record. So, for example, if a patient is seen by both a primary care and a specialty clinic, changes made to the medical records at either facility are not immediately captured in the medical records of both facilities, and require multiple steps to send, receive, and enter information; errors and omissions are possible at all stages.
Blockchain can be used to provide all clients and providers with identical content. The decentralized ledger approach to information management gives all parties simultaneous access to a single record of strongly encrypted data at relatively low cost. It also creates an audit trail each time any data item in the record is changed, helping to maintain the integrity of the system and its information. Eventually, blockchain could be used to provide secure and accurate medical information for all individual patients.
With blockchain technology, clients could actually play some role in managing the medical records of their pets and permission can be given to different providers and entities to access and modify those records, where all such modification attempts are securely recorded, annotated, and largely tamper‐proof.
If a pet has received treatments from multiple doctors at different facilities, all that information can be accessed from the blockchain, and there would be an audit trail for any changes made. Ultimately, the success of any such system depends on the participation of many medical providers, or there are few benefits over those seen with traditional electronic medical records.
One of the main benefits for blockchain use in healthcare is that it is decentralized, which provides enhanced security. Because the data record is replicated across many nodes rather than on one central computer, it is more resistant to a hacking attempt or manipulation. If any one computer is hacked, other separate computers in the network that are using the blockchain would still maintain accurate information.
Blockchain itself does not perform analytics, but permission could be granted for analytics to be performed on such data. This could be extremely powerful in veterinary medicine in which large numbers of small clinics exist globally, but a single database could potentially be mined for a wealth of information relative to pet‐specific care (such as breed predispositions, disease prevalence, epidemiology, etc.).
Other areas where blockchain can prove very useful is with online directories of doctors and other healthcare providers. Hospitals, doctors' groups, laboratories, and insurers all try to maintain their own online listings, but these frequently become outdated or require providers to notify the entities that the information has changed or is outdated. With blockchain, providers can update their own information at will. Especially in veterinary medicine, with so many clinics unaffiliated with one another and potentially using different practice management software, there can be many islands of information with very few opportunities for data bridges. Blockchain can help address that.
Another area of importance for blockchain is the management of personal data online. With blockchain, a patient's entire medical record can be stored in a ledger and encrypted with a private key. Changes in this information can be communicated to the ledger with the patient's authorization and securely shared with various providers. Because of the audit trail feature, everyone is aware exactly who made a change, when the change occurred, and what was changed.
There are many other potential applications, from managing prescriptions through the blockchain so that all participants know when and where a prescription was filled, to tracking laboratory results through the system, to verifying veterinary licensing. and updating information directly.
The following is an example of a fictional veterinary blockchain application.
A veterinary blockchain project was established with participation of veterinary hospitals, laboratories, and pet health insurance companies. Dr Smith of ABC Animal Hospital is a participant along with many of her colleagues.
Mrs Jones first presented her spayed female labradoodle Daisy to the clinic and once she shared her public key with the clinic, they were able to access information from all the clinics that Daisy had visited previously. In those records were also entries from diagnostic laboratories, along with time codes and verified user stamps of all participants. In fact, there was even an entry from a genetic testing laboratory indicating that Daisy carried a variant for exercise‐induced collapse, and that might prove very useful should she ever display evidence of weakness.
Over the next few years, Dr Smith came to appreciate the importance of blockchain to medicine. Once, after hours, Daisy needed to be seen at an emergency clinic, and Mrs Jones was able to provide that clinic with a key to access Daisy's healthcare information, including recent bloodwork that had been run. Similarly, when Daisy showed some evidence of lameness, she was referred to a specialist; the specialist appreciated access to the previous medical records, including the genetic screening, and was able to append the medical record with relevant findings, accessible to Dr Smith and others who had been given permission. Laboratory testing that had been performed was similarly entered into the record, directly by the laboratory.
Mrs Jones had purchased pet health insurance for Daisy, which was in effect since Daisy was a puppy. The pet health insurance company participated in the blockchain process and the shared ledger of encrypted data allowed all parties to view the same accurate information about the insurance claim, without anyone having to send medical information back and forth. Mrs Jones found it very convenient to see that the insurance company was able to quickly acknowledge and process the claim.
One of the main advantages of blockchain is that it allows multiple permitted providers to access and append information in a medical record.
Blockchain tends to be much more secure than other forms of databases and while it is still theoretically “hackable,” it is much more difficult to do so than with most other systems.
Blockchain maintains an audit trail, so that it is immediately obvious to all when a provider makes an entry or change to a medical record.
The concept of blockchain may sound exotic, but it is already being very successfully employed within many physician networks.
The main disadvantage of blockchain is that it is of limited benefit until there are a critical number of medical professionals participating in the process.
2.12.4 Cautions
Blockchain is more difficult to hack, and tends to be more secure than traditional systems, but with enough computing power it is possible that even blockchains could be hacked. So, it is considered very secure but not completely impervious to hacking. One concern in this regard is that since most blockchain networks run the same code, any vulnerability detected could potentially put the whole network at risk. To keep things in perspective, though, most other systems are much less secure and tend to be easier to hack.
To be fully effective, blockchain requires that a large number of providers participate in the process. Without such participation, it loses much of its benefits of multiuser access.
As with most systems, it is also important to determine that data are accurate when first entered into the blockchain ledger. Sometimes, such as when a medical record contains information from multiple sources, it can
