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What are the Greatest Use Cases for Blockchain in Healthcare? New Research Explores the Possibilities

June 6, 2018
by Rajiv Leventhal
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Frost & Sullivan researchers analyzed the top healthcare uses cases for blockchain and how soon they might be implemented in health systems

Across the healthcare spectrum, there is a great deal of uncertainty and unfamiliarity when it comes to how blockchain technology could be applied. While most would agree that the industry can benefit from leveraging blockchain in various ways, one recent report points to how it’s potential in precision medicine is gaining traction.

The report, from New York City-based consultancy Frost & Sullivan, examines the global healthcare crisis, looking closely at chronic disease, aging populations, and rising costs, while exploring the challenges inherent in precision medicine—including the big data conundrum, interoperability, cybersecurity, value-based care reimbursement, data ownership, and healthcare consumerism. As such, the researchers believe that blockchain technology can be the solution to many of those issues and is the missing piece in healthcare digital transformation.

Greg Caressi, senior vice president, transformational health at Frost & Sullivan, recently spoke with Healthcare Informatics about the report’s key takeaways, the role that blockchain could have in precision medicine, and other use cases for blockchain in healthcare. Below are excerpts of that interview.

What was your motivation for exploring the role that blockchain could have in precision medicine and elsewhere in healthcare?

We are an analyst consulting firm, so we’re always looking at new technologies as they are being brought to market, and at companies doing interesting things in this space. And part of our job is to look at what real opportunities there are within those technologies to apply them in real-world use cases, to figure out what the monetary value of those applications are, and to separate hype from reality.

So we did a study on blockchain about a year ago where we spoke to a wide number of companies. It is a technology in its infancy and it has been applied in certain use cases in other industries, and there were some in healthcare already underway at the time. So we talked to vendors, users, other industry experts and blockchain experts, and put together our research as what we saw as the top use cases and the most interesting companies in this space.

Greg Caressi

What has your research revealed thus far?

For providers, it hasn’t been really taken up in healthcare. The pharma industry is certainly doing things, and you have seen the recent payer announcements around blockchain utilization for processing claims. It fits well there. Providers are exploring this, and it was about a year ago when I was speaking to a group of hospital CIOs, and some of them didn’t know what blockchain was or hadn’t even thought about applications in their settings.

So early adoption applications are in the provider world will be a little bit more down the line, and right now it’s more around transactional exchanges of information, such as claims adjudication and drug supply chains, other than in Estonia, where a national medical record concept is being tried. But that isn’t mature in the U.S. market and it would be unlikely to get adopted here. When you [think about] moving into the 2019 to 2021 time period, you can start looking at IoMT (Internet of Medical Things), medical device information, and clinical trials, which do involve providers who will be participating in that, though they won’t be the originators.

Some folks have tried putting together exchanges that would involve providers making service lines available when they aren’t fully booked, sort of like Priceline for healthcare services. You have entities that are able to give access to that exchange for their employees or members to get access to services, but that is probably more in the post-2020 range.

You mentioned the top use cases for blockchain in healthcare that you researched. Can you explain those in more detail?

We identified what we thought were the five biggest use cases in terms of just dollars: the biggest one was for drug supply chain, so the ability to remotely audit the drug supply chain. That is the biggest opportunity where pharma can have the ability to trace back in their supply chain down to the API level, and see when there is an issue with a product that does demand an audit and/or recall. They can be precise in terms of where that manufactured lot comes from.

The others we identified as in the top five as far as earliest adopting and impact in terms of dollars included claims adjudication and billing management, and we have seen payers announce they will use blockchain for that purpose since we have published the research; and clinical trials and population health research where you are trying to collect data from a wide range of participants. And this impacts precision medicine because as you look at precision medicine trials, you’re looking at having access to more defined populations that are going to be more dispersed. You get the ability to access them quickly to collect data, validate that data, and have all of the trial protocols documented and adhered to, so there is value in clinical trials that can be done through blockchain.

