Blockchain for the Future of the Healthcare Enterprise

By Andy Aroditis, CEO, and
Daniel Cidon, CTO, NextGate
Twitter: @NextGate
Twitter: @andyaroditis
Twitter: @dcidon

During the next decade, the healthcare industry will gradually increase adoption of blockchain technology to address nagging issues that have plagued the healthcare IT enterprise since it feverishly began digitizing health records.

When blockchain’s use becomes more ubiquitous, the architecture will take its place as a tool that complements existing and foundational patient data management solutions like EHRs and enterprise master patient index (EMPI) databases. But for now, health IT executives are still figuring out how they’ll apply blockchain to advance their mission.

In recent years, issues around data security, lack of interoperability between disparate systems, and the need to access medical data on demand are just some of the use cases prime for blockchain application.

As digital innovation matures and the exponential growth of patient information intensifies, CIOs and other health IT leaders are exploring novel use of artificial intelligence, machine learning and blockchain to create efficiency, strengthen data security, and improve care delivery.

While machine learning and AI in healthcare are becoming more prevalent, blockchain has been slower to gain traction. However, that will change, as the industry recognizes that blockchain extends far beyond bitcoin and other cryptocurrencies.

According to Acumen Research and Consulting, the global blockchain in healthcare market will value more than 1.7 billion in 2026, and will have a compound annual growth rate (CAGR) of 48 percent during 2019 to 2026.

Research from Global Market Insights, Inc., shows a similar trend. Global blockchain technology in the healthcare market will be worth more than 1.6 billion by 2025. Driving blockchain adoption in healthcare, the report states, is the data exchange and interoperability component of blockchain, as well as using the technology for reducing operational costs and maintaining data privacy.

Many healthcare executives tout blockchain as a technology that can drive trust, transparency and integrity of patient data used in diagnosis, treatment, payment, prescriptions and research. Understanding how blockchain can be leveraged, however, requires “what” the solution is and “where” it can fit into the healthcare IT enterprise.

Blockchain basics for identity management
Blockchain is a system of sequenced transactions that are timestamped and difficult to change. The chain holds the sequence of all actions within the ledger so that the records are linked from the very beginning to the most recent. As a shared system infrastructure, blockchain’s appeal is that the information in each block creates a distributed digital ledger among authorized network participants. Authorized participants to the network can be clinicians, health insurance companies, and pharmacists etc, who have access to an immutable record of peer-to-peer transactions. Because most blockchain software is open source, the technology can be used to drive the process of data distribution between health IT systems.

Furthermore, blockchain can be leveraged to extend the value of EHRs and EMPIs to enhance patient’s control of their data through the use of self-sovereign identity applications within blockchain.

For example, one of the most valuable attributes of EMPI is its ability to match patients to their records. Through the use of self-sovereign identity and its model of verifiable credentials, patients’ can access an app on their phone that stores their identity and use an ID number and identity information to prove who they are when they conduct a transaction on the blockchain network. This feature of blockchain can enhance patient data security by eliminating other identity providers that may sell, share or fraudulently use patient data.

Additionally, cryptography is a key aspect of blockchain technology which both secures the identity of the sender of the transaction, and safeguards against past patient related records being tampered with.

For those sharing health related data in a blockchain dataset, a transparent approach can foster accountability and information sharing among participants, which is critical to the promotion of interoperability among healthcare organizations and the systems they operate.

On the ground, health facilities continue to make an effort to collect accurate patient data, but poor data quality, errors in demographic information, duplicate records and an inability to match patients with their health records continue to occur. Without interoperability between systems at physician offices, hospital departments, pharmacies and other healthcare facilities, clinicians often don’t have a panoramic view of a patient across the continuum of care.

The inability to access information that provides a comprehensive, longitudinal view of a patient’s records creates inefficiencies, slows physicians’ ability to make informed decisions, and weakens patient safety and patient matching efforts which stymies the ability to improve the quality of care.

Interoperability between health IT systems is challenging
However, in a healthcare landscape that lacks structures to collect, share and analyze data and where mission critical information is often stored on-premise in a centralized environment with local databases, it remains to be seen how well blockchain’s decentralized cloud-based network can knock down the siloes of patient data that still exist.

To its credit, blockchain can prevent unauthorized individuals from accessing patient information. The technology can also simplify the medical billing process by eliminating third parties representing health organizations, and it can help with care team collaboration, process automation and pricing transparency. Still, blockchain cannot do what other data management technologies are already doing at healthcare organizations.

Amazon Web Services (AWS) warns companies that building a scalable blockchain network requires each network participant to manually provision hardware, install software, create and manage certificates for access to the network, and configure network components. In essence, creating a scalable blockchain network can be difficult to create and demanding to manage.

To help build a scalable blockchain network, cloud computing vendors like AWS and Microsoft Azure are improving their blockchain service products that will assist healthcare organizations manage their blockchain initiatives.

To help implement blockchain, healthcare organizations might be better off engaging managed service providers (MSPs) who have the skills, experience and know-how to execute projects of this nature. MSPs can also help healthcare IT executives to tie blockchain technology to machine learning algorithms that can generate deeper health data analysis and insights.

Another technical challenge is that blockchain can be difficult to use. If one participant wants to change the information within a block, all participants must agree. There are also numerous steps required to add information to the system.

As the healthcare system moves toward the value-based care model that ties payments for delivery of care to the quality of care provided, there will have to be greater adoption of blockchain solutions to show its value in healthcare. How blockchain could be leveraged to improve population health, bundled payment initiatives, telehealth, ACOs and HIEs is still an open question.

Another important consideration is whether parties using the technology agree on data governance which includes deciding on who will own the healthcare data and who is in charge of sharing that data. Users will also have to decide how they’ll go about guiding the change management aspect of a blockchain project. Physicians, insurance companies and pharmacies have different processes and procedures that they use to handle patient records. To do the job, MSPs can help their health IT partners to streamline the process.

Despite the challenges, however, blockchain can help to overcome many of healthcare’s interoperability and data integrity challenges facing the IT enterprise. While blockchain in healthcare is still relatively immature, the technology has the potential of putting the patient at the center of health data exchange, while providing an accurate, comprehensive view of one’s care history.

This article was originally published on the NextGate Blog and is republished here with permission.