Records & Information Management Month 2021: The Future of Blockchain & EHRs
“Healthcare organizations face a lack of interoperability and a lack of access to holistic datasets that showcase the entire history of the patient.”
Chrissa McFarlane, CEO of Patientory
A young woman that we will call Jenny was brought to the emergency room after she was involved in a car accident while on vacation in Florida. When she arrived at the hospital, she was unconscious and didn’t have any form of ID in her pocket, so the medical providers were unable to identify her or what happened.
She was taken into emergency surgery to address the severe injuries she sustained during the crash. The anesthesiologist administered a standard drug to ensure she remained unconscious during the surgery. But the medical team didn’t realize that Jenny was on a medication that was incompatible with the drug. As a result, she didn’t make it through the surgery.
One of the problems that medical providers still face today is the absence of readily available patient medical records. Even though today more than 85 percent of physicians use electronic medical records (EMRs) to manage physical records in a digital environment, this does not mean that your complete medical data is readily available. Improvements have been made since the days of paper-based record keeping. However, even institutions that use EMRs face problems with scattered data.
Do you know if a complete set of your medical records exist? In all likelihood, your data is actually siloed between various institutions that you have visited over the years. While we are at the point where the technology to create a comprehensive set of your medical data is here, that doesn’t mean it’s being implemented by your care providers.
In this article, we will explore the current problems with EMRs and the future of the healthcare industry’s database management.
Challenges With Electronic Patient Data Management
While electronic records solve various problems regarding hospitals’ operations by eliminating inefficient paper-based systems, they present a new set of problems that healthcare institutions have to contend with. One major problem electronic systems present has to do with data privacy; electronic data is vulnerable to being compromised by hackers.
Between 2009 and 2020, more than 3,700 healthcare data breaches were reported to the Department of Health and Human Services’ Office for Civil Rights. Those breaches resulted in the loss, theft, exposure, or impermissible disclosure of 268,189,693 healthcare records.
And these instances are only on the rise. Statistics show there has been an upward trend in data breaches over the past ten years, with 2020 seeing more data breaches reported than any other year since records first started being published.
The Health Insurance Portability and Accountability Act (HIPAA) was created to protect patient data from fraud and theft. As a result, medical providers must adhere to strict federal guidelines. In 2009, Congress also passed the Health Information Technology for Economic and Clinical Health (HITECH) Act. HITECH essentially strengthened HIPAA, increasing both security protocols and penalties for violations.
Yet, as more hospitals move from paper-based systems to electronic data management systems, an increasing number of institutions fail to comply with HIPAA’s standards. In 2018, the Office for Civil Rights issued a record amount of HIPAA settlements, totaling $28.7 million in fines, a 22 percent increase over the previous record.
Another problem that electronic patient data management has yet to conquer has to do with connectivity. As previously mentioned in the case of Jenny, since she had visited multiple hospitals over the years, her data was scattered between multiple institutions. Therefore, there was no complete record that a medical team could look at to understand her full medical history.
“Healthcare organizations face a lack of interoperability and a lack of access to holistic datasets that showcase the entire history of the patient,” said Chrissa McFarlane, the CEO of a technology company called Patientory.
“In terms of security, our app is built on blockchain technology, which is a secure framework and system for managing healthcare data,” McFarlane said.
Their mobile app allows you to store your health-related data collected from devices like smartwatches in the same place that your doctors store your medical data. But how do companies like Patientory that apply blockchain help to address some of the issues with electronic patient data management?
A Potential Solution: Blockchain
Blockchain is a notoriously difficult concept to grasp. Most of us have heard of one specific application of blockchain—Bitcoin, a digital currency used to buy and sell goods. But blockchain has applicability in various industries, including healthcare and medical records.
Since the invention of EMRs, a hospital would be the one to host your electronic medical records. These institutions have a number of computers at their data center with everyone’s information stored as records in a patient database.
However, storing these records in one location makes them susceptible to hackers finding ways to steal information—a prominent cause of the growing number of HIPAA violations. Any new hospital you visit would have to make an agreement to share data with your old hospital. While somewhat impractical, this is largely the situation today.
