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I. Introduction
A blockchain, by design and definition, is a particular type
of database [1]. It is constructed as a to-read-only-once data-
base.This means that blockchain databases are designed to
be only-ever-created, and not edited or deleted. Data stored
in a blockchain decentralized ledger (computer file asset) is a
transactional type of data that requires space of 1 kB or less,
and no one is able to access it as long as the owner holds the
private keys. Moreover, the owner can use the InterPlanetary
File System (IPFS) to access the data and transfer it from
one computer to another much faster and more securely and
economically in comparison to centralized databases [2].
The rationale for the use of blockchain technology in
healthcare is the fact that maintenance of a typical healthcare
information system involves various operations including
but not limited to performing backup storage services, hav-
ing recovery mechanisms in place, and ensuring up-to-date
fields [3]. In a blockchain, data are distributed across the
network, and there is no single point of failure leading to an
inherent backup mechanism. Also, a single version of data
is copied on every node of the blockchain. This reduces the
volume of transactions that occur between information sys-
Blockchain Applications for Healthcare Data
Management
Dimiter V. Dimitrov
Diavita Ltd., Varna, Bulgaria
Objectives: This pilot study aimed to provide an overview of the potential for blockchain technology in the healthcare sys-
tem. The review covers technological topics from storing medical records in blockchains through patient personal data own-
ership and mobile apps for patient outreach. Methods: We performed a preliminary survey to fill the gap that exists between
purely technically focused manuscripts about blockchains, on the one hand, and the literature that is mostly concerned with
marketing discussions about their expected economic impact on the other hand. Results: The findings show that new digi-
tal platforms based on blockchains are emerging to enabling fast, simple, and seamless interaction between data providers,
including patients themselves. Conclusions: We provide a conceptual understanding of the technical foundations of the po-
tential for blockchain technology in healthcare, which is necessary to understand specific blockchain applications, evaluate
business cases such as blockchain startups, or follow the discussion about its expected economic impacts.
Keywords: Health Information Interoperability, Information Storage and Retrieval, Genomics, Artificial Intelligence,
mHealth
Healthc Inform Res. 2019 January;25(1):51-56.
https://doi.org/10.4258/hir.2019.25.1.51
pISSN 2093-3681 • eISSN 2093-369X
Case Report
Submitted: December 18, 2018
Revised: January 11, 2019
Accepted: January 23, 2019
Corresponding Author
Dimiter V. Dimitrov
Diavita Ltd., 68 Br. Miladinovi str. G, Varna 9000, Bulgaria. Tel:+359-
87777-9937, E-mail: dimiter.v.dimitrov@gmail.com (https://orcid.
org/0000-00003-3766-5850)
This is an Open Access article distributed under the terms of the Creative Com-
mons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-
nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduc-
tion in any medium, provided the original work is properly cited.
ⓒ 2019 The Korean Society of Medical Informatics
52 www.e-hir.org
Dimiter V. Dimitrov
https://doi.org/10.4258/hir.2019.25.1.51
tems, thus reducing the burden on the healthcare ecosystem
[4].
With the progress in electronic health-related data gather-
ing, cloud healthcare data storage and patient data privacy
protection regulations, new opportunities are opening for
daily health data management, as well as for convenience
for patients to access and share their own health data (Table
1). In this study, the available applications of blockchains in
healthcare and cases of their use are reported in general.
II. Case Description
1. Blockchain for Electronic Medical Record (EMR) Data
Management
The potential for the use of blockchain technology in hospi-
tals has started to be tested in several pilot projects globally.
Last year in the United States, Booz Allen HamiltonCon-
sulting developed and implemented a blockchain-based pilot
platform designed to help the Food and Drug Administra-
tion’s Office of Translational Sciences explore how to use the
technology for healthcare data management (Figure 1). The
pilot project is currently being implemented at four major
hospitals; it is usingEthereumto manage data access via
virtual private networks. The project is built on the IPFS to
utilize encryption and reduce data duplication via off-chain
cloud components with cryptographic algorithms to create
user sharing [6].
