HealthTech: How Blockchain Can Simplify Healthcare Compliance
Washington and Lee Journal of Civil Rights and Social Justice
HealthTech: How Blockchain Can Simplif y Healthcare Compliance
Kathryn M. Bennett 0 1 2
0 Washington and Lee University School of Law , USA
1 This Note is brought to you for free and open access by the Washington and Lee Journal of Civil Rights and Social Justice at Washington & Lee University School of Law Scholarly Commons. It has been accepted for inclusion in Washington and Lee Journal of Civil Rights and Social Justice by an authorized editor of Washington & Lee University School of Law Scholarly Commons. For more information , please contact , USA
2 Kathryn M. Bennett, HealthTech: How Blockchain Can Simplify Healthcare Compliance, 25 Wash. & Lee J. Civ. Rts. & Soc. Just. 287 (). Available at: https://scholarlycommons.law.wlu.edu/crsj/vol25/iss1/9
Part of the Civil Rights and Discrimination Commons; Health Law and Policy Commons
HealthTech1: How Blockchain Can
Simplify Healthcare Compliance
Kathryn M. Bennett*
This Note broadly explores solutions to modern-day
accessibility and security problems latent in electronic health
records. Specifically, this Note discusses HIPAA and HITECH, the
current law in place, and how blockchain technology can be used to
fix the accessibility and security problems of current electronic
health records. This Note proposes that blockchain technology can
help a healthcare industry struggling to adhere to the current rule
of law in an era of Big Data. Further, Blockchain technology can
help individual consumers, particularly those with significant
health issues, obtain the best possible medical care while
simultaneously keeping their private and sensitive information
safe. This innovative technology offers the security and
sophistication needed to usher healthcare providers and healthcare
consumers into a new technological era fraught with privacy issues.
V. Practical Uses of Blockchain Technology?from the Banking Industry to the Most Impoverished............302 VI. Blockchain Pitfalls?Drawbacks of a New Technology .......................................................................306
VII. How Blockchain Technology Can Change EHRs? ?A New Model for Health Information Exchanges.? .......307 VIII. Conclusion........................................................................312
Have you been to a doctor?s office where they plug your vital
signs and information into a computer? Have you used a website
to talk to your doctor about refilling prescriptions or to schedule
your next appointment? The technological age has brought about
changes not only to smartphones but also to the way persons
interface with their doctors?this is the age of electronic health
While the switch to electronic heath records (EHRs) has
important and consequential benefits, switching to EHRs has also
presented several difficulties.2 The most prominent difficulty is the
combination of the decentralized information and the
amalgamation of different software tools that doctors and
healthcare providers use to file their electronic healthcare
records.3 The lack of a centralized tool has made it difficult for
doctors and healthcare providers to share information across
offices, threatening patient privacy.4 Many patients justifiably
2. See Frank Moss, Our High-Tech Healthcare Future is Here. But It?s Not
What I Thought., TWINE HEALTH (Jan. 28, 2016),
https://www.twinehealth.com/blog/our-high-tech-healthcare-future-is-here.-butits-not-what-i-thought (discussing the future of healthcare and electronic
healthcare records) (on file with the Washington & Lee Journal of Civil Rights &
3. See id. (discussing latent difficulties in the adoption of electronic
healthcare records and the struggle of healthcare providers to find and use
appropriate EHR software).
4. See Why Hackers Are Increasingly Targeting Electronic Health Records,
TREND MICRO (Apr. 3, 2017),
http://blog.trendmicro.com/why-hackers-areincreasingly-targeting-electronic-health-records/ (discussing latent issues with
electronic healthcare records and why those issues make electronic healthcare
worry that their information will be ?hacked.?5 In 2016 alone, ?on
average, at least one health data breach occurred every day.?6
Hackers prey on health records because it is easy for them to access
the fragmented and ?siloed? systems.7 At the same time, because
healthcare providers are legally required to provide EHRs,8 many
are stuck with systems that leave patients open to data and
The possible solution lies in a modern technological innovation
that changes the way transactions occur on a daily basis?
blockchain.10 Summed up, a ??blockchain is an incorruptible digital
ledger of economic transactions that can be programmed to record
not just financial transactions but virtually everything else.??11 By
tracking data in a fashion that also protects informational
privacy,12 Blockchain technology could be the key to fixing the
inherent failings of the current software systems housing EHRs.
records softer targets for data hackers) (on file with the Washington & Lee
Journal of Civil Rights & Social Justice); see also Lynda C. Burton, Gerard F.
Anderson, & Irvin W. Kues, Using Electronic Health Records to Help Coordinate
Care, 82 MILBANK Q. 457, 460 (2004) (discussing the ?barriers to widespread
adoption? of electronic health care records).
5. See Why Hackers Are Increasingly Targeting Electronic Health Records,
supra note 4 (discussing latent issues with electronic healthcare records and why
those issues make electronic healthcare records softer targets for data hackers).
7. See id. (discussing why the issues with electronic healthcare records
make them easy targets for data hackers).
8. See Health Information Technology for Economic and Clinical Health
Act, Pub. L. No. 115-231 (codified in scattered sections of 42 U.S.C.) (2009)
(stipulating the legal requirements for electronic health care records and
9. See Why Hackers are Increasingly Targeting Electronic Health Records,
supra note 4 (discussing latent issues with electronic health care records and why
those issues make electronic healthcare records softer targets for data hackers).
10. See Ameer Rosic, What is Blockchain Technology? BLOCKGEEKS,
(last visited Nov. 3,
(discussing the fundamental characteristics of blockchain technology) (on
file with the Washington & Lee Journal of Civil Rights & Social Justice).
11. See id. (discussing the fundamental characteristics of blockchain
12. Blockchain 101 Infographic, IBM,
Nov. 3, 2018)
(citing Don & Alex Tapscott, the authors of Blockchain Revolution)
(on file with the Washington & Lee Journal of Civil Rights & Social Justice).