And then health data exchange is another use case we researched, though there are limitations. Genomics data, for example, doesn’t fit well within the blockchain since the volume of data becomes too large in the current technology models.

And then there is cybersecurity. When we talk about the Internet of Medical Things, the ability to have locations where data can be included from a number of sources, and limitations on access, and have data governance and control within blockchain, is one of its strengths. When you think of Bitcoin transactions, and you think of IoMT, and all that data, you can have all those pieces of data to be securely accessed by those given rights, and then others can give inputs as well.

Speaking of the health data exchange use case, we’re hearing from some people who think that this is an unrealistic application, and then others who are very hyped up about it. Where do you stand?

I was on a panel at a recent digital health event and they asked us what is the most overhyped technology, and blockchain was the winner. It’s getting more press than it has use cases that will be rolled out. But health information exchange is one of the areas where you have the biggest challenges. There aren’t a lot of incentives in place for those that control the data today—which are generally the hospitals and health systems—to share that data outside of their own users. Of course, there is a lot of value in care coordination, but in an ACO (accountable care organization) or similar model, there usually already is a way to exchange some level of data.

As you look at more people inputting and drawing on that information in a broader sense nationally, then maybe you start to see more value there. In the U.S. right now, we don’t have a way to tag that information. So if you have data input from where you live currently and are traveling and have to go see a doctor, and you lived somewhere else 10 years ago, we don’t have a way to make sure that “you are you” in all of those locations. There is no master patient index at a national level and that’s a barrier we need to figure out in the U.S. for data exchange overall. It’s not surprising that Estonia is the first location giving this a shot because it’s a small market and they do have the ability to tie that same-named person through an identification code that everyone has agreed to use.

There are also other issues around terminology, and regulatory concerns that providers will be nervous about every time they share information. So while it is supposed to be secure, some loss or theft of information, like we have seen through Bitcoin, adds psychological and technical barriers. I would not expect data exchange to be [blockchain’s] first use.

In a lot of ways, many say that blockchain works best when lots of players are involved, but the realty is that the implementations we see today are those where we have a single enterprise driving it for a reason or a defined set of partners. Whether it’s a pharma company tracking their supply chain or a payer looking at claims adjudication, it’s a defined set of players and usually one big entity that sees value and drives the system—just like Walmart drives a system out to all of its suppliers. It’s easier to get someone to drive the bus and then force someone to come along.

How important is it to discern fiction from reality when working with vendors who might be saying that this is the next great thing?

It’s very important. There is a trust factor, a need factor. While we all recognize the need for interoperability, [stakeholders] are working on other approaches they have already invested in. So there is not a huge appetite for throwing those out the window. For providers, a large [motivation] for health information exchange is to do analytics on that more holistic patient record and understand who’s at risk. And analytics doesn’t fit well with a blockchain. Blockchain is great at being able to have a “track and trace” of a transaction, but it’s not a data repository system that allows you to go in and run analytics on that combined set of data. You have to be able to pull the data back out to do that.

Can you offer any blockchain predictions for the next year or two?

I think as you see some of the entities that are adopting it, as they see value out of it, you will see things happen quickly in the pharma and payer markets. So that’s the immediate future: drug supply chain, identity verification and management, and claims adjudication. Hashed Health is working on a way to check licenses of clinicians. That’s a transaction model that fits well in blockchain. We believe that those transactional models will create value by the end of next year.

The next wave includes clinical trials, where you have applications potentially tying into the requirements for unique identifiers within medical devices—again, more transaction. But for the broad applications, in terms of shared medical records, it will be post-2020 before you will see a widespread recognition and push to adopt them that goes beyond just a few examples here and there.

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Survey: Who Will Shake Up Healthcare? C-Suite Leaders Weigh In

August 20, 2018
by Heather Landi, Associate Editor
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With new, disruptive entrants coming into the healthcare market, which company is poised to have the biggest impact on healthcare? The majority of C-suite leaders have their eyes on Amazon to shake up healthcare, according to a recent survey of healthcare C-level executive leaders.

