain.

While Smith noted that there are many ways the technology could be used, it is in someways a new gold rush when it comes to startups, and could lead to a crowded market. 

“The promise of this is leading to hundreds of startup companies jumping on this trying to create this blockchain-enabled application,” Smith said. “Some of them are going to become very successful and many of them we will never hear about again.”