This article first appeared in Digital Edge, The Edge Malaysia Weekly on July 5, 2021 - July 11, 2021

It is no secret that the Malaysian healthcare system is fragmented and mired in outdated practices.

The coronavirus pandemic, for one, has highlighted the need for better technological advances to help improve efficiency, especially since the healthcare industry is among the industries most targeted by hackers, after the financial services and government sectors.

The failing of the existing structure took centre stage when a 2020 report found that the Malaysian healthcare system was one of the most vulnerable to cybercriminals. In Malaysia, 1.3 million medical and non-medical devices have been exposed and, of that number, at least 450 were medical devices, according to findings by Trend Micro, a cybersecurity provider.

Such malicious attacks are not only costly, as hackers withhold vital information hostage and demand payment for their release but the downtime can jeopardise the care and livelihood of patients, points out Jasbir Singh, vice-president of applications at Oracle Malaysia.

Given these issues, the healthcare sector should take advantage of blockchain technology, which allows for the safer, faster transmission and storage of health records by providers, he says.

As Malaysia aspires to become a digital-first nation, its healthcare sector is a key area expected to benefit from improvements to connectivity and data infrastructure.

While the privacy and security of medical data is paramount, improvements to the quality of care cannot happen without a powerful technology that ensures transparency such as blockchain, says Jasbir.

Currently, the use of a centralised electronic health record data poses a risk to patients, as few within the healthcare sector have resilient cybersecurity processes built in. According to a 2019 Microsoft-commissioned study by Frost & Sullivan, cyber-attacks could cost healthcare organisations in the Asia Pacific an average of US$23.3 million.

“Blockchain technology can help with accurate data management, fraud reduction and the tracking of drugs. With blockchain, all the stakeholders of the healthcare system can be easily tracked,” he says.

Blockchain is a system of recording information in a way that makes it difficult or impossible to change or hack. It is essentially a digital ledger of transactions that is duplicated and distributed across the entire network of computer systems on the blockchain.

As each block in the chain contains a number of transactions, and every time a new transaction occurs, a record of that transaction is added to each participant’s ledger.

In healthcare, the concept of track and trace is critical. Take the Covid-19 vaccine, for example. With blockchain, it can be traced right down to the manufacturer, the batch it came from and even the source of active ingredients in the vaccine.

“If there was some adverse effect or adverse reaction to a vaccine or any medicine, all one needs to do is to trace all the way back right to its source and researchers can troubleshoot from there. They can trace which of the active ingredients is causing adverse reactions and work backwards,” says Jasbir.

Right now, the healthcare industry is adopting the technology in bits and pieces, so the entire tracking of the supply chain, as well as various stakeholders, is not possible, he says.

“Blockchain is the most powerful tool that ensures that the records cannot be changed. That’s why there is such a value to bitcoin. If somebody changes a record, it requires everyone in that whole ecosystem to agree. Immutable record is very important, and especially when you’re dealing with dangerous drugs, like vaccines, as it has an impact on human life,” says Jasbir.

All around the world, healthcare systems are struggling with the problem of data silos — where patients and their healthcare providers have an incomplete view of medical histories. This is propelling the need for open collaboration and data sharing between multiple organisations, he adds.

In 2016, Johns Hopkins University published research showing that the third leading cause of death in the US was medical errors resulting from poorly coordinated care, such as planned actions that were not completed as intended or errors of omission in patient records.

“Let’s look at services offered by telehealth and remote therapeutics start-ups. For example, Naluri [a digital healthy lifestyle coaching start-up] focuses on providing health coaching and mental wellness, but they can only provide coaching and talk therapy, they cannot administer drugs.

“So, their client then will have to see a doctor to get a diagnosis and prescription, and that information stays at the clinic or hospital. At the same time, there is a company out there that is selling psychiatric drugs, which are classified as dangerous, as they are potent drugs to treat conditions like depression and the manufacturer of those drugs have their own database.

“Now, if we could have a platform where the pharmaceutical manufacturer, hospital or clinic and Naluri keep their records, it makes it easier to pull health history information together in a way that ensures the right healthcare decisions at the right moment,” he says.

As prescription drugs require the highest levels of security to meet supply chain compliance, tracking the process via blockchain is more efficient and simpler, points out Jasbir.

Blockchain is already used significantly in the supply chain industry, thanks to its real-time ability to accurately and immutably provide records of each step in the logistics process. As such, the records serve as a single source of truth for all parties involved in the process.

“When it comes to prescription drugs, it is important to monitor the patient to see what works for them, but right now there is no communication between these three stakeholders. But if there were a platform of communication between all three parties, a patient’s identification (ID) could be easily tagged to the drug ID.

“This is useful for not only tracking and monitoring purposes but also for manufacturers to produce better medication. With a blockchain, healthcare records can be securely updated in near-real-time, with updates visible to interested parties,” says Jasbir.

With a collaborative channel, doctors will also have accurate information about one’s medical history to correctly assess one’s health and potentially suggest lifesaving treatment.

Right now, in the light of data privacy laws such as the Personal Data Protection Act (PDPA) and the highly sensitive personal data being collected, using blockchain as a collaborative tool is still a challenge.

Given the Malaysian government’s intention to become a digital nation by 2025, however, Jasbir believes the country stands to gain enormous efficiencies from emerging technologies such as blockchain.

Apart from better medical recordkeeping, blockchain technology is also beneficial when it comes to insurance claims — which are more often than not fraught with inconsistencies.

A blockchain can address several security concerns regarding digital health insurance records, says Jasbir.

“Accuracy, long-term records and transferability are crucial, similar to health records. In the insurance space, the need for fraud detection and protection is even greater.

“Every stakeholder will be able to manage their data in a way that it is auditable. And, there are no questions around its being manipulated. The only way to do that is by putting in more automation.”

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