Medical data are highly privacy-sensitive; hence giving patients control of access to their own records and exchange of health data between institutions raise the risks of data exposure, and opens up issues around trust and security. Blockchain technology could be useful in ensuring medical data integrity and privacy. Blockchain will serve as a platform and is seen to provide benefits in the transformation of healthcare in Malaysia. This article presents the description of how blockchain can be adopted to solve problems in telemedicine, counterfeit drugs and coronavirus. Two use cases of blockchain in Malaysia healthcare are presented that will foster the understanding of how blockchain is applied to solve healthcare problems.Nor’ashikin Ali , Associate Professor, University Tenaga Nasional UNITEN
Healthcare organisations have consistently improved their healthcare delivery through the adoption of Information Technology (IT). The digital transformation in healthcare through the evolution of Electronic Medical Record Systems (EMRs) and Electronic Health Record Systems (EHRs) to the Internet of Things-enabled healthcare devices help improve the quality of healthcare delivery by curbing costs, reducing inefficiencies, and saving lives. This transformation enables health data sharing between healthcare professionals, and medical institutions, and thus, information about patients is available electronically, and easily accessible by multiple authorised users. Furthermore, the current trend of mobile applications via smartphones that uses Internet of Things features such as sensors, and GPS provide rapid access to medical data. Medical data are highly privacy-sensitive; hence giving patients control of access to their own records and exchange of health data between institutions raise the risks of data exposure, and opens up issues around trust and security.
There has been considerable hype about the potential of blockchain technology within healthcare, and it is therefore, important to shed light on some blockchain concepts, and the role of blockchain in healthcare. Some use cases are described that will foster the understanding of how blockchain is applied to solve healthcare problems.
BLOCKCHAIN TECHNOLOGY: BEYOND BITCOIN
The emergence of blockchain technology seems to be a potential solution to the underlying problems of security and privacy in healthcare. Blockchain is also known as a distributed ledger technology that was initially introduced for financial applications; it originated from Bitcoin as an accounting system with a public, secure, and verified ledger (Nakamoto, 2008). The main feature of blockchain is that it makes possible the exchange of electronic coins between two or more parties without the need for an intermediary to validate the transaction (Crosby et al., 2016). In a blockchain platform, individuals can coordinate their own activities, and interact directly with one another in a more secure and decentralised manner. Traditional electronic transactions rely on the third party as an intermediary to validate, safeguard and preserve transaction. For example, in online purchase, the consumer has to go through the bank to make payment to the seller that also involves transaction fees. Frauds may happen. In healthcare, the traditional transactions in transferring a patient’s health records can be lost, or copies can be made for illegal purposes. The latest blockchain technology has shifted from financial applications to non-financial applications; consequently, it is now considered as a general purpose technology that can benefit healthcare sectors. Figure 1 exhibits how Blockchain works.
When Malaysia started the multimedia super corridor (MSC) initiative in 1997, its aim was to transform the nation into a knowledge-based economy. One of MSC core initiatives was Telemedicine, a relatively new field providing remote delivery of healthcare services with the aim to provide equal access to quality healthcare. However, the Internet was not well developed nor were technologies such as the Internet of Things (IoT) and artificial intelligence (AI) commonplace at the time. When the technology has evolved, digital healthcare is a becoming a new trend that will improve the provision of care for patients; telemedicine and more technologies are embraced to provide an ecosystem that enhances the healthcare services in Malaysia. Now Malaysia is on the verge of the Fourth Industrial Revolution (4IR), adopting connected devices, data analytics, and artificial intelligence (AI)for easy accessibility and sharing of data over the internet. With this IR4.0, a healthcare application of IoT technologies or the Internet of Medical Things (IoMT) can support clinical decisions, reduce incorrect diagnosis, improve data access among patients and practitioners. However, this advanced technology may create issues related to the ownership and integrity of the data. Blockchain is seen as a viable solution for digital healthcare as it has the potential to revolutionise the handling and sharing of medical records. Among the areas in Malaysian healthcarethat could greatly benefit from three important qualities of blockchain technology–decentralisation, immutability, and security are telemedicine, counterfeit drugs and coronavirus as these areas are the current trends that have received wide attention.
The equitable access to quality healthcare by Malaysians has consistently been the primary objective of the Ministry of Health (MOH). Since 1997, telemedicine has been adopted to transform the healthcare system by providing easy access through virtual connection between a doctor and the patient. The rise of telemedicine is attributed to innovations in mobile medical and non-medical devices that enable patients to collect medical data and communicate them to their providersover telecommunications lines. However, some of the major challenges to occur over virtual connection are the security, sensitivity, and privacy of the medical data. During remote diagnosis, clinical data are exchanged, and they might be accessed by the third parties. Blockchain is a distributed ledger technology that could create efficient ways to transfer data effectively and communicate across organisations. Blockchain applications enable secure, immutable and anonymous transactions across networks. It provides a secure network, and help establish a seamless exchange of data and increase consumer trust in the system. Doctors can access patients’ data in a decentralised ledger. Similarly, patients also have the ability to access their medical records when needed and share the data with their doctors. Blockchain enables both the patient and doctor to secure a personal copy of the ledger without a single party having control over the data. A medical record that is generated and signed is immutable–the record cannot be modified. Any effort of access or modification can be quickly traced and recognised. With guaranteed security and privacy protection, blockchain has the potential to engage more patients to connect virtually with their doctors.
