How blockchain can aid healthcare delivery

Distributed ledger technologies or DLTs (better known as ‘blockchain’) have been revolutionising several industry sectors.

DLTs, which often incorporate advanced cryptographic tools, work by breaking up the total transactional dataset into encoded portions, which are saved across several node locations (which could be physical or, increasingly, virtual). The data cannot be modified unless all the nodes are in consensus, thus offering a superior degree of protection than other classical and centralised storage and retrieval approaches.

DLTs bring an assurance in the immutability of the data they encode, and thus a degree of trust, which could benefit all areas where third-party verifications are required.

Although manipulation of large-scale data sets could be energy draining and the second quantum wave is challenging the security of DLTs, post-quantum cryptography and newer approaches to consensus (as, for example, pioneered by Hedera, a company that is creating a public network) mean DLTs are here to stay.

Today, DLT use cases are emerging in diverse avenues, from automating third-party audits to energy metering, registration of land records and securing the supply chain in the FMCG sector.

IIT Madras has been developing use cases for DLTs in the fields of healthcare and digital data, which are significant in view of the deepening network coverage and an ageing population with a corresponding rise in lifestyle and non-communicable diseases.

For example, small to medium-scale clinics and healthcare providers, who serve the majority of people in our country, often lack proper digital infrastructure, without much interoperability. Maintenance of hack-proof databases containing information on the various elements in the healthcare supply chain, including medicines, vaccines, payments and insurance, diagnostic tools and even organs, is a major challenge; lack of transparency and trust makes this process vulnerable to shortages, illegal transactions, intersecting with complex social challenges such as human trafficking.

The large-scale digital data in contexts such as industrial and private IOT (internet of things), as well as social networks, face the challenges of third-party access and immutable storage and transmission. Through the use of DLTs the team at IIT Madras seeks to develop elegant and scalable solutions for issues such as data duplication, maintenance of record privacy and lack of interoperability across geographies.

Earlier this year, the team developed BlockTrack, a blockchain-powered app for secure digitisation and management of digital health records, and demonstrated it through limited field trials at IIT Madras Institute Hospital.

The app has a separate interface for patients to provide data, with a proper system of permissions and consent, while doctors can view the subsequent data flow and provide additional inputs.

User registration, profile editing, and record creation and access were registered on the blockchain created by using the computer systems available at the hospital and the Centre for Nondestructive Evaluation.

Supported by a CSR grant from Infosys, ‘BlockTrack’ was developed over Hyperledger Sawtooth, and a ‘proof of elapsed time’ (PoET) algorithm was used as the consensus protocol. (Hyperledger is a multi-project, open-source collaboration hosted by The Linux Foundation, to promote blockchain technologies.)

Synchronisation of nodes, ledger updates upon node failure and processing speed were some of the parameters of our custom-created blockchain network that were tested.

The trial studies demonstrated that our framework could work robustly, handle patient digital records over a local blockchain, and, importantly, access them from a different physical location through the creation of a unique ID.

BlockTrack is being further developed over Hyperledger Fabric, a blockchain infrastructure more widely used in the healthcare context globally, with more modules for hospital administration to access and update records, and diagnostic centres to add test results.

BlockTrack has been received enthusiastically by stakeholders in the healthcare sector, and the team could develop partnerships with organisations for its wider deployment. Through MoUs with NGOs such as telemedicine pioneer MedIndia and the organ donation-focused MOHAN foundation, the team seeks to further test and develop BlockTrack with an expanded range of modules and node network.

Trial studies at IIT Madras Hospital also made the team acutely aware of the potential challenges in taking BlockTrack to the hinterlands, particularly in IT support infrastructure. The team is working on hybrid models for DLT implementation, with a pared-down algorithmic base implemented on physical infrastructure leveraging the cloud.

At this stage, perhaps our work is also in the ‘Goldilocks zone’ of technologies, in line with the goals of the National Digital Health Mission (NDHM), which seeks to empower health data fiduciary platforms within an integrated digital health infrastructure.

The NDHM has built a framework of several building blocks to enhance the patient’s continuum of care and the interoperability in the healthcare ecosystem, mediated by information and communications technology, or ICT. The NDHM is looking for data protective features such as anonymisation, de-identification, encryption, and vital responsibilities in the data fiduciaries and data processors, in addition to consent management, as part of its framework — avenues where solutions like BlockTrack are vital. Indeed, the emerging National Digital Health Ecosystem (NDHE), with a thrust on unique health IDs and roll-out of schemes such as the Ayushman Bharat Digital Mission (ABDM), offers unique opportunities for pioneering and scaling such solutions to benefit healthcare delivery across the board.

This work is now being upgraded to cover networks of sensitive data in large distributed clusters in contexts such as supply chain, digital media and industrial sensor logs. IIT Madras is enthused by the application of DLTs to realise distributed social networks (for example, through the ShortHand app) and its potential to impact sectors such as skilling and innovation.

Growing synergies with NGOs, industry CSR and government agencies that enhance capabilities and further catalyse these initiatives are encouraging.

IIT Madras’s partnership with Hedera, for example, offers us a unique opportunity to aid in the development of novel approaches to the problem of consensus in DLTs. The institute, in general, and the team, in particular, have a strong history of collaboration through CSR channels, leveraging support from such majors as CapGemini, GAIL, WIN and NSE Foundations to translate our technologies in the health and sanitation spaces to the field.

These partnerships will help DLT innovations positively impact socially relevant avenues such as organ transplant, digital health record management and workforce upskilling.

With a spectrum of research activities — from program analysis and cryptography to hardware enhancements — the faculty working on DLTs across several departments at IIT Madras are exploring collaborations to accelerate the efforts and develop industry-ready solutions.

The writer is Professor, Department of Mechanical Engineering, IIT Madras

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