Can Blockchain Help to Deliver the NHS Long-term Plan?

Can Blockchain Help to Deliver the NHS Long-term Plan

The first NHS Electronic Patient Record systems were introduced over 20 years ago. Since then, we have seen technological advances never imagined. Yet, still, only a few of us can access our own health data, and fewer still can do anything meaningful with it. Charlotte Lewis looks at how the technology behind blockchain has the potential to deliver improved patient centred care while increasing patient privacy, security and interoperability of health data – all key ambitions of the NHS Long Term Plan.

The NHS’s ambitions for digital technology

Digitally enabled care will go ‘mainstream’ across the NHS – that is the bold, raw commitment set out in the NHS Long Term Plan (January 2019). The Plan’s ambition for the service is palpable, with technological advances expected to provide new possibilities for prevention, care and treatment.

The Long Term Plan builds on some of the broad themes set out in The Future of Healthcare (October 2018), Matt Hancock’s, the Secretary of State for Health and Social Care, vision that the NHS will offer a ‘digital first’ approach to enable patients to communicate with clinicians and therapists and use data to develop more sophisticated ways of monitoring patients remotely.

Data is a significant asset to the NHS, as the medical data of over 65 million people is, collectively, a dataset with incredible potential. Yet, there are currently significant practical issues with data sharing. The Long Term Plan recognises that the starting point for patients and staff is interoperability of data and systems with technology standards mandated and rigorously enforced.

The Future of Healthcare committed to setting ‘national open standards for data, interoperability, privacy and confidentiality, real-time data access, cyber security and access rules’.  So far, we have the new Code of Conduct for Data-driven Health and Care Technology (February 2019) which promotes the use of open standards when collecting and extracting data from information technology systems.

Blockchain in healthcare

Early reports about blockchain were dominated by references to cryptocurrency, which made it seem like the only application for the technology would be financial markets. But, at its heart, blockchain is about trust. Put simply, it is a distributed ledger that cannot be corrupted or changed without disrupting the chain in that process. It therefore allows people who don’t know each other to collaborate, to share information, within trustworthy environments. There are few places and sectors this is needed more than in health care.

Truu, for example, has adopted the technology as a means to enable a new style of trusted relationship between individuals and organisations. Using distributed ledger technology, Truu has developed a way for medical employees to be able to prove who they are instantly, securely and digitally, avoiding the need for long delays due to administrative burdens and increasing levels of trust.

Blockchain for medical records

Blockchain technology offers a new model for electronic health information exchanges. According to a Deloitte report, capitalising on this technology has the potential to connect fragmented systems and in the long term, a nationwide blockchain network for electronic medical records may improve efficiencies and support better health outcomes for patients.

A permissioned ledger for medical data, which patients could control form their mobile phones, has the potential to transform the relationship patients have with their health records. Using the technology, individuals would stay in control of and have access to their personal health records and could grant or deny permission for others to access it, whether they be clinicians, researchers or even commercial organisations. This places patients at the centre of their own health and care in a technological sense and therefore echoes the aspirations of the Long Term Plan for the NHS to deliver more person-centred care.

 Organisations such as Medicalchain and Dovetail Lab have developed patient centred solutions based on distributed ledger technology.

Medicalchain is a decentralised platform that enables secure, fast and transparent exchange and usage of medical data. It uses blockchain technology to create a user-focused electronic health record and maintain a single true version of the user’s data. Their app MyClinic.com allows patients to take full control of their healthcare records through blockchain technology and provides access to flexible telemedicine services. The company plans to “put everyone in control of their health records and be a partner in their healthcare management”.

Dovetail Lab has harnessed distributed ledger technology to verify identity, store consent and create tamper-proof audit records of every data exchange. Their solution is described as the ‘software glue’ that sits between the different technologies and allows them to talk to each other but only if the patient gives their consent.

Elsewhere in the world, countries are embracing the technology at a national level. Estonia and Dubai are two such countries that are demonstrating how blockchain can facilitate secure and reliable sharing of electronic health records among healthcare stakeholders, including making interactions more efficient. The Estonia e-Health Foundation is developing a blockchain-based system that will secure the medical records of more than 1 million patients – the system has been designed to enable entry of new data and keeps the records secure from any alteration. Patient empowerment, transparency and improved dialogue between stakeholders are just a few of the benefits the technology has to offer.

But there are operational challenges to blockchain

The public are, rightly, protective over their personal information, not least their health records. As a digital mechanism for creating trust, blockchain would appear to be the perfect solution for securely sharing health records. However, while the technology creates trust, there is poor public trust in the blockchain. Many people’s only experience of blockchain is in relation to cryptocurrency which has a poor reputation for its links to criminal organisations, the Dark Web and fraudulent transactions. For this reason, some organisations who use blockchain have started to distance themselves from the technology in their marketing and focus more on their practical solution.

Many of the key benefits of blockchain: immutability, anonymity, and decentralised control can make it difficult for the technology to comply with the EU General Data Protection Regulation 2016/679 (GDPR). Some of these benefits can, however, be realised without storing health records on the blockchain itself. Indeed holding medical records on the blockchain would be hugely inefficient given the size of the data! One solution is to store most of the personal data “off chain”, usually on the existing EHR system, with the technology being used as a key to access the information and record the changes made.

There is a huge amount of hype around blockchain which might fuel the negative feeling. However, if we focus on the technology itself we can see the benefits in healthcare, particularly in secure access to medical information. Rather than disruptive, we need to see it as a fundamental technology.

So, will blockchain revolutionise healthcare?

In short, blockchain should not be seen as the magic bullet for a unified electronic health records system. But it could be the tool that provides trust, data integrity and control – all issues that patients have raised as concerns they have with their health data being shared.

That then opens up the huge possibilities that can be achieved by being able to share health data including those aims sited in the Long Term Plan.

 

By Charlotte Lewis, Senior Associate, Mills & Reeve

Sources

https://www.longtermplan.nhs.uk/

https://www.gov.uk/government/publications/the-future-of-healthcare-our-vision-for-digital-data-and-technology-in-health-and-care/the-future-of-healthcare-our-vision-for-digital-data-and-technology-in-health-and-care

https://www.gov.uk/government/publications/code-of-conduct-for-data-driven-health-and-care-technology/initial-code-of-conduct-for-data-driven-health-and-care-technology

https://www2.deloitte.com/us/en/pages/public-sector/articles/blockchain-opportunities-for-health-care.html

https://www.visitdubai.com/en/business-in-dubai/grow-your-business/dynamic-dubai/dubai-the-worlds-first-blockchain-city

https://www.blockstuffs.com/blog/countries-adopting-blockchain

https://coinify.com/news/estonia-dubai-medical-records-blockchain/?q=/estonia-dubai-medical-records-blockchain/

https://www.truu.id/

https://medicalchain.com/en/

https://www.dovetaillab.com/