Difference between revisions of "Journal:Strengthening public health surveillance through blockchain technology"

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Blockchain has commonly been used in four primary ways in healthcare: in [[electronic medical record]] (EMR) implementations at the hospital level, for resource management in health systems, for patient-level applications, and for disease surveillance at the community level.
Blockchain has commonly been used in four primary ways in healthcare: in [[electronic medical record]] (EMR) implementations at the hospital level, for resource management in health systems, for patient-level applications, and for disease surveillance at the community level.


1. ''Hospitals and EMRs'': Blockchain is one of the popular technologies used in EMRs found in modern hospital ecosystems in industrialized nations. Blockchain's ability to improve decentralization, data provenance, and robustness has made it suitable for storing, managing, and sharing [[Information privacy|protected health information]] in EMRs.<ref name="SharmaAnOptimal17">{{cite journal |title=An optimal routing scheme for critical healthcare HTH services — An IOT perspective |journal=Proceedings from the Fourth International Conference on Image Information Processing |author=Sharma, A.; Kumar, R. |pages=1–5 |year=2017 |doi=10.1109/ICIIP.2017.8313784}}</ref> For example, an electronic health chain (or interoperable health blockchain) could be based on a blockchain-based EMR system which uses IBM's Hyperledger Fabric modular blockchain framework.<ref name="Roman-BelmonteHow18">{{cite journal |title=How blockchain technology can change medicine |journal=Postgraduate Medicine |author=Roman-Belmonte, J.M.; De la Corte-Rodriguez, H.; Rodriguez-Merchan, E.C. |volume=130 |issue=4 |pages=420-427 |year=2018 |doi=10.1080/00325481.2018.1472996 |pmid=29727247}}</ref> This technology helps to achieve scalable data security and optimize the performance of the EMR system. Arguably, blockchain may also be considered for improving transactions in billing and managing insurance claims, as well as surveillance measures like nosocomial infection surveillance.<ref name="Roman-BelmonteHow18" /> The advantage of this technology is that a lot of data can rapidly be stored, processed, and shared with stakeholders without any link failure/delay.<ref name="EkblawACase16">{{cite web |url=https://dci.mit.edu/research/blockchain-medical-records |author=Ekblaw, A.; Azaria, A.; Halamka, J.D. et al. |work=2nd International Conference on Open & Big Data 2016 |pages=1–13 |date=August 2016}}</ref> According to Peterson ''et al.'', it can also reform health database interoperability with built-in authentication controls, which lowers the risk of data theft.<ref name="PetersonABlock16" />
1. ''Hospitals and EMRs'': Blockchain is one of the popular technologies used in EMRs found in modern hospital ecosystems in industrialized nations. Blockchain's ability to improve decentralization, data provenance, and robustness has made it suitable for storing, managing, and sharing [[Information privacy|protected health information]] in EMRs.<ref name="SharmaAnOptimal17">{{cite journal |title=An optimal routing scheme for critical healthcare HTH services — An IOT perspective |journal=Proceedings from the Fourth International Conference on Image Information Processing |author=Sharma, A.; Kumar, R. |pages=1–5 |year=2017 |doi=10.1109/ICIIP.2017.8313784}}</ref> For example, an electronic health chain (or interoperable health blockchain) could be based on a blockchain-based EMR system which uses IBM's Hyperledger Fabric modular blockchain framework.<ref name="Roman-BelmonteHow18">{{cite journal |title=How blockchain technology can change medicine |journal=Postgraduate Medicine |author=Roman-Belmonte, J.M.; De la Corte-Rodriguez, H.; Rodriguez-Merchan, E.C. |volume=130 |issue=4 |pages=420-427 |year=2018 |doi=10.1080/00325481.2018.1472996 |pmid=29727247}}</ref> This technology helps to achieve scalable data security and optimize the performance of the EMR system. Arguably, blockchain may also be considered for improving transactions in billing and managing insurance claims, as well as surveillance measures like nosocomial infection surveillance.<ref name="Roman-BelmonteHow18" /> The advantage of this technology is that a lot of data can rapidly be stored, processed, and shared with stakeholders without any link failure/delay.<ref name="EkblawACase16">{{cite web |url=https://dci.mit.edu/research/blockchain-medical-records |title=A Case Study for Blockchain in Healthcare: “MedRec” prototype for electronic health records and medical research data |author=Ekblaw, A.; Azaria, A.; Halamka, J.D. et al. |work=2nd International Conference on Open & Big Data 2016 |pages=1–13 |date=August 2016}}</ref> According to Peterson ''et al.'', it can also reform health database interoperability with built-in authentication controls, which lowers the risk of data theft.<ref name="PetersonABlock16" />