2. Blockchain and Healthcare Data Protection
In Europe the relationship between blockchains and the
General Data Protection Regulation (GDPR) is somewhat
controversial. On one hand, blockchains seem to represent a
good alignment with GDPR (when it comes to data portabil-
ity, as an example, or consent management, data traceability
and lawful access auditability). On the other hand, various
issues can be identified (when it comes to right to be forgot-
ten, but also when the technical implementation through
smart contracts might weaken the actual control over data,
through automatic execution). One option to tackle this is-
sue is ‘dynamic consent management’, which is fully in line
with the GDPR provision regarding consent [7]. In addition,
it is considered that ‘private blockchains’, e.g., Enterprise
Blockchain can easily comply with GDPR directives since
the transactions of the digital records of the stored infor-
Table 1. Blockchain companies for healthcare data management
Blockchain company
Name Country Website
EMR data management PokitDoc USA http://pokitdoc.com
Gem USA http://enterprise.gem.co/health
Yo u B a s e USA http://www.youbase.io
EHR data management Medicalchain USA http://www.medicalchain.com
HealthWizz USA http://www.healthwizz.com
Curisium USA http://www.curisium.com
Hearthy Spain http://hearthy.co
Iryo Slovenia http://iryo.io
Robomed Russia http://www.robomed.io
PHR data management Medcredits USA https://medcredits.io
MyClinic UK https://myclinic.com
Point-of-care genomics Nebula Genomics USA http://www.nebula.org
Genomes.io USA http://www.genomes.io
TimiCoin USA http://www.timicoin.io
Shivom Switzerland http://shivom.io
Oncology patients network OncoPower USA http://oncopower.org
Pharma & drug development Embleema France http://www.embleema.com
BlockPharma France http://www.blockpharma.com
Chronicled MediLedger USA http://www.mediledger.com
EMR: Electronic Medical Record, EHR: Electronic Health Record, PHR: Personal Health Record.
53Vol. 25 • No. 1 • January 2019 www.e-hir.org
Blockchain Healthcare
mation can be modified and erased by private entities or
authorities who can own and control this platform, using a
particular class of consensus algorithm [8]. These private
blockchains are run by a single company or organization,
but they grant access to users, typically organizations, that
fulfill certain pre-established credentials or criteria [9].
Such systems would be similarly managed in terms of how
a company manages its private web applications. Their use
cases could include the following: record keeping by govern-
ment agencies, public health records owners, and healthcare
reimbursement providers. In the future, these private block-
chains could have the most significant impact on healthcare
policy and management. The potential of blockchains is
also addressed by the European Commission Research &
Innovation Program IMI (Innovative Medicine Initiative)
Pilot project named “Blockchain Enabled Healthcare” lead
by Novartis, which aims to leverage existing standards, such
as Ethereum, and to develop complementary standards if re-
quired. The focus is on enabling services that directly benefit
patients [10].
3. Blockchain for Personal Health Record (PHR) Data
Management
Personal life-log data recently has begun to be captured
through wearable sensors or medical IoT devices as per-
sonal health records (PHR). Real-time artificial intelligence
(AI)-powered healthcare analytics will be fed back to the
related users, including patients, physicians, pharmaceutical
researchers, and payers [11,12]. This entire PHR service tra-
jectory is becoming a valuable source of data for blockchain
service providers. (Figure 2).
Distributed or decentralized applications (Dapps) devel-
oped on the blockchain enable physicians and patients to
easily participate in telemedicine with no middleman costs
aside from the minimal fees of the Ethereum network, thus
enhancing patient empowerment.
4. Blockchain for Point-of-Care Genomics
According to Timi Inc., which is a blockchain platform com-
pany, an individual patient’s data is estimated to be worth
as much as USD 7,000 per year [13]. Most of the mHealth
companies developing blockchain services target the poten-
tial of patients to own and sell their health data with a focus
on personal Electronic Health Records (EHRs) and wellness-
routine profiles gathered by wearable sensors, as well as the
personal (at-home) genome [14]. Therefore, many consumer
companies have been offering DNA sequencing for some
time. The company ‘23andMe’, which was founded in 2006,
is the most prolific, offering direct-to-consumer genetic
testing services [15]. However, privacy is a major issue in
the healthcare industry. Last year, 23andMe announced that
they hadsold a USD 300 million stakein the company to the
pharmaceutical giant GlaxoSmithKline, effectively handing
over access to the 5 million customers’ data, despite it only
containing exome data. To address such future concerns,
blockchain startups in healthcare claim to offer a solution for
Data users layer
(physician, researcher, government,
company)
Data management
layer
Blockchain cloud
Data
management
Cloud
EHR
Healthcare provider A
EMR EMR
PHR
Research
Analysis
Data
entry
Coding Design
Quality
assurance
Informed
consent
User
Healthcare provider B
Figure 1. US pilot project ‘Blockchain
for Hospitals’.