II. Overview of the History of Electronic Health Care Records and Data Privacy
By definition, an EHR is ??a longitudinal electronic record of
patient health information generated by one or more encounters in
any care delivery setting. Included in this information are patient
demographics, progress notes, problems, medications, vital signs,
past medical history, immunizations, laboratory data, and
radiology reports.??13 EHR systems store an individual?s records in
a single location for a particular health care provider, so that
doctors and nurses can access up-to-date information at later
dates.14 There are many benefits to using EHRs: EHRs, if
implemented correctly, (1) allow doctors to communicate across
offices about patient specific issues; (2) make it easier for doctors
to track patient care; and (3) save time, which can be critical in
Starting as early as the late nineties and early 2000s, private
individual healthcare providers started recognizing the benefits of
EHRs and, accordingly, began using EHRs in their practices.16 For
example, in 2003, ?a number of well-known health systems and
academic medical centers, such as the LDS Hospital in Salt Lake
City and Brigham Women?s Hospital in Boston . . . developed their
own integrated electronic clinical record system.?17
The federal government has also started to take notice of
EHRs.18 For instance, in 2003 the Agency for Health Care
Research and Quality (AHRQ), ?the leading federal agency in
supporting research on information technology,? awarded fifty
million dollars in grants to ?support organizational and
community-wide implementation and diffusion of health
information technology . . . .?19 Similarly, the federal government
also relies on ?highly developed integrated electronic clinical data
systems in the Veterans Health Administration (VHA) and the
U.S. Department of Defense.?20
EHRs were first alluded to in government regulations in the
Health Insurance Portability and Accountability Act (HIPAA) of
1996.21 References to electronic records appear most notably in
title II, subtitle F of HIPPA??Administrative Simplification.?22
There, it states that the purpose of HIPAA is to improve ?the
efficiency and effectiveness of the health care system, by
encouraging the development of a health information system
through the establishment of standards and requirements for the
electronic transmission of certain health information.?23 HIPAA,
however, primarily describes how to keep patient medical
information private rather than the EHRs themselves.24
The Federal Government first introduced the importance of
widespread EHR use as part of the American Recovery and
Reinvestment Act of 2009 (Recovery Act).25 The Recovery Act was implemented following the economic recession of 2008 as a way to stimulate the economy.26 Among several enumerated goals, the
Recovery Act aims to ?provide [the] investments needed to increase
economic efficiency by spurring technological advances in science
and health.?27 To achieve this goal, the Recovery Act calls for the
implementation of the Health Information Technology for
Economic and Clinical Health Act (HITECH Act).28 HITECH
amended the Public Service Act to ?establish within the
Department of Health and Human Services an Office of the
National Coordinator for Health Information Technology.?29 The
National Coordinator?s would oversee the ?development of a
nationwide health information technology infrastructure that
allows for the electronic use and exchange of information . . . .?30
To achieve this task, HITECH amended the Public Health Service
Act to ensure (1) ?the electronic exchange and use of health
information and the enterprise integration of such information?31
and (2) ?[t]he utilization of an electronic health record for each
person in the United States by 2014.?32 HITECH also imposes EHR
adoption incentives for Medicare and Medicaid as well as
?penalties on those who refuse or fail to adopt or implement
EHR systems.?33 Thus, the federal government created HITECH to
help usher the healthcare industry into the modern technological
era.34 Although HITECH did not solve every problem for
healthcare providers and patients, its adoption signaled the dawn
of widespread use of EHRs.35
27. American Recovery and Reinvestment Act of 2009, Pub. L. No. 111-5,
?3(a)(3), 123 Stat. 115, 116 (codified in scattered sections of 16 U.S.C., 42 U.S.C.).
28. See id. ?13001 (describing HITECH and its role in implementing
electronic health records).
29. Id. ?13101.
33. See Jenny Carroll & Daniel O. Carroll, Electronic Health Records, 299
APR N.J.L. 55, 57 (describing the implementation scheme of HITECH).
34. See id. at 55 (describing the history of the implementation of HITECH
and electronic health care records and the importance of HITECH?s
35. See id. at 61. (same).
III. What is HITECH?Just a New HIPAA? HITECH?s Benefits
HITECH goes well beyond HIPAA in ensuring the
development of widespread EHR use. HITECH offers a complex
implementation scheme in order to ensure health care providers
switch over to EHRs.36 Primarily, HITECH lays the foundation for
a government-sponsored EHR incentive program: ?[T]o receive
incentive payments . . . providers must be eligible and must
successfully demonstrate meaningful use of EHRs for each year of
participation in the EHR incentive program.?37 Beyond these
requirements, HITECH ?relies on [Centers for Medicare and
Medicaid Services] (CMS) to promulgate regulatory requirements
to determine how and when providers achieve ?meaningful use? of
certified EHRs.?38 In its efforts, CMS has adopted a ?staging?
strategy in order to ?phase in the requirements for EHR adoption
and meaningful use over time in successive stages.?39 The staging
breaks down in the following ways: (1) Stage One?the
?meaningful use criteria is focused on data capture and sharing?;40
(2) Stage Two?the ?meaningful use criteria is focused on
advance[d] clinical processes?;41 and (3) Stage Three?the
?meaningful use criteria is focused on improved outcomes . . . .?42
Healthcare providers that comply with the stages receive
incentive payments, while those who do not become ?subject to
penalties of payment adjustments.?43 The staging process offers
health care providers the ability to gradually adopt EHRs in a way
that ?maintain[s] flexibility with ever-changing and rapidly
developing HER technology . . . .?44 Accordingly, the staging
strategy ?allow[s] rulemaking based on user experience with the
available technology, [with] each stage . . . progressively and
incrementally expand[ing] the requirements for achieving
meaningful use of EHRs.?45 Thus, no healthcare provider is rushed
into adopting an overly complex and incomprehensive EHR
Nevertheless, HITECH and CMS?s regulatory staging fails to
account for the realities of EHR implementation in practice. As
mentioned in their article, Electronic Health Care Records,47 legal
scholars Jenny Carroll and Daniel O. Carroll reviewed several
studies on the ?real world (i.e., non-legal) challenges for healthcare
providers adopting and implementing EHR systems.?48 They
divided the challenges into three categories: ?[(]1) [C]ost; [(]2)
technical issues; and [(]3) workforce training and education.?49
Healthcare providers sustain substantial costs to purchase
and install EHR systems.50 Implementing an EHR system can
?cost a single physician approximately $163,765.?51 Furthermore,
many healthcare providers must bear this cost until they can show
CMS that their EHR system meets the ?meaningful use?
standard.52 Those who cannot afford the initial cost of an EHR
system face ?financial penalties for not meeting the new
standards? under Hitech and CMS regulations.53 Thus, the
regulatory scheme puts providers in a Catch-22: Pay for EHR
implementation or pay a penalty.
Healthcare providers must also remain vigilant of technical
problems that could hamper their ability to comply with
HITECH.54 For example, healthcare providers have to choose EHR
systems that address ?technical concerns, such as system
interoperability (i.e., healthcare data maintained in ?silos?),
non-standardized EHR applications, concerns about privacy and
security, risks of technical errors[,]?55 and many other issues.
Healthcare providers essentially have to ?shop? for software that
meets their EHR needs.56 Is the government, then, asking our
doctors to become technical software experts?
