Interoperability. Blockchain. As of 2018, it’s difficult to talk about one without hearing about the other.
Systems interoperability that would provide nationwide access to a common database of health information — no matter what EHR is used — is healthcare’s holy grail. Healthcare leaders, physicians, medical researchers and yes, patients, are frustrated by our inability to safely share the massive healthcare information we collect via our millions of data systems. Many technology leaders think blockchain will disrupt this inefficient status quo and even revolutionize healthcare. Is blockchain just another ho-hum tech concept du jour? It’s too late to dismiss it: a significant number of hospital leaders are already blazing the trail with blockchain solutions.
A 2017 IBM study found that 16% of surveyed healthcare executives in the United States and other countries planned to implement a commercial blockchain solution by this year, and over half expected to by 2020. These trailblazers expect that key blockchain benefits will be major reduction of imperfect information and information risks (e.g. security breaks) and a bounty of newly accessible information. These results, in turn, will enable reliable ways for health professionals to safely track, analyze and use health information across disparate providers and systems. Follow-on benefits are many, including the ability to create an accurate Master Patient Index which is now a worrisome impossibility; high integrity revenue cycle tracking which could greatly reduce unnecessary costs; reduction in medical errors, estimated to be the third leading cost of deaths in the United States; more efficiencies for physicians including spending more time with patients and less on admin; and sharing of resources and analytics across pharma and biotech researchers to expand disease identification capabilities and develop better preventative and therapeutic solutions.
Too good to be true? Well, many are betting on the potential of blockchain. The global healthcare blockchain market is estimated to experience double-digit growth to $5.61 billion by 2025, according to an April 2018 report from ResearchAndMarkets.com. IBM Watson Health has reached an agreement with the Centers for Disease Control and Prevention to study the potential benefits of blockchain for the healthcare industry. Mayo Clinic just signed a joint working agreement with Medicalchain to collaborate on initiatives to “explore the potential benefits of blockchain technology in healthcare.”
Don’t think blockchain is THE silver bullet. But blockchain applied to our healthcare systems is expected to solve many issues that plague our data-siloed industry.
What is blockchain technology? It’s time to know.
Blockchains are not difficult to understand once you realize that they are not linear, not like a spider web, and not even hundreds of spider webs of connected data. Start thinking about the atoms within the spider webs!
The concept behind blockchain includes three main components: a widely distributed network, a shared ledger with validated access identities, and digital transactions. Wired magazine notes that while blockchain is known for powering bitcoin, “It’s really a generic tool to keep secure data in a distributed, encrypted ledger—and control who has access to that ledger. Rather than having one central administrator that acts as a gatekeeper to data—a list of digital transactions—there’s one shared ledger, but it’s spread across a network of synchronized, replicated databases visible to anyone with access (my italics). Blockchains … live on many individual devices instead of existing on central hubs.”
As the IBM report suggests: “Forget, for a moment, “big data.” Instead, think “long data” – short for longitudinal data – and its application to healthcare.” Data that is captured in blockchains can be shared in real time across a scalable group of individuals and institutions. All events and transactions are time-stamped and become links in a long chain. This becomes a permanent record that can’t be tampered with. As an example, an X-ray or blood work creates a digital transaction, and bits of code group it into an encrypted block with other transactions. Each transaction is validated by a physician or clinician trusted with an access key and then timestamped.
Permissions are a significant component of blockchain’s value. If a blockchain requires no permissions, all parties can view all records. On permissioned blockchains, privacy is maintained by agreement on who can view which data, whether it’s a patient’s health record or a bottle of medicine being followed through the supply chain.
Blockchain has unprecedented privacy and security benefits. The secret sauce of blockchain is that hacking one block in the chain is impossible without simultaneously hacking every other block. This is a very difficult proposition for cybercriminals. Today, storage and transmission of patient data is mostly governed provider by provider via purchased electronic health records, internally connected systems, and their pooled databases. With notable health information exchange exceptions, healthcare information is siloed. And it is very hackable. Blockchain’s inherent decentralization of databases makes them much smaller and widely spread, thus diversifying PHI and other sensitive information, and disappointing would-be hackers. Blockchains are already recognized in other industries as an exceptional factor in regulatory compliance. Since blockchains provide a real-time audit trail, the appropriate parties are notified of non-compliant events as they happen, automatically enforcing privacy regulations, as an example.
What does blockchain mean for healthcare per se?
Blockchain adoption: opportunities for healthcare professionals
Safe streamlining of EHR information and processes across the healthcare landscape is on the top of physicians’ and healthcare leaders’ wish lists for more efficiency. So, the interoperability enabled by blockchain is particularly promising for its potential to transfer relevant patient data from one provider to another no matter the location or the providers’ particular EHR. For physicians, this would enable customized individual treatment plans co-developed by a patient’s various caregivers, based on full histories, patient genetics, lifecycle and environment. Blockchain would also enable improvements and even cost savings in many healthcare processes. For example, blockchain combined with other technologies would enable major efficiencies in the claims process and improve the overall healthcare experience for all stakeholders. Health researchers would have access to broad, comprehensive data sets to advance the understanding of disease, and accelerate biomedical discovery and drug development.
Blockchain adoption: benefits for patients
Blockchain also offers big advantages to patients by giving them constant access to their wellness data and promoting healthy lifestyles to reduce chances of contracting major disease. Data stored through blockchain would be so navigable that it could “lead to zero friction points between the time a patient sees a doctor and the time payments and settlements are made.”
The prognosis for blockchain technology in healthcare
Obstacles abound in a forecast of blockchain’s final role in healthcare, not unlike every disruptive technology or initiative in healthcare IT’s evolution. More understanding of yet another esoteric subject is needed. Technical standards need to be agreed upon and secured. EHR and related tech industry leaders need to expand healthcare priorities beyond their company profit borders. Priorities must be balanced throughout the industry.
Despite opportunities that blockchain (and other interoperability-focused technologies) may present, the biggest elephant in the room is, as always, that healthcare industry change is slow. Healthcare organizations justifiably have put direct patient care first, with payment for it a close second. But the rise of initiatives in value-based care, data analytics, artificial intelligence solutions, e-health, telemedicine and population health management is already carving a path into healthcare’s future, offering clear new potential for a superior national healthcare system.
At this point in time, there is no lack of information on blockchain and its capabilities. At the last College of Healthcare Information Management Executives (CHIME) CIO Forum, Don Tapscott of the Blockchain Research Institute offered five tips on how healthcare leaders can make some inroads on understanding and benefitting from the technology. “Every day you’ll be staggered,” Tapscott said.
It’s time to take blockchain seriously, if you aren’t already. Blockchain’s striking growth as a force in resolving the healthcare world’s critical need for HIT interoperability has become undeniable.