Reaction Data, a market research firm focused on the healthcare and life sciences industries, surveyed about 100 healthcare organization leaders on which companies will have the biggest impact on healthcare, and why for its recently published report on healthcare disruption and the future of the healthcare market. The report also looks at emerging technologies and healthcare organizations’ future technology plans.

About 80 percent of the healthcare leaders surveyed are C-level executive leaders—27 percent CEOs, 17 percent CIOs, 17 percent chief nursing officer (CNOs), 17 percent CFOs and 7 percent revenue cycle management directors. Almost half of the respondents were from hospitals.

According to the survey, 59 percent of provider organization leaders think Amazon will be the most disruptive, with 75 percent of CEO respondents choosing Amazon as having the most potential for real disruption. Fourteen percent of respondents cited Apple, 8 percent selected Google, 7 percent chose Microsoft, 4 percent said IBM, 3 percent cited Walmart and less than 3 percent said Salesforce.

The report cites one CEO’s comment: “[Amazon has] visionary leadership and the ability to make the change happen.”

The report also breaks down the number of comments each vendor received per attribute, with 14 attributes such as “name recognition,” “ability to commodify,” “progressive/innovative,” “predictive analytics,” and “affordable.” Amazon received the most comments and, based on those comments, appears to have the most diverse attributes, according to the report, as respondents cited the company for all 14 attributes.

Amazon has made several moves into the healthcare space, including its acquisition of PillPack, an online pharmacy startup, back in June. Earlier this year, Amazon, Berkshire Hathaway, and JPMorgan Chase & Co. announced that they were launching an initiative to improve satisfaction and reduce costs for their companies’ employees. Details of that joint venture have been vague, but experts have pointed to reducing healthcare fraud and administrative costs as key areas that the companies will focus on.

The report also summarizes the work underway at Apple, Google and Microsoft, including Apple and Google’s ongoing efforts to develop their devices and apps and continued development of artificial intelligence (AI); Microsoft’s work with St. Jude Children’s Research on genomics and advancing cloud and AI and IBM’s work in cloud, encryption and data mining. Salesforce allows providers to utilize its cloud CRM tool to manage patients and store data.

Reaction Data also surveyed respondents on emerging technologies, and 29 percent cited telemedicine as a technology that will have the biggest impact, although telemedicine has been around for decades. Twenty percent of respondents cited AI. Only 2 percent cited blockchain, despite all the buzz that technology has been generating. Combined, virtual services/telehealth and AI accounted for almost half of the responses. What’s more, 15 percent cited interoperability, 13 percent selected data analytics, 11 percent cited mobile data and 7 percent said information security. Cloud was cited by 3 percent of respondents.

The number one use case for telemedicine is reaching patients who live in rural areas, according to a quarter of respondents, with the same percentage citing “follow up care” and “managing specific patient populations.”

With regard to AI and machine learning, the vast majorty, 65 percent, of respondents said the technology was “important” and 16 percent said it was not important; 19 percent were neutral. However, while providers clearly see the technology as important, more than half of respondents (53 percent) are at least a year away from adopting it, and many are three years away from adoption. Twenty-eight percent said they plan to adopt AI in one to two years, while 25 percent said they are 3-plus years away from adopting the technology. What’s more, 15 percent have no plans to utilize AI. Fourteen percent of respondents said their organization has been using AI for a while, 11 percent plan to adopt the technology in the next year and 7 percent have adopted some AI.

Breast imaging is by far the main use case for AI, according to the report, with three-quarters of respondents citing this area for AI adoption. The report also breaks down what providers are looking for in AI technology—convenience (33 percent); interoperability (27 percent); technology (18 percent); predictive analytics (11 percent); affordability (5 percent) and progressive/innovative (2 percent).

The report also looks at business trends in healthcare, noting that there have been dozens of mergers and acquisitions recently. These include provider/provider, vendor/vendor, and payer/payer relationships. Now the lines are being blurred as entities are crisscrossing into new spaces. “Examples include CVS acquiring Aetna, Optum purchasing Advisory Board, PinnacleHealth getting picked up by UPMC, Walgreens partnering with NewYork-Presbyterian, Apollo buying LifePoint Health and merging it with RCCH HealthCare Partners, and many others,” the report states.