Any EHR implementation also requires extensive employee
training.57 Think of nurses inputting your data into a computer
when they take your vitals. Like with any new technology, human
users need help to understand a software?s basic functions. But,
extensive employee training means more costs: Costs to train and
costs associated with interruptions in daily workflow.58 If the
training is not successful, human error and poorly trained
employees can ?threaten a successful launch and the healthcare
provider?s substantial investment of time and money.?59 Add
training and workflow interruption to the growing list of EHR
Healthcare providers must also comply with guidelines and
standards under HIPAA and HITECH that offer little help in
actually choosing appropriate software to safeguard protected
information. HIPAA was enacted to ensure that patients ?have
rights over [their] own health information, no matter what form it
is in.?60 More specifically, ?Congress recognized the need to
54. See Carroll & Carroll, supra note 33, at 58 (describing what healthcare
providers need to do in order to implement EHRs and comply with HITECH).
56. See id. (describing the role of healthcare providers in EHR
57. See Carroll & Carroll, supra note 33, at 58 (describing what healthcare
providers need to do in order to implement EHRs and comply with HITECH).
60. OFF. FOR C.R., PRIVACY, SECURITY, AND HEALTH RECORDS 2,
rs/privacy-security-electronic-records.pdf (on file with the Washington & Lee
maintain strict privacy protection for Protected Health
Information (PHI) and therefore authorized the Department of
Health and Human Services to promulgate regulations . . . known
collectively as the Privacy Rule.?61 The Privacy Rule has four main
objectives: (1) To ?[e]nsure the confidentiality, integrity, and
availability of all electronic protected health information[;]?62 (2) to
?[p]rotect against any reasonably anticipated threats or hazards to
the security or integrity of such information[;]?63 (3) to ?[p]rotect
against any reasonably anticipated uses or disclosures of such
information that are not permitted[;]?64 and (4) to ?[e]nsure
compliance with this subpart by its workforce.?65 The Privacy Rule
applies to any HIPAA ?covered entities? which includes any
healthcare provider who, regardless of size,66 ?transmits any
health information in electronic form in connection with a
transaction covered by [HIPAA].?67 HIPAA, however, does little to
provide specific guidance to covered providers as to the best way to
safeguard data.68 HIPAA merely gives vague guidelines such as,
?[a] covered entity must maintain reasonable and appropriate
administrative, technical, and physical safeguards to prevent
intentional or unintentional use or disclosure of protected health
information.?69 But, what is ?reasonable and appropriate??
Healthcare providers are left alone to determine which software
will comply with HIPAA?s complicated Privacy Rule.
Journal of Civil Rights & Social Justice).
61. Id.; see Standards for Privacy of Individually Identifiable Information,
66 Fed. Reg. 12,434 (Feb. 26, 2001) (to be codified at 45 C.F.R. pt. 160, 164)
(articulating the ?Standards for Privacy of Individually Identifiable Health
62. 45 C.F.R. ? 164.306(a)(1) (2018).
63. Id. ? 164.306(a)(2).
64. Id. ? 164.306(a)(3).
65. Id. ? 164.306(a)(4).
66. See U.S. DEP?T OF HEALTH & HUM. SERVICES, SUMMARY OF THE HIPAA
PRIVACY RULE 2 (May 2003),
https://www.hhs.gov/sites/default/files/privacysummary.pdf (providing an
overview of the HIPPA privacy rule) (on file with the Washington & Lee Journal
of Civil Rights & Social Justice).
67. Id. ? 160.103.
68. See id. pt. 160, 165 (failing to provide guidance on protecting data).
69. U.S. DEP?T OF HEALTH & HUM. SERVICES, supra note 66, at 14.
What about HITECH? HITECH is essentially an extension of
HIPAA?s privacy protections. HITECH ?increases the scope of
privacy and security protections available under HIPAA [and]
increases potential legal liability for non-compliance and provides
more enforcement of HIPAA rules.?70 In tandem, HIPAA and
HITECH impose significant penalties on these providers who
violate the PHI regulations and the Privacy Rule.71 Since the
enactment of HIPAA and HITECH, there have been over 20,000
compliance investigations among healthcare providers.72 Among
the top three compliance issues cited in these investigations was
?[l]ack of administrative safeguards of electronic PHI.?73 Penalties
for these breaches ?can bring fines as high as $50,000 per violation
and up to $1.5 Million per year.?74 Thus, healthcare providers
receive little concrete guidance on how to comply, while
simultaneously becoming subject to severe penalties for
noncompliance. Beyond government penalties, data breaches
themselves cost health care providers significant amounts. At $398
per comprised record, the average cost of data breaches in the
healthcare industry is more expensive than the $217 per
compromised record for standard breaches in other industries.75
Non-compliance means that healthcare providers could be hit twice with increased costs.
In an effort to keep themselves compliant, some providers hire
compliance officers.76 These compliance officers, however, come at
a price. According to the U.S. Bureau of Labor Statistics,
compliance officers can make upwards of $70,000.77 This added
expense, in combination with the costs of the software itself,
training, and potential penalties makes HER implementation
difficult and costly.
HIPAA and HITECH purport to ensure EHR implementation
by incentivizing providers to not only adopt EHRs, but also keep
records safe and confidential.78 Nevertheless, these regulations
seemingly do nothing more than police. They only offer rules to
follow and the penalties to pay when rules are broken.79 They offer
little guidance to help providers navigate the complicated world of
technology.80 As a result, providers implement expensive
technology their employees know little about.81 Furthermore, as
Big Data increases, it becomes harder and harder to oversee and manage the security of healthcare records.82 HITECH?s policing does not account for healthcare providers who make good faith
76. See Ryan Black, No One Is Sure Why Amazon Needs a HIPAA
Compliance Officer, HEALTHCARE ANALYTICS NEWS (Jan. 16, 2018),
http://www.hcanews.com/news/no-one-is-sure-why-amazon-needs-a-hipaacompliance-officer (detailing how more and more companies are hiring
compliance officers and how compliance officers can help businesses follow
healthcare regulation) (on file with the Washington & Lee Journal of Civil Rights
& Social Justice).
77. Occupational Employment and Wages, May 2017: 13-1041 Compliance
Officers, U.S. BUREAU OF LAB. STAT.,
(last visited Feb. 22, 2018)
(providing the national salary estimates for compliance officers) (on file with the
Washington & Lee Journal of Civil Rights & Social Justice).
78. See Carroll & Carroll, supra note 33, at 56, 60 (explaining that after they
reviewed several studies, the authors categorized the main challenges presented
to healthcare providers in implementing EHR systems).
