Blockchain, as is, currently lacks a number of elements needed to make it successful as a national record keeping framework to replace our current system. Many of these barriers are monetarily driven, such as the incentives to create this very large network of connected “blocks” of data. The current EHR market is valued at tens of billions of dollars, and very recently, many academic universities and other large health systems have poured millions of dollars into new vendor-led commercial health record systems in large part incentivized by the federal government [3, 4]. To ask hospital systems, community clinics, and solo physician offices to remove their current record system and replace it with a digital ledger is a disservice to not only to patients but also medicine. To augment this event, blockchain would likely not completely replace the current system but act more so as a supplemental vehicle. For example, in each of these “blocks” would be kept a small amount of information to describe a specific patient (or procedure); however, most of the healthcare information would be kept off of the blockchain. The link embedded in that block would act as a shepherd to an off-block API that allowed you to view MRI results, X-rays, Pathology results, among a myriad of other information about that specific patient or procedure kept in a current Enterprise Data Warehouse (EDW) database.
Furthermore, additional thought would have to be developed to determine how record data would be stored on blockchain. Would blockchain run into the same types of barriers that we arrive at now; how should we store our current data? Until we find common ground – Agreeing to storing all demographic information in a nationally recognized standard format - Hospital A may choose to store data on the blockchain in English, however Hospital B will select to store it in a separate format such as German. In this same arena, maintenance of the blockchain and transaction costs would have to be taken into account. A subset of networks would have to exist potentially run by large private corporations and subsidized by the government to ensure proper functioning of the network. This could potentially skew the purpose of migrating to blockchain since a centralized body or subset of bodies would have to be involved in data governance and maintenance.
A number of niche areas do exist that could easily improve the efficiency of the current system; however, blockchain will not in its current state offer the complete answer for all of the current medical record tribulations. Initially, blockchain may be better suited as an example such as in our description above, creating a system for monitoring a pharmaceutical supply chain from distributer to store front, medication management, setting up a permissioned block chain that allows reporting of population health data directly to CMS, creating a de-identified research dataset, among many other “low hanging” opportunities. With the appropriate incentives and governance structures or a program such as the very recent Meaningful Use program, a large argument could be made in many other regions of healthcare besides the non-exhaustive list of examples above. Working towards a large scale medical record-keeping repository is goal we should strive for; however, obtaining multiple small wins with “low hanging fruit” will allow enough momentum to be created for a national push on regulation and private sector parties to improve our national record keeping system.