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The HIPAA Data Standards Series: Bitcoin Reveals the Future of Healthcare

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On February 5, 2016, hackers attacked Hollywood Presbyterian Medical Center’s computer systems. They prevented hospital staff from gaining system access and said they would only restore it if they received a payment of 40 bitcoin (about $17,000).

While small in scale and cost, this security breach may unknowingly show us healthcare’s future. And no, that doesn’t mean we all need a bitcoin account to pay modern-day highway robbers.

Where we’re at

As I explained in my first post in the series, we’re facing a laundry list of new industry expectations and trends: clinical attachments, PACDR, HIPAA 7030, ICD-11, unstructured data, and cognitive computing — just to name a few.

These trends and tools have created a more complex system, one that houses even more sensitive data, and then requires more transactions involving that data. At first glance, that would appear to be a bigger target for hackers and offer more entry points for them to access the system.

And there’s some truth in that. But the same technology that allowed the hackers to anonymously receive their ransom also has the potential to usher in a new era of healthcare records management and interaction between patients, providers, and payers.

The bitcoin secret

The promise of bitcoin is not necessarily the new way to pay. It’s the underlying technology that allows the payment to be trusted by both parties and secured from hacking — and, more specifically, how that technology can be used throughout the entire healthcare data infrastructure. This technology is known as blockchain.

Blockchain is a decentralized, anonymous transaction technology that allows parties to exchange information electronically with trust, accountability, transparency, and security. For a bitcoin transaction, that blockchain application is limited to financial data. But blockchain can apply to any data exchange in any industry — including healthcare.

The blockchain contains a history of all transactions performed within the system. Every validated transaction, or batch of transactions, gets encrypted and becomes a block. Each new block is then added to the last block. The result is a chain of blocks arranged in a known sequence.

Let’s use a healthcare transaction to illustrate how it works.

In a traditional payment for services, the transaction is tracked on two independent ledgers. Say you’re a patient who owes $200. Your bank sends money to your healthcare provider’s bank. Then your bank makes a note in its ledger that $200 should be subtracted from your account. When your healthcare provider’s bank receives the money, it makes a note in its ledger that $200 should be added to the account.

With blockchain technology, a distributed ledger of transactions is maintained by each system participant. When you authorize payment of $200 from your account to your doctor’s account, the transaction is noted once in each copy of the ledger.

In contrast to the traditional approach, ledger accuracy is maintained by the transaction participants operating through consensus. And, once entered and verified, the information can never be erased. Finally, the transaction is accurately recorded without exposing confidential details about the subject matter or the parties involved. Only the patient and doctor have cryptographic keys to access the data.

Applying blockchain to healthcare

As this example shows, the healthcare payments application is clear. But blockchain can be applied to the entire healthcare records system — including the new data exchange formats and reporting requirements.

For example, we could set up a patient’s complete medical history as a digital record, one that’s available 24×7 worldwide. Only the patient, or their healthcare agent, would hold the permanent cryptographic key to their digital record. The patient could share this record and its data with any healthcare facility, provider, payer, or even a family member, by granting access with a temporary key.

Temporary keys could be managed with smart contracts — enforceable agreements between two parties that are also enabled by blockchain technology. For instance, you could establish a smart contract with an MRI provider, granting them a temporary access key to your record. They would then perform the MRI and you’d use the smart contract and its blockchain technology to pay them. Once they received payment, they would update your record with the MRI results and their access key would be revoked. You’d then grant your specialist a temporary access key to your record and the treatment process would continue.

How blockchain impacts you

As a healthcare data standards expert, some may wonder why I’m so excited about blockchain. After all, there are no healthcare data standards in the blockchain. That’s true — but blockchain has the potential to transform our interaction with the industry data standards.

The MRI example illustrates how blockchain will cause us to reevaluate current data ownership and data security models. And the interaction of the various parties and systems with that secured, decentralized data shows how this technology may impact healthcare data sharing.

That’s because the data in the blocks, or referenced by the blocks, will be HL7, ASC X12, or perhaps NCPDP. To be effective, our data processing systems and infrastructure will need to understand and interact with current and future data standards — all within a blockchain environment.

Fortunately, IBM is committed to blockchain as evidenced by our charter membership on the Linux Foundation’s open-source Hyperledger Project, as well as our contribution of 44,000 lines of code to the effort. Further, we’re working to integrate blockchain technology with our business tools, including the IBM Transformation Extender.

The result will be tools that understand industry data rules and formatting standards — like the volume of healthcare data rules and standards — and can do it within a blockchain environment. Learn how blockchain will fundamentally transform the way we do business.

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