79. See American Recovery and Reinvestment Act of 2009, Pub. L. No. 111-5,
123 Stat. (stipulating statutory guidelines for healthcare technology
infrastructure); see also Health Insurance Portability and Accountability Act of
1996 (HIPAA), Pub. L. No. 104-91, 110 Stat. 1936 (stipulating statutory
guidelines for privacy in the healthcare industry).
80. Supra note 79. (stipulating statutory guidelines but barely discussing
how to implement them).
81. See Carroll & Carroll, supra note 33, at 58 (describing the pressing need
to train employees in EHR software).
82. See Juliano, supra note 70 (noting the natural consequences of
implementing complicated EHR software).
efforts to comply with HITECH but nevertheless have
understandable troubles finding effective data solutions. Such
incomplete regulations leave many electronic health records?and
Many patients have suffered the consequences, and will
continue to suffer the consequences, inherent in the current EHR
systems used by healthcare providers. Chief among the risks to
individual healthcare consumers is general patient safety.83
Because many healthcare providers use data management
systems in silos, it is very difficult for providers to communicate
with one another about patient care.84 For patients with extensive
and inter-related health issues, this can lead to serious hazards
such as medication mistakes and allergy risks.85 For example, in
an incident described in a report by the U.S. Department of
Veterans Affairs? Informatics Patient Safety Office, an emergency
department doctor prescribed a patient medication that she was
allergic to because a network problem with the EHR system
prevented the doctor from remotely accessing the patient?s listed
allergies.86 These are just some of the host of concerns plaguing
patients under current EHR systems.
As many scholars posit, what is needed is a solution that can
?handle both storage and management of large amounts of
data?87 in a centralized location that allows cross pollination of
information with other providers, while simultaneously
maintaining the privacy and integrity of the data involved.88 Well,
what about a blockchain?
83. See M.W. Meeks et al., An Analysis of Electronic Health Record-Related
Patient Safety Concerns, U.S. NAT?L LIBR. OF MED. (2014) (observing and
investigating patient safety concerns related to electronic medical records
concluding that ?institutions with long-standing as well as recent EHR
implementations should build a robust infrastructure to monitor and learn from
84. See Carroll & Carroll, supra note 33, at 60 (?Rather than one physician?s
office calling another to request medical records, or faxing a consent to do so,
providers can now pull or push data from an online portal containing information
compiled by multiple specialists and providers.?).
85. See Meeks, supra note 83 (providing examples of hidden dependencies in
current EHR systems).
86. See id. (same).
87. See Juliano, supra note 70 (explaining the effects of healthcare law on a
healthcare industry grappling both with Big Data and compliance issues).
88. See id. (same).
IV. What is a Blockchain?the Truth Ledger89
When most people hear the word blockchain, they associate it
with the ever-popular cryptocurrency, BitCoin.90 Blockchain is the
technology behind BitCoin and, more importantly, has
aggressively expanded beyond the economic sectors that deal with
cryptocurrency.91 A blockchain is ?a database or ledger that
maintains a continuously growing list of data records or
transactions.?92 Blockchain thus refers to multiple blockchains
that can be used by various actors, rather than just one universal
blockchain. Blockchains are essentially sophisticated versions of
excel spreadsheets.93 Blockchain technology, however, has some
key qualities beyond traditional excel spreadsheets which may be
helpful to healthcare providers and EHR implementation.
Blockchains are generally ?shared publically.?94 This does not
mean that your law professor can access a blockchain and see the
medical history recorded within. Rather, in a private blockchain,95
information is shared publically among the specific ?nodes,?96 or
89. Nickname for Blockchain from Professor Josh Fairfield of Washington &
Lee University School of Law. This section will only cover the basics of blockchain
technology for the reader.
90. See Portia Crowe, There is a ?Game Changer? Technology on Wall Street
and People Keep Confusing It with Bitcoin, BUS. INSIDER (Mar. 5, 2016),
http://www.businessinsider.com/what-is-blockchain-2016-3 (explaining the
differences between BitCoin and blockchain and describing the essential
characteristics of the Blockchain) (on file with the Washington & Lee Journal of
Civil Rights & Social Justice).
See id. (same).
92. See Alexia Jengten, Cryptosphere?Unraveling the Mystery Part I:
Blockchain: A Ledger for the Modern Era, IPOHUB (Sept. 15, 2018),
https://www.ipohub.org/cryptosphere-unraveling-the-mystery-part-1-blockchaina-ledger-for-the-modern-era/ (giving a basic understanding of blockchain and its
capabilities) (on file with the Washington & Lee Journal of Civil Rights & Social
See id. (giving a basic understanding of blockchain and its capabilities).
See id. (same).
95. See Praveen Jayachandran, The Difference Between Public and Private
(last visited on Nov. 4, 2018)
difference between a private and public block chain) (on file with the Washington
& Lee Journal of Civil Rights & Social Justice).
96. See Jengten, supra note 92 (defining a node and explaining how a node
fits into the overall Blockchain System).
participants,97 of that block.98 Accordingly, blockchains are
permissioned?they give ?each member of the network . . . access
rights so that confidential information is shared on a need-to-know
basis.?99 The nodes input the information and ?maintain the
entries (known as blocks) and every node sees the transaction data
stored in the blocks when created.?100 This means various
participants can see data that other participants entered.101 Thus,
a blockchain ?works as a shared system of record among
participants on a business network, eliminating the need to
reconcile disparate ledgers.?102
Blockchains are also considered secure.103 This is because ?the
ledgers and underlying databases are immutable and
irreversible.?104 In other words, ?posts to the ledger cannot be
revised or tampered with . . . .?105 Blockchains use cryptography106
97. An example of a ?participant in the ledger? for these purposes would be
one healthcare provider among a group of other ?nodes? or other healthcare
98. See Jengten, supra note 92 (explaining the basic structure of a
Blockchain 101 Infographic, supra note 12.
100. Jason Bainter, The Smoke Detector: Do You Know How Blockain Is
Chaging Business?, CPA CTR. OF EXCELLENCE (Mar. 7, 2017),
/03/07/the-smoke-detector-doyou-know-how-blockchain-is-changing-business (on file with the Washington &
Lee Journal of Civil Rights).
101. See Jengten, supra note 92 (?All nodes within a network have complete,
unfettered access to the ledger because each node has a complete copy of the
ledger on its server.?)
Blockchain 101 Infographic, supra note 12.
103. See id. (explaining that changes to a blockchain require consensus ?from
all network members, and [that] all validated transactions are permanently
recorded. No one, not even a system administrator, can delete a transaction.?).
