Electronic copy available at: https://ssrn.com/abstract=3006389
Why Blockchain Technology is Important for
Thomas F Heston MD FAAFP
July 20, 2017
Abstract. Blockchain technology is a system of creating an immutable,
secure, distributed database of transactions. Blockchains were initially
created to provide a distributed ledger of financial transactions that did not
rely upon a central bank, credit company, or other financial institution.
The technological breakthrough, however, has been extended to
transactions involving legal matters, medical records, insurance billing,
and smart contracts. One primary way that blockchain technology is
important to healthcare professionals in that it can revolutionize medical
database interoperability. This greater interoperability can help improve
access to medical records, imaging archives, prescription databases. Given
that a patient’s medical history is a primary cornerstone of good medicine,
blockchain technology has the potential to dramatically improve medical
Blockchain technology is a system of ensuring a secure, tamper-proof, and permanent record of
transactions. The fundamental idea of a distributed secure ledger was invented in 2008 by
Satoshi Nakamoto (1). Initially, the technology created bitcoin, which verifies financial
transactions without the requirement for a central authority, the federal reserve, a central bank, or
other financial institution. Because the method of transaction verification involves a network of
computers, rather than a single computer, it is very fault-tolerant. Any single computer can be
added or removed from the network at any time without corrupting the ledger of transactions.
Because the ledger is duplicated across all network computers, transactions are secure and
immutable. A key feature of blockchain technology is that it is trust-less: transactions are
processed by the network so there is no need to trust a single computer, database, or institution.
The initial blockchain created bitcoin, which consists of a secure, immutable, distributed
database of financial transactions. However, the technology has also been extended to create a
system of secure, immutable, distributed computer programs allowing the creation of smart
contracts and artificial intelligence (2).
Electronic copy available at: https://ssrn.com/abstract=3006389
Interoperability is the ability to work together in an oganized manner. Applied to electronic
medical records, interoperability means the ability of large computer databases containing patient
information to effectively communicate with each other and ultimately communicate the data to
healthcare providers quickly in a meaningful way (3).
Even though the Internet has been has been transmitting data around the world for almost 50
years now, critically important medical data remains for the most part hidden away tightly in
silos, run by hospitals, clinics, and insurance companies. This tight lock on patient records means
that even when going a short distance within the same town it is difficult to access medical
records from a different clinic. Although the clinic is in the same city, the silo housing medical
records is just as isolated as if it was located thousands of miles away. These silos effectively
control medical records, instead of the patient controlling their own medical records (4). Because
of the hassle of transferring medical records, many patients will stay within a single healthcare
system for the sole reason that their medical records are housed within that system.
3. Case Study
One of the biggest challenges in medicine is inaccessible medical records for acutely ill patients
unable to verbalize or recall their personal information. For example, a patient was admitted
from the emergency room because of an acute respiratory failure. He could not verbalize his
medical history, because all of his focus and efforts were upon getting enough air. In terms of his
medical history, his medical team was flying blind.
The patient was a 48 year old long haul truck driver from out of town. No family was at the
bedside and no medical records were available. What medications was he on? What allergies did
he have? Given all of the unknowns, the patient received the generic, one size fits all treatment
for acute hypoxic respiratory failure.
Over the next several hours, his heart rate gradually increased into the 130’s. Most likely, he was
developing sepsis from an acute infection which was the cause of his initial breathing
difficulties. In response, he was given antibiotics and intravenous fluids, again the generic
treatment for what was the most likely cause of his condition. But it turns out his symptoms were
due to something else entirely, that would not have been missed if old medical records had been
The patient just had a severe exacerbation of his chronic obstructive pulmonary disease. He
didn’t have sepsis at all. His increased heart rate was due to beta blocker withdrawal from not
getting his routine nightly dose of metoprolol. He was eventually discharged from the hospital in
good condition, back at his baseline. His hospitalization, however, was prolonged by a full day
and he received unnecessary antibiotics all because nobody knew he was on a beta blocker. His
old medical records were in Oklahoma, locked up safe and secure in an electronic database. We,
however, were in Oregon. While his medical records were secure in Oklahoma, they were not
useful. His home clinic’s database had no interoperability with the clinical database at the
hospital in Oregon. The result was not fatal, however, his hospitalization was prolonged and his
diagnosis delayed due to poor computer database to computer database communication.
4. Future Directions
The next major advance in medical records is not going to be a new software program that runs
on a database isolated within a single healthcare organization. The next advance will be the
creation of a distributed ledger which will effectively transfer control of patient records from the
healthcare organization to the individual. When medical records become as freely mobile as
people, we will have made a tremendous leap forward in medicine. Blockchain technology is the
key scientific breakthrough enabling this major step forward.
The process of making the medical records of individuals readily accessible requires the use of
distributed databases stored on the cloud in a secure yet open manner. The records must be
secure, immutable, and at the same time easily accessible. Blockchain technology is the vehicle
that makes all of these goals possible (5).
1. Nakamoto S. Bitcoin: A Peer-to-Peer Electronic Cash System . 2008 Oct; Available from:
2. Buterin V. Visions, Part 1: The Value of Blockchain Technology [Internet]. Ethereum Blog.
2015 [cited 2017 Jul 13]. Available from:
3. Brodersen C, Kalis B, Leong C, Mitchell E, Truscott A. Blockchain: Securing a New Health
Interoperability Experience. 2016 Aug; Available from:
4. Mandl KD, Kohane IS. Escaping the EHR trap--the future of health IT. N Engl J Med. 2012