Counterfeit drugs are a serious issue and illegal in Malaysia. According to the Emerging Markets Health Network, counterfeit drugs constitute approximately 5% of total medicines in this country, compared with more industrialised countries where it is estimated to be less than 1%. It threatens the public health, and cause financial losses to pharmaceutical companies. For the prevention of counterfeit drugs, blockchain is a way to ensure that an immutable chain or transaction ledger keeps track each step of the supply chain at the individual drug level. Blockchain can help reduce fraud using a shared digital ledger. This approach brings more transparency to transactions throughout a supply chain and between members of a business network. Using Blockchain, participants can see the history and transfer of assets, and thus, prevent modifications of the data and transactions, so fraudulent transactions are easier to identify. The blockchain helps increase trust and transparency, with customers being able to track pharmaceutical products throughout the supply chain. Using a bar code scanner, manufacturers and customer can see the record of transactions of the drug, which is delivered on the blockchain in real time. What blockchain can offer is its ability to identify, trace, verify and notify illegitimate drugs.
Recently, due to the COVID-19 coronavirus that causes Malaysia to be placed as the most affected country in South East Asia, the government has implemented a nationwide movement control order that limits public movements as an effort to curb the spread of Covid-19 beginning 18 March until 31 March 2020. Blockchain technology emerges as a useful tool to help manage and mitigate coronavirus. Blockchain technology could tackle various aspects of the issue. Blockchain has the ability to track medical and insurance claims payouts after adding covid-19 as a critical illness. Throughout the coronavirus outbreak, donation of supplies (face masks, sanitisers, handwashing liquids, etc.) has increased. To prevent from frauds, a blockchain-based donation tracking platform enable donors to see where funds are most urgently needed and thenthey are provided with verification that their donations have been received. Currently, there is an increase in demand for the materials such as masks, gloves, and sanitizer, which will cause an increase in counterfeit production. Blockchain could be a platform that enables users to trace the demand and the supply chains of medical supplies, thus preventing frauds in the supply chain process.Management of health records including patients’ data, and treatments given of coronavirus patients is more secure and reliable as data are protected and unaltered.
Use Cases of Blockchain in Malaysian Healthcare
This blockchain-based application, known as cHEART is built on Hyperledger Fabric, an open source blockchain technology. It was implemented by AmalMedik clinic, the first clinic that adopts blockchain technology. cHEART allows patients to take full control of their healthcare data aggregated from wearables, EMR (Electronic Medical Records) and IoMT (Internet of Medical Things).The pilot at AmalMedik which commences in October 2019, will allow DATA8 to gather feedback from doctors and patients to refine its platform and continue development ahead of its commercial launch. cHEART is expected to reduce patients’ wait-time since they can make appointment with their favourite doctor on-line. cHEART provides a secure platform that takes care of patients’ data privacy. Patients can have access to their own records, and doctors can haveaccess to their patients’ data for better accurate diagnosis because blockchain allows all parties to own their data.
Another medical application that utilises block chain technology is Doc2Us, a mobile application that enables users and patients to connect and chat with healthcare professionalsvia real-time chat services. Starting from normal text-based chatting services, Doc2Us has been improved to be a telemedicine provider for hospitals, clinics, and pharmacies. This application provides a service that helps connect doctor and pharmacist as well as patient and doctor. Doctors are also able to order and request blood tests for patients and review the results few days later via the App.
To ensure data integrity and privacy, Doc2Us adopts blockchain technology providing a secure platform that empowers users to take care of their medical data. Users can update their medical history and vital signs like blood pressure, temperature etc. Patients can authorise parties to have access (read, write, or either) to their health record. Data can be shared securely across different parties such as clinics, hospitals, laboratories and more.
Blockchain technology creates opportunities to solve several problems plaguing the healthcare sector in Malaysia. Although the application of the blockchain technology is still new, it holds great promise in strengthening Malaysian healthcare system.The field is evolving rapidly; we are looking forward to see significant positive impact of blockchain in healthcare sector in Malaysia.
Crosby, M., Pattanayak, P., Verma, S., &Kalyanaraman, V. (2016).Blockchain technology: Beyond bitcoin. Applied Innovation, 2(6-10), 71.
Engelhardt, M. A. (2017). Hitching healthcare to the chain: An introduction to blockchain technology in the healthcare sector. Technology Innovation Management Review, 7(10).
S Nakamoto, Bitcoin: A peer-to-peer electronic cash system. (2008) Retrieved from https://bitcoin.org/bitcoin.pdf
Nor’ashikin Ali is an Associate Professor at University Tenaga Nasional (UNITEN), Malaysia. She has presented her research in several conferences and published many papers in journals including two publications in International Journal of Medical Informatics. Currently, she is supervising PhD students in the area of blockchain, knowledge management, machine learning, teleconsultation, and the use of fitness apps for obesity prevention. She has secured several research grants including one research grant in teleconsultation.