Babbitt column | See the application of blockchain in medical and health fields from drug anti-counterfeiting and medical insurance claims

Editor's Note: The original title is "Application of Blockchain in the Field of Health Care"

In 2016, the State Council issued the “13th Five-Year National Informatization Plan”, and the blockchain was included in the national informationization development plan for the first time.

On May 28, 2018, General Secretary Xi Jinping made an important speech at the 19th Academician Conference of the Chinese Academy of Sciences and the 14th Academician Conference of the Chinese Academy of Engineering. He will blockchain and artificial intelligence, quantum information, mobile communications, and things. Networking is listed as a representative of a new generation of information technology. In the field of people's livelihood, we actively promote the application of blockchain technology in the fields of education, employment, pension, precision poverty alleviation, medical health, commodity anti-counterfeiting, food safety, public welfare, and social assistance.

As an important field of national blockchain technology application, the medical and health blockchain is becoming a hot spot for the construction of national health informationization.


Basic introduction of blockchain

Blockchain technology originated from the groundbreaking paper "Bitcoin: A Peer-to-Peer Electronic Cash System" published by a scholar named "Satoshi Nakamoto" in 2008.

In a narrow sense, a blockchain is a chained data structure in which data blocks are sequentially connected in a chronological order, and cryptographically guaranteed non-tamperable and unforgeable distributed ledgers.

The main differences between blockchain networks and traditional database storage data are: anonymity, decentralization, non-tamperable, distributed storage, multiple backups, data encryption, and so on.

Anonymity means that any user in the blockchain network does not include any data related to personal information in the transaction process. The user and the user can trade through the address, and the address can theoretically Unlimited generation.

Decentralization refers to the method of reaching consensus through multi-node joint decision-making, transforming the original single management decision-making scheme into multi-party joint negotiation decision, and all nodes in the blockchain network have equal data control rights and obligations, and any node has The data stored in the blockchain network can be accessed, and the access process can be performed concurrently and concurrently.

Non-tamperable means that the blockchain is excluded from the creation block, and each subsequent block contains the unique hash of the data in the previous block, and then the blocks are concatenated by a unique hash value. Once the block data of one of the nodes is changed, the hash value generated by this block will also change.

In the process of block connection, the subsequent block cannot find the block corresponding to the hash value of the previous block, and the blockchain is forced to be disconnected. The data saved by the node is no longer recognized by other nodes. , become worthless.

The concept of distributed storage and multiple backups is different from the distributed storage of today's databases. The distributed storage of the blockchain not only stores the data in different geographical locations and physical devices, but also has complete book data in each device instead of data fragmentation. By using the Merkle tree technology to solve the data redundancy to a certain extent. The rest of the problem.

Data encryption mainly refers to the use of a public key to decrypt a private key or a private key to decrypt a public key by means of asymmetric encryption. In the process of data transmission, the data does not need to contain the key for data decryption, but the decryption operation is performed by the key in the receiver's hand to eliminate the information security hazard caused by the interception in the data transmission process.

Application Analysis of Blockchain in Medical Industry

In this section, we analyze the application prospects of blockchain in the medical industry from three aspects: drug anti-counterfeiting, medical insurance claims and electronic case records.


1.1. Drug anti-counterfeiting

Counterfeit drugs are a recognized problem that affects people's lives and the reputation and return on investment of the pharmaceutical industry. It is estimated that up to 30% of the drugs sold in emerging markets each year are counterfeit, and the annual loss of life due to counterfeit drugs is about 1 million (World Health Organization 2018).

The global counterfeit drug business is between $75 and $200 billion annually (GrantThornton 2018). The US Drug Supply Chain Security Act (DSCSA) and the International Health Care Traceability Standard (GTSH) are designed to protect consumers from counterfeit drugs.

DSCSA requires: (1) The drug distributor should be able to verify the authenticity of the returned product before reselling in 2019; (2) The pharmaceutical company should be able to track all prescription drugs (Enterprise Times 2018) by 2023.

However, to date, the full implementation of global traceability standards in the pharmaceutical supply chain is still in the foreseeable future.