2. ''Resource management in health systems'': Blockchain can facilitate managing logistics and human resources in healthcare systems. For example, counterfeit medications and instruments below standard can be supplied to healthcare systems from external vendors. Use of blockchain can validate the quality standards at different nodes of the supply chain and inform the respective authorities about suspected discrepancies.<ref name="TsengGovern18">{{cite journal |title=Governance on the Drug Supply Chain via Gcoin Blockchain |journal=International Journal of Environmental Research and Public Health |author=Tseng, J.H.; Liao, Y.C.; Chong, B. et al. |volume=15 |issue=6 |at=E1055 |year=2018 |doi=10.3390/ijerph15061055 |pmid=29882861 |pmc=PMC6025275}}</ref> Moreover, human resource management in the digital age requires storing and using employee data for attendance, vacation scheduling, performance appraisal, and security measures with complex authentication processes. Use of blockchain can make such processes efficient and contribute to the development of smarter health services organizations.
2. ''Resource management in health systems'': Blockchain can facilitate managing logistics and human resources in healthcare systems. For example, counterfeit medications and instruments below standard can be supplied to healthcare systems from external vendors. Use of blockchain can validate the quality standards at different nodes of the supply chain and inform the respective authorities about suspected discrepancies.<ref name="TsengGovern18">{{cite journal |title=Governance on the Drug Supply Chain via Gcoin Blockchain |journal=International Journal of Environmental Research and Public Health |author=Tseng, J.H.; Liao, Y.C.; Chong, B. et al. |volume=15 |issue=6 |at=E1055 |year=2018 |doi=10.3390/ijerph15061055 |pmid=29882861 |pmc=PMC6025275}}</ref> Moreover, human resource management in the digital age requires storing and using employee data for attendance, vacation scheduling, performance appraisal, and security measures with complex authentication processes. Use of blockchain can make such processes efficient and contribute to the development of smarter health services organizations.

Revision as of 23:25, 11 May 2020

Full article title Strengthening public health surveillance through blockchain technology
Journal AIMS Public Health
Author(s) Bhattacharya, Sudip; Singh, Amarjeet; Hossain, Md Mahbub
Author affiliation(s) Himalayan Institute of Medical Sciences, Postgraduate Institute of Medical Education and Research,
Texas A & M University
Primary contact Email: docbilu at gmail dot com
Year published 2019
Volume and issue 6(3)
Page(s) 326-333
DOI 10.3934/publichealth.2019.3.326
ISSN 2327-8994
Distribution license Creative Commons Attribution 4.0 International
Website http://www.aimspress.com/article/10.3934/publichealth.2019.3.326
Download http://www.aimspress.com/article/10.3934/publichealth.2019.3.326/pdf (PDF)

Abstract

Blockchain technology is a decentralized system of recording data and performing transactions which is increasingly being used across many industries, including healthcare. It has several unique features like the validation of transaction processes, prevention of systems failure from any single point of transaction, and approval of data sharing with optimal security, to name a few. At the hospital level, blockchain technologies are used in electronic medical records systems, insurance claims systems, billing management processes, and so on. Moreover, this technology is helpful to manage logistic and human resources to achieve the quality of care in learning health systems. In many countries, blockchain is being used to promote patient-centered care by sharing patient data for remote monitoring and management. Furthermore, blockchain technology has the potential to strengthen disease surveillance systems in cases of disease outbreaks resulting in local and global health emergencies. In such conditions, blockchain can be used to identify health security concerns, analyze preventive measures, and facilitate decision-making processes to act rapidly and effectively. Despite its limitations, research, and practice based on blockchain technology have shown promises to strengthen health systems around the world, with a potential to reduce the global burden of diseases, mortality, morbidity, and economic costs.

