The Canadian healthcare system was founded on the principles of universality, accessibility, comprehensiveness, portability, and public administration. Yet, our healthcare system is still lagging behind to facilitate the sharing of health records between primary healthcare providers, pharmacies, and specialists in a secure and efficient manner. Over the past decade, health has become a hypergrowth industry, which has the attention of companies such as Apple and Google, and resulted in greater progress of health data management per institution or region. However, in this increasingly complex political, economic, and social landscape, blockchain presents a solution for system level change that can increase healthcare data interoperability.
Blockchain is a record-keeping technology consisting of blocks that each store digital information of transactions, such as date, time, and amount, who is participating, and a hash that distinguishes one block from another, before being connected using cryptography. While blockchain is most popularly known for its contributions in cryptocurrency, a market research report published by P&S Intelligence found that the global healthcare market for blockchain was valued at $44.6 million in 2017 and is expected to exceed $500 million between 2018–2023. Currently, health data sharing holds 40% of the market and is predicted to grow at the highest compound annual growth rate.
Over the past few years, while greater effort has been made to standardize, secure, and share health data, there are still concerns surrounding data security. In June 2018, over 80 000 Canadians’ health records were hacked from an Ontario government provided home care service. The hackers contacted CBC News stating that they gained access to these files, which included patients’ health number, diagnosis, medication records, and more, because the system had not been updated in 2 years and the files were not encrypted. Currently, more than 60% of Canadian practitioners use Electronic Medical Records (EMRs), which lets them to track patient medical history. Blockchain is decentralized, permission-based, and encrypted, thus allowing for health information to be shared in a verifiable and immutable transaction.
Blockchain implementation should first link physicians with each other. There were over 89 000 physicians across Canada with little clinical connection between one another. In many cases, EMR systems are incompatible with each other, especially across provinces. The ability to share patient information in an effective way is crucial because different health professionals may be working with the same patients, thus this could result in a decrease in duplication of medical tests and give patients greater ability to visit the most convenient healthcare provider location with minimal concern of medical records privacy. Unlike hospitals, most physicians do not have the financial or administrative means to implement large scale projects, such as the Shared Health Information Network Exchange project taking place between three hospitals in Ontario. The majority of physicians run their own clinics, where they manage patient health, EMRs, medical supplies, and expenses, thus could be the ones to most benefit from a government and private partnership to assist implementing blockchain within their practice. As indicated by U.S. Food & Drug Administration, the pharmaceutical industry plans to incorporate blockchain within its operations to help with tracking drugs. This indicates that the next step could be to use blockchain in connecting healthcare teams’ EMRs to pharmacies, hospital systems, and insurance providers.
Information transfer processes are simplified by blockchain serving as smart contracts, in which a private key for medical information only grants access to specific professionals at a given time. For example: if a patient was to complete paperwork at a family physician’s clinic but had a follow-up conducted at a different clinic, a smart contract would transfer medical information based on pre-set rules by the patients. This technology could allow patients secure access to their health records and gain more control over who is able to retrieve them. It also aligns with Ontario’s eHealth Strategy 2.0, to enhance the Patients First experience, incorporate ministry leadership, and strengthen health information privacy.
Previously in Ontario, the Local Health Integration Networks were responsible for the regional management of healthcare in Ontario, which officially began transforming into Ontario Health Teams (OHTs) in October 2019. The creation of OHTs is one of the biggest health systems restructuring to take place in years, that also plans to promote data sharing and innovation. The implementation of blockchain can be done in partnership with teams like Ontario Health and private support companies that would install and teach professionals how to use the system.
The provincial government would need to develop strategies that address legal concerns, the creation of trial programs, and buy-in from healthcare teams for blockchain. Additionally, educational programs must be designed for primary care practitioners to become aware of this technology, the benefits for their practice and patients, as well as resources to receive further information. This strategy would further address challenges that Canada faces in implementing blockchain, including unclear cost and regulations.
The most significant challenge in implementing blockchain technology in the healthcare system is the shift in management and strategic approaches needed to embrace new ways of doing things. Blockchain would provide a secure process of transferring patient health data and connecting healthcare professionals with patients. While there are still challenges with implementing blockchain into our healthcare system, pilot programs in other countries, such as the UAE and the Netherlands, and its increasing integration in other industries are clear indicators that this could be a viable opportunity to optimize healthcare delivery in Canada. As other health innovations such as wearable technology and remote patient monitoring develop, it will be interesting to see how this unfolds.
Dhruvika is an undergraduate student at Western University, pursuing an Honors Specialization in Health Science with Biology. She has a strong interest in learning about emerging healthcare trends and technology, as well as taking an entrepreneurial mind-set to improve health outcomes. This led her to work in clinical neuroscience research, a health technology start-up, and social impact investing.