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CDC IT Leader Details Progress on Developing an EHR Blockchain

October 1, 2018
by Heather Landi, Associate Editor
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Blockchain is an innovative technology that has garnered a significant amount of interest across many industries, and, within the U.S. healthcare industry, thought leaders and innovators continue to weigh in on the potential opportunities, and the countless complexities, around the adoption of blockchain technologies.

Many healthcare organizations are pushing forward with pilot projects and proof of concept initiatives to explore the development of blockchain and distributed ledger technologies, yet this is a technology that is still very much in its nascent stages. Potential use cases for blockchain in healthcare will be topic of discussion by a panel of experts during the Healthcare Informatics Beverly Hills Health IT Summit, scheduled for November 8-9 at the Sofitel Los Angeles at Beverly Hills.

As noted in a Fast Company article, companies like IBM and Microsoft are exploring how the technology can be used in traditional industries to sync up data like logs and transaction records between business associates, like health providers and the Centers for Disease Control and Prevention (CDC). IBM and the CDC’s National Center for Health Statistics are collaborating to build a proof of concept for an electronic health record (EHR) blockchain, and there is the potential for the technology to be used as a data system that could track public health issues.

The CDC’s National Center for Health Statistics collects a large amount of health data from surveys. The blockchain project is focused on the National Ambulatory Medical Care Survey (NAMCS), which is a national survey designed to provide information about the provision of medical care services in office-based physician practices in the U.S. NAMCS is designed to meet the need for objective, reliable information about the provision and use of ambulatory medical care services in the United States. Findings are based on a sample of visits to non-federally employed office-based physicians who are primarily engaged in direct patient care and, starting in 2006, a separate sample of visits to community health centers, according to the CDC’s website.

Askari Rizvi, chief of the technical services branch of the CDC’s Division of Health Care Statistics, says the CDC looks for innovative solutions to resolve business problems and is developing a blockchain use case to potentially see what types of current and future EHR data collection challenges can be addressed. Rizvi recently spoke with Healthcare Informatics Associate Editor Heather Landi about this proof of concept project, what project leaders have learned so far about blockchain’s potential and what they hope to accomplish with the project. Below are excerpts of that interview.

What is the CDC-IBM blockchain collaboration focused on and what is the aim of the project?

The collaboration started about a year and a half ago. The CDC has an official collaborative agreement with IBM. The CDC is a large organization, and we have a lot of different centers and I’m part of the National Center for Health Statistics. The CDC’s Innovations Committee reached out to several centers to see if anyone had a project to utilize blockchain for, and I made a case for the EHR proof of concept on a blockchain project, and it was well received within the CDC community along with IBM as well. I picked one of our services, called the National Ambulatory Medical Care Survey, or NAMCS, and we based the proof of concept on the NAMCS to get us started. Currently, it’s quite a process to capture that data [for the NAMCS], so the idea is to capture EHR data, so that we can bypass a lot of that and so we can get the data in real-time.

Askari Rizvi

We have created a proof of concept, but we do have a small application where we can demo the project. I’ve spoken at a number of conferences and events where we have demoed the project. The entire project is hosted at IBM and it is a research and development project. It does not have any real data. I want to be very clear because we take privacy and security extremely seriously here at NAMCS; all the data that in this proof of concept is completely synthetic data. And, because it is an R&D project, and there’s no real data involved, we could put it offshore. There’s a lot of legislation and regulations we would normally follow in a traditional federal application, which you don’t have to do when you’re doing a research and development project. But as we move toward a production solution, which would be a long-term strategy, then we would need to get the appropriate approvals and the authority to operate.

Based on what you have seen so far, what are the benefits of using blockchain?

Essentially, we’ve created a promising EHR blockchain proof of concept based off our NAMCS. Thus far, the primary benefits that seem quite promising are consent management, sharing of data, enhanced privacy and security controls and embedded audit trails. The long-term vision is to be able to collect large sets of data, which should provide researchers and organizations the ability to develop deeper insights and trends. We are at a stage with our proof of concept where we are recruiting for partners, specifically EHR vendors. The vision is to partner up with EHR vendors to build capability in our solution where the sharing of the data becomes simple for the providers, and, at that point, all we would need is consent from the providers.

What drew your interest to exploring blockchain technology? Are there particular challenges that blockchain might help to solve?

