How blockchains can help healthcare: Interview

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Ammon Fillmore is an attorney at Hall Render, which is the largest healthcare-focused law firm in the U.S. Fillmore has lectured on the top five things healthcare executives need to know about the ledger distributing technology and how it has the potential to change almost everything. As Fillmore notes, the majority of medical group managers and IT specialists agree that blockchain can at least help, if not solve problems with connection, privacy and patient record sharing. While many agree it has a lot of potential benefit, healthcare has not been so quick to hop on the blockchain. Digital Journal: How is the world of healthcare technology changing?Ammon Fillmore: Healthcare technology is rapidly changing from a convenient or novel tool for clinicians to supplement health care services to the irreplaceable platform delivering health care for each patient encounter. Routine patient interactions now include electronic health records and similar “clinical decision support” powered by artificial intelligence and “big data” analytics. Historically, health care was limited to face-to-face interactions; however, health care technology is increasingly patient-driven and emphasizes patient-facing electronic records and payment portals, telemedicine applications, and effective means for physicians to quickly communicate with their patients and other providers that move beyond the physician’s office walls. Consumer-driven health care technology will require secure, timely, transparent, and accurate methods for data storage and transmission. Health care technology is increasingly exploring “Blockchain” applications to exchange and maintain information and health records between providers, payors, and patients.

Australian and PNG doctors and nurses performing surgery in Operation Open Heart. Port Moresby Gener...

Australian and PNG doctors and nurses performing surgery in Operation Open Heart. Port Moresby General Hospital, Papua New Guinea.

Rocky Roe/AusAID/File

DJ: What are the advantages of Blockchain for healthcare? Fillmore: Blockchain applications may decentralize the storage and authentication of information, allocating it across a “distributive ledger” amongst the participants. This means that all participants, or “nodes,” on the designated Blockchain have a complete copy of the information. Information is no longer stored in a single data warehouse or repository but across all nodes on the Blockchain. Each transaction or change to the information is a new “block” along the chain. This distributive ledger offers an alternative means for health care providers to backup and access information because it is nearly impossible for all nodes to suffer simultaneous data loss. This also provides increased confidence in data accuracy as each Blockchain node has an updated copy of the ledger and, first, previous “blocks” along on the chain are never deleted, only replaced by a new “block”; and, second, new blocks must be added to the chain through appropriate and approved protocols. DJ: Is this application of equal interest within and between health centers? Fillmore: The health care industry is increasingly vertically and horizontally integrated with traditional physical, geographic, and market boundaries dissolving as technology digitally connects providers, patients, and payors. Technologies like Blockchain offer a systematic solution that will sort individuals to be either “on” or “off” the Blockchains. While some Blockchains will be private and others public or semi-public, any company or clinician, independent of size or location, that provides or supports health care should be interested in the Blockchain or face the real prospect of being excluded from access to the flow of information.

Following Spain's civil war doctors and nurses would reportedly steal babies from parents deeme...

Following Spain’s civil war doctors and nurses would reportedly steal babies from parents deemed politically dangerous to Francisco Franco or born out of wedlock, and give them to families in favour of the regime


DJ: Do you see this type of technology becoming more commonplace? Fillmore: Blockchain is already being utilized by financial, real estate, insurance, and advertising companies, and even local and state governments are exploring the future of Blockchain applications. As recent cyberattacks have shown the vulnerability of centralized storage, the health care industry sees Blockchain as the next step in cyber security “arms race,” accessibility, and information accuracy. DJ: Will the Internet of Things be influential? Fillmore: The Internet of Things or “IoT” is a key stakeholder for health care technology and the Blockchain development. IoT emphasizes the decentralization of collecting and processing information. As personal IoT-equipped technology communicates with health care providers (e.g., my fitness watch uploads my health goals and my smart phone my recent grocery purchases), managing the accuracy and availability of this information is a priority. Blockchain may provide a solution to push and pull information from various IoT devices through an accurate and secure application that do not rely upon a centralized authority. DJ: Does this type of technology appeal to a certain demographic? Fillmore: Blockchain is especially appealing to industries that are heavily dependent upon frequent and high volumes of information exchange that require auditable and secure records. Given that information technology is critical infrastructure for both the public and private industry, it is likely to have a very broad appeal. DJ: Why has the take-up with Blockchain and healthcare been so slow? Fillmore:Because the health care industry is subject to a unique and stringent regulatory environment, it must reject risk tolerance other industries would readily accept, and it must accept financial margins other industries would reject. While Blockchain will be adopted by the health care industry, other industries, such as finance, are already early adopters. Deploying new technology such as Blockchain in health care will require: first, alignment with applicable laws that may not contemplate such disruptive technologies; second, sufficient demonstration that Blockchain does not create unmanageable risks to patients and information security; and third, a market price that is fiscally tolerable. DJ: Are there any security risks? Fillmore: Blockchain shows incredible promise to secure information and prevent data loss. Despite Blockchain’s potential, it is still both in its infancy and subject to human error. The fewer the number of Blockchain nodes, arguably, the more fragile the Blockchain. Likewise, Blockchain theorists argue that it could be subject to a “51 percent Attack.” Under a 51 percent Attack, a group of users controlling a majority of the Blockchain network’s computing power could disrupt the Blockchain and prevent the addition of new blocks.


Bay Dynamics

While this type of attack is defensible, Blockchain operators will have to incorporate and adopt suitable network architecture and rules to protect the integrity of the Blockchain. Industries contemplating a Blockchain application should also be mindful that while Blockchain can be used to maintain the accuracy of the information across all nodes, it does not mean that the information input is accurate or true. DJ: What other areas of technology are of interest to you? Fillmore: The health care industry continues to explore new and innovative technologies. With the recent and continuous developments in artificial intelligence and machine learning, clinicians and patients can expect continued advancements in health technology. Health care is also increasingly a target for cyberattacks, and health care technology will need to be implemented in a manner that continues to provide patients confidence that their information is secure and reliable. Ammon Fillmore’s practice focuses on advising hospitals, health systems and physician organizations of all sizes on health law-related matters, including technology, privacy and security, information systems and regulatory compliance, as well as emerging and growing areas of information technology such as mobile applications, data ownership and meaningful use and merit-based incentive payment system compliance.