Let’s compare the current storage of electronic patient records with what a blockchain database could offer. A blockchain database is decentralized, meaning multiple, identical copies of it are stored on a large number of computers sitting on the internet. Once up and running, no single company or entity owns the database; it is an organic program that follows the rules it was given when it was created.
A blockchain is also more reliable than simple electronic medical records because disconnecting even several of the computers hosting a blockchain from the internet has no effect. There are still innumerable machines available to host the blockchain and continue to process its transactions.
A blockchain is also highly secure, as any record introduced to the database must be processed and agreed upon by a majority of the participating computers before it is added. Once added, it is highly impractical—nearly impossible—to tamper with the record without simultaneous access to all of those networked computers. This security is incredibly beneficial when hosting your digital wallet or private health information.
Benefits of Blockchain to EMRs
Blockchain can be applied specifically to EMRs.
Blockchain technology itself is rooted in advanced computer security, which is particularly applicable in managing our sensitive healthcare data. The blockchain itself functions on cryptography, which can be used to encode or scramble our data in a way that only authorized people can decode or descramble to view it. Encryption is the standard practice for maintaining privacy with digital data, whether we are making an online purchase, or making sure no one else can see our text message conversations with others. Privacy, security, and identity are built-in.
Because the blockchain involves adding digital blocks or records to our chain or database, the full history of the blockchain is stored on every machine that is hosting it. This helps with auditing medical records and their access under HIPAA’s requirements.
As previously mentioned, the blockchain itself is decentralized. In other words, it is not owned by a single institution. But what does this mean, practically speaking?
“For consumers, the Patientory app gives users ownership of their data. Through our solution, patients have ownership of their data; therefore, we help providers in delivering better care through access to the entire histories of patients,” McFarlane explained.
Why is it important that patients own their own data? Let’s imagine if Covid-19 vaccine eligibility involved you granting your state vaccine handlers access to your healthcare data. Searching the blockchain, vaccinators could validate your eligibility and know that the attestations of your health status come from trusted hospitals and institutions, all while keeping the rest of your medical records that you might not want to reveal private.
The Application of the Internet of Things
These days, we are generating more data than ever, including around our health. Digital watches can continuously monitor our heart rate, devices can monitor our sleeping habits and step counts, and smart scales can keep track of our daily weight.
As more of these “Internet of Things” devices proliferate our lives, by proxy, we’re generating data that can be valuable to doctors when we need care. This data may be stored by Garmin, FitBit, or Apple. As this data grows, they effectively form self-generated health records.
Potentially, we could allow health insurers access to our exercise history to receive discounted rates, or even opt to have our healthcare data made available to researchers anonymously. This creates the ability for trend analysis; an increase in illness or flu originating in one part of the world could be flagged by AI technology and one day predict the next pandemic. Or trends of illnesses based on characteristics like race or gender could be discovered by AI operating on a large body of public, anonymous healthcare data, leading to better outcomes for all.
As with the transition from paper records to electronic records, the clear benefits above will still come with new challenges to solve. For instance, multiple, competing blockchains like Patientory may be created to solve the same problem, leading to the same siloing problem that exists today.
For example, there are dozens of cryptocurrencies that have followed Bitcoin. Digital transformations take time, and we need usable products on the market that adhere to all the requirements of HIPAA and HITECH to convince hospitals and patients to switch to new ways of doing things.
Let’s consider an alternative outcome for Jenny. In a future where blockchain dominates EMRs, Jenny arrives at the ER unconscious, but the EMT has recovered her phone.
The doctor brings up the emergency call screen and swipes right, where she sees that Jenny has health records available and an emergency contact who can grant access to them. The contact does and the doctors at the hospital have access to Jenny’s identity and health history.
Jenny rides her Peloton regularly, rarely visits the hospitals outside of annual checkups, and—there it is—her list of prescription medications. The anesthesiologist takes note. Jenny undergoes emergency surgery, recovers, and is able to leave the hospital the next week.
Medical records and receiving the best care possible are important to each and every one of us. This April, during Records and Information Management Month, as you take stock of the current state of affairs, consider the nascent technologies that paint an optimistic future for healthcare. Have conversations about the key problems that need to be solved today, and the future of patient medical records at your institution.