Blockchain Technology in Healthcare

By Gunasekaran Thirumurugan

Blockchain Technology in Healthcare, discuss the recent advancements in the blockchain powered healthcare industry such as electronic health record management, insurance, clinical trials, pharma supply chain management, precision medicine, Pharmacogenetics, nutrigenetics and health/drug informatics.

• Language: English
• Publisher: Gunasekaran Thirumurugan
• Release date: Sep 27, 2020
• ISBN: 9798689463179

Gunasekaran Thirumurugan

Thirumurugan received B. Pharm and M. Pharm (Pharmaceutical Biotechnology) from the Tamilnadu Dr. M. G. R. Medical University, Chennai and scholar at JNT University, Kakinada, India. He authored 3 books and 3 chapters, 29 peer reviewed research publications in the top publishers such as Nature, Elsevier, Wiley, Taylor & Francis, Informa Etc., He presented 11 research papers at scientific conferences. He is teaching more than 10 years in the Pharmaceutical educational institutions including Jimma University and Ambo University, Ethiopia.

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Content

Blockchain technology: a new era of health care opportunities

Blockchain technology in medical record management

Blockchain technology integrated Genomics, Pharmacogenetics

Blockchain powered drug supply chain management system

Blockchain technology in precision medicine

Blockchain technology in health insurance industry

Blockchain technology in Medical/drug informatics

Blockchain technology in nutrigenetics/nutrigenomics

Blockchain technology in clinical trials management

Blockchain technology: a new era of health care opportunities

Abstract

A blockchain is a decentralized public ledger to which everyone has access, but without a central authority having control. Blockchain technology was introduced in 2008, Satoshi Nakamoto created the world’s first blockchain based network called Bitcoin, initially intended to record financial transactions between one individual to another based on peer to peer (PtoP) system (specially an alternative to the banking industry). There are great opportunities in this disruptive technology and revolution in this space has just begun. The purpose of this book is to discuss the role that blockchain technology can play in the field of medicine and health care industry. This chapter provides an overview of blockchain technology and definitions, terms related to the blockchain.

Keywords: blockchain technology; Cryptocurrencies; Bitcoin; Medicine; Healthcare.

Introduction

The use of blockchain technology is in the field of economics called cryptocurrencies in general, in particular  bitcoins, its usefulness is extending to other fields such as medicine, agriculture and food industry, pharmaceutical industry, insurance industry, etc.,. Digital world has fashioned efficiencies, innovative products, and good customer relationships worldwide by the efficient exploit of mobile, social media, IoT (Internet of Things), analytics and cloud technology to produce models for better decisions [1]. Blockchain technology was introduced in 2008, initially intended to record financial transactions between one individual to another based on peer to peer (P2P) system [2]; its applications have mostly progressed with technological advances and the growing interest of global companies. In the healthcare sector, blockchain technology is interesting for numerous features due to its immutability which makes it an outstanding support for authenticating sensitive data such as clinical trials consents, patient medical records. Moreover, there is a possibility of publishing smart contracts that automate and make easy many processes or the formation of a network that agrees with the state of the information. The concepts are convenient for a broad range of industries as finance, government and manufacturing where security, scalability and efficiency must meet.

Overview of Blockchain

The in depth technical foundation of the blockchain technology is outside the scope of this book. However, it is imperative to discuss on some blockchain technology concepts, features and terminologies that will encourage the understanding of how blockchain technology is applied to answer healthcare problems.

Blockchain technology removes the need for a centralized trusted third party in distributed applications. By making it feasible for two or more parties to carry out transactions in a distributed environment devoid of a centralized authority (Trusted Third Party; example, Central bank or reserve bank in the finance sector), blockchain technology defeats the difficulty of single point of failure which a central authority would otherwise commence. Blockchain also get better transaction speed, by removing the delay introduced by the central authority, and at the same time, blockchain technology makes transactions cheaper as the transaction fee charged by the central authority is removed. In the position of a central authority, the blockchain uses a consensus mechanism to reunite discrepancies between nodes in a distributed application. The difference between centralized and decentralized systems is shown in Figure.

