Real empowerment of patients is a must if we want to maintain afloat the current health care systems that are reaching a breaking point due to the rise of chronic diseases, the Covid-19 pandemic and the aging of the population.
Patient empowerment is not possible if patients do not have real ownership of their electronic medical record (EMR). New technologies have served as a building block in their aim to achieve this, with opportunities such as the Horizon 2020 EU Research and Innovation programme, funding various initiatives that aim to give patients access to their EMR.
Yet, well-known and large-scale projects, such as Smart Open Services for European Patients (epSOS) with 50 public and private beneficiaries from 25 countries, did not succeed to fulfill their mandate to empower patients with access to their EMR.
Still the demand of patients to access their medical health records is often not met. Major smartphone operating systems try to fill the gap, in particular Apple’s iOS, by starting to include an electronic health records (EHR) feature.
How could Distributed Ledger Technology (DLT) like Blockchain help?
DLTs could help to solve data management, privacy, and security issues, improving interoperability and easing the flow of data between practitioners, hospitals, healthcare systems and other healthcare stakeholders through the use of a decentralized, immutable database.
For example, data from any EHRs, different wearables/devices and in general any form of IOT data can be used within the ledger, in a trusted, secure, transparent and interoperable environment.
To date, DLT is still seeking its place and wide deployment within mainstream healthcare, despite its potential of a wide range of prospective applications in healthcare and many of them currently in pilots or in proof of concept stages.
The main promising applications within healthcare:
1) Patient Record Access: Presenting the electronic medical records (EMR) of patients on an appropriately permitted blockchain would give cryptographic assurance on data quality without any need for human involvement. The Estonian Government project (https://e-estonia.com/solutions/healthcare/e-health-record/) is a good example of this application.
2) Preventive Health Care and Wellness Activities: Ledger Technologies & Blockchain could also be used to incentivize preventive health care and wellness activities.
3) Verifying the Supply Chain: Given that blockchain is created in a chronological and auditable manner, the technology can act as a means of verification for the different components of the supply chain.
The tracking of the health care chain components could be logged into a blockchain ledger with the intention to check and identify potential fraudulent activity. Some current projects in low income countries are using this approach.
- Example: tracking the vaccination cold chain process.
- Example: Drug counterfeiting (10 % of prescription drugs are counterfeit leading to thousands of deaths annually).
4) Clinical Trials Tracking and Verification: Clinical trial data is difficult to collect and maintain across the different health care systems. Thus, DLT and blockchain is opening up huge opportunities for the implementation within clinical trials.
5) Management of Patient Consent for real-time Monitoring Data: Blockchain can provide an audit of access to data and to allow the patient to manage consent for the transmission of their real-time monitoring data.