Observations Heads Up

The hackers holding hospitals to ransom

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2214 (Published 10 May 2017) Cite this as: BMJ 2017;357:j2214

Could Blockchain technology help? Re: The hackers holding hospitals to ransom

This is regarding a possible suggestion for a future direction the NHS could take regarding its databases, information security etc. to not only potentially improve efficiency but also security and privacy concerns. This is adapted from a short article I wrote on Blockchain technology for the JIPMER (Jawaharlal Institute of Postgraduate Medical Education and Research in India) 2017 alumni reunion in the UK (the author's mother being an alumnus of JIPMER).

** Main Body of Article/Response begins here **

This is aimed at those of you who are either decision-makers, in the position to influence them, or who are looking to advocate solutions for healthcare reform either within your own trusts or across the NHS more broadly. Essentially, NHS databases and data-sharing arrangements are generally inefficient, impede effective service-delivery, and prevents optimal utilisation of data. Some of you may or may not have heard of Blockchain technology and this might be something worth exploring.

Applications of Blockchain technology are not just limited to crypto-currencies and the financial services industry. A Blockchain is a database that maintains a continuously a growing set of records. It is a distributed database, which means there is no central authority that holds the entire ‘chain’. Instead, each participating ‘node’ has a copy of the ‘chain’. It’s also ever-growing – data records are only added to the chain (so the records cannot be tampered with or modified – thereby ensuring their integrity). Fundamentally:

1. Transactions are the actions created by the participants in the system.
2. Blocks record these transactions and make sure they are in the correct sequence and have not been tampered with. Blocks also record a time stamp when the transactions were added.

Blockchain technology can, therefore, be used in tracking billions of connected devices, patient records and information, etc; it can enable the processing of transactions, and ensure the integrity of data (so that it is verifiable) whilst the cryptographic algorithms ensure peoples’ privacy. In this sense, it is secure, efficiently accessible, and enables privacy (so much so that many people use Bitcoin – which uses Blockchain technology – to illegally buy drugs, weapons, and so on, because they are confident of their anonymity being preserved).

Recently, the US Department of Health and Human Services (a Federal Government agency) sponsored a blockchain research contest (the ‘Blockchain Challenge’) and the Chamber of Digital Commerce (a leading trade association representing the digital asset and blockchain industry) provided an executive overview of “over 70 white papers from industry and academics” within its report: ‘Blockchain Healthcare & Policy Synopsis’. Amongst “the main areas for the application of blockchain in healthcare were thought to be: real item verification of doctor’s license status, drug delivery supply chain auditability, insurance claim fraud detection, continuing education validation, and digital wallets could be used to store a set of medical records, allowing the patient to have their records in digital form, giving them control of who sees their medical information.”

There is also the potential to ensure that the Blockchain can help secure the Internet of Things (IoT) as it pertains to healthcare because, according to an article entitled “Inside Risks: The Future of the Internet of Things” by Ulf Lindqvist and Peter Neumann, healthcare establishments already use devices that are remotely-controlled and accessible; this includes patient monitors, body scanners, pacemakers, defibrillators, infusion pumps, main and auxiliary power, lighting, and air conditioning. If compromised, people could literally be killed through malicious software and actors remotely – Blockchain technology can, therefore, help ensure security, integrity, human safety and health.

Ideas can be spread through both top-down and bottom-up approaches – indeed, an idea often only materialises effectively in large organisations when a combination of both is used (at least to some degree). If you think this is something your practice, your trust, or the NHS could benefit from more broadly, it is worth investigating and speaking to others, raising it in various fora and seeing whether the idea gains traction. I don’t proclaim to have significant expertise but there is a lot of research going into Blockchain technology – Guardtime is the world’s largest Blockchain company by revenue (and they have implemented Blockchain solutions in many contexts) whilst, in the UK, University College London hosts the UCL Research Centre for Blockchain.

As Doctors, you have the opportunity to make recommendations about improving healthcare services that are taken more seriously by service-users than your ordinary policymakers and NHS management. Data-sharing and NHS databases are a source of major inefficiency throughout our healthcare system – it can be dealt with. Now, the need for improving the NHS Cyber Security apparatus presents a potential opportunity to kill two birds with one stone.

Competing interests: No competing interests

17 May 2017
Vishal Wilde
Incoming Civil Service Fast Streamer, Masters Student, Researcher, Journalist, Politician and Creative Writer.