104. Bainter, supra note 100; see Nitin Anand, Applications of Blockchain in
FinTech, MEDIUM (Aug. 6, 2018),
https://medium.com/futrtec/applications-ofblockchain-in-fintech-86b3c8c3a5ab (describing the fundamental characteristics
of blockchain) (on file with the Washington & Lee Journal of Civil Rights & Social
106. For an in depth look at cryptography see Gary C. Kessler, An Overview
of Cryptography, GARYKRESSLER.NET (Aug. 11, 2018),
https://www.garykessler.net/library/crypto.html (providing the basic concepts of
cryptography) (on file with the Washington & Lee Journal of Civil Rights & Social
to both verify these ledger posts and keep them secure.107
Cryptography essentially encrypts data to prevent those outside of
a permissioned chain from gaining access to the data recorded
within.108 Finally, Blockchain is automated: ?The software is
written so that conflicting or double transactions do not become
written in the data set and transactions occur automatically.?109
Thus, a blockchain is essentially a ledger that collects and keeps
track of data automatically.110 But, how is blockchain technology
already useful in real world transactions? Case studies by the
banking industry, the government, and many others demonstrate
just how useful blockchain technology can be.
V. Practical Uses of Blockchain Technology?From the Banking
Industry to the Most Impoverished
Blockchains are used and can be used in a host of different
economic sectors. Specifically, Blockchain use has recently
increased among players in the banking industry.111 Ripple, a
blockchain provider, has been on the forefront of the blockchain
movement, ?enable[ing] banks to transact directly with each other
and lower[ing] the total costs of settlement.? 112 Ripple?s pitch to
banking institutions is that ?[b]y joining [their] growing, global
network, financial institutions can process their customers?
payments anywhere in the world instantly, reliably and
cost-effectively.?113 Ripple and Ripple?s blockchain have been the
center of a plethora of transactions and projects between banks.114
For example, Ripple?s blockchain is used to power an
instant-remittance service115 for use between banks in Japan and
Thailand.116 Using blockchain in this manner helps Japanese and
Thai banks ?boost the speed, efficiency and cost of the countries?
remittance corridor, which sees around $250 million transferred
every year, largely as a result of the 40,000 Thai nationals living
in Japan.?117 Furthermore, a host of prominent international
banks?including Barclays, HSBC, Deutsche Bank, and others?
have banded together to use Ripple?s chain to create ?the utility
settlement coin.?118 The coin is ?a digital currency that will
primarily be used to quickly clear and settle financial
transactions . . . to reduce the time, cost and capital required for
the post-trade clearing and settlement process, as well as to
improve financial-market efficiency.?119
Blockchain technology is also useful in supply chain
interactions.120 Blockchains work well in supply chain interactions
because they enable ?proof of ownership and the transfer of
ownership from one entity to another without using a trusted third
party intermediary (like a bank).?121 Moreover, the various
transactions between parties in the supply chain are fully recorded
on the blockchains, allowing parties to verify transaction
information.122 Companies, such as T-mining, for example,
specifically use a blockchain to verify shipments between
parties.123 Blockchain technology works well in this context
because it acts as a ?digital distributed ledger [that] create[s] a
single electronic place where all the myriad documents related to
a shipment . . . [are] housed.?124 The security of blockchain
technology also cuts down on the number of ?fictitious pickups?125
that increasingly plague supply chain industries.126
Beyond businessmen and profit-seekers, governments and
nonprofits use blockchains to help impoverished people in the
United States and across the world.127 In May 2017, the United
Nations, Parity Technologies,128 and Datarella,129 worked together
to implement the United Nation?s World Food Programme (WFP)
blockchain.130 The Programme gave Syrian refugees
cryptocurrency-based vouchers that were used to purchase food
items.131 The blockchain platform was ?successfully used to record
123. See id. (same).
125. See id. (?[Fictitious pickups] occur when con artists show up at a
shipper?s dock, provide fabricated insurance documents, DOT numbers for trucks,
and pickup documentation.?).
126. See id. (describing blockchain?s responsiveness to an industry-specific
127. See Quora, What Is Blockchain Used for Besides Bitcoin, FORBES
/11/17/what-is-blockchainused-for-besides-bitcoin/#5a0373d3446e (describing situations where nonprofits
and governmental bodies have used blockchain to provide aid for impoverished
and hungry people) (on file with the Washington & Lee Journal of Civil Rights &
128. Parity Technologies is a blockchain infrastructure startup based in
London, UK. See About Parity Technologies, PARITY, https://www.parity.io/about/
(last visited Nov. 4, 2018)
(describing Parity Technologies) (on file with the
Washington & Lee Journal of Civil Rights & Social Justice).
129. Datarella is a German-based blockchain provider. See Imprint,
(last visited Nov. 4, 2018)
(identifying Datarella?s headquarters in Munich, Germany) (on file with the
Washington & Lee Journal of Civil Rights & Social Justice).
130. See Michael del Castillo, United Nations Sends Aid to 10,000 Syrian
Refugees Using Ethereum Blockchain, COINDESK (June 13, 2017),
https://www.coindesk.com/united-nations-sends-aid-to-10000-syrian-refugeesusing-ethereum-blockchain/ (reporting on the World Food Programme) (on file
with the Washington & Lee Journal of Civil Rights & Social Justice).
131. See id. (same).
and authenticate transfers for about 10,000 individuals.?132 The
success of the program has led to an expansion that will seek to
achieve ?Zero Hunger by 2030.?133
Innovators and business organizations recognize the
importance of blockchain technology in other sectors of the
economy as well. For example, food distributors are looking to
potentially use blockchain technology to help ?establish the
authenticity of food.?134 IBM is exploring blockchain?s use in ?food
traceability, and has [accordingly] announced a consortium with
several major food producers and retailers [to delve into the
subject].?135 Some are even looking into using blockchains to
protect against voter fraud.136 The startup Follow My Vote plans
to use the emerging technology to cut down on voter fraud.137
Blockchain technology ?has the ability to provide an unhackable
electronic vote-counting system . . . [that] can secure an election
during voter registration, . . . account for the voters
identification[,] and insure [that] votes cannot be tampered with at
a later date.?138 A blockchain would act as a ?permanent and public
ledger for votes as tallied?promising a future of equitable
democratic election around the world.?139 Blockchain technology
has many potential uses still to be explored.