Keywords: blockchain technology, telemedicine, medical informatics, disease outbreaks, population surveillance

Introduction

In the twenty-first century, many scientific innovations have changed the means of day-to-day communication, transactions, and decision-making. Blockchain is such a technology, which is being considered as one of the most significant inventions since the development of the internet.[1] It is also popularly termed as the next generation of “internet of things.”[2] The rise of Bitcoin and other cryptocurrencies have certainly helped blockchain to gain the spotlight across the globe. However, experts believe that blockchain is more than cryptocurrencies and that it may offer greater benefits to the users of complex systems.[1][3] Blockchain technology is commonly used for online money transfers and bank payments. It is also used in automobile manufacturing, cybersecurity, exit poll development, educational endevors, insurance systems, and time trend forecasting.[4] Recently, blockchain technology has gained popularity several other domains, including health systems. This is because it offers a safer and decentralized database that can operate independently from a centralized administrator.[3] According to Angraal et al., a unique selling point of the blockchain system is that once digital validation takes place, the network itself streamlines and validates the subsequent process of transaction. It safeguards the transaction history and allows data to be transferred directly between third parties.[5]

In this article, we discuss how blockchain technology works and how it can be used in complex situations like strengthening public health surveillance.

Blockchain and its applications

A blockchain is defined as “a distributed system (decentralized) which performs the dual function of recording and storing the records of the transaction. In this blockchain, the data is located in a network of personal computers called ‘nodes’ without any central control.” (Figure 1). The main advantage of this decentralized technology is that all the dealings or variations in the data are captured with real-time updates across the network.[6] The information that gets stored in each node is similar and permanent. It can't be distorted. Hence, this technology is transparent and autonomous, and as such it improves the quality of shared data between different stakeholders.[7] In this system, to validate the transaction, cryptographic algorithms are used.[8] This is different from a “trust-in-the-third-party” mechanism, where an online transaction takes place when two willing parties approve the transaction by use of a digital signature.[2] Moreover, blockchain overcomes the challenge of “single point failure,” which is common in centralized information management systems.[9] Currently, however, the average centralized healthcare system lacks the advantages offered by blockchain, including transparency and trust, data security and privacy, cost-effectiveness, and verifiability of data, as well as fast and real-time data transfer to all trusted parties.[10]


Fig1 Bhattacharya AIMSPubHlth2019 6-3.png

Figure 1. Centralized (a) and decentralized network (b)

Types and uses of blockchain

There are two main types of blockchains:

1. Open-access blockchains, which makes all records visible to the stakeholders; and

2. Limited-access blockchains, which restricts the access of data/information.[11]

Open-access blockchains are more appropriate to the health sector. Presently, cryptocurrency such as Bitcoin (some of the most popular applications of blockchain technology) depends on this type of technology.[12]

Blockchain technology in healthcare

Blockchain has commonly been used in four primary ways in healthcare: in electronic medical record (EMR) implementations at the hospital level, for resource management in health systems, for patient-level applications, and for disease surveillance at the community level.

1. Hospitals and EMRs: Blockchain is one of the popular technologies used in EMRs found in modern hospital ecosystems in industrialized nations. Blockchain's ability to improve decentralization, data provenance, and robustness has made it suitable for storing, managing, and sharing protected health information in EMRs.[13] For example, an electronic health chain (or interoperable health blockchain) could be based on a blockchain-based EMR system which uses IBM's Hyperledger Fabric modular blockchain framework.[14] This technology helps to achieve scalable data security and optimize the performance of the EMR system. Arguably, blockchain may also be considered for improving transactions in billing and managing insurance claims, as well as surveillance measures like nosocomial infection surveillance.[14] The advantage of this technology is that a lot of data can rapidly be stored, processed, and shared with stakeholders without any link failure/delay.[15] According to Peterson et al., it can also reform health database interoperability with built-in authentication controls, which lowers the risk of data theft.[12]

2. Resource management in health systems: Blockchain can facilitate managing logistics and human resources in healthcare systems. For example, counterfeit medications and instruments below standard can be supplied to healthcare systems from external vendors. Use of blockchain can validate the quality standards at different nodes of the supply chain and inform the respective authorities about suspected discrepancies.[16] Moreover, human resource management in the digital age requires storing and using employee data for attendance, vacation scheduling, performance appraisal, and security measures with complex authentication processes. Use of blockchain can make such processes efficient and contribute to the development of smarter health services organizations.

