Blockchain technology and mental health care in India

There are a lot of mixed feelings about the possible introduction of blockchain in the Indian market. A lot of research and development is currently being conducted and countless man hours being invested in making blockchain technology accessible and user-friendly. The aim of this article is to understand the basic principles of the technology, the role it can play in the mental health arena, and some of the perceived advantages and disadvantages of using the technology. It is important to mention that it is difficult to fully ascertain the benefits of blockchain at this point in time.

Until and unless the technology is widely accepted and used, we will not be able to come to a realistic conclusion of its effectiveness.

What is blockchain technology?

Blockchain technology was conceptualized in 2008 by Satoshi Nakamoto; however, it gained recognition with the launch of Bitcoin. Blockchain is not a new technology, but an amalgamation of three pre-existing technologies – the Internet, private key cryptography, and a peer-to-peer network adhering to a protocol. A blockchain is a list of records (called ‘blocks’) which form a virtual chain using cryptography. This technology makes it easy for digital information to be distributed, but not copied. A blockchain provides a decentralized database, called a digital ledger, of transactions that anyone with an internet connection can view.

It aims to make the exchange of data secure and virtually impossible to hack. As there is only a single creator and owner of a particular data, the chances of data manipulation are eradicated and authenticity of data increases. There are owners of documents and no other authorized users. The unique cryptography key (a long string of numbers) is the only authentication required. Possession of this key is proof of ownership of the document.

The information on blockchain is accessible across multiple locations. As data is not stored in one particular location, it makes it difficult for hackers to hack into the system, and therefore makes it a secure form of information sharing.

What are advantages of blockchain for mental healthcare sector?

• Uniformity: Data is stored in a single file format. This makes it easy for people to access and understand the data globally.

• Accessibility: Data can be easily accessed across clinics, hospitals, and insurance companies. It will prevent loss of historical and relevant data and will improve diagnosing and treating of mental illness with the point of reference available through the data.

• Control: The patient will remain in control of who can have access to the data at all times.

What are disadvantages of blockchain for mental health care?

• New technology: Just like a new line of treatment, we cannot be certain of all of the advantages. There is bound to be a lot of trial and error before we can expect to reap the benefits.

• High startup cost: The technology is expensive and requires high processing power, leading to hefty electricity consumption. It is unclear how many clinics and hospitals will likely be able to afford to use the technology.

• Requires joint effort: Mass calibration is required within the health sector for blockchain to become successful in India. A movement which requires the support of major players within the health ecosystem is required for it to flourish.

• Not able to handle large datasets: At present, the technology can handle personal data and prescriptions. It is likely to face challenges in storing large files like CT scans and X-rays.

• Open to human error: The technology still relies upon manual entry of information. If a person makes an error while inputting the data into the system, the data will get stored and distributed.

One of the main advantages of this technology is the decentralization of data. History of clients with accurate dates, diagnoses, and prior treatment interventions are crucial in forming a plan of treatment. A few diligent clients carry with them thick files of prescriptions and notes left by mental health professionals they have visited in the past. With others, mental health professionals often rely on the patients’ memory and interpretation of their condition as explained to them by others. It would be wonderful to be able to access accurate and relevant information at the click of a button.

I do, however, feel that the practicality of entering the data can pose certain challenges. Professionals with a busy practice may find it difficult to enter all the data into the system. If the professional has an assistant input the data, he/she not only breaches confidentiality between the doctor and the client but also limits control over the accuracy of the data.

In our country, doctor hopping has been a prevailing trend among people. If all mental health professionals could have access to a uniform system which was used across the board, it would save time and help the mental health professional proceed with treatment options relevant to the person’s condition. Take, for example, a case where a psychotherapist has been working with Cognitive Behavioural Therapy (CBT) with a client for years without much success, and this record is available for the new therapist to access. The new therapist can then select a different line or modality of treatment instead of pursuing CBT further.