Blockchain in Telemedicine

The development in technology and increased demands for personalized care has made it necessary for the healthcare industry to adopt Blockchain gradually. Blockchain’s abilities have made it an immensely successful technology across various industries. The emergence of Blockchain came with solutions to multiple issues prevailing in the healthcare industry for so long. The increasing incidences of data breaches, privacy issues, counterfeit drugs, and so on are the significant factors driving the healthcare blockchain market’s growth. According to Marketsandmarkets, the global blockchain healthcare market is predicted to reach $829 million by 2023.

The decentralized Blockchain technology facilitates the telemedicine sector by providing secure information sharing, verifiable data, and privacy of PHIs (Protected Health Information). While telemedicine was evolving for some years, the covid-19 pandemic gave the required boost to it. The pandemic created the necessity to increase virtual healthcare and remote treatment to facilitate social distancing. The telemedicine market has witnessed significant growth in the past year. Statista mentions, the telemedicine market was valued at around $45 billion in 2019, which is now expected to grow nearly four times and reach more than $175 billion by 2026. This growth will be bolstered by many significant factors such as increased in-person treatment costs, telemedicine funds, and an increment in the number of digital health users.

• Combining Blockchain and Telemedicine
• How does Blockchain work in a Telemedicine system?
• What opportunities does Blockchain provide to telemedicine?
• What are the benefits of Blockchain in Telemedicine?

Combining Blockchain and Telemedicine

Blockchain: It is a decentralized technology exceptionally good at eliminating third-party intervention, providing a secure sharing environment and maintaining transparency throughout the system.

Telemedicine: It is a platform to deliver care at a distance. It facilitates remote patient monitoring, video conferencing, distant treatment, auto-payments and other clinical services via electronic systems.

Before integration with Blockchain, centralization was a key impediment for telemedicine systems. However, centralized systems always pose the risk of a single point of failure and are highly prone to various external and internal data breaches, risking systems’ reliability. Blockchain Technology now handles such crucial issues efficiently. It follows a distributed architecture to manage the shared ledger of health records. All the ledger copies are synced and verified with every node associated with the Blockchain. Tracing medications and drugs across the supply chain, tracking infected patients’ locations, verifying physicians’ credentials and protecting health records are among the key challenges addressed by Blockchain.

The intrinsic features of blockchain include:

• Decentralized: Decentralization increases the overall robustness of the system. No single entity is given control of all EHRs. Consensus protocols govern the network that is controlled by many entities.
• Transparent: It helps identify and detect any suspicious user or actions performed on the distributed network.
• Auditable: The concerned authorities can trace drugs’ provenance and track the development throughout the supply chain.
• Open-source access: Blockchain enables open access to all; patients can access physician’s profiles, physicians can view patient’s medical history records, or any other authorized user can access the data.
• Anonymous: The identities of participants are kept anonymous during transactions to maintain the security of data.
• Immutable: Public-key cryptography assures the health records’ immutability by digitally signing every transaction before written onto the ledger.

How does Blockchain work in a Telemedicine system?

Digital health identity registration and authentication

The Blockchain-enabled decentralized application includes an intuitive user interface portal to facilitate sharing and viewing patients’ data to create a collaborative treatment plan. Participants’ identity verification and authentication are done using digital identities. Telemedicine applications have a Registry smart contract dedicated to maintaining the patients’ and healthcare providers’ digital health identities who register with the application. The registry saves provider’s phone numbers and email addresses using public encryption and signing keys generated at user registration time.

Step 1: User requests for registration

A user (patient or doctor) generates a request to register a digital id with a verified email.

Step 2: Request forwarded

The portal of telemedicine decentralized application receives this request and forwards it to the server.

Step 3: Encryption keys created

The server verifies the legitimacy of the request. Once the verification is successful, encryption and signing keys are created. These user’s public keys (signing and encryption) are then registered in Registry smart contract.

Step 4: Keys download option available to the user

Now, the server displays options for the user to download keys on the portal.

Step 5: Registration response

The portal sends a registration response to the user.

Step 6: Login request

Once the registration is done, the user requests for login with signing keys.

Step 7: Request forwarded

The login request is then sent to the server for further verification.

Step 8: Identity verification

In response to the login request, the server verifies identity existence in the Registry smart contract.

Step 9: Verification response

The response of verification is then returned to the server.

Step 10: Response forwarded

The server forwards this response to the portal.

Step 11: Response displayed

Finally, the portal shows the response to the user.

Data access authorization

Blockchain follows a token-based exchange system to allow permission for data access. Smart contracts for data access logs all user interactions and requests on the portal. It keeps track of what data is shared or no longer shared with which user by whom and when. All these accesses are structured to map user identities and authorizations to custom-named access tokens, which are represented as a nested object associated with the boolean value (true/ false) based on access granted or not. In case of access revocation, authorization is set to false and the associated token’s value is set to empty. The workflow of this process includes the following steps:

Step 1: Clinician shares new prescription data with the patient

A clinician generates a request to communicate a prescription with the patient.

Step 2: Request forwarded

The portal forwards this request to the server.

Step 3: Server requests for the patient’s public key

The server requests the patient’s public key to verify their existence.

Step 4: Return requested key

In response to the verification request, the registry contract verifies the patient’s existence and, if the patient exists, returns the requested keys to the server.

Step 5: Log generated token

Now, the server generates an access token for the patient and logs this token on Access Contract.