In recent years, domestic drug safety incidents have occurred frequently, such as the 2016 vaccine fraud incident in Shandong and the “longevity biology” vaccine fraud incident in the country in 2018. After decades of implementation of the drug supervision and management system, there is still such a serious security. The problem has emerged, which fully exposes two major problems in China's pharmaceutical industry:

The first is that the safety of drugs is difficult to guarantee, and the incidents of counterfeit drugs that endanger public safety are frequent and difficult to supervise.

The second is that when large foreign pharmaceutical companies adopt information management, most of China's pharmaceutical companies still use artificial methods in many aspects, which leads to low efficiency and high cost of pharmaceutical companies, and management of pharmaceutical companies. The layer can not grasp the key information, can not integrate raw materials, production, warehousing, logistics, sales and other information, seriously affecting the competitiveness of enterprises.

Based on the blockchain's non-tamperable nature, the blockchain-based drug traceability system, each time-stamped transaction will be automatically copied to the blockchain and cannot be modified, all partners in the supply chain know This fact makes it easy for all parties to collaborate to verify the source of information.

The blockchain's non-tamperable features not only ensure the authenticity of the data, but also ensure the security of data transmission, while also achieving the effect of reducing costs.

Drug manufacturers, wholesalers, and terminal sales have made it transparent to auditing and tracking inventory through the use of drug traceability systems to ensure the safety of drugs, making it difficult for fake drugs to enter the medical market.

In terms of the needs of system users, supply chain visibility is a common requirement of all parties. This technology can well monitor the whole process of production from transportation to transportation to sales.

The open and untamed nature of the blockchain has allowed the drug traceability to see a better way out. Therefore, the blockchain technology can help solve the problem of centralized medical data storage, difficult security sharing, and excessive dependence on organizational reliability, and realize decentralized, secure, and non-tamperable medical data sharing.

1.2. Medical insurance

Since the Chinese government first promulgated the "Decision on Establishing a Basic Medical Insurance System for Urban Employees" in 1998, and gradually established a basic medical insurance system for urban workers and a basic medical insurance system for urban and rural residents throughout the country, China’s basic medical insurance has been It has been implemented and practiced nationwide for more than 20 years.

In these 20 years, the medical insurance fund coordinating units at all levels have established a system of systematic fund management and fund use, and serve the daily production, life and learning of the people of the country. Most of the medical expenses have been solved for the vast majority of the people.

According to statistics, in 2015, the proportion of hospitalization expenses for urban workers, urban residents, and new rural cooperatives reached 75%, and the proportion of personal medical expenditures to total social health expenditures was less than 30%, and the medical welfare level of the people showed a steady increase. situation. At the same time, the fund management department is also worried about the problem of rapid growth in medical insurance expenditures year by year.

China's basic medical insurance fund expenditures are growing year by year. The reason is that the population covered by medical insurance has increased year by year and the fund has been abused or illegally taken. But the latter is a phenomenon that should be avoided as much as possible.

The traditional medical insurance control method is mainly the manual review and the total prepayment system management mode during medical insurance settlement. However, the manual review mode has the problems of low efficiency, narrow coverage, error-prone, successful experience and unsuitable promotion of replication and continuous development in the environment of rapid data growth. The total prepayment system cannot fundamentally solve the illegal use of the medical insurance fund. The problem is that it is easy to damage the enthusiasm of medical institutions.

After the research on the current mode of medical insurance operation, the over-centralized management mode and the respective situation of the medical insurance institutions may be the root cause of the current medical insurance review dilemma.

The research on the popular blockchain and smart contract technology, the decentralized governance mechanism of blockchain technology, the information disclosure and other features, and the programmable automatic execution mechanism of smart contracts will become the solution to the dilemma of medical insurance review. Important means.

Using blockchain technology to achieve medical insurance, and finally solve the medical insurance audit dilemma has obvious advantages:

1. The intelligent contract distributed on the blockchain network can replace the manual labor insurance audit work and liberate the manager's hands, which can effectively reduce the labor cost and error rate.

2. The monitoring of intelligent contracts can take place in any part of the medical treatment process. As long as the various information systems of the hospital are connected to the medical insurance chain network, the pre-set inspection rules in the smart contract can automatically initiate the examination of each behavior of the doctor and the patient. And can alert you about abnormal behavior.

