Across the healthcare ecosystem, IT leaders at patient care organizations are still grappling with the critical issues of seamlessly exchanging health data across systems and also being able to properly secure it. Indeed, although the healthcare industry is behind most other sectors when it comes to interoperability and security, newfound optimism has emerged in the form of a technology that potentially can help solve both of these challenges—blockchain.
Recent momentum around blockchain in healthcare spurred Healthcare Informatics’ editors to name it as one of our Top Tech Trends for healthcare IT in 2017, despite applications of the technology still being at a nascent level, industry-wide. For a reminder, blockchain technology is most commonly associated with digital currency, and is a data structure that can be time-stamped and signed using a private key to prevent tampering.
Applied to healthcare, blockchain would offer the potential of a shared platform that decentralizes health data without compromising the security of protected health information. Chris Kay, chief innovation officer at the Louisville, Ky.-based Humana, offers a specific example of its prospective use in healthcare: “Imagine that you go to the doctor today and get a blood test, but you need to see a specialist, so a referral is made. But your health records don’t come with you; you show up to the specialist as a new patient. Here, you get a poor customer experience with a lot of friction in that system. But what will it look like in a distributed ledger world where there is cryptography and trust built in such that you as a consumer has a note on the blockchain that contains your health records? The provider who was contracted with an insurance company has the payments and scheduling on separate notes. As that provider makes a note, or does a procedure or a surgery, that becomes an indelible block on the ledger. You are building your health history over time.”
Just as importantly, noted Micah Winkelspecht, founder and CEO of Gem, a Venice, Calif.-based startup developing a blockchain application platform, in an interview with Healthcare Informatics last summer, when the interaction happens, “It becomes your integrity layer, in terms of keeping a time-stamped registry of every document, so no document can be modified without others knowing. And it provides the authenticity layer because every action is authenticated and recorded on the blockchain, so you know who is doing what with the data and at what time.” Winkelspecht, whose company is now focusing more on healthcare and has partnered with the Philips Blockchain Lab, refers to blockchain as the “universal source of truth” and “the interoperability model for how EHRs [electronic health records] should work.”
In a more recent interview, Winkelspecht notes that this shared ledger “is not owned or controlled by any one company, but instead acts like a public utility for the entire industry.” The end result is the patient’s complete medical history, with each transaction linked together by a ledger—but not in a centralized place such as a health information exchange (HIE). In fact, this is what separates blockchain from an HIE, some experts say—there is no one organization holding all of the data in one place, but rather separate entities each holding a “token” on the chain.
“Blockchain effectively takes out the middle man; conceptually you would not have these health information exchanges that have struggled to get to mainstream,” explains Vince Vickers, KPMG’s healthcare technology leader. “There have been a lot of good efforts in certain states, and some HIEs have done well, but in relative terms, [compared] to the financial services industry—where I can go to an ATM, no matter where I am in the world, and get my money—patient data obviously is very limited in that way. And the HIEs are very slow moving. So blockchain is a really interesting disruptor. When you put it in those terms, that it could potentially, not necessarily eliminate HIEs, but at least change them structurally and provide a new value proposition, I see it as potentially picking up a lot of steam,” Vickers says.
Blockchain has recently caught the attention of federal healthcare leaders as well. The Office of the National Coordinator for Health Information Technology (ONC) last year held a “Use of Blockchain in Health IT and Health-Related Research” challenge, which involved soliciting whitepapers on blockchain’s use in healthcare. The agency named 15 winners spanning across the industry, and one key lesson learned from the whitepapers, according to Steve Posnack, director, Office of Standards and Technology at ONC, is that blockchain can complement, enhance and supplement existing infrastructure. “In these types of explorations with its use, there is potential to automate certain things that are routine transactions that otherwise involve human adjudication right now. This [includes] clinical health data exchange or administrative transactions such as financial payments on the claims side,” Posnack says.
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