54 www.e-hir.org
Dimiter V. Dimitrov
https://doi.org/10.4258/hir.2019.25.1.51
consumers wanting to have a DNA test done, while keeping
data ownership. They offer the option of data monetization
through blockchain-supported providers. For example, a
startup calledNebula Genomicsis offering whole-genome
sequencing for free, as a way to stock up for its real ploy: a
blockchain-based genetic marketplace [16]. Once users have
their genome sequenced, they can charge a fee, in tokens, to
anyone who wants to access it. Thereafter, those tokens can
be redeemed for additional tests and products that will fur-
ther interpret DNA. Genomes.io is another genomics block-
chain company that allows consumers to securely store their
genome from the moment it is sequenced and subsequently
grant access selectively. The idea is to prevent genetic infor-
mation getting into the wrong hands, while giving consum-
ers the opportunity to sell their genetic data bit by bit if they
wish to do so [17].
5. Blockchain for EHR Data Management
Blockchain technology is also a viable choice for personal
EHR management. So-called ‘smart contracts’, could allow
patients to be remunerated with tokens for their sharing of
health data with providers and their research partners. For
example, Health Wizz is piloting a blockchain- and FHIR-
enabled EHR aggregator mobile app, which usesblock-
chainsto tokenize data, enabling patients to securely ag-
gregate, organize, share, donate, and/or trade their personal
medical records [18]. The idea is to enable individuals to
control their health data as easily as they do their online
bank accounts to allow better communication between
healthcare organizations and caregivers to pave the way for a
higher standard of care.
As an EHR blockchain company, Medicalchain is work-
ing on enabling various healthcare agents, such as doctors,
hospitals, laboratories, pharmacists, and insurers, to request
permission to access and interact with patients’ medical
records [19]. Each interaction is auditable, transparent, and
secure and is recorded as a transaction on Medicalchain’s
distributed ledger.
III. Discussion
On a blockchain, it is cheap to verify the integrity of an in-
dividual transaction. A single piece of information can be
audited in real time; moreover, its integrity is available to any
participant in the network. As a result, costless verification
can be economically implemented. For example, healthcare
accounting information that can be built up with integrity
from the simplest units of transactions has previously con-
stituted a time consuming and costly audit. Now, with block-
chains, this process can run continuously in the background
in compliance with regulations [20].
There are five potential benefits of blockchains in com-
parison with traditional healthcare database management
systems [5]. First, blockchains enable decentralized manage-
ment; they are suitable for applications where healthcare
stakeholders (e.g., hospitals, patients, payers, etc.) wish to
collaborate with one another without the control of a central
management intermediary. Second, blockchains provide im-
mutable audit trails; they are suitable for unchangeable data-
bases to record critical information (e.g., insurance claim re-
Figure 2. Personal health record data
for blockchain service pro-
viders or data brokers.
Data from patients
Blockchain platform
Healthcare payers
Pharma R&D
Ethereum Hyperledger Multichain
HydraChain EOS.IO Real-time analytics
Corda
Chaincore Openchain
Heterogeneous medical data
55Vol. 25 • No. 1 • January 2019 www.e-hir.org
Blockchain Healthcare
cords). Third, blockchains enable data provenance; they are
suitable for use in managing digital assets (e.g., patient con-
sent in clinical trials). The ownership can only be changed
by the owner, following cryptographic protocols. Also, the
origins of the assets are traceable (i.e., the sources of the data
and records can be confirmed), increasing the reusability of
verified data. Fourth, blockchains ensure the robustness and
availability of data; they are suitable for the preservation and
continuous availability of records (e.g., the electronic health
records of patients). Finally, they increase the security and
privacy of data; data is encrypted in blockchains and can
only be decrypted with the patient’s private key. Even if the
network is infiltrated by a malicious party, there is no practi-
cal way to read patient data.
Conflict of Interest
No potential conflict of interest relevant to this article was
reported.
Acknowledgments
The Author would like to thank Mrs. Tajsa Zajc from Faces
of Digital Health for the critical review of the Manuscript.
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