In fact, it is not just medical insurance rules. The rules of the medical profession such as rational drug use can also be defined in smart contracts to help the industry comprehensively assess the behavior of a medical staff.

When the doctor prescribes the medicine and the patient pays the fee, the smart contract can play a role, truly realizing the whole process coverage of the pre-existing reminder, the event monitoring, and the post-mortem review. And greatly ease the pressure of centralized review afterwards.

3. The blockchain network itself is a secure information sharing network. When data hot standby is implemented, it is difficult to suffer external attacks and data loss or tampering.

Medical insurance participants connected by a blockchain network can realize information sharing with each other, which can completely solve the problem of information islands, improve the efficiency of medical insurance business, and save costs for society.

4. Due to the flexibility and scalability of the decentralization of the block network, it is very gradual in implementation. The agent node does not have to be laid all over the country and can be built gradually. And the new node access will not put pressure on the centralized server like the traditional centralized network system.

Similarly, when an individual node fails, it will not affect the operation of the entire network. All the service nodes that have accessed this node will be automatically assigned to other nodes by the entire network to continue the work, and the process is smooth in the case of the network. Almost impossible to feel.

1.3. Electronic medical record

In recent years, reforms in the medical and health fields have had little effect, and urban residents still face many difficult problems in medical treatment.

In the face of the dilemma, the State Council has repeatedly stated in the government work report that it is necessary to gradually build and develop medical associations at all levels so that grassroots people can enjoy indiscriminate and convenient medical services at all levels of medical institutions.

Among them, building a regional health information platform based on healthy electronic medical records, and promoting data sharing between medical and health institutions at all levels is a top priority. Thanks to the rapid promotion of the “big data” and “cloud computing” to the medical industry, it provides technical support for medical organizations to collect and process massive amounts of medical data.

But at this stage, these medical data are more only transferred and shared within the hospital. All along, because the information between hospitals at all levels is not smooth, and the lack of proper data sharing mechanism as a guide, the doctors can not see the patient's complete medical records, which increases the difficulty of precise treatment.

At the same time, the medical records are stored in the hospital system, the patients can not view and use their own medical records, and the centralized storage method makes the patient's privacy easy to be stolen by criminals.

Regardless of security and systemicity, there is currently no model or application that can ensure the security of medical record data storage, and also promote the sharing of electronic medical records between hospitals.

For a centrally isolated medical system, if a high level of information security protection is done, it is difficult to share data between organizations. At the same time, what kind of power doctors have for the medical records they have issued has always been a hot topic in the industry. Can we correctly ensure that these records are not maliciously altered? This is where we need to think technically.

It can be seen that if the medical records are effectively shared and transferred among multiple medical organizations, it will be able to help and improve the medical treatment status of our residents to a greater extent.

Traditional technology is difficult to meet these two requirements, but the emergence of blockchain technology has solved the problem of security and sharing of medical information.

On the one hand, the irreversible modification of blockchain data ensures that the data stored in the blockchain is safe and reliable.

On the other hand, the traceability of blockchain data also ensures that every data written to the blockchain is traceable, and any forgery is difficult to achieve. In addition, because the data in the blockchain is distributed and stored, it is not monopolized by an organization, which provides conditions for data sharing between organizations. In the development of blockchain-based systems, smart contracts can be further deployed into the blockchain, allowing patients to directly manage their medical records.

In addition, if the doctor can view the patient's complete visit information from the patient, this provides a scientific basis for the doctor's accurate diagnosis.

In the electronic medical record system based on blockchain technology, patient medical record information of each hospital is stored in the blockchain medical record system. The patient encrypts his medical record data through his own private key. In the case of patient authorization, the hospital has the right to modify and increase the patient's medical record information to ensure the privacy of the patient data information.

The hospital's access to data information is carried out through a unified client, enabling data sharing. Due to the workload mechanism in the blockchain, its internal data is extremely difficult to be tampered with, effectively ensuring the safety of patient medical record information. Patients can also trade their own private keys, which translates traditional electronic medical record information into new digital assets.

However, China now lacks the technical talent reserve in the blockchain field, the management model needs to be improved and some shortcomings of the blockchain technology itself. We believe that when these three aspects have the same conditions, the application prospects proposed in this paper still have a lot of room for development.