When healthcare experts talk about data integrity, they’re not just thinking about whether or not the original authors filled in all the fields and ticked all the boxes. They are talking about trust.
Completeness is one small piece of the trust puzzle, but accuracy, consistency and responsibility – who created it, why, when, and how – are also critical for ensuring that information is reliable and useful for decision-making.
Healthcare organizations have no other option but to ensure that their clinicians and business intelligence professionals can trust their data. After all, patient lives often hang in the balance.
While increasing interoperability and health information exchange is a large part of the battle, blockchain may turn out to be the industry’s secret weapon in the fight against untrustworthy data.
Google subsidiary DeepMind Technologies is certainly convinced that blockchain, or something like it, is the key to creating confidence in an ecosystem where data is created on the fly, stored in disparate locations, mashed together with varying degrees of success by analytics algorithms, and returned to users in less-than-optimal ways through electronic health records, data dashboards, third-party applications, and even Excel spreadsheets.
“Now that you can use data for so many more purposes, people aren’t just asking about who’s holding information and whether it’s being kept securely – they also want greater assurances about precisely what is being done with it,” wrote Mustafa Suleyman, DeepMind’s Co-founder and Head of Applied AI and Ben Laurie, Head of Security and Transparency, on the company’s blog.
“Imagine a service that could give mathematical assurance about what is happening with each individual piece of personal data, without possibility of falsification or omission. Imagine the ability for the inner workings of that system to be checked in real-time, to ensure that data is only being used as it should be.”
Blockchain can do that, asserted the authors, by providing a clear audit trail for data that is nearly impossible to tamper with.
It may seem counterintuitive to rely on the decentralized nature of blockchain to produce a single source of truth, but the technology requires all members of the “chain,” a public or private community, to agree upon and approve all changes and transactions related to their common data holdings.
“We think this approach will be particularly useful in health, given the sensitivity of personal medical data and the need for each interaction with data to be appropriately authorized and consistent with rules around patient consent,” said Suleyman and Laurie.
“For example, an organization holding health data can’t simply decide to start carrying out research on patient records being used to provide care, or repurpose a research dataset for some other unapproved use. In other words: it’s not just where the data is stored, it’s what’s being done with it that counts. We want to make that verifiable and auditable, in real-time, for the first time.”
DeepMind’s healthcare division is releasing a product that actually blends blockchain with more traditional data auditing strategies. Instead of a decentralized ledger held by multiple entities that must all approve suggested changes, the company is planning to use a single ledger and decision tree structure that guarantees a meaningful and trusted audit trail.
“Every time we add an entry to the ledger, we’ll generate a value known as a ‘cryptographic hash,’” the blog post explained. “This hash process is special because it summarizes not only the latest entry, but all of the previous values in the ledger too. This makes it effectively impossible for someone to go back and quietly alter one of the entries, since that will not only change the hash value of that entry but also that of the whole tree.”
The company even hits another square on the buzzword bingo card by citing FHIR as a potential avenue for helping to overcome some of the interoperability challenges inherent in the problem.
Ideally, users will be able to query the system to see if data is being used appropriately, which could help healthcare organizations stick to privacy and security rules surrounding health data exchange and research. Patients could even get access to the data logs, DeepMind predicts, to keep tabs on how their personal health information is being stored and accessed.
That may be a very attractive prospect for patients in the United Kingdom’s National Health Service (NHS), which has already been buffeted by privacy criticisms over a previous DeepMind collaboration.
In 2016, New Scientist published a data sharing agreement between DeepMind and the NHS that gave the company broad license to collect and store years’ worth of patient data that went far beyond the scope of its app development project.
Perhaps having learned its public relations lesson, DeepMind is now committing to a more open and transparent development process, including regular blog updates about its successes and setbacks.
“We hope that by sharing our process and documenting our pitfalls openly, we’ll be able to partner with and get feedback from as many people as possible, and increase the chances of this kind of infrastructure being used more widely one day, within healthcare and maybe even beyond,” said Laurie and Suleyman.
The prediction may be an accurate one. Blockchain has quickly captured the imagination of health IT developers looking for more secure and efficient ways to ensure data integrity. A January survey by IBM indicates that sixteen percent of healthcare organizations may adopt a blockchain-based solution by the end of 2017 as they seek to foster precision medicine, interoperability, and patient engagement.
Brian Behlendorf, Executive Director of the multi-industry Hyperledger blockchain collaboration, also believes that healthcare is ripe for some positive disruption.
“There’s an opportunity to capture the holy grail of health IT, which is to put the patient back in the center of their care,” he told HealthITAnalytics.com earlier this year. “We can provide much more transparency balanced against confidentiality. We can change the landscape of that by adopting blockchain – and hopefully cut the costs of bureaucracy and overhead that make healthcare so expensive.”
Significant technical and bureaucratic challenges lie ahead, acknowledged the DeepMind executives, but the benefits of architecting a data auditing system that can help guarantee higher levels of transparency, accountability, and trust will be crucial for the continued advancement of the healthcare industry.
“We recognize this is really hard, and the toughest challenges are by no means the technical ones,” they said. “Building this is going to be a major undertaking, but given the importance of the issue, we think it’s worth it.”