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Amid data security concerns and fragmented health systems, blockchain offers India a robust tool to secure health records and enhance digital healthcare
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The need for high-quality healthcare is rising along with the population, and digital health solutions are essential for improving accessibility, affordability, and efficiency. Electronic health records, or EHRs, are the primary digital tool used by the healthcare industry to improve the standard of patient care. However, problems have surfaced as patient data is increasingly stored and transmitted online. Cyberattacks have found centralised systems to be appealing targets, resulting in breaches that jeopardise private patient data and erode public trust. Healthcare providers can now significantly enhance the confidentiality and integrity of up to 90 percent of medical data by using blockchain-powered storage, reducing the risks of breaches and unauthorised access.
Transparency, data immutability (i.e. data cannot be altered or deleted), and the ability to foster trust without a central authority are among the key features that blockchain technology offers. These qualities can be used to facilitate communication across various software programs that are part of the healthcare ecosystem, all while maintaining data integrity and facilitating easier access to EHRs. Given the strict data privacy requirements mandated by laws like the General Data Protection Regulation (GDPR) in the European Union and the Health Insurance Portability and Accountability Act (HIPAA) in the United States, it is uncertain whether India's healthcare system can handle these demands.
Keeping data in EHRs secure is always a priority, given that EHRs have become the industry standard in the healthcare sector. However, due to centralisation, fragmented systems, and insufficient access controls, EHRs have frequently encountered significant security and privacy issues. For instance, in 2022, the All India Institute of Medical Sciences (AIIMS), Delhi, experienced a ransomware cyberattack that compromised sensitive data, including patient records and research information, thereby threatening patient confidentiality. Additionally, since medical records are kept at the originating facility, patients may not have easy access to them when they move from one hospital to another. For EHR administration, this lack of interoperability and smooth data transmission between hospitals presents a major obstacle.
With its secure and dependable decentralised framework—where data is not kept on a single central server but rather distributed across several separate computers—blockchain technology can be utilised to circumvent issues associated with conventional healthcare architecture for the safe storage, exchange, and retrieval of EHRs. Through this, decentralisation improves system resilience and eliminates the necessity for a single central authority. Within the decentralised framework of blockchain, interoperability enables the secure and efficient exchange of patient data between various systems and organisations.
For every data block, the blockchain creates a unique fingerprint, or hash, using cryptographic hash methods such as SHA-256. Because these hash methods generate fixed-size outputs according to the input data, it is nearly impossible to decipher the actual data from the hash. Any changes made to the data would produce a completely different hash, alerting the network to possible tampering. Smart contracts are self-executing agreements recorded on a blockchain, with their terms directly encoded into code. They operate without the need for intermediaries by automatically enforcing and verifying the fulfilment of contract requirements on permissionless blockchains like Ethereum. For EHRs, smart contracts can manage access permissions, ensuring that only authorised parties (such as a specific healthcare provider) can read or write records. Patients, for their part, can authorise or revoke access to their data at any point, thus retaining control of the personal information they share. This feature adds a layer of security and helps build trust, as every transaction is recorded and can be audited.
While blockchain holds significant potential for India's healthcare ecosystem, its viability depends on cooperation from a variety of stakeholders—including patients, technology companies, healthcare providers, and policymakers—to test, standardise, and scale solutions that strike a balance between innovation, security, and regulatory compliance.
Blockchain is already being used by several healthcare institutions to improve data security. Guardtime has partnered with Estonian healthcare providers to implement blockchain technology to safeguard the nation's health data system. By storing health records on a decentralised blockchain, this solution allows patients to manage who can access their data and prevents unauthorised changes. Likewise, in the United States, healthcare providers are required to make patient data accessible. A blockchain-based system called MedRec was piloted by the Beth Israel Deaconess Medical Center in collaboration with the MIT Media Lab to manage electronic medical records. The system provides patients, healthcare professionals, hospitals, urgent care facilities, private clinics, and insurance companies with secure access to blockchain medical records. Patients can manage who has access to their personal health information and receive notifications when data transactions are initiated.