VI. Blockchain Pitfalls?Drawbacks of a New Technology
Despite the many successful and potential uses of blockchain
technology, it nevertheless comes with some drawbacks.140
Blockchain technology development has fallen to a relatively small
number of companies, and the majority of these are startups.141 As
a result, individual developers of the technology?the human
element?are ?scarce and expensive.?142 Moreover, some
blockchains that were ?near-free? now feature ?notable transaction
costs.?143 Companies must pay blockchain providers like Ripple to
help them do business, while also bearing additional per
transaction costs that can reach approximately $0.20.144 Although
such a cost may seem insignificant, the sheer volume of
transactions can quickly add up to large amounts.145
Furthermore, because blockchain technology is new, many
still do not use it.146 The lack of commercial blockchain users
inhibits the potential of the technology as a viable business tool?
for blockchain to be effective, all parties in a business transaction
must adopt it.147 For example, in a supply chain transaction, all
parts of that supply chain?from manufacturer, to delivery service,
to distributor?must use the blockchain:148 ?If a blockchain is not
a robust network with a widely distributed grid of nodes, it
becomes more difficult to reap the full benefit.?149
Finally, blockchain is, simply, complicated.150
Understanding nodes, cryptography, and blocks may be difficult
for first-time users or perspective buyers.151 Also, like with other
information databases that rely on user input, human-error can
cause problems that blockchain ledgers cannot automatically fix.152
Thus, although ripe with benefits, there are some drawbacks to blockchain usage.
VII. How Blockchain Technology Can Change EHRs??A New
Model for Health Information Exchanges.?153
The Office of the National Coordinator for Health Information
issued a Technology Interoperability Roadmap that ?define[d]
critical policy and technical components needed for nationwide
[EHR] interoperability [under HITECH] . . . .?154 The three main
components of the Roadmap include (1) ?[u]biquitous, secure
network infrastructure[;]? (2) ?[v]erifiable identity and
authentication of all participants[;]? and (3) ?[c]onsistent
representation of authorization to access electronic health
information, and several other requirements.?155 Accordingly, the
inherent characteristics of Blockchain technology uniquely lend
themselves to addressing these regulatory requirements156 as well
as the two other issues that plague healthcare providers:
?(1) [C]ost; [and] (2) technical issues . . . .?157
Permissioned blocks158 offer medical providers one central
location to speak with other authenticated medical providers and
thus cure the silo effects of the current systems in place.159 For
example, Medical Provider X and Medical Provider Y are both
nodes on a permissioned block.160 X and Y have a patient in
common that they jointly treat for a serious disease.161 Under
current EHR systems, if X and Y did not use the same software or
system, it would be difficult for them to share information about
the patient with each other.162 In fact, the decentralization of
information could lead to duplicates in electronic medical records
that could then lead to mistakes in treating the patient.163 This
would defeat one of the government?s purposes for EHR
implementation: The efficient sharing of patient information
across offices to ensure better care.164 But, by using a blockchain,
X and Y can see (1) that they are authenticated and permissioned
users on the block as well as (2) all of the pertinent and important
information on the block.165 Thus, ?[c]apitalizing on this technology
has the potential to connect fragmented systems to generate
insights and to better assess the value of care.?166 Thus, blockchain
integrated EHRs may help decrease the risk of medication mix-ups
and allergy threats.
158. See Blockchain 101 Infographic, supra note 12 (giving a basic
understanding of blockchain and its capabilities).
159. See Blockchain: Opportunities for Health Care, supra note 153
(describing how blockchain?s inherent characteristics can cure certain problems
in the healthcare sector).
160. See Jengten, supra note 92 (describing nodes in a blockchain).
161. So, for example, think of a general practitioner who is working with a
162. See Menachemi, supra note 13, at 50 (explaining common errors in
electronic medical records).
163. See Carroll, supra note 33, at 56.
164. See Menachemi, supra note 13, at 52 (describing medical issues that
could arise without a properly implemented EHR system); see also American
Recovery and Reinvestment Act of 2009, Pub. L. No. 111-5, 123 Stat. 115 (noting
that part of the goals of HITECH and the Recovery Act is to promote more
efficiency in the healthcare sector).
165. See Blockchain: Opportunities for Health Care, supra note 153
(describing how blockchain?s inherent characteristics can cure certain problems
in the healthcare sector).
166. See id. (discussing how Blockchain might benefit healthcare providers
implement EHR systems).
Furthermore, because posts on a blockchain cannot be
reversed or tampered with, and because Blockchain does not allow
duplications in data sets,167 the risk of EHR information
duplication is low.168 Similarly, ?additions and subtractions to the
medical record [are] well understood and auditable across
organizations.?169 Thus, for example, if healthcare provider X
discovered an allergy for a patient that he shares with healthcare
provider Y, X would update the record to reflect as much, and Y
would easily discover the update, protecting the patient from the
associated risk. Under current EHR systems, the risks of wrong,
duplicate, or lack of information are an issue. For example, if a
hospital patient ?ended up being transferred to another hospital,
the new hospital may not be able to access data about [his or her]
care that was pushed to the first hospital.?170 What if the first
hospital gave the patient a drug that could interact negatively with
a drug given at the second hospital? Blockchain can address this
problem by ensuring data integrity for its users.171 Again,
blockchain technology could significantly protect medical providers
and patients from costly mistakes.
Blockchain also greatly increases the security of EHRs172 and
can thus decrease the risks of sensitive information leaks for
patients and the costs of data breaches for healthcare providers.173
As previously mentioned, the current systems in place make it easy
167. See Crowe, supra note 90 (describing the basic characteristics of a
168. See id. (same).
169. See John D. Halamka et al., The Potential for Blockchain to Transform
Electronic Health Records, HARV. BUS. REV. (Mar. 3, 2017),
/03/the-potential-for-blockchain-to-transform-electronichealth-records (giving examples of how blockchain might help the healthcare
industry) (on file with the Washington & Lee Journal of Civil Rights & Social
171. See Blockchain: Opportunities for Health Care, supra note 153
(describing how blockchain?s inherent characteristics can cure certain problems
in the healthcare sector).
172. See id. (describing how blockchain?s inherent characteristics can cure
certain problems in the healthcare sector).
173. See Carroll, supra note 33, at 56 (explaining that after they reviewed
several studies, the authors categorized the main challenges presented to
healthcare providers in implementing her systems).
for hackers to access sensitive and private patient information.174
This forces the costs and penalties associated with data breaches onto healthcare providers.175 If health care providers used blockchain technology instead, data breaches and their associated costs would likely decline.176
Blockchain data security is sophisticated and complicated.177
Each member on a blockchain has a secret private key and a public
key.178 The public key ?[i]dentifies the sender and receiver of each
transaction[,]? while the private key ?acts as a unique signature on
the transaction? that encodes sent messages and decodes received
messages.179 In terms of EHRs, this would mean that each patient
would have both a public key and a private key to identify them.180
Both the public key and the private key are encrypted in order to
protect a person?s information.181 Having such a key system limits
hacking and data security breaches because ?the hacker would
need to individually hack every single user to obtain unique
private keys to access identifiable information of value.?182
Limiting data breaches means costs saved for health care
providers and patients.