3. Patient-level applications: Due to its decentralized features protecting data safety concerns, blockchain is increasingly being used to share health data with patients and their caregivers. Such patient empowerment initiatives are also fostering meaningful use of health information technology and improving patient-provider communication across digital platforms.[17] Furthermore, blockchain-based mHealth interventions are enabling remote patient monitoring through use of biosensors, thus bridging the access gaps in patient-level health services.[18]

4. Community disease surveillance: Surveillance is defined as the “systematic, ongoing collection, collation, and analysis of data and the timely dissemination of information to those who need to know so that the action can be taken.”[19] It is done for both communicable diseases and non-communicable diseases by all national health systems according to their national priorities as per WHO's International Health Regulations (IHR). For example, deadly viruses like Nipah can travel across the globe within 36 hours and may lead to a pandemic, further compromised by rapid and uncontrolled urbanization and globalization.[20] Communicable disease surveillance is an ongoing, complex, and inefficient process, because a huge number of self-regulating organizations report to a centralized information system. As such, it remains a challenging task to maintain seamless information flow in a timely manner.[21][22] Moreover, sufficient incentive is rarely provided to routine staff.

The sequence of events that occur after a healthcare worker reports a potential case is depicted in Figure 2.


Fig2 Bhattacharya AIMSPubHlth2019 6-3.png

Figure 2. Sequence of events in disease surveillance system



References

  1. ↑ 1.0 1.1 Chen, G.; Xu, B.; Lu, M. et al. (2018). "Exploring blockchain technology and its potential applications for education". Smart Learning Environments 5: 1. doi:10.1186/s40561-017-0050-x. 
  2. ↑ 2.0 2.1 Alam, T. (2019). "IoT-Fog: A Communication Framework using Blockchain in the Internet of Things". International Journal of Recent Technology and Engineering 7 (6): 833-838. http://www.ijrte.org/download/volume-7-issue-6/. 
  3. ↑ 3.0 3.1 Meinert, E.; Alturkistani, A.; Foley, K.A. et al. (2019). "Blockchain Implementation in Health Care: Protocol for a Systematic Review". JMIR Research Protocols 8 (2): e10994. doi:10.2196/10994. PMC PMC6384534. PMID 30735146. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6384534. 
  4. ↑ Campbell-Verduyn, M. (2017). Bitcoin and Beyond: Cryptocurrencies, Blockchains, and Global Governance. Routledge. pp. 221. ISBN 9780415792141. 
  5. ↑ Angraal, S.; Krumholz, H.M.; Schulz, W.L. et al. (2017). "Blockchain Technology: Applications in Health Care". Circulation: Cardiovascular Quality and Outcomes 10 (9): e003800. doi:10.1161/CIRCOUTCOMES.117.003800. PMID 28912202. 
  6. ↑ Rathee, G.; Sharma, A.; Kumar, R. et al. (2019). "A Secure Communicating Things Network Framework for Industrial IoT using Blockchain Technology". Ad Hoc Networks 94: 101933. doi:10.1016/j.adhoc.2019.101933. 
  7. ↑ Crosby, M.; Nachiappan; Pattenayak, P. et al. (2016). "BlockChain Technology: Beyond Bitcoin" (PDF). Applied Innovation Review (2): 6–19. http://scet.berkeley.edu/wp-content/uploads/AIR-2016-Blockchain.pdf. 
  8. ↑ Sharma, A.; Kumar, R. (2019). "Service-Level Agreement—Energy Cooperative Quickest Ambulance Routing for Critical Healthcare Services". Arabian Journal for Science and Engineering 44: 3831–3848. doi:10.1007/s13369-018-3687-z. 
  9. ↑ Li, I.-C.; Liao, T.-C. (2017). "A Survey of Blockchain Security Issues and Challenges". International Journal of Network Security 19 (5): 653–659. doi:10.6633/IJNS.201709.19(5).01. 