I have a hefty background in IT; I’ve been doing it for a few decades. Anytime I see a new technology, I’m interested in finding out what it has to offer, so essentially, that is what piqued my interest. By no means am I a blockchain expert. It was more so as an R&D project, to see what it is and how can it possibly help us manage our national healthcare surveys. As we’ve been through a series of meetings and working sessions, we began to realize that it will enhance the privacy and security of our service, which is always a key aspect, along with better sharing of the data, consent management, and the audit trails.

But, besides that, there was another primary goal. The survey response rates have been declining throughout the industry, so we wanted to think out of the box in order to compensate for that. The idea was if we can build a solution with EHR vendors or these larger systems that host a lot of the data that we need for research, then it would become a lot easier. We would have larger data sets, and we would have them in real-time; there wouldn’t be any issues with the frequency of the data that we are receiving. Some people describe blockchain as a decentralized database, and it really depends on the model that we create going forward. We’re flexible; we have capped the proof of concept at a very high level in terms of flexibility, because depending on the partners that we select, we want to make things as easy as possible for them. I think for the next steps, once we have a number of partners, then we would ask for them to send data from their EHR system and then we would move forward.

What are the next steps with this project, and what is the long-term goal?

What we’ve built so far, it is promising. I see that it does offer several benefits, in terms of privacy and security and audit trails. For the next steps, when we’re able to get a number of providers and if we’re able to build a bridge, or let’s say [the providers] are a node on our blockchain, then it becomes easier to share data from that EHR system for any of the providers, because we would build that bridge between our application and the different EHR vendors. All the providers would need to do is to give us consent, and then we would have that data, from that EHR system. It’s a very long-term strategy. It’s not going to be done any time in the next few months. It is a holy grail of where we are headed, and then we can tap into the data, and depending on the different data sets, we can even enhance the data collection that we currently do. There are many data elements that we collect, and EHR systems have a lot more data elements, so we’re increasing our ability to capture additional data sets, and then providing the flexibility for researchers to be able to run their analysis, look at deeper insights, and come up with trends.

I just want to, again, that all the data for this blockchain prototype is completely synthetic; there is no real data that we’re using here. And, I want to be clear on our current state versus our “to-be” state. So, current state is, we have developed this proof of concept, it’s off-site, no data, and, on top of that, we’re simulating providers. The “to-be” state would be to get providers, partner up with them, start collecting synthetic data from them and then moving toward production state.

What does the status of this proof of concept signify to you about the potential for blockchain adoption in healthcare? Do you see other potential use cases?

There are a number of different centers in CDC that are focused on solving different business problems for CDC, and their mission and goals are very different. I think blockchain could be used for a number of those business units. The idea over here is to get this R&D project off the ground, get it working, have providers on board and move forward towards a production stage. I think that will open things up where others can see that this product looks promising and that it could resolve certain issues. People use blockchain for supply chain management, so another use case could be where the CDC could see the different areas when you are tracking down let’s say, some sort of bacteria in a product. If you have a system that’s developed on a blockchain, you can see where that product originated from. Essentially, you could work your way backwards, go all the way to the origins of where that product came from, and you could identify the source. That would be another use case.

Moving forward, what are some of the potential challenges with this project?

We’re at a juncture where we need to partner up with the EHR vendors or different providers or systems. I think that would be the current challenge, or the biggest challenge for us to face. We want to make sure we’re able to pick the right partners, so we can get something going and continue to make progress.

 


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Take the Lead to Deploy Emerging Technologies for Improved Outcomes

December 14, 2018
by Brad Wilson, Industry Voice, former CEO of Blue Cross and Blue Shield of North Carolina
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It is a thrilling time to work in healthcare. As the former CEO of Blue Cross and Blue Shield of North Carolina (Blue Cross N.C.), I have had the opportunity to be at the forefront of using new technologies to improve outcomes for our members. Now as a member of the CitiusTech advisory board, I continue that focus on emerging technologies, such as artificial intelligence (AI), and the potential to accelerate the shift to value-based care and improve the healthcare system in material ways.

AI is starting to make a distinct impact in helping providers deliver more effective care, lower costs and create a more consumer-friendly healthcare system. Blue Cross NC recently piloted the use machine learning, a type of AI, to identify spikes in prescriptions for a costly medication. The company reached out to doctors who had been prescribing the medicine in significant numbers. Alerting just one particular physician practice to a generic equivalent brought estimated annual savings of $750,000 for Blue Cross NC customers. The potential of AI is not measured only in dollars, but cost savings are an important consideration.