Step 6: Patient requests access

Once the patient is logged in, he generates a request to access available data and upload a private encryption key.

Step 7: Request forwarded

The portal delivers this request generated by the patient to the server.

Step 8: Server requests for all tokens accessible to patients

The server then requests all the tokens accessible to them.

Step 9: Return requested tokens

In response, the Access Contract returns all requested tokens to the server.

Step 10: Request to update and display links to data sources

The server then decrypts and verifies the signature to obtain access tokens and generate clickable hyperlinks with the patient’s uploaded key. The server requests the portal to update and display download links to data sources.

Step 11: Display links

The portal then displays links that are accessible to the patient.

What opportunities does Blockchain provide to telemedicine?

Patient Consent Management

Several challenges are involved with traditional consent management, such as limited trust on third-party servers, inability to conduct fair audit trails and high convergence time in sharing EHRs with specialists. Blockchain addresses these challenges and enables telemedicine applications to build trust among patients. Through Blockchain, patient consent management is assured and protected via several peers participating in the network. Moreover, the intrinsic features of the Blockchain (such as transparency, immutability, etc.) assist in conducting audit trails to verify compliance with consent management policies.

Traceability of remote treatment

For effective distant treatment, a face-to-face encounter of patients and doctors is required. Telemedicine services follow direct-to-consumer and business-to-business models. The former model facilitates patients to directly communicate to doctors for discussing their health conditions, whereas, in the later model, caregivers participate in the consultation and medical education services leveraging tools that support video and audio conferencing. Moreover, Blockchain enables telemedicine applications to provide a single and coherent electronic records view for all participating stakeholders. Transparency and visibility of EHRs assist in tracing the medical history of patients to propose suitable treatment.

Traceability of in-home medical kits and devices

The use of in-home medical kits and devices to help self-diagnosis in a non-clinical environment was generally considered less trustworthy by physicians because of the lack of information about the provenance of medical equipment, lack of transparency and visibility. Blockchain removed this issue by providing completely immutable and transparent record transactions to ownership and performance of testing kits on the distributed ledger. Reputation scores of all medical devices and test kits are recorded using smart contracts.

Secure access to personal health records

The personal records on traditional telemedicine systems using cloud platforms are prone to risk as a single entity manages them. The decentralized blockchain platform provides the power of controlling data to the owner of the data itself. Smart contracts register and authorize users to access the patient’s data according to the patient consent policy.

Automated payments

Blockchain supports digitally signed automatic payments to ensure non-repudiated secure transactions.
In comparison to traditional centralized systems, Blockchain does not involve any third-party to settle payments. In this way, Blockchain aims to gain the trust of patients. Moreover, Blockchain supports micropayments by offering cryptocurrency tokens based payment. The direct transfer of crypto tokens to the service provider’s wallets enhances the system into a more secure, fast, auditable and transparent approach.

Trustworthy monitoring of elderly care services

IoT-enabled healthcare devices assist the telemedicine sector in monitoring patient’s health remotely. Devices in-built with biomedical sensors continuously monitor the patient’s health and store data on a high-performance server. A malfunctioning device may sometimes capture inaccurate data, which can lead to medical errors. Blockchain helps resolve this issue by employing smart contracts to register and verify biomedical sensors’ access rights. A Smart contract can avoid any unforeseen emergency by timely triggering an alert to doctors.

Reputation aware specialist referral services

During remote patient treatment, medical referrals and expert opinions are sought through medical alliances and Smart contracts. Blockchain allows healthcare providers to store these referral documents on the IPFS (InterPlanetary File System) server.
An IPFS hash associated with the document saved on the Blockchain is returned to authorize consulting healthcare specialists to access it.
The hash prevents the alteration of the stored document and maintains its integrity. The referring healthcare provider can update the reputation score on Blockchain based on the consulting health specialist’s total service time and satisfaction score.

What are the benefits of Blockchain in Telemedicine?

Secure data sharing

Blockchain allows the sharing of data in a secured encrypted format. Both patients and doctors can securely exchange personal copies of the ledger; no single party will have complete control over the data.

Improved healthcare

Healthcare services such as remote patient monitoring, distant treatment, auto payments, insurance services and efficient data management, Blockchain in telemedicine aim to improve healthcare services.

Better Data Management

The blockchain-enabled public healthcare system helps doctors, patients and healthcare workers manage highly confidential patient data in the most cost-effective, secure and transparent manner.

Transparency

Blockchain’s accuracy and transparency are unrivaled. With the introduction of Blockchain in telemedicine, the cases of insurance fraud and data breaches have significantly reduced. Moreover, the decentralized nature of Blockchain and the use of smart contracts have also contributed to increasing the network’s transparency.

Self-custody

Blockchain facilitates patients by providing complete control and permission to manage the accessibility of their data. In this way, patients have custody of their data and have control over who can access their personally identifiable encrypted data.

Conclusion

Blockchain plays a vital role in securing health data, remote patient treatment and monitoring, identifying frauds and automating micropayments. Many experts and specialists have already admitted that Blockchain is going to rule the future. The way we connect, pass the information, share health data and every other digital activity is getting more secured by Blockchain.

If you are looking to incorporate Blockchain into your healthcare business or searching for a company to develop a telemedicine application from scratch, you’ve reached the right place. Get in touch with our team of health-tech experts and discuss your requirements.