Blockchain is abuzz in healthcare today, with providers, payers and digital health developers all touting its potential to increase work efficiencies, securely transmit and share data and improve patient outcomes.

Numerous examples of late show how companies are looking to capitalize on the trend.

In June, the U.S. Patent and Trademark Office awarded Walmart a patent for a system that caches a person's medical information in a blockchain database and allows first responders to retrieve it in a medical emergency. The wearable device in which the blockchain resides includes a biometric scanner that creates a unique signature for the user and an RFID scanner to scan the user's PHI.

And earlier this year, San Francisco startup Akiri launched a vendor-agnostic tool called Akiri Switch that uses blockchain to securely transmit information using codes, permitting organizations to share and verify data across disparate systems. The company has financial backing from the American Medical Association.

Meanwhile, Humana, UnitedHealthcare, Optum, MultiPlan and Quest Diagnostics announced a blockchain-enabled initiative to boost the accuracy of health plan network provider directories.

There's additional evidence blockchain is on the minds of many in the healthcare industry. According to a 2017 Black Book Market Research survey, nearly 20% of hospital leaders and 76% of health insurance executives are either thinking of deploying some form of blockchain technology or are already implementing it. When asked about interoperability, 93% of managed care organizations and 70% of hospitals said blockchain holds huge promise.

A more recent IDC report predicts that one in five healthcare organizations will have progressed beyond the pilot stage to employing blockchain technology in operations management and patient identity.

As the volume of personal health data has exploded in recent years, so has the challenge of interoperability and data security. "Blockchain essentially brings with it certain properties that … may be able to unleash a lot of the untapped value and the logic from these relatively stagnant and siloed data reserves we see in healthcare systems," says Mutaz Shegewi, an IDC analyst and the report's author. Those properties are decentralization, better distribution and making data more immutable.

Potential use cases include incentivizing patients to exchange data and improving administrative data quality and management. The advent of fast healthcare interoperability resources (FHIR) and open APIs also could give rise to blockchain grids for distributing and sharing clinical data, according to the report.

A lot of excitement surrounding the technology ignores some difficult realities, though. Its development is still nascent, it can be difficult to identify willing users and the few use cases don't usually involve work in a clinical setting. The future of blockchain in healthcare is promising, but still largely unclear.

Blockchain at its earliest stages in healthcare

Despite all the interest and hype around blockchain, the technology remains largely unproven in healthcare.

"It is extremely early in the development cycle of this technology," says Noah Zimmerman, director of Mount Sinai's Health Data and Design Center and its newly launched Center for Biomedical Blockchain Research. "We’re really building the infrastructure and plumbing right now in the same way that the protocols for the internet lay the groundwork for what would later become possible."

What is exciting about blockchain, and what sets it apart from a lot of other technologies, is its human-centered focus, Zimmerman says. The technology — which originated as a secure vehicle for transferring cryptocurrencies — revolves around building large-scale open networks and then incentivizing people to participate in those networks.

"What blockchain has been able to do is create markets where a market didn't previously exist," Zimmerman says. "The question is, are there ways to harness that same kind of behavior — getting people involved and incentivized to achieve an important goal — and do that in the healthcare space?" he tells Healthcare Dive.

The fact that anyone can build on top of an open blockchain network contrasts sharply with the current situation where a limited number of stakeholders control access to large amounts of health data. That could potentially lead to all kinds of applications in areas ranging from healthcare administration to clinical trials and drug development, population health and more.

The other part, incentivizing people to join the blockchain network, is trickier. Providers, payers, drug and medical device companies all have incentives to do certain things, but there’s little or no overlap in what those are.

Numbers are key

The more numbers of people who join the network, the more robust the entire blockchain solution is. And the biggest challenge in that is trying to convince everyone to get on the network because the incentives are not always aligned, says Bhooma Chutani, practice head for blockchain and distributed ledger technologies at LTI in Mumbai, India.

She notes, for example, that some companies or organizations may stand to gain more than others by participating in the blockchain, and some smaller ones may not have the necessary infrastructure.

Another challenge is information. There's plenty of academic work in the core cryptography and underlying technology that are supporting actual blockchain development, but when you look at application areas, all that information is being driven by marketing departments," Zimmerman says. "And a lot of it is probably … either overselling what's possible or straight up misleading."

The Center for Blockchain Biomedical Research hopes to answer some of the questions about what blockchain can and can't solve in healthcare. It is focusing on three types of projects: academic research, developing and testing its own blockchain systems within the Mount Sinai health system and partnering with tech companies and healthcare organizations in applying blockchain technology. The center's first corporate partnership will be announced within a few weeks, Zimmerman said.

Early use cases in supply chain, management settings

While healthcare is still in the very early stages of exploring blockchain in more direct clinical and business processes, in terms of being able to leverage the technology and support supply chain and operations management use cases and patient identification, "that's very much in the pipeline," Shegewi says.

LTI is working with a large European insurance company on a wellness program that uses blockchain to track healthy behaviors at both a corporate and an individual level and reward participants with discounted insurance rates, Chutani says. Similar programs are already being used by automobile insurance companies to track and encourage safe driving habits.

Embleema has developed a patient-driven blockchain network that lets patients securely share their medical records and PHI, such as Fitbit data, and sets rules regarding who can view and access the data. Users can revoke or change their sharing authorizations as any time.

"Patients can check in real-time who has accessed their records and when, giving them a full audit-trail of who accessed their data," Robert Chu, CEO and founder of the Metuchen, New Jersey-based startup, told Healthcare Dive via email. "Both mechanisms are coded in the blockchain as smart-contracts, and therefore cannot be falsified or tampered with."

Zimmerman sees potential in creating these types of data marketplaces and rewarding patient participation, but thinks suggestions that people will be able to own their PHI are being oversold as a use case. There's no self-destruct mechanism that keeps people from using a person's data off the blockchain even after that person has revoked access, he says.

Still, Zimmerman sees opportunities for blockchain to incentivize patients with rare diseases to band together and collect data in conjunction with pharmaceutical companies to develop new treatments, and in areas like behavioral health. Perhaps blockchain could be harnessed in ways that not only encourage people to adopt healthy behaviors and avoid harmful ones but also promote other social determinants of health, such as housing, that are known to be important predictors of health and healthcare spend.

Not ready for primetime

Some basic problems need to be solved before blockchain can become mainstream in healthcare. Information and incentivizing people to participate is one. Scalability is another. The most popular application use on the Ethereum network, which is the largest blockchain after Bitcoin, is Cryptokitties, in which users collect, breed and trade virtual kittens. As the game accounted for more and more traffic on Ethereum (about 30%, according to Zimmerman), performance of the network slowed dramatically.

"If you have a game, and it wasn't even a super popular game, if that kind of thing can bring a network to its knees, then such a network today is not really ready for primetime in healthcare," Zimmerman says. He expects it will be at least a couple more years before the initial, interesting consumer-facing capabilities for blockchain start cropping up in the healthcare space.

"We’re cautiously optimistic," he adds. "What we're trying really hard to do is not contribute to the hype cycle, but be a little bit more balanced and systematic in how we approach this as a technology and how it can fit into healthcare systems of the future."