Many individuals and companies are recognizing the benefits
of using blockchains for EHRs and, accordingly, are working to
implement the technology. SimplyVital Health is among a number
of companies that are working to create a healthcare specific
blockchain.183 With their platform, Health Nexus, SimplyVital
uses blockchain technology to ?secure blockchain data storage and
transmission,?184 among members of the healthcare community.
The blockchain itself is healthcare specific: SimplyVital ensures
compliance with HIPAA and HITECH, allows for physicians and
healthcare providers to share information and data with each
other, and also allows healthcare providers to work with others
across the industry such as pharmacies, insurers, and the like.185
Thus, SimplyVital gives healthcare providers a specifically tailored and easy option that does not require the latter to act as software experts?companies like SimplyVital act as experts on their behalf.
Yet, although using a blockchain like Health Nexus poses
significant benefits for healthcare providers and patients, there
are still some drawbacks.186 Technology like Health Nexus and
blockchain in general, as previously mentioned, is still in its early
stages.187 This not only means that the technology is limited and
expensive,188 but also that ?it will take decades for blockchain to
seep into [the] economic and social infrastructure.?189 This is
because blockchain, as a business model, rests on the upheaval of
current economic and social infrastructure, not on the simple
replacement of one of more aspects of it.190 Further, for blockchain
technology to be successful in the healthcare sector, all players in
the healthcare sector will have to adopt it. As one scholar put it, ?a
social network with just one member is of little use; a social
network is worthwhile only when many of your own connections
have signed on to it.?191 Blockchain then becomes a game of
personal choice?who will step up and be the first one to commit?
Blockchain technology also does not solve the costs and
burdens of employee education and training as well as human
error.192 If a nurse inputs a patients? information incorrectly, or
does not know how to accurately input the patients information,
the blockchain will not automatically fix the error.193 Blockchain
technology only corrects duplications or contradicting
information.194 An initial input that does not conflict or duplicate
another input will remain in the record.195 Furthermore, as
previously mentioned, blockchain technology is complex and may
require additional training and help from a blockchain company,
like SimplyVital, to help healthcare providers and employees fully
understand and integrate blockchains into their existing records
systems.196 Thus, moving forward, the cost of implementation will
likely remain a concern.
Despite its potential drawbacks, blockchain technology offers
a comprehensive system that can help healthcare providers select
a EHR management system that not only complies with HIPAA
and HITECH, but that also offers healthcare providers efficiency,
ease, and relative cost neutralization. Today, healthcare providers
can attack a traditional business model with a lower-cost solution . . . [b]lockchain
is a foundational technology: It has the potential to create new foundations for
our economic and social systems.? (emphasis in original)).
192. See What Are Blockchain?s Issues and Limitations, supra note 143
(detailing blockchain limitations and how that might affect the potential future
use of the technology).
193. See id. (same).
194. See id. (same).
195. See id. (same).
196. See id. (detailing blockchain limitations and how that might affect the
potential future use of the technology).
struggle with various EHR systems that fragment communication
between providers.197 This fragmentation leads to both issues of
privacy as well as general safety198?how can providers effectively
treat if they lack necessary information from other providers?
Providers and patients end up suffering the costs of these systems
and get no reprieve or help from the government: The government
only acts to penalize those who fail to comply instead of educating
providers as to the proper path to take.199 Faced with an impossible
dilemma and significant threats to patients, providers need help.
Blockchain technology offers substantial help. It takes care of
the ?silo? issue, thereby increasing communication between
providers and thus reducing cost and liability.200 It also takes care
of privacy concerns with its permissioned chains and key system.201
The only potential issues with blockchain is its relative complexity
and newness.202 But, hopefully with time, blockchain will become
ingrained in the economic infrastructure203 and its complexity and
newness will wane to growing maturity. As many scholars posit,
blockchain is not a ?panacea?204 for the healthcare industry but
perhaps one day it will be.
Benefits and Burdens ......................................................293
IV. What is a Blockchain-the Truth Ledger .......................300
1. This is a take on ?FinTech,? or the slang for Financial Technology . The
Fairfield of Washington & Lee School of Law. * Candidate for J.D. May 2019 , Washington and Lee University School of
Technology .......................................................................306 13 . Nir Menachemi & Taleah H. Collum , Benefits and Drawbacks of
Electronic Health Record Systems, 4 RISK MGMT . HEALTH POL'Y 47 , 48 ( 2011 )
Management Systems Society) . 14 . Burton , Anderson , & Kues , supra note 4, at 458. 15. See Benefits of Electronic Health Records, UNIV . OF S. FLA.,
visited Nov. 3 , 2018 ) (giving an in-depth discussion of what EHRs are , who uses
Civil Rights & Social Justice). 16 . See Burton , Anderson , & Kues, supra note 4, at 467 (detailing the history
take notice of EHRs) . 17 . Id . 18 . See id. at 470 (describing the federal government's historical
EHRs) . 19. Id. 20. Id. 21. See Health Insurance Portability and Accountability Act of 1996
(HIPAA) , Pub. L. No. 104 - 91 , 110 Stat. 1936 ( 1996 ) (establishing statutory
guidance on healthcare information compliance) . 22 . Id . ? 262 . 23. Id . (emphasis added) . 24 . See id. (stipulating rules on informational privacy) . 25 . See American Recovery and Reinvestment Act of 2009, Pub . L. No. 111-5 ,
123 Stat. 115 (codified in scattered sections of 42 U .S.C.). 26 . See Overview of the American Recovery and Reinvestment Act of 2009
(last visited Nov. 3 , 2018 ) (describing the reasons for the Recovery Act and its
Social Justice) . 45 . Id . 46 . See id. (describing the basics of HITECH implementation and the
benefits of the staging process to health care providers). 47. See id. (describing the basics of HITECH) . 48 . Carroll & Carroll, supra note 33, at 58 . 49. See id. (explaining that after they reviewed several studies, the authors
implementing EHR systems) . 50 . See id. (detailing the specifics of each stipulated category ). 51 . Tara O'Neill Hayes , Are Electronic Medical Records Worth the Costs of
Implementation , AM. ACTION F. ( Aug . 6, 2015 ),
Justice) . 52 . See id. (describing the issues with implementing EHR systems and the
costs of implementing such systems as a burden on health care providers ). 53 . Id . Nevertheless, O 'Neill Hayes notes that ?[p] roviders are allowed to
approved, these providers would not be penalized . ? Id. n.7 . 70. See Jason Juliano, HIPAA HITECH and Big Data Privacy Concerns,
LINKEDIN (Mar. 12 , 2014 ), https://www.linkedin.com/pulse/hipaa-hitech -big-data-
(on file with the Washington & Lee Journal of Civil Rights & Social Justice) . 71 . See id. (describing issues of non-compliance) . 72 . See id. (same) . 73. Id. 74. Id . 75 . See SPRINKLR , HOW TO CALCULATE THE COST OF A DATA BREACH 3 ( 2015 ),
Cost_of_a_Data_Breach_Updated_V01.pdf (providing estimates of data breach
Highest Cost , Says Ponemon, HEALTHITSECURITY (May 27 , 2015 ),
& Social Justice) . 107 . See id. (same) . 108 . See id. (same) . 109. Anand, supra note 104. 110. Blockchain 101 Infographic, supra note 12 . 111. See John Manning, How Blockchain is Changing the Banking Industry,
INT'L BANKER ( Sept . 4, 2017 ), https://internationalbanker.com
& Lee Journal of Civil Rights & Social Justice) . 112 . See id. (noting companies providing blockchain services) . 113 . See Our Company, RIPPLE, https://ripple.com/company/ (last visited Nov.
