Developed as a means of tracking international bitcoin transactions over the internet, blockchain technology is starting to send ripples across the healthcare industry with promises of improved data flow between disparate systems and heightened security. The goal is to enhance transparency and trust among participants in the blockchain, while creating a more patient-centric healthcare system, says Micah Winkelspecht, founder and CEO of blockchain startup Gem. Winkelspecht recently spoke with Healthcare Dive from New York City, where he was attending a conference about this new technology.
Healthcare Dive: What exactly is blockchain technology?
Micah Winkelspecht: It really started with bitcoin, which was attempting to create a global accounting system and a global ledger to be able to move around digital currency. Bitcoin is very good at tracking ownership of digital assets, and now financial institutions are looking at taking the same technology and not only using it for digital currency but also to track stocks, bonds, derivatives, futures, basically all of the different financial assets.
The newer blockchain systems are moving from the concept of building a global calculator to building a global computer, and they’re allowing for all different types of applications, not just financial applications. Basically, these are applications that run across an entire industry or across global regions where individual members who are participating in that application don’t necessarily need to trust each other, but they can still operate on the same application or computer to be able to perform some goal.
So this sort of getting at the whole issue of interoperability?
Winkelspecht: Yes, absolutely. This is a tool that is built for interoperability by design. Essentially, blockchains are really just a protocol layer, like TCP/IP for the internet. It’s essentially a bunch of rules that people agree to follow and software that’s written to those rules, and anybody can build the software as long as they speak the same rules. So it can be completely open source. It’s basically like a language that all of the companies that are participating agree to speak in order to be able to interoperate with each other.
Does blockchain require specific technology that companies have to invest in?
Winkelspecht: There is a lot of technology that has gone into these systems. None of it is really brand new technology. It’s old technology that’s been combined in a very unique way to create an incredible new type of architecture. A lot of the concepts that are involved go back about 30 years, a lot of basic cryptography concepts. They’re called public-key/private-key cryptography, which is really the heart of blockchains. And so the technology’s not new. It’s a lot of heavily used, trusted concepts, but they’re combined in a new way to create this unique type of architecture.
How can blockchain be applied to healthcare?
Winkelspecht: There are a lot of ways that it can be applied to healthcare. We’re looking at the entire healthcare continuum, because we really believe that blockchains are going to become the underlying fabric for [that] continuum. It’s going to be the architecture of the underlying data layer that unites all of the disparate services of the healthcare industry into one interoperable system — all the way from tracking data from fitness devices and general wellness metrics, to treatment at medical providers, to prescriptions, all the way through to medical claims adjudication.
And what we’re trying to build here, essentially, is we want to unite all these services to become more of a patient-centric healthcare system where we’re essentially tracking the entire lifecycle of a patient for their entire journey through the healthcare system and are able to give more control to patients over how their data is used and how it’s shared, to actually give them access to their own data.
How would you do that?
Winkelspecht: So one of the unique properties about blockchains is that they’re not centralized systems. If you think about the current healthcare system, it’s based around a bunch of centralized systems — whether it’s EHR companies that are managing medical records on behalf of the industry or medical processors that are acting as go-betweens in the middle of providers or insurers — these intermediaries are essentially becoming giant centralized warehouses of patient data.
The blockchain flips that on its head and says, instead of centralizing, let’s create a decentralized, distributed, global data repository for the entire industry that’s basically shared by everyone and controlled by no one. Rather, it’s controlled by everyone, so major participants who are participating in this blockchain also serve to secure and protect it.
This is sort of a fundamental tenet of blockchain. Blockchains are designed as a new type of security model for critical data where the data is completely distributed across many different nodes across the internet. And the change history, or the log of everything that’s going on with the data, is recorded in an immutable ledger and an immutable log that can’t be changed. And so you have a perfect history of everything that everybody has done within that system. And because you have this immutable ledger, and you have this immutable log of all the events on the network, multiple parties who otherwise wouldn’t be able to necessarily trust each other directly can now trust in the ledger, and they can see the history of events and know that it’s true.
So this becomes the basis for building out cross-industry workflows between multiple companies that would normally need to go through some intermediary in order to do business with each other or in order to share patient data with each other. This allows them to share in this infrastructure and to be able to communicate directly peer to peer.
How do these security aspects relate to concerns like ransomware?
Winkelspecht: One of the problems with ransomware is that it tends to attack systems that are creating central repositories of data, so when hospitals are getting attacked, the software is attacking systems that are warehousing a lot of data. With a blockchain, that data is spread across the entire network, so there’s no one point of failure that you can attack.
So blockchains are going to be a bit of an answer to the ransomware problem, the same way that they’re also a part of the cost. Most ransomware is now asking for victims to pay out using bitcoin, which obviously is blockchain technology, but ransomware has been around for a long time and it’s used many different methods. It just happens to be using bitcoin today. The reality is that the very same technology that the ransomware hackers use is also going to be the antidote to the ransomware problem by essentially creating failsafe systems where data is not stored in any sort of honey pot.
What are some specific things that Gem is doing with blockchain in the healthcare sector?
Winkelspecht: We’re exploring the entire continuum with multiple parties. The only one we’ve announced so far is Philips, and we’re going to have more announcements coming. Unfortunately, I can’t talk about the specific case that we’re working on with Philips, but we’re exploring the way clinical data can move between multiple parties who need to have access to that data, but to do it in a way where there are very strong promises around security and confidentiality and data integrity. We want to make sure that the right person has the right access to the right data at the right time, and no more.
What is the takeaway for healthcare CEOs when it comes to blockchain?
Winkelspecht: Luckily, the healthcare industry has the benefit of the learnings of the financial industry. I’ve been at this for over three years now, and when I started, the entire financial industry looked at bitcoin and blockchain technology as kind of a joke. They didn’t really get it. They said that would never work.
About a year and a half ago, that started to change, and now I’m at a conference with all of those bankers and IBM and major companies around the world. And what I’ve observed is simply a transformation in the way these organizations are thinking. They’ve gone from essentially having very little to no knowledge of blockchain to becoming experts, and there’s not a single financial institution in the world at this point that doesn’t have some sort of blockchain-related product going.
In the healthcare industry, it’s very new. While there are companies who are beginning to explore it, it’s a very new concept. I would encourage CIOs and CEOs to look at the transformation of the financial industry and to get ahead of the curve.