From the
PRESIDENT
Robert A. Zaring, MD, MMM
GLMS President | [email protected]
A TRANSFORMATIVE Technology
L
ast year, IT and financial worlds were
abuzz with Craig Steven Wright’s
claims that he was the elusive Satoshi
Nakamoto. It remains to be seen if
Wright is or is not Nakamoto. How-
ever, what I hope is that right now you are
asking who Satoshi Nakamoto is and what does
he have to do with health care. To answer those
questions, we must take a quick jaunt back to
the 1990s to the early days of the internet, and
look at a group known as the “Cypherpunks.”
The Cypherpunks were created in 1992 by
Eric Hughes, Tim May and John Gilmore. Some
of the other famous members of the group in-
cluded Jacob App elbaum, Julian Assange and
Hal Finney. The group were Libertarian-lean-
ing activists who believed that only through
cryptography could privacy and security be
maintained in a digital world. They also were
in search of a currency which would not be
centrally controlled. The group feared central
control of the currency by institutions such as
the Federal Reserve, because they believed it
allowed for too much manipulation and cor-
ruption. Many ideas were brought up, such as
BitGold, but none hit the mark. The search
went on, but interest in the currency they en-
visioned waned until 2008 with the collapse of
the financial markets.
Only two months after the failure of Lehman
Brothers, a paper was released entitled “Bitcoin:
A Peer-to-Peer Electronic Cash System” by
Satoshi Nakamoto. A few months later, the
first exchange of Bitcoin occurred. Although
Bitcoin has weathered peaks and valleys, its val-
ue continues to rise. Today, Satoshi Nakamoto,
whoever he (or they) may be, is estimated to
have well over a billion U.S. dollars worth of
Bitcoin. You may be wondering what do Bitcoin
and health care have to do with each other?
The answer to that question is that the real
beauty of the technology is not Bitcoin, but the
underlying technology known as Blockchain.
It is important to understand that Bitcoin
does not equal Blockchain. One could say that
Bitcoin and Blockchain are related to each other
the way email and the internet are. As email
is just one use or application of the internet,
Bitcoin is just one application of Blockchain.
So, what is Blockchain?
Blockchain is a distributed digital ledger se-
cured by cryptography. In accounting terms,
a ledger is a detailed record of transactions.
Blockchain is also an accounting of transactions
but in a digitally distributed network. Multiple
transactions are placed in a block and digitally
linked to another block, which links to another
block, and so on, hence the name Blockchain.
No transaction or block can be changed with-
out majority acceptance of all the individual
computers in the distributed network. The
computers must solve special algorithms to
approve a change, and multiple copies of the
correct ledger are on all computers and updat-
ed immediately. If one copy is incorrect from
being tampered with, it is easily identified in
comparison to the others and corrected. To
understand the use of this technology, consider
a house that was built and had several additions
and fixes. Each change would be a transaction
and no change could be deleted or forgotten as
everything that happened would be recorded
and would be immutable. Therefore, the life of
the house would be recorded and verifiable for
any potential buyer, eliminating title fraud or
potential problems about the house that may
not have been disclosed.
This distributed immutable digital ledger
has many potential uses in health care. Some of
those uses include: clinical trials where altering
or creating data would not be possible; drug
traceability from creation to patient ending
the problem of counterfeit drugs; immediate
insurance eligibility determination and claims
processing, and an Electronic Health Record
(EHR) that allows for interoperability, with
patients able to determine with complete se-
curity who sees their records. I cannot go into
every scenario of how this would work, but
for a brief example, consider the EHR. Every
change or addition would create a new trans-
action with a unique pointer created and sent
to an outside depository, where the patient
information is held. The patient could approve
those asking to see their information by using
smart contracts or computer logic built into the
Blockchain. Every addition or change would be
authenticated and marked in the Blockchain
but, at the same time, held as completely secure
with only those given authorization able to see
the information. Given this cryptography, the
Blockchain is essentially hacker-proof, elim-
inating the problems with ransomware and
other serious HIPAA violations.
The financial industry is embracing Block-
chain rapidly. It’s estimated that by 2021, Block-
chain will grow to a 2.3 billion dollar market
from its 339.5 million market today. Health
care organizations are currently investing in
the technology, and last year the Office of the
National Coordinator for Health Information
Technology offered a challenge for white papers
on how to use it best. Furthermore, Estonia,
one of the most tech savvy countries in Europe,
has partnered with the Blockchain company,
Guardtime, to protect all its medical records.
Dubai is planning on doing the same and ad-
vancing its use of Blockchain by securing all
government records by 2021.
Many have lamented health care’s slow adop-
tion of horizontal technologies in the past. But,
it appears with Blockchain, health care is keep-
ing pace and may be on the verge of imple-
menting a truly transformative technology.
Dr. Zaring is an anatomic and clinical pathologist
with Louisville Pathology Associates and practic-
es at Jewish Hospital.
NOVEMBER 2017
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