In 2021, India launched the Ayushman Bharat Digital Mission (ABDM) to build and integrate health data registries and records, thereby fortifying the digital health ecosystem. Through digital highways, it seeks to bridge the existing divide between the various stakeholders in the healthcare ecosystem. However, due to concerns about data privacy and potential competition, healthcare providers may be reluctant to share patient information. The creation of a national healthcare blockchain for Indians could help address this challenge. By automating procedures to reduce administrative burdens, expediting claims for improved cash flow, eliminating fraud through secure data handling, and ensuring accurate, efficient billing with a shared ledger, blockchain can contribute to minimising healthcare costs.
PwC's pilot studies indicate that blockchain can facilitate the nationwide exchange of EHRs by offering smart contracts for managing patient consent and a tamper-proof audit trail. However, these studies also highlight the challenges of integrating blockchain with existing health Information Technology (IT) systems. The government's recent National Blockchain Framework demonstrates its commitment to decentralised, citizen-centric services and provides a governance model that could be used for the secure management of healthcare data.
The collaboration between the Indian Institute of Technology (IIT) Bombay and BFI (Blockchain for Impact) exemplifies efforts to improve the healthcare ecosystem by making medical services and commodities more accessible to everyone. Furthermore, integrating blockchain with Artificial Intelligence (AI) and Internet of Things (IoT) for real-time patient monitoring could enhance data integrity and enable predictive analytics. However, this convergence requires integrated infrastructures and strong data governance frameworks. While blockchain holds significant potential for India's healthcare ecosystem, its viability depends on cooperation from a variety of stakeholders—including patients, technology companies, healthcare providers, and policymakers—to test, standardise, and scale solutions that strike a balance between innovation, security, and regulatory compliance.
The practical implementation of blockchain technology in India for the protection of EHRs rests on a thorough and well-defined policy roadmap. Governments and regulatory agencies must establish specific rules and regulations if blockchain technology is to be widely adopted in the healthcare industry. However, limitations and potential challenges, including scalability, interoperability, and regulatory compliance, exist. These issues can be addressed through i) the use of hybrid blockchains, which offer improved scalability compared to public blockchains; ii) by collaborating with stakeholders to define interoperable data formats and standardised protocols for seamless integration with existing systems; and iii) by focusing on well-defined pilot projects with clear objectives before attempting nationwide implementation.
The ABDM's approach to healthcare digitisation relies heavily on public-private collaborations. IT companies drive innovation by integrating the frequently updated ABDM platform with solutions like AI, IoT, blockchain, and cloud computing. Although these collaborations enhance productivity, cybersecurity and data privacy concerns persist. Partnerships with private hospitals are still in their early stages but are expected to expand in the future. Legal challenges should be addressed by collaborating with policymakers to draft legislation that fosters innovation while ensuring data privacy and security. To comply with existing data protection rules, strong encryption protocols and access control mechanisms must be put in place.
The healthcare sector must develop standardised protocols for consensus building, access management, and encryption to fully realise blockchain's potential.
Healthcare providers can foster partnerships with government agencies, research institutes, and academic institutions for collaborative blockchain projects. These partnerships can provide access to cutting-edge research, industry best practices, and regulatory advice, ensuring the successful implementation of blockchain in the healthcare sector. The healthcare sector must develop standardised protocols for consensus building, access management, and encryption to fully realise blockchain's potential. Interoperability between different EHR systems and blockchain networks can be made possible by clear standards, ensuring safe exchange and easy data access. These guidelines will strengthen healthcare data security, improve efficiency, and enhance data portability between providers by promoting consistency in blockchain design and implementation.
Blockchain must be carefully and selectively deployed to revolutionise India's healthcare sector, given the country's unique infrastructural and regulatory challenges. When implemented strategically, it has the potential to significantly enhance the security, efficiency, and transparency of patient care. Blockchain development services are likely to become a cornerstone of a safer, more effective, and patient-focused healthcare ecosystem. They also hold the key to building a more reliable and trustworthy EHR system.
Madhavi Jha was a Research Intern at the Observer Research Foundation.
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