The survey also gauged healthcare provider organizations’ acquisition plans. While 61 percent said they plan to remain independent, the survey found that 39 percent of provider organizations are currently planning to either acquire other organization, execute a merger, or sell to a larger organization, which points to a dynamic market becoming even more in flux.

“The impacts to the vendors who sell to these organizations, to the payers who negotiate with them, to the care providers who work for them, and to the patients who are treated by them, could be significant. It isn’t an overstatement to say that it is critical to keep a very close watch on this market dynamic,” the report states.

With a significant percentage of organizations planning to change their ownership structure and make-up in the next few years, along with organizations adopting new technologies, and with new entrants moving in, it appears that there will numerous forces at work to shake up healthcare soon.


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Will IBM Watson Repeat History?

August 15, 2018
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Recently, there have been some articles about IBM Watson and healthcare.  In particular, a blog by John Lynn speculates on the “health” of IBM Watson in healthcare.

I’ve had my own personal experiences with IBM in healthcare.  While with GE, we did a joint venture with IBM in the early days of PACS and RIS, and I was an original IBM MedSpeak/Radiology reseller in the early days of speech recognition.  In both cases, IBM did not have the financial wherewithal to play the long game in terms of the technology and exited both.

Interestingly enough, MedSpeak/Radiology was not the first foray into digital dictation for IBM, so they exited that business multiple times.  I also have to say, MedSpeak/Radiology was a pioneering technology that was very competitive.  It just wasn’t the business case the IBM management was looking for.  Similarly, IBM’s effort with GE toward RIS and PACS was naively predicated on employing IBM’s RIS product, and not on interoperability with other RIS vendors.

There are countless business examples of companies launching products based on great expectations, only to have them fail to achieve those expectations.  There are also countless examples of companies getting into products that have no relevance to existing businesses because the think they have a “better mousetrap.”  One that comes to mind is GE.  Years ago, GE developed in their research center an electric garden tractor which was very innovative for the 1970’s.  Unfortunately, when GE attempted to bring the product to market, they discovered they did not have a single market channel that addressed lawn-care equipment!  GE ended up selling it to Bolens for a fraction of the development cost.  And, in retrospect, it was premature given the current fascination with electric vehicles!

I am not implying that IBM hasn’t done its homework on IBM Watson.  I suspect it may be more of two other factors at play.  One, it’s a question of chicken and egg.  Is the advancement of Artificial Intelligence more about the application or the platform?  Secondly, does IBM have the infrastructure to succeed?  In the case of the first factor, IBM is more about the platform than the application.  In the second case, the same could be said for the platform versus the application, as IBM does not have a significantly parallel channel that would address AI applications.

I think this is why IBM initially acquired Merge Technologies, as they saw it as both a “sandbox” to learn imaging, but they may have also seen it as a potential distribution channel.  With further understanding, they were quick to learn that attempting to develop and market applications through Merge would make them a competitor to other viable players such as GE, Philips, and Siemens.  That resulted in a move to create “consortiums” that could develop applications on the IBM Watson platform, thus broadening the appeal of IBM Watson across a broader distribution channel.

The question going forward is – has IBM learned from its history of past healthcare ventures?  If IBM can make a business case for addressing Watson as the platform for AI, it might be a stronger case than trying to be the end point for AI.  This would be consistent with its strength in computational platforms in business, which have classically been a better business model than applications (OS2 or Lotus vs. Microsoft Windows and Office anybody?!). 

I recall the OS2 days versus Microsoft Windows.  As a fan of OS2, I had hoped it would succeed.  Unfortunately, as I learned, there were very few applications for OS2, which is ultimately why people purchased personal computers in the first place.  If IBM had been smart, they would have given OS2 software licenses away in an attempt to build consumer demand for the development of applications.  Unfortunately, that didn’t happen, and I doubt there are any OS2 users out there today.

