Although blockchain was originally conceived as a technology for a revolutionary financial tool - Bitcoin, the earlier description of the technology suggests that the technology could be applied to other areas, including healthcare.
In twelve years of operation, the blockchain-based Bitcoin payment system has never been hacked. If the technology can provide trust in inherently risky financial environments, it can help in less aggressive ones such as healthcare. However, it is necessary to understand where to use the main advantages of distributed registry technologies -increasing trust, speed of approval of documents and reducing costs by reducing the number of intermediaries. It is also necessary to identify problem areas and see if the use of new technology will be beneficial. This chapter will look at some of the applications of blockchain technology.
Storing patient data with consent management
EHR implemented on blockchain is, probably, the first application possibility of blockchain technology in healthcare that comes into mind, as the requirements for the system are covered fully by the core features of the technology. Since this thesis is dedicated to this particular application, this chapter will not include the corresponding description.
Supply Chain Surveillance
Another application of blockchain in healthcare is to monitor the supply chain of common drugs. Blockchain has been used in supply chain management for a long time so the best practices may be obtained from the similar projects in the different fields (Korpela et al., 2017). Today customers cannot trace what they bought in the pharmacy drug was produced by. When the customer buys a drug, one may ask for a certificate for it. But no one prevents an unscrupulous supplier or seller from faking it. Counterfeit and substandard drugs are amongst current serious problems in the pharmaceutical industry.
The basic idea behind using blockchain for supply chain management is that every transaction brings together all stakeholders in the blockchain: from manufacturers to suppliers and further to pharmaceutical organizations and, finally, to customers (patients).
In this case, any changes or attempts to tamper with the prescription will be immediately detected.
Case - blockchain-based supply chain in India
Counterfeit drugs are a serious problem in India. Approximately 3 percent of medicines are substandard or counterfeit (Chatterjee, 2010). There is an extreme need for traceability of the origin of drugs and how they have been handled throughout their journey through the supply chain. Research and interviews have confirmed that the risk of counterfeit drugs arises at the point of transfer between different stages of the complex supply chain (e.g., between wholesalers, distributors, and subdistributors). At each stage of the transfer of drugs from the factory to the consumer, drugs can be substituted or adulterated.
The National Informatics Centre of India has developed and implemented a Drug Authentication and Verification Application (DAVA) (davaindia, 2020). The system is based on the use of serial numbers as the unique identifier provided by manufacturers to identify products. The main goal of the initiative was to improve transparency and help India remain a global leader in the production of safe pharmaceutical products. DAVA provides manufacturer-level product information that can be verified by other stakeholders.
However, it has been determined that blockchain can provide more functionality. For example, the system in its current form does not provide visibility into every transaction. In addition, DAVA does not allow products to be tracked throughout the supply chain or track temperature compliance. All of this can be achieved using blockchain and IoT technologies. The National Transformation Institution of India (NITI Aayog) organized a blockchain-based drug-tracking pilot project. Numerous health and technology partners participated in the project: drug manufacturers, carriers, logistics solution providers, and drug retailers. As such, the project required the integration of a number of independent IT systems to transmit information about the receipt and movement of goods. Efforts were made to limit manual entry of such data.
As the drug moved through the chain, each transaction was automatically transferred from internal IT systems and recorded in a registry with a timestamp. In addition, the blockchain recorded location and temperature, making the entire path transparent to stakeholders and limiting the possibility of tampering with the record.
The project demonstrated that blockchain can provide a higher level of transparency, efficiency and reliability of transactions in the pharmaceutical industry. Blockchain allows real-time access to product information, not for manufacturers, transport companies and distributors, but for consumers as well.
Smart contracts for insurers
The third big application of blockchain is smart contracts (Raikwar et al., 2018). In a narrow sense, a smart contract refers to a set of functions and data (current state) located at a certain address in the blockchain. The billing process begins when the patient arrives at the medical organisation and continues until the patient is discharged. It includes several steps: registering the patient, recording the services rendered, sending the information to the insurer, and receiving the insurance reimbursement. The billing scheme can be complicated as some of the services may be paid for by the insurance company and some by the patient.
The current operational difficulty with medical billing is the lack of transparency between medical organizations, patients and insurance companies. With the current systems there is a frequent case of insurance abuse by the patients and even the insurance frauds.
Blockchain makes the system transparent, thereby eliminating mistrust. Unlike the traditional centralized systems currently used in healthcare, which allow information to be changed and deleted, blockchain and its characteristic of immutability of data is more suitable for recording important medical data, such as those related to insurance claims.