Many of us practitioners have heard the term blockchain and that it will allow technology to work and flow much more efficiently. However, many of us do not understand the concept and how it will benefit healthcare, let alone how we treat and care for our patients. Blockchain is considered by some as a disruptive technology that is essential to make industries function, including healthcare and eye care. Decentralization, transparency, and immutability are the three pillars of blockchain that allow free transactions, or blocks, to occur and that are transcending over many industries. This technology was originally described in 1991 by Stuart Haver and Scott Stornetta, where they wanted to create a system to store data securely using timestamps, where it could not be changed or tampered.1 The following year they designed a system called Merkle Tree that enabled multiple documents to be stored into a block.2 In 2008, a group of unknown individuals with a pseudonym of “Satoshi Nakamoto” introduced Bitcoin that implemented the concept of blockchain as it is known today.3
Essentially, blockchain is a public, decentralized, secure digital database, or ledger, that stores transactions, or other events chronologically with a timestamp that cannot be altered or deleted, where it is linked to a previous event. Transactions are stored in blocks and are encrypted with the hash system, starting with the first “genesis block” then linking additional blocks chronologically.4 Each person accessing the blocks is known as nodes and there is no central authority controlling access as long as another node is in the network. As more blocks are added, it forms a chain and is managed peer-to-peer where everyone is allowed access of the full copy of the blockchain to validate. Consensus is achieved when a new block is added where everyone in the network validates it to prevent any tampered blocks.4 Tampered blocks would be rejected. Conceptually, this mirrors a centralized medical record of a patient who may see multiple physicians and may have multiple conditions. Every new visit to any physician will create a new event, or record, that is timestamped and encrypted with the hash system that will be stored on the chain. The patient has the authority to allow other physicians to access their blockchain network and have access to their chronological blockchain medical history, diagnosis, and treatments.5
The application of blockchain in healthcare creates a unique solution to the interoperability challenge between electronic health records by reducing complexity, enabling “trust-less” collaboration, and encrypting unalterable information.6 It also allows patients to have more control over their own medical records. Additionally, it offers other applications in healthcare to credential medical staff, drug supply chain security, research, and development of new pharmaceuticals, clinical trials, and insurance fraud.7 The expected growth of global blockchain is 63.85% CAGR from 2018 to 2025, reaching a value of $61 billion.8
Blockchain technology has not been widely accepted because of the few successful trials where HHS, medical associations, and insurance companies need proof-of-concept clinical trials to be accepted. Other limitations are slow transactional speeds, the platform cannot be used for analytics, and has a small block capacity. Electronic health records are comprised of images, large documents, and reports that require high-capacity storage spaces which can easily exceed the chain capacity. Because there are not any rules and regulations, costs and who will own the data chain are unknown, adoption of blockchain has been extremely slow in healthcare.9
VisionBanker made an announcement in 2019 that they plan to disrupt the eye care market with their blockchain facial recognition app slated to launch this year.10 It will allow patients to store their own prescriptions after an eye exam, which will allow them to check any future changes. The facial recognition technology configures the patient’s facial geometry to assist with virtual try-on of frames. The original concept and basis of the company were started to improve access to eye care in urban and rural communities in Asia and Southeast Asia, where the myopia epidemic is growing.
Blockchain has shown to be successful in applications of insurance claims, Bitcoin and other cryptocurrencies, and business and financial services, but it does not provide a complete, short-term solution for healthcare. Because it is still in its infancy stages for healthcare, it will require much more capital investment to implement blockchain to electronic medical records, and create the security and regulations required to be a long-term, utilized technology.
Bryan M. Rogoff, OD, MBA, CPHM has a unique background in areas of holistic eye care, business management and healthcare reform. He specializes in LEAN clinical management and operations, technology implementation, healthcare strategy, and strategic partnerships. Currently, he serves as a consultant for for the FDA, Immediate Past-President & Education Chairperson for the Maryland Optometric Association, Federal Keyperson and Meetings Committee Member for the American Optometric Association, reviewer for the Council on Optometric Practitioner Education and is the Founder of Eye-Exec Consulting, LLC. To contact Bryan, visit www.eye-exec.com or email firstname.lastname@example.org. He can also be found on LinkedIn, Facebook, Twitter and Instagram.