
Blockchain Healthcare 2016 Report – Promise and Pitfalls - kysar_tom
https://tierion.com/blog/blockchain-healthcare-2016-report/?hn
======
bduerst
I've had someone pitch the same blockchains-as-EMR to me, and they made the
same mistake of construing data integrity with data security.

Blockchains are public record, which you _do not_ want your health data stored
in. Even this article acknowledges that and recommends using private
blockchains, which offers no competitive benefit over other decentralized
databases.

This just seems like another hammer looking for a nail.

~~~
kysar_tom
The Bitcoin blockchain is really great for value transfer and data integrity.

You want a hash of your data stored in the Bitcoin blockchain, that can
referenced at a later point in time to validate the accuracy of the data.

~~~
zaphar
You are describing the Merkle Tree which is not unique to the blockchain and
existed some time before bitcoin. This isn't an argument for bitcoin it's an
argument for the Merkle Tree.

~~~
kysar_tom
Tierion anchors the root of a Merkle Tree made up of all inbound records every
10 minutes into a Bitcoin transaction. With that root in a Bitcoin
transaction, you can use a portable cryptographic proof (Tierion calls them
blockchain receipts) to validate the integrity of each record at a later point
in time.

The Bitcoin blockchain is a global immutable data ledger that makes for a
great place to anchor hashes to.

~~~
bduerst
Okay, that is not blockchains for healthcare, that is third party validation
for hashing. You're just storing the validation in Bitcoin's public network
instead of your own secure servers. There are problems with this:

\- You can't guarantee which block the transaction is on [1], which means all
your customer encryption is asynchronous (slow).

\- Your customers are assuming that you're keeping your private keys safe,
which is not any different than trusting a non-bitcoin verification provider.

\- The first quantum computer is going to destroy ECDSA, meaning your private
keys will be reversed and every health product depending on your service will
be trustless. Merkle trees can theoretically be used in a post-quantum world
[2], but the method by which you're generating the root for the tree is not
safe because you're relying on a network you don't control (Bitcoin).

How is this competitively good for healthcare?

[1] [http://www.ibtimes.com/bitcoins-big-problem-transaction-
dela...](http://www.ibtimes.com/bitcoins-big-problem-transaction-delays-renew-
blockchain-debate-2330143)

[2] [https://en.wikipedia.org/wiki/Post-
quantum_cryptography#Hash...](https://en.wikipedia.org/wiki/Post-
quantum_cryptography#Hash-based_cryptography)

~~~
grubles
As per [0], cryptography standards such as ECRYPT II tend to say that
Bitcoin's 256-bit ECDSA keys are secure until at least 2030-2040.

[0]
[https://en.bitcoin.it/wiki/Quantum_computing_and_Bitcoin](https://en.bitcoin.it/wiki/Quantum_computing_and_Bitcoin)

~~~
bduerst
Just because the bitcoin wiki says it, doesn't make it a good prediction.
Experts also used to say that a computer couldn't beat a Go Grandmaster until
2030.

The other points are still problems of using bitcoin right now.

------
doctoring
As a clinician, I'd love a way to see all the past health records of any
patient that walked in the door. They usually would love for me to as well.

I'm not sure how blockchain as a technology necessarily moves us forward to
get there. The vendors have a stranglehold on medical record software and have
no incentive to work together, share data, or agree to any standards -- I
mean, it wasn't until last year that the two hospitals I work at (owned by the
same umbrella hospital, using software from the same vendor, and 3 miles apart
from each other) could electronically access records from each other. We had
to fill out paper forms, make phone calls, and send faxes to get access.

It's not for want of a technological breakthrough that we've been struggling
so much...

~~~
mcculley
Agreed. I carry all of my health records on a very small USB flash drive in my
pocket. Every time I show it to a doctor, they are scared to plug it into
their desktop for fear of malware.

~~~
ramidarigaz
And that seems like a totally rational fear too.

~~~
ChoHag
It totally is, and the computers they use should not have working USB ports on
them.

~~~
mcculley
Amusingly, I work with a rather large organization which still buys machines
with PS/2 keyboards and fills the USB ports with epoxy. This is the state of
security.

------
waynevaughan
Part of the challenge is that the word blockchain is misused. Here's a quote
from the first page:

“…the term ‘blockchain’ has been so misappropriated that no one knows what it
means anymore.” – Elaine Ou, Bloomberg

People are using blockchain to describe Bitcoin, private ledgers, the public
Ethereum network, private Ethereum forks, and other tech that shares design
characteristics with Bitcoin.

------
dvcc
I read through this and I still have no idea what they actually applied the
idea of the blockchain to within healthcare. To an HIE? Does each patient
receive their own "wallet" that is their patient record? This just seems to be
a generic overview of EHRs/Blockchains within the same page.

~~~
waynevaughan
Thanks for reading the report. This last weekend there was the first
Blockchain Healthcare conference where blockchain was pitched as a panacea for
a wide spectrum of healthcare problems.

[https://godistributed.com/health/](https://godistributed.com/health/)

Our report was targeted at a non-technical audience. Printed copies were
distributed to about 500 attendees. We wanted to make them aware that while
there may some opportunities for using blockchain technology also comes with
substantial risks. We want to help them cut through the hype and maintain a
healthy dose of skepticism.

Gartner recently placed blockchain technology at the beginning of their hype
cycle.

[https://pbs.twimg.com/media/CtxEq0MWAAA3EQe.jpg](https://pbs.twimg.com/media/CtxEq0MWAAA3EQe.jpg)

~~~
RyJones
Not coincidentally, Hyperledger just started a working group for healthcare.
[0] Coincidentally, a healthcare application won this week's Hackathon in
Amsterdam [1] [https://www.finextra.com/pressarticle/66385/medical-data-
app...](https://www.finextra.com/pressarticle/66385/medical-data-application-
wins-abn-amro-hyperledger-hackathon)

[0] [https://lists.hyperledger.org/pipermail/healthcare-
wg/2016-O...](https://lists.hyperledger.org/pipermail/healthcare-
wg/2016-October/000001.html)

[1] [https://www.finextra.com/pressarticle/66385/medical-data-
app...](https://www.finextra.com/pressarticle/66385/medical-data-application-
wins-abn-amro-hyperledger-hackathon)

------
aub3bhat
I am pretty sure that Gmail database is 1000x times larger than all non-
imaging healthcare data for entire population of the world.

There are instances where blockchain type technology is useful such as
transactions between multiple parties with lack of trust. This isn't true in
healthcare and surely not for EMR/EHR data.

------
natrius
Blockchains are like scrolls: you can write information on them that a society
can use to coordinate current actions based on the past. You don't want a
scroll for your medical records. You want a journal that can't lose data and
can safely give access to any app you want to install without losing privacy.
That sounds more like Urbit than a blockchain.