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On Figure Left, there are multiple ledgers, but all the records are in the custody of one central place, in this case, the Central Trusted Third Party. In fundamental nature, the Central Trusted Third Party maintains the state of the ledger. When there is a discrepancy between two nodes about the true state of the ledger, the Central Trusted Third Party is consulted as the final authority to determine the true state of the ledger. On the contrary, in Figure Right, there is single ledger, but all the nodes have a copy of the ledger and some level of access to its contents. To retain the integrity of the ledger, the nodes must have a means to agree on the true state of the ledger, in the absence of a Central Trusted Third Party. When the nodes agree on a particular true state of the ledger, it is referred to as agreement. The different ways in which agreement is achieved in blockchain technology will be explained in the coming section.

Mainly, the blockchain technology uses cryptographic primitives to obtain the majority of its capabilities. Participants in a blockchain network are represented as nodes and each node uses public key infrastructure (PKI) [3] to generate and propose transactions. The entire participant possesses a pair of public and private keys. The public keys serve as the public address of the user at the same time as the private key is used to authenticate the user. When a transaction is generated, it has to take account of the public key of the user who generated the transaction, the public key of the receiver (ex., phone) of the transaction and the transaction message. All of these are bundled together and cryptographically signed using the user’s private key and then broadcast to the other nodes in the blockchain network. When this is done, the user is said to have proposed a transaction.

A block is a compilation of legitimate transaction proposals that are received within a period of time; say 10 min [2]. A legitimate transaction proposal is one which convinces the validation requirements. The process of validation ensures that the proposed transaction is lawful, for example, that it generated from an authorized user (node). The agreement algorithm determines the order in which the validated blocks are added to the ledger. There are special nodes in a blockchain network that are responsible for running the agreement algorithms (i.e., for validating transactions and determining the order in which transaction blocks are added to the blockchain). These special nodes are referred as miners and the process of validating transactions and ordering them in the blockchain is called as mining. Once a transaction proposal is received by a miner, the miner proceeds to verify if the transaction is legitimate. Validated transactions are integrated into a block. After a period (or block) of time, the new block of validated transactions is linked (or chained) to the previous blocks, generating a chain of blocks, known as "blockchain". The blockchain is replicated amongst all the nodes in the network, such that each node has an identical database or ledger of all the transactions in the network.

At this time, it is better to clarify the definitions of blockchain technology. There are a lot of different blockchain definitions offered, ranging from application-specific to the greatly technical. For example, Coinbase, the world’s largest cryptocurrency exchange, defines blockchain as a distributed, public ledger that contains the history of every bitcoin transaction [4]. As an application-specific definition, this characterization does not account for the fact that blockchains can be reused for other cryptocurrencies and industry applications independently. The Oxford English Dictionary broadens the definition somewhat, defining blockchain as a digital ledger in which transactions made in bitcoin or another cryptocurrency are recorded chronologically and publicly [5].This definition also falls short as blockchain technology can be used autonomously of Bitcoin and other cryptocurrencies. Both these definitions also emphasize the role of a blockchain as a digital ledger, and much of the literature would agree with this. However, this domain is developing rapidly, and ledger usage is simply a feature of the blockchain but not its essence. This feature only pertains to blockchain applications that focus on managing the exchange of value in the case of virtual assets. A somewhat broader definition is offered by Webopedia where a blockchain is defined as a type of data structure that enables identifying and tracking transactions digitally and sharing this information across a distributed network of computers, creating in a sense a distributed trust network. The distributed ledger technology offered by blockchain provides a transparent and secure means for tracking the ownership and transfer of assets [6].

Evidently, there is a need for a clear and concise definition of blockchain. Based on the theoretical underpinnings of blockchain technology outlined in the previous sections, we provide the following definition of a blockchain: A decentralized database containing sequences, cryptographically linked blocks of digitally signed asset transactions, governed by a consensus model. Through this connotative definition, to highlight the core constituents for