National Institutes of Health (NIH) in the United States: How Blockchain Can Improve Security and Privacy in Healthcare Systems

The outbreak of COVID-19 has exposed many issues in the medical field. How can blockchain technology help the existing healthcare system? We can find answers in the paper "How Blockchain Ensures Digital Healthcare" published by the National Institutes of Health (NIH) in the United States. Original Title: "Weekly Review of Sprout Happiness | As Fear Spreads with the Virus, What Can Blockchain Do?" Authors: Khaled Shuaib, Heba Saleous, Karim Shuaib, Nazar Zaki Translation: Sprout Happiness In the face of disaster, humanity has shown its vulnerability, but at the same time, we have also shown our strength. With the continuous escalation and spread of the Wuhan epidemic, every related development is touching the hearts of people nationwide and globally. Every day in the news, we see numbers fluctuating, and behind these numbers are individual lives. The sudden epidemic has magnified pre-existing problems, and at this moment, the good and evil of human nature are unequivocally revealed. We are fearful, but we also hope. Yes, the human body remains fragile, but we can arm ourselves with continuously evolving new technologies to overcome the current challenges! We already have big data, cloud computing, AI, IoT, blockchain, and other emerging technologies, and they will undoubtedly play a significant role in this disaster. As a part of the blockchain industry, we contemplate what assistance it can provide for epidemic control. Some have proposed epidemic prevention and control alert plans, while others have offered blockchain public welfare solutions. Indeed, these suggestions are very good, but I believe what we need most now is solutions that can help with healthcare. In the news, we see some infected individuals choosing to refuse isolation when not officially diagnosed, which poses significant challenges to epidemic control. What causes this? The answer is simple: fear. In addition to the fear of an unknown virus, humans also have psychological fears of privacy exposure. The massive leakage of early patient information, coupled with the characteristics of the existing healthcare system, amplifies this fear. Lack of confidence, fear of embarrassment, or disclosure of personal information may lead to patients unwilling to provide accurate information or, in some cases, providing false information, affecting treatment plans, causing public health concerns, and even leading to severe health complications and death. In this issue, we highly recommend the research paper "How Blockchain Ensures Digital Healthcare" published by the National Institutes of Health (NIH) in the United States, hoping to help alleviate this fear.

Humans strive to maintain health and live fulfilling lives, making healthcare an essential part of everyone's life. In order for healthcare providers to deliver proper medical care, patient records are kept in clinics and hospitals. These records help doctors understand a patient's past diagnoses and current health status. Until recently, many medical records were still kept in physical files. While this may not be a primary issue for hospitals or clinics, it can be a burden for patients. Other issues with paper records include data loss (due to various reasons) and difficulties related to data recovery.

Electronic Health Records or Electronic Medical Records (EHR / EMR) have improved healthcare infrastructure by making it easier for doctors to store, view, share, and update patient records. However, like any electronic record system, security and privacy issues have become a challenge for these systems. Another issue is the cost of implementing the infrastructure needed to store electronic records. Initial costs include hardware and software expenses to run the electronic medical system, maintenance, updates, and staff training. Users must have basic computer knowledge to use the system. Otherwise, without training, hospital staff may initially find it difficult to organize information and generate and format reports without assistance. Without understanding how to use the electronic medical system, staff may store or update records with incorrect information. This can lead to incorrect diagnoses, incorrect medical procedure sequences, and incorrect prescriptions of medications and dosages, which can result in health complications and even patient death. This is why employee training should be included in the cost of implementing electronic medical systems.

However, even with training, the introduction of a new system can lead to initial service interruptions.

Another problem with Electronic Medical Records (EMR) systems is the fragmentation of patient data. Since patients may visit different clinics, fragmented patient data may exist in different locations. While digitizing patient data has alleviated the problem of sharing electronic medical records, the main issue still lies in achieving interoperability between medical information systems, as clinics may use different EMR systems. This means that patient data may exist in different formats, which could put patients at risk, as reformatting data into a readable format takes time and may result in data loss. Additionally, professionals input information into databases differently. In a critical and sensitive environment like a hospital, a minute can make a difference for a patient, as reformatting data into a readable format can be time-consuming and may lead to data loss. Professionals cannot afford to waste time due to fragmented records and interoperability issues!

In addition to the challenges of fragmentation and interoperability, the use of EMR systems can also raise privacy concerns. This is because healthcare infrastructures are not patient-centric. While patients provide information to healthcare professionals, they do not control the EMR themselves. This means that patients cannot control who views their data, and where the data is transmitted and stored.

To address concerns about patient privacy, some regions have enacted regulations such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States and the General Data Protection Regulation (GDPR) in Europe. While these regulations may increase patients' control over their data, they cannot completely prevent intentional or unintentional disclosure of private data. Thus, patients may continue to feel uneasy about their data being stored and exchanged electronically.

Internally within organizations, electronic medical records (EMR) are typically part of a database, stored centrally within the medical infrastructure. This centralized infrastructure may have a single point of attack, and if breached by cybercriminals, it could hinder medical services. Cybercriminals can benefit from stolen EMR data by selling it to other parties or demanding ransom for it, known as "ransomware." Furthermore, cybercriminals may attempt to use patients' data to try to obtain prescription drugs for themselves or others.

Aside from stealing and misusing patient information, EHR and EMR systems still face fraud issues. Fraud can occur in two ways: prescription drug and insurance fraud. Prescription fraud occurs when prescription details are altered or duplicated to receive certain drugs that are typically unavailable. Insurance fraud occurs when insurance companies raise the insurance prices while reducing benefits, or when healthcare professionals make incorrect diagnoses for patients to submit false insurance claims. This not only increases healthcare costs for patients but also allows healthcare professionals to exploit the system by presenting false information as facts.

In response, the academic community has proposed several methods to improve typical healthcare infrastructures, and blockchain technology has been incorporated. In recent years, some researchers have begun proposing the use of blockchain to improve electronic medical systems, particularly in handling EMRs. This is because EMRs contain private information, and patients wish to conceal information from unauthorized individuals, which blockchain