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Executive Summary

Humans today are experiencing unprecedented longevity, with older adults wishing to age independently, actively, and at home. As a result, there must be a necessary shift in how governments and countries view health care systems. These systems must be more proactive, promoting healthy lifestyles and behaviours, while having the necessary infrastructure to provide support, minimize risks, and allow for successful aging in place.

Globally, society is currently in an age of ubiquitous and smart technologies that can monitor our health effortlessly and in real time, including mobile, wearable, and connected devices. Active Assisted Living (AAL) technologies are used to promote independence and the quality of life of individuals, especially amongst vulnerable and elderly populations. When AAL is applied properly and respects security and privacy, it can facilitate an improved quality of life for older adults that includes better health, increased longevity, and supported independence. Alongside the development of technologies like AAL, we are seeing advancements in new areas of Information and Communication Technologies (ICT), such as Blockchain.

Blockchain technologies have gained in popularity since the development of cryptocurrencies in 2008 and have since been proposed as solutions to solve challenges in several fields. Blockchain can be seen as a tamperproof, decentralized virtual ledger that uses cryptography to ensure security and privacy. By design, Blockchain can provide more interoperability, availability, and robustness. Health care has long been plagued by inefficiencies and limitations, such as difficulties in the collection, sharing, and use of patient data to improve health outcomes – hence the potential value of an immutable ledger in mitigating these issues. Solving these challenges may also allow for a better management of the demands of an increasingly aging population: as innovative and smart technologies collect, share, and analyze older adults’ data, they can help them live more independently and risk-free.

Previously, CSA Group published reports on emerging sharing technologies with the Mowat Centre [1] and on the AAL landscape in Canada with the Ubiquitous Health Technology Lab [2]. This current report builds on these previous reports by exploring how Blockchain is being used in industry to mitigate challenges in health care, exploring issues associated with this innovation, and focusing on how the technology can be used to improve AAL technologies as well as current standards in the field and future opportunities.

Insights and results have been obtained by conducting a literature review and consulting with stakeholders through semi-structured interviews. The objective was to identify opportunities and challenges to the application of Blockchain for health care and, more in depth, in the field of AAL. These analyses also provided insights into the development of new standards for the development of solutions using Blockchain and AAL. The goal of this report is to provide a better understanding of the Blockchain areas in which the development of standards can make a difference, specifically in the realm of connected devices and AAL.

Throughout the literature review, the following challenges were identified and grouped into five areas:

1. Electronic Health Records
2. Supply Chain
3. Health Insurance
4. Genomics
5. Consent Management

The interviews were used to confirm the results from our literature review, as well as obtain more information on Blockchain technologies. For example, Blockchain can provide several features to address health care issues, including immutability, decentralization, and security. However, Blockchain technology also has disadvantages that need to be balanced in its implementation, such as scalability issues, redundancy, and complex governance structures.

From the aforementioned challenges, consent management was singled out as one of the most pressing and promising applications of Blockchain in health care. All challenges and issues highlighted throughout the report depend, on some extent, on data sharing between different entities in a trusting and secure manner. To further our understanding of the application of Blockchain in health care, the main findings from the literature review and interviews were used to guide the development of a Blockchain-based consent management platform for AAL data. This platform can potentially increase transparency in the consent management process, enabling more efficient data-sharing.

The interviews conducted by our research team, in combination with the experience in the development of a Blockchain platform, have provided critical insights on current gaps in the availability of standards, guidelines, and best practices for supporting the use of blockchain in the AAL domain. There are currently few standards focusing on AAL technology, Blockchain, and the integration of both. Most stakeholders who are developing Blockchain solutions or who are involved with remote patient sensing are using existing health care and health informatics standards; Blockchain standards are currently in development or have been very recently published. In this report, we provide an overview of relevant Blockchain standards under development, in addition to discussing several opportunities for standards development such as knowledge translation, cybersecurity, governance, and privacy by design.