  10. ↑ Vazirani, A.A.; O'Donoghue, O.; Brindley, D. et al. (2019). "Implementing Blockchains for Efficient Health Care: Systematic Review". Journal of Medical Internet Research 21 (2): e12439. doi:10.2196/12439. PMC PMC6390185. PMID 30747714. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390185. 
  11. ↑ Beck, R.; Avital, M.; Rossi, M. et al. (2017). "Blockchain Technology in Business and Information Systems Research". Business & Information Systems Engineering 59: 381–84. doi:10.1007/s12599-017-0505-1. 
  12. ↑ 12.0 12.1 Peterson, K. (September 2016). "A Blockchain-Based Approach to Health Information Exchange Networks". Use of Blockchain in Healthcare and Research Workshop. https://oncprojectracking.healthit.gov/wiki/display/TechLabI/Use+of+Blockchain+in+Healthcare+and+Research+Workshop. 
  13. ↑ Sharma, A.; Kumar, R. (2017). "An optimal routing scheme for critical healthcare HTH services — An IOT perspective". Proceedings from the Fourth International Conference on Image Information Processing: 1–5. doi:10.1109/ICIIP.2017.8313784. 
  14. ↑ 14.0 14.1 Roman-Belmonte, J.M.; De la Corte-Rodriguez, H.; Rodriguez-Merchan, E.C. (2018). "How blockchain technology can change medicine". Postgraduate Medicine 130 (4): 420-427. doi:10.1080/00325481.2018.1472996. PMID 29727247. 
  15. ↑ Ekblaw, A.; Azaria, A.; Halamka, J.D. et al. (August 2016). "A Case Study for Blockchain in Healthcare: “MedRec” prototype for electronic health records and medical research data". 2nd International Conference on Open & Big Data 2016. pp. 1–13. https://dci.mit.edu/research/blockchain-medical-records. 
  16. ↑ Tseng, J.H.; Liao, Y.C.; Chong, B. et al. (2018). "Governance on the Drug Supply Chain via Gcoin Blockchain". International Journal of Environmental Research and Public Health 15 (6): E1055. doi:10.3390/ijerph15061055. PMC PMC6025275. PMID 29882861. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6025275. 
  17. ↑ Engelhardt, M.A. (2017). "Hitching Healthcare to the Chain: An Introduction to Blockchain Technology in the Healthcare Sector". Technology Innovation Management Review 7 (10): 22–34. doi:10.22215/timreview/1111. 
  18. ↑ Saravanan, M.; Shubha, R.; Marks, A.M. et al. (2017). "SMEAD: A secured mobile enabled assisting device for diabetics monitoring". Proceedings of the 2017 IEEE International Conference on Advanced Networks and Telecommunications Systems: 1–6. doi:10.1109/ANTS.2017.8384099. 
  19. ↑ Last, J.M., ed. (2001). "A Dictionary of Epidemiology". Oxford University Press. ISBN 9780195141696. https://books.google.com/books?id=RPaQY8cG4N4C. 
  20. ↑ Fan, V.Y.; Jamison, D.T.; Summers, L.H. (2018). "Pandemic risk: how large are the expected losses?". Bulletin of the World Health Organization 96 (2): 129–34. doi:10.2471/BLT.17.199588. 
  21. ↑ Islam, N.; Faheem, Y.; Din, I.U. et al. (2019). "A blockchain-based fog computing framework for activity recognition as an application to e-Healthcare services". Future Generation Computer Systems 100: 569–78. doi:10.1016/j.future.2019.05.059. 
  22. ↑ Khan, S.U.; Islam, N.; Jan, Z. et al. (2019). "An e-Health care services framework for the detection and classification of breast cancer in breast cytology images as an IoMT application". Future Generation Computer Systems 98: 286–96. doi:10.1016/j.future.2019.01.033. 

Notes

This presentation is faithful to the original, with only a few minor changes to presentation. In some cases important information was missing from the references, and that information was added.

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