4, 2018 ) (describing Ripple and what they can do for banking institutions) (on file
with the Washington & Lee Journal of Civil Rights & Social Justice) . 114 . See Manning, supra note 111 (describing increasing blockchain use in
the financial technology sector) . 115 . An instant -remittance service is a service used to instantly send money
dictionary.thefreedictionary.com/remitter (last visited Nov. 4 , 2018 ) ( on file with
the Washington & Lee Journal of Civil Rights & Social Justice) . 116 . See Manning, supra note 111 (describing increasing blockchain use in
the financial technology sector) . 117. Id . 118 . Id . Other lending institutions that have joined this effort include Credit
Group), State Street, Banco Santander, Bank of New York Mellon, and NEX. Id. 119. Id . 120 . See Steve Banker, Blockchain In The Supply Chain: Too Much Hype,
FORBES (Sept. 1 , 2017 ),
https://www.forbes.com/sites/stevebanker/2017/09/01/blockchain-in - the-supply-
chain-too-much-hype/#124e16f198c8 (describing the plethora of uses for
Civil Rights & Social Justice). 121 . Id . 122 . See id. (describing the plethora of uses for blockchain in the supply 132 . Id. 133 . Id .; see Zero Hunger Challenge, U.N.,
http://www.un.org/en/zerohunger/challenge. shtml (last visited Feb . 21 , 2018 )
Civil Rights & Social Justice). 134 . See Banker, supra note 120 (describing the different commercial uses for
blockchain) . 135. Id . 136 . See Quora, supra note 127 (discussing the democratic potential of
Blockchain) . 137 . See How We Can All Stop Voter Fraud, FOLLOWMYVOTE .COM,
https://followmyvote.com /can-stop-voter-fraud/ (last visited Nov. 4 , 2018 )
& Lee Journal of Civil Rights & Social Justice); see also Quora, supra note 127
beyond Bitcoin) . 138 . Quora, supra note 127 . 139. Id . 140 . See Banker, supra note 120 (describing the beneficial uses of Blockchain
while keeping in mind its potential difficulties). 141. See id. (describing the history of blockchain usage and what blockchain
usage looks like today) . 142 . See id. (same) . 143 . See What Are Blockchain's Issues and Limitations , COINDESK,
visited Nov. 4 , 2018 ) (identifying the potential pitfalls of Blockchain) (on file with
the Washington & Lee Journal of Civil Rights & Social Justice) . 144 . Id . 145 . See id. (describing the potential limits to using blockchain technology). 146. See Banker, supra note 120 (describing a specific shortcoming of
blockchain) . 147 . See id. (describing a practical problem of blockchain that , in turn, leads
to other problems) . 148. See id. (explaining what is required for a blockchain to function
effectively) . 149. What Are Blockchain's Issues and Limitations, supra note 143 . 150. See id. (describing the potential limitations of blockchain technology ). 151 . See id. (same) . 152 . See id. (same) . 153 . See Blockchain: Opportunities for Health Care , DELOITTE ,
opportunities-for-health-care . html (last visited Nov. 4 , 2018 ) (describing how
Journal of Civil Rights & Social Justice) . 154 . See id. (quoting the Office of the National Coordinator for Health
Information Technology) . 155 . See id. (discussing the requirements for effective EHR operation set forth
in the roadmap) . 156 . See id. (same) . 157 . Carroll, supra note 33, at 58 . 174. See Why Hackers Are Increasingly Targeting Electronic Health Records ,
supra note 4 (describing why electronic medical records are soft targets for
hackers) . 175. See id. 176. See Blockchain: Opportunities for Health Care, supra note 153
in the healthcare sector) . 177 . See id. (noting the advantages of blockchain). 178. See Jengten, supra note 92 (?A message that is encoded with a private
key can only be decoded with its paired public key, and vice versa . ?) . 179 . Id . 180 . Id . 181 . See id. (describing the security latent in blockchain ). 182 . Blockchain: Opportunities for Health Care , supra note 153 . 183. See Jesse Damiani, SimplyVital Health is Using Blockchain to
Revolutionize Healthcare , FORBES (Nov. 6 , 2017 ),
blockchain-revolutionize-healthcare/#ba9a347880a0 (exploring SimplyVital and
Social Justice) . 184 . See Health Nexus, SIMPLYVITAL, https://tokensale.simplyvitalhealth.com
(last visited Nov. 5 , 2018 ) (describing SimplyVital and its new technology , Health
Justice) . 185 . See id. (describing the benefits of Health Nexus for the healthcare
sector) . 186. See What Are Blockchain's Issues and Limitations, supra note 143
use of the technology) . 187 . See Marco Iansiti & Karim R. Lakhani , The Truth About Blockchain,
HARV. BUS. REV. ( Jan . 2017 ), https://hbr.org/ 2017 /01/the-truth -about-blockchain
Justice) . 188 . See What Are Blockchain's Issues and Limitations , supra note 143
use of the technology) . 189 . See Iansiti, supra note 187 (describing why Blockchain is not in
widespread use yet) . 190 . See id. (explaining that ?blockchain is not a 'disruptive' technology, which 197 . See Menachemi, supra note 13 , at 48 ( describing medical issues that
could arise without a properly implemented system ). 198 . See id. (same) . 199 . See Carroll, supra note 33 , at 57 (describing the costs and burdens of
providers) . 200 . See Blockchain: Opportunities for Health Care , supra note 153
in the healthcare sector) . 201 . See id. (same) . 202 . See Iansiti, supra note 187 (describing the potential issues with
Blockchain and why it is not in widespread use yet). 203. See id. (describing why Blockchain is not in widespread use yet ). 204 . See Blockchain: Opportunities for Health Care , supra note 153