If IBM can take stock of its history, there is a fighting chance for IBM Watson to be a significant factor in healthcare.  But, the company will need to learn how best to foster the development of AI applications.  In his blog, John Lynn relates the experience of Lukas Wartman of the McDonnell Genome Institute at the Washington University School of Medicine in St. Louis, who laments on how much faith one can put in the results (of using Watson).  As with past technologies, we are at the tip of the iceberg in terms of applying the technology.  Here’s hoping that IBM can figure this one out, be in it for the long game, and live up to the hype of IBM Watson!


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Analyzing Blockchain’s Evolution in Healthcare: Two Experts Dive into the Details

August 15, 2018
by Rajiv Leventhal, Managing Editor
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Two healthcare leaders at KPMG believe that blockchain activity in healthcare will ramp up in the next 12 to 24 months

Earlier this year, five prominent healthcare organizations—Humana, MultiPlan, Quest Diagnostics, and UnitedHealth Group’s Optum and UnitedHealthcare—announced they would be launching a blockchain-based pilot program with the aim to improve healthcare data quality and reduce administrative costs. The organizations said they would be specifically examining how the technology could help ensure that the most current healthcare provider information is available in health plan provider directories.

While many more details of this initiative are not yet known, this announcement has opened the eyes of other healthcare IT leaders who have become increasingly curious about this emerging technology. For instance, at the Nashville Health IT Summit earlier this summer, a senior executive from MultiPlan, which is part of this pilot project, was asked about his perspectives on the research and development work done on blockchain in healthcare in the past few years.

To this point, two leaders at KPMG—Arun Ghosh, the firm's U.S. blockchain leader; and Michael B. Yetter, director, healthcare management consulting—recently spoke with Healthcare Informatics about the impact of this new initiative, what the greatest use cases are for blockchain in healthcare today, and how quickly providers and payers might start moving into full-scale projects. Below are excerpts from that discussion.

What are you hearing about blockchain right now as it relates to its greatest use cases in healthcare? What are people most bullish about?

Yetter: From a client perspective, things are a bit on the early side. But [we often see that] as many emerging technologies gain momentum in some other sectors, you will see the pathway through pharma and then into healthcare with payers and providers. We are seeing that same pattern here. On the ground in the healthcare space, especially amongst payers and providers, we’re starting to see more interest in meaningful pilots. We have had some earlier adopters doing proof of concepts and pilots—many around claims or aspects of claims management, and some around the regulatory impacts of the supply chain.

Michael B. Yetter

We are starting to see the nature of conversations around what those use cases could be become increasingly sophisticated around things such as consortiums on provider data, and making sure the historical challenges around getting provider data to agree across multiple entities—who are either submitting or processing claims—that those specific data elements or attributes or shared or reconciled in a better way. So that’s one good example for where you are starting to see collaboration.

Ghosh: The additional capability that blockchain provides, versus traditional EHR (electronic health record) systems, and other enterprise technology that exists today, is that from the time of an encounter to the time of discharge, we see blockchain being piloted around records and interactions with the patient, but also interactions with the pharmaceutical ecosystem—from drug provisioning or procurement to drug administration. Even with the Obama administration saying that we need EHRs across the board, it’s still nascent in terms of who has access to what kind of record and what kind of electronification exists.

Arun Ghosh

So blockchain is coming as the next level of granularity: if we can provide immutable records that are now at the time of pre-diagnosis all the way to wellness, we can track getting better, but also not returning to the hospital. Now, we have a story. Between payers, providers, pharmaceuticals, and distributors, we are seeing varying levels of interest and adoption. They are saying, “let’s pilot a certain part of this,” but there is still no end-to-end view yet, from what we have seen.

What are your thoughts on the MultiPlan/Humana/Optum/Quest/United initiative? Would you classify this as a meaningful pilot?

Yetter: From an outside view, and we haven’t been directly involved, it’s my understanding that this collaboration is focused on provider data sharing. I would classify that as more meaningful because they are bringing multiple parties together to solve for a specific use case and problem. So it goes beyond the earliest conversations, going back a year or more, that were more about learning and understanding the technology. Now they are saying that they get the technology, so let me apply this to a problem we have and something that we can enhance in the industry. And seeing multiple big players involved is encouraging.

