Many people believe blockchain is going to solve all of the world’s problems including something that has plagued the healthcare industry for decades: interoperability of medical records and data. While blockchain and interoperability of medical records could have a symbiotic relationship, there is nothing inherent in blockchain that addresses the interoperability problem of healthcare data.
In the world of health care, sharing data requires a centralized server or the transmission of bulk data between institutions. According to a study by the Mayo Clinic, centralization may increase security risks while bulk data transmission may force institutions to give up control of their data.
What makes blockchain unique is that it is actually decentralized and utilizes an open ledger of data through an intricate system of blocks. Instead of centralization, trust is distributed to participating parties in the network. In effect, blockchain operates as the “Level 1 and Level 2” of an infrastructure that is efficient, decentralized and secure.
As CEO of a company that directly works with the implementation of a decentralized blockchain application, I have seen this system provide a common supporting technical architecture and infrastructure for sharing health data transactions. But it can do nothing to provide interoperability of medical records where the requirement is to convey clinical intent across institutional boundaries.
On the other hand, the health care industry has begun to coalesce around fast health care interoperability resources (FHIR) as a new standard for exchanging data. Health care standards organization, Health Level Seven International (HL7) is responsible for creating this standardized model of data exchange, which leverages web application programming interfaces (APIs) to provide a standard interface so any authorized application can send and receive data with proper authentication. (Full Disclosure: Our CTO has joined the HL7 FHIR Foundation as a member.)
Analogous to the layers of the open systems interconnection model (OSI Model), FHIR translates system-specific data representation to standard formats in order to improve interoperability of data between different applications and systems including mobile devices. In the context of blockchain, the data itself can be either off-chain or on-chain depending on whether it is a public or private blockchain.
You might have heard terms like LOINC and SNOMED tossed around in the context of health care delivery. These are systematically organized codes, terms and definitions used in clinical documentation and reporting. When delivering care, it is vital that these codes are understood and interpreted in a consistent manner across healthcare settings. The problem is that different electronic health records (EHR) systems have their own implementation of clinical definitions. As a result, the same health information has the potential to be identified by a number of different values and hence subject to misinterpretation.
The good news is that FHIR supports information sharing by a variety of document formats which are validated to ensure they meet current standards. The higher the level of detail in the FHIR profiles for things such as conditions and vital signs, the greater the likelihood that the meaning will be exactly understood between sender and receiver systems.
An alternative approach is to have an external terminology server that represents code systems and vocabularies and works with FHIR as a resource. The terminology server can be referenced for the latest versions of code systems and vocabularies instead of having these reside in FHIR. The external terminology server can be maintained and updated as new versions of standards are finalized.
Regardless of which path the industry takes, it is clear that achieving true semantic interoperability is going to take a lot of work.
Combined with blockchain, FHIR can uphold the security and integrity of health data transactions. Even though they work in very different ways, their potential to disrupt traditional health care is far-reaching and full of promise. However, nirvana lies in true semantic interoperability of clinical information and blockchain is not going to help with that.
