How bitcoin's sister technology could change the future of healthcare

The larger world didn't start paying much attention to bitcoin until 2013. That was the year mainstream companies like Microsoft, Expedia and Dell, among others, began to accept the alternative, electronic payment method. That was also the year the Department of Homeland Security shut down the Silk Road, a "dark web" hub for illegal activity, and began to investigate the Tokyo-based digital exchange Mt. Gox, seizing millions of dollars in bitcoin in the process.  

Bitcoin an electronic currency that exists but can't be touched, that operates above banks with no central authority and is issued by collective action. It promises extensive control over capital for businesses and individuals and enables efficient transfer worldwide with no limitations or surcharges.

The currency's site puts it simply — "bitcoins are digital coins you can send through the internet." Bitcoin supporters and detractors alike have touted the system as having the potential to upend economics as we know it. As might be expected, bitcoin has faced pushback at nearly every turn.

However, now that more eyes are trained on bitcoin, some argue the real magic behind the coin is being overlooked: a code, called blockchain, which acts as the unbreakable security backbone of all bitcoin transactions.

"It helps to think about a blockchain kind of like a global computer," says Micah Winkelspecht, founder and CEO of Gem, a blockchain technology company. "It's a giant machine that allows us to interoperate with each other and to do that in a very trusted way. Economists call it the global trust machine — a giant network of connected computers all operating together to come to a consensus on what is true."

Mr. Winkelspecht founded Venice, Calif.-based Gem after working to build a community of bitcoin users in Los Angeles around the same time the term "bitcoin" became more familiar. He began writing an open source library to help build security tools for the currency and, by his own admission, went down the rabbit hole and never came back.

Gem began as a way to offer those open source tools to other developers, so they wouldn't have to start from scratch when designing applications for bitcoin. Then Mr. Winkelspecht began to notice a lot of interest from large financial institutions who were hyped on the fervor with which smaller, younger companies were moving toward bitcoin and its related technologies. After a time it became apparent that healthcare, in its relentless search for better interoperability and cybersecurity, stood to benefit from blockchain.

Every time a patient sees their physician, they create a wake of digital activity, Mr. Winkelspecht says. That wake ripples through the care continuum, from the pharmacist who fills a prescription to the pharmaceutical firms from which they order drugs.

"What the blockchain allows us to do is create a new type of fabric for the underlying infrastructure of the entire healthcare industry," Mr. Winkelspecht said. "It would allow all parties — from insurers to providers — to connect in real-time and share information essentially instantly, without having to pass paper or even data back and forth."

Two of the primary components that make up a blockchain are identity and historical record, which Mr. Winkelspecht compares to a giant log of events, each of which is attributed to a proof in the real world. The log is unchangeable, so it provides a secure record of exactly who did what, where and when. This "integrity layer" provides a guarantee that no data contained in a blockchain has been modified or changed. These guarantees are strong enough that the blockchain enables users to track activity across an industry, or across countries. This is one of the reasons the financial sector, which is global in nature, was the first to become enamored by the technology and first to adopt it.

"It allows you to move data from point A to point B anywhere in the world with strong guarantees around the integrity and confidentiality of that data, so only the right person at the right time has access to it," Mr. Winkelspecht says.

In March 2016, Estonia's e-Health Authority partnered with Guardtime, a blockchain company, to help secure and facilitate interoperability for its nationwide EHR system.

Mr. Winkelspecht sees the most promising places for blockchain to be used in healthcare at the connecting points between stakeholders, like insurers and providers. The blockchain would allow the appropriate parties to view, edit and find the data in the exact same place, without the middlemen, routers and third companies that handle not only the data but the network connections parties use to pass sensitive information back and forth.

Blockchain is often viewed as a financial technology, which may be why its place in healthcare has been slow-moving. But the pattern that the financial sector established with bitcoin and blockchain will probably play out the same way for hospitals and health systems, according to Mr. Winkelspecht.

"It took about a year and a half for the financial industry to go from looking at bitcoin and saying, 'This will never work,' to where it is now, where essentially every major financial institution in the world is either exploring blockchain or has active teams devoted to building projects using it," Mr. Winkelspecht says.

Currently, Mr. Winkelspecht says he doesn't know of any healthcare organizations in the U.S. actively using the technology. Part of the reason may be related to cost — for many, upgrading to blockchain could require gutting antiquated systems. But once the perception around blockchain dissipates and healthcare stakeholders begin to understand not only how the technology works, but its implications, it could take off much in the same way it did in finance.

"This year already we're seeing major healthcare organizations beginning to explore it and we're working to help them start building prototypes and pilot programs," Mr. Winkelspecht says. "It's on a very short time horizon."

More articles on health IT:

What the US can learn from Estonia's electronic health records 
The future of the hospital is the network 
US government at the bottom of the barrel when it comes to cybersecurity: 7 insights 

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