Some have said that the greatest use of blockchain in healthcare could be improving on how HIEs (health information exchanges) operate today. Do you agree?

Yetter: I don’t think this is achievable in the short term, and there is the bigger picture of truly getting to a complete HIE—and when I say complete, I mean the truly clinical data that is shared between entities, and ideally something that is more accessible to the patient. The ingredients are there for blockchain to make that significantly more usable, and something that can be potentially controlled and accessed by the actual patient or member. And the patient or member can then have the ability to access the information, and also to permission through some of the mechanisms through blockchain, the sharing of that data or specific parts of the data to others who need it in the healthcare environment. There is a lot of good capabilities there that will evolve in this direction to have blockchain enabling more advanced HIEs, but it will be several steps along the pathway before we truly get to that transformation.

Ghosh: Part of this [potential] disruptive model is that it’s the true democratization of healthcare data—if my data is now being “streamed” into a blockchain, I have ownership of it. So the hypothesis of value here is that if the individual can control his or her data, and then can choose who to share it with—the plan, provider, or someone like Nike or Under Armour—the concept is that there are rewards, such as avoiding rehospitalizations.

How can healthcare organizations better prepare their infrastructures now to implement blockchain in the future?

Yetter: I think the blockchain [implementation] would be more of an add-on, especially in the near term. And I think you will see some of the major vendors out there, be it EHR or adjudication systems, start to consider and build in aspects of blockchain into their own platforms. So there will be a broader enablement that will naturally flow into the infrastructure as it moves forward. But in the near term, there is a good opportunity to add blockchain capabilities to what they already have, and then leverage it for specific cases of pilots or at-scale activities.

Ghosh: The big thing to recognize is that the way enterprise blockchain is evolving, from an infrastructure perspective, it is becoming augmentative rather than disruptive. So you can take an EHR and then you can augment the whole EHR workflow, from encounter to discharge, on the blockchain, [while maintaining] what the traditional EHR looks like. You don’t have to transmit all the data, like you would do in a data warehouse, into another ecosystem. You can leave it as source and hash parts of it on the blockchain as you build the blocks along the workflow. The enterprise blockchain vendors are making this easy to adopt.

There has been plenty of back-and-forth about just how much security blockchain can provide. What are your thoughts on this?

Ghosh: Anytime you encrypt data, it can always be decrypted. A blockchain is nothing but a distributed database at the end of the day. If you have access to that database that doesn’t have a consensus mechanism attached to it, then it is a little insecure. Looking at the T.J. Maxx breach a few years ago, people were swiping their credit cards and the transmission from the point of fail system to the storage system was being intercepted; that was the hack. In the same way, from the time that the traditional system would write to the blockchain, you can intercept that data, and that’s when the insecurity could come into play. And those standards are still evolving. There is no vendor out there that can not only encrypt the transmission protocols between source and blockchain, but also ensure that the blockchain itself is secure.  

What predictions could you offer for blockchain’s continued evolution in healthcare?

Yetter: In 12 to 24 months, you will see a lot of fast-moving activity, and with the changing nature of conversations and the work being done now, there is a clear signal that we are at a bit of an inflection point. But I think we will accelerate the meaningful work in this space and bring the technology in. Going back to the idea of acceptance and use of emerging technologies in other sectors first, we are seeing blockchain in place in financial institutions in meaningful ways. So in the next year or two, I think we will see the same thing in healthcare, whether it’s aspects around provider data, or getting into exposing things to the patient or member so they have greater control. We’ll see a lot of energy and investment in that space.

Ghosh: I think that beyond the pilots that you see today, the voice of the customer will be increasingly automated with enterprise blockchain. Within healthcare, the issue is, how do you provide greater autonomy, depending on who has the data and where? It’s not one or two companies that are trying to do something; it’s five or 10 that want to get together before someone else beats them to it.



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