The B word - 'Blockchain'.. and how will this probably apply to medicine & healthcare..

A Block chain in simple words represents source of one single truth.

It can represent a record of human exchange at a particular point in history.

So what is blockchain here?
It's a generalised framework for implementing decentralised compute resources.

In simple terms :

    A blockchain is a digitized, decentralized, public ledger of all cryptocurrency transactions. Constantly growing as ‘completed’ blocks (the most recent transactions) are recorded and added to it in chronological order, it allows market participants to keep track of digital currency transactions without central recordkeeping. Each node (a computer connected to the network) gets a copy of the blockchain, which is downloaded automatically.

Let's understand via the Medrec - Case study done by MIT

• The block content represents data ownership and viewership permissions shared by members of a private, peer-to-peer network.  
• Include in the record a cryptographic hash of the record to ensure against tampering therefore indicating the ingregity of the data.
• Providers can add a new record and patients can authorise sharing of records between providers.
• Ethereum block chain employs a DNS like implementation which maps an already existing and widely accepted form of ID e.g. name or social security # to the person's Ethereum address. A syncing algorithm handles data exchange "off-chain" between a patient database and provider database after referencing the blockchain to confirm permissions via a database authentication server.

A chain can be composed of the below :

A) Registrar contract

    - name e.g. - sam smith, ethernet address

B) Summary contract
   - sam ethernet address, ppr address

C) Patient Provider relationship `

  -  owner, emr queries, permissions, mining bounties.

A block chain can comprise of a mix of A, B  & C over a period of time.

Sample implementation may compose of the following:

MedRec Service --> DB gatekeeper --> EHR Manager --> Miner -- to mine data on the blockchain

A MedRec service receives a request for data - contact with DB gatekeeper after checking the EHR or  Ethereum manager - getting contract of requestee provider or consumer and then using the Miner to mine the query over the blockchain.

Quoted by the case study as below -- 
'As envisioned by the Precision Medicine Initiative (PMI), the MedRec patient record would reflect the many facets of health data, by accepting not just physician data, but also data from the patient’s Fitbit, Apple HealthKit, 23andMe profile, and more. Patients can build a holistic record of their medical data and authorize others for viewership, such as physicians providing a second opinion or family members and care guardians.'

MedRec smart contract structure can represent one model of Healthcare Care Directory and Resource Location. secured by public key cryptography enabled with crucial properties of provenance and `data integrity. A block chain log provides clarity for communication authorisation across the Health IT ecosystem and an audit for subsequent inquiries.

Some of the worlds best healthcare firms are already started to support the above model to understand the impact and include the Ethereum smart contracts to orchestrate a content access system across separate storage and provider sites.

Block chain will find it's use and continued growth in the usage as the data-security and autonomous data governance comes more into practise. This promises to be be a prime form of data exchange when virtualised access bodies like enhanced artificially intelligent agents or avatars start transacting on behalf of the provider or client in future. Block chain transformation is gradual but might soon pickup speed once the autonomous governance strategy require the same to be the authenticating and authorising entity for any transaction request in timeline history.

Stay tuned for more updates on this ...