Machine learning works by applying sophisticated algorithms to rich datasets from electronic medical records (EMRs), patient-reported data, claims and a host of other sources. To be successful, this requires both access to data and significant investment to support the depth and breadth of data analytics capacity and capability.

Yet, historically, one of the biggest barriers to value-based models has been providers’ and payers’ possessiveness of their own data. There is a good business reason for that possessiveness: competitive advantage. The different parts of the healthcare system do not want competitors to use shared data to steal business. But the guarding of data drives healthcare costs higher and, more importantly, makes delivering better, more personalized healthcare more difficult. In the past, power came from hoarding information; today, there is power in serving as an information hub.  Healthcare providers and payers are starting to understand this and there is more willingness to work together in sharing what has traditionally been closely held information.

As consumers’ voices gain in numbers and decibels, it’s clear that analytics technologies that can lead to better care at lower cost are desperately needed, particularly for payers. But the entire healthcare industry needs to move more rapidly. Health plans need to enrich, deepen and widen their analytics capabilities as quickly as possible. If they don’t, we will continue to see disruptors like Google, Apple, and Amazon enter the healthcare market—companies that have a demonstrated ability to be nimble and maximize the impact of their data.

For both providers and payers, forward-thinking organizations recognize that building their own data analytics solutions is not always the answer. Often there is not enough time, resources or enough of the right talent to deliver the capacity and capability required. Fortunately, robust turnkey solutions coupled with deployment expertise are available to efficiently and cost-effectively integrate data and analytics within an organization’s clinical, financial and administrative processes.

As health plan executives map out their strategic plans, look to these emerging technologies as accelerators for leveraging data to manage risk, optimize performance, engage consumers, enhance population care, and improve clinical outcomes to reduce readmissions and further drive evidence-based medicine. The opportunity is here to transform healthcare delivery in significant ways. Success will go to those organizations that understand the potential of these new technologies and take the lead to deploy them effectively—today. 

Brad Wilson is former CEO at Blue Cross and Blue Shield of North Carolina and is a member of the new CitiusTech Advisory Board. Mr. Wilson joined Blue Cross NC in 1995 as General Counsel and held a variety of senior-level positions before being named CEO in 2010. Under his leadership, Blue Cross NC grew to a $9 billion company serving over 3.8 million customers. Mr. Wilson has also served as Director of the BCBS Association, AHIP and numerous other national and state healthcare organizations.

 


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Investors Have Strong Interest in HIT Sector, Despite Valuation Concerns

December 13, 2018
by Heather Landi, Associate Editor
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Healthcare IT remains a hot investment sector despite concerns about these companies being overvalued, according to KPMG-Leavitt Partners 2019 Investment Outlook, a survey of health care investment professionals.

Looking ahead to 2019, more than a third of respondents (34 percent) said they were most interested in investing in health care IT, followed by care management (31 percent), home health (23 percent), retail-centric medical groups (22 percent) and primary care practices (21 percent).

New York City-based KPMG and Leavitt Partners, based in Salt Lake City, surveyed 175 respondents online from corporations, health systems, investment banks, venture capital and private equity firms between September 17, 2018 and October 21, 2018. Of those surveyed 32 percent were C-suite executives; 29 percent were principal, partner or managing director; 32 percent were vice president or director; 6 percent were analysts/associates and 2 percent held other titles.

“We are not surprised by the great deal of interest in health care IT and care delivery outside the hospital,” Governor Mike Leavitt, founder of Salt Lake City-based Leavitt Partners and former Utah Governor and U.S. Health & Human Services Secretary said in a statement. “As health care continues to march toward value, the emphasis on moving care to lower cost sites and enhanced coordination will continue, and those who can increase quality and lower cost will win.”

According to an October report from Rock Health, 2018 is already the most-funded year ever for digital health startups. Digital health funding in this past third quarter soared to $3.3 billion across 93 deals, pushing 2018 funding to $6.8 billion, already exceeding last year’s annual funding total, which was $5.7 billion, by more than a billion dollars.

