​Blockchain technology has the potential to transform health care, placing the patient at the center of the health care ecosystem and increasing the security, privacy, and interoperability of health data. This technology could provide a new model for health information exchanges (HIE) by making electronic medical records more efficient, disintermediated, and secure. While it is not a panacea, this new, rapidly evolving field provides fertile ground for experimentation, investment, and proof-of-concept testing.​

What is blockchain and how can it provide opportunities for health care?

​A blockchain powered health information exchange could unlock the true value of interoperability. Blockchain-based systems have the potential to reduce or eliminate the friction and costs of current intermediaries.

The promise of blockchain has widespread implications for stakeholders in the health care ecosystem. Capitalizing on this technology has the potential to connect fragmented systems to generate insights and to better assess the value of care. In the long term, a nationwide blockchain network for electronic medical records may improve efficiencies and support better health outcomes for patients.

What is blockchain?

At its core, blockchain is a distributed system recording and storing transaction records. More specifically, blockchain is a shared, immutable record of peer-to-peer transactions built from linked transaction blocks and stored in a digital ledger. Blockchain relies on established cryptographic techniques to allow each participant in a network to interact (e.g. store, exchange, and view information), without preexisting trust between the parties. In a blockchain system, there is no central authority; instead, transaction records are stored and distributed across all network participants. Interactions with the blockchain become known to all participants and require verification by the network before information is added, enabling trustless collaboration between network participants while recording an immutable audit trail of all interactions.

Blockchain as an enabler of nationwide interoperability

The Office of the National Coordinator for Health Information Technology issued a shared nationwide interoperability roadmap, which defines critical policy and technical components needed for nationwide interoperability, including:

• Ubiquitous, secure network infrastructure
• Verifiable identity and authentication of all participants
• Consistent representation of authorization to access electronic health information, and several other requirements.

However, current technologies do not fully address these requirements, because they face limitations related to security, privacy, and full ecosystem interoperability.

Implementation challenges and considerations

Blockchain technology presents numerous opportunities for health care; however, it is not fully mature today nor a panacea that can be immediately applied. Several technical, organizational, and behavioral economics challenges must be addressed before a health care blockchain can be adopted by organizations nationwide.

Shaping the blockchain future

Blockchain technology creates unique opportunities to reduce complexity, enable trustless collaboration, and create secure and immutable information. HHS is right to track this rapidly evolving field to identify trends and sense areas where government support may be needed for the technology to realize its full potential in health care. To shape blockchain’s future, HHS should consider mapping and convening the blockchain ecosystem, establishing a blockchain framework to coordinate early-adopters, and supporting a consortium for dialogue and discovery.​