What do medical records, teleradiology, supply chain management, credentialing, and clinical research all have in common? They all are potential use cases for blockchain technology.
In a March 26 presentation to the Society for Imaging Informatics in Medicine, Woojin Kim, M.D., chief medical information officer in the healthcare division of Nuance Communications, explained some of things he thinks radiologists need to know about blockchain — both positives and challenges. Kim was a co-founder of Montage Healthcare Solutions, which was acquired by Nuance in 2016. Previously Kim had served as interim chief of division of musculoskeletal imaging, director of the Center for Translational Imaging Informatics, and chief of radiography at the Hospital of the University of Pennsylvania.
Kim began with a basic tutorial on what blockchain is. It creates a decentralized, distributed ledger, and databases that are immutable.
“Blockchain and its potential benefit of decentralized management, immutable audit trails and improved security are being leveraged in other industries such as finance and retail,” he noted. “Although you don't hear as much about it as you do about artificial intelligence, there are a number of efforts to use this technology in healthcare,” adding that it has the potential to benefit radiology.” However, he added that there are many privacy and security challenges blockchain needs to overcome before it can be adopted. “As it becomes more widely adopted and the technology improves, it will be important for radiology professionals to be more familiar with it and understand when to use it and when not to.”
One of the most common potential use cases cited involves electronic health records (EHRs). As others have mentioned, blockchain could allow for a paradigm shift to patient-centric control of health data. Using a radiology example, Kim asked how often does a patient have to repeat the information about her contrast allergy and presence or lack of metal in her body? Pretty much every time she gets a contrast exam or MRI. “If this information were stored in a blockchain, the patient can decide who has access to this information,” he said. “Instead of being asked every time or even multiple times in a single visit, all authorized persons would have access to this information. It gives control back to the patient about their own health records while maintaining one unified record instead of siloed records in many different places.”
Other radiology use cases include image sharing and teleradiology. Kim said that for an image-sharing application, the patients can have complete ownership of their own imaging data and the patients themselves can determine who has access to their data. “This framework allows for more patient-centered and patient-driven healthcare. Leveraging its distributed nature, such use cases can be extended to teleradiology as well.” He mentioned a company called Nucleus Health, an Etheruim-based image-sharing company that uses blockchain to pass a Dicom web URL and uses a DICOM web RESTful API for the actual image viewing. “This allows them to keep the protected health information off the blockchain by keeping the original imaging data locally. Their blockchain stores a unique exam ID tied to the data, giving patients the ability to grant access to whomever they like for sharing images,” he explained.
Outside of healthcare you often hear about blockchain used in finance and supply chain management, Kim noted. Blockchain has potential use cases in claims and billing. Smart contracts could be used to speed up claims approval and be used to facilitate preauthorization processes. In the area of supply chain management, one can use blockchain to track and manage medical products. “You could also store inspection and maintenance records of all your imaging equipment on the blockchain,” he said.
Credentialing is another promising application. “Currently physician credentialing is a complex, time-consuming and costly process,” he said. “Have you ever wondered why you have to repeat all this information each time? Why can’t there be an ongoing record of this? Why do I have to attest my CME activities to the boards when they can all be kept in one place and they can get answers instantaneously. Imagine if a physician’s records of his or credentials were on a blockchain, including medical education history, CMEs, and medical legal records; then when I get a request for those records from hospital A or a medical board, I would simply grant them access. This would save so much time and money.”
The same technology that could patients to share access to their medical records could allow for them to more easily participate in clinical research projects. But Kim also stressed that the highly sensitive nature of PHI is a major challenge that needs to be taken into account when designing blockchain applications in healthcare. “This is why so far many are using blockchain for pointers, while keeping sensitive data off-chain, which allows for better speed and scalability.”
Although you don't hear as much about blockchain as you do about artificial intelligence, there are a number of efforts to use this technology in healthcare, Kim noted, but again there are many challenges blockchain needs to overcome before it can be adopted. Here is Kim’s advice. “It’s so easy to get caught up in the hype and buzzwords of emerging technology like AI and blockchain. Be honest and ask yourself, can this be done without a blockchain? Could it be done just as well with existing technology? Also, ask yourself if blockchain is a big improvement over the current process. Don’t use it just because it is the latest technology being hyped. And if you do use it, start small.”