Drilling down into respondents’ predictions for investment activity in 2019, in the health care and life sciences market, 96 percent of respondents see either a lot or a moderate amount of investment in health IT and data next year, while a similar percentage (90 percent) see significant or moderate investment in outpatient services. Forty-four percent forecast a lot of investment in post-acute care services, 39 percent predict significant investment in provider services and about a quarter of respondents believe there will be a lot of investment in managed public programs, payer service providers and pharmaceutical and biotech manufacturers. Eighteen percent believe there will be significant investment in medical device and diagnostics and medical equipment.

The survey results indicate there is concern that health IT is overvalued, yet investors believe there is some room to climb.

The majority of investment professionals see health care IT investments as an overvalued sector (64 percent), yet 40 percent expect the valuations to increase in 2019 while 51 percent see them staying the same. About two-thirds of respondents (62 percent) think the health IT sector will grow faster than the market in 2019, and three quarters of investment professionals see increasing competition in the health IT market. Investors also estimate that the average purchase price multiple, in terms of EBITDA, will be 12.5 for the health IT sector in 2019. Survey respondents expect ongoing demand for tools to help with consumerism will impact investment and deal making in the sector, according to the survey.

About four in ten respondents believe the healthcare market is experiencing a “moderate bubble,” while 9 percent believe the bubble will likely burst.

Care management solutions for risk-bearing providers, a highly competitive sector which helps coordinate care of the chronically ill or seriously injured, are expected to be the second highest sector for investment behind health care IT, similarly driven by trends of consumerism and increased focus on early care interventions.

Looking at potential drivers of M&A activity in the health care and life sciences sector in the coming year, 64 percent of respondents cited cost consolidation and economies of scale, while 45 percent cited accretive acquisition strategies. Forty percent of respondents see changing payment models as a driver of M&A activity, and 38 percent cited pressure from competition. Other drivers cited by respondents include expansion/divestiture of service areas (25 percent), geographic expansion/contraction (24 percent), revenue synergies (22 percent), need to deploy cash on balance sheet (17 percent), and regulations and legislation (13 percent).

“Deals are largely being driven by the need for savings, economies of scale, and improving cash flow or accretive earnings per share,” Carole Streicher, Deal Advisory leader for healthcare & life sciences at New York City-based KPMG, said in a statement. “Secondarily, there is a bit of a defensive posture motivating investments as health care organizations contend with competition and reimbursement models connected to quality and efficiency, as well as the entrance of tech firms investing in the sector.”

 

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Report: Massachusetts General Hospital Targeting Various Blockchain Use Cases

December 7, 2018
by Rajiv Leventhal, Managing Editor
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Massachusetts General Hospital (MGH) researchers are partnering with MediBloc, a Korean healthcare blockchain company, with the aim to improve patient data sharing and storing, according to an article in CoinDesk.

Per the article, the Laboratory of Medical Imaging and Computation by MGH and Harvard Medical School will be escalating research in a variety of broad areas “from medical image analysis to health information exchange by leveraging our cutting-edge technologies such as blockchain, artificial intelligence and machine learning,” according to Synho Do who is the laboratory’s director.

Do specifically told CoinDesk, “In collaboration with MediBloc, we aim to explore potentials of blockchain technology to provide secure solutions for health information exchange, integrate healthcare AI applications into the day-to-day clinical workflow, and support [a] data sharing and labeling platform for machine learning model development.”

Interestingly, MGH won’t be using any real patient data for its research, but rather simulated data, according to officials, since the various institutions that have the real patient data keep it in a way “that can’t be shared securely and often is in various incompatible formats.”

MediBloc’s CEO noted that the company is not only developing a distributed ledger for storing and sharing medical data, but also working on a tool that would convert data now held by hospitals from existing formats to a universal one, per the article.

For this initiative, MediBloc has already gotten partners across Asia, including eight healthcare organizations and 14 technology companies, officials said.

Earlier this year, a testing environment version of the blockchain was launched, and the network is expected to go live before the end of the year before becoming fully functional in the second quarter of 2019. Furthermore, there are also apps in the works that are planning to go live next year, with one of them, currently in a beta testing phase, “designed for patients to sell the information about their symptoms and the prescriptions they get to MediBloc. After that MediBloc will analyze that data and sell the analysis to pharmaceutical and insurance companies,” according to the story.

In the end, the main goal of the blockchain project will be to let patients independently decide what to do with their information.

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