Blockchain: The building-block for better healthcare

The issue of data silos and fragmented care has long been a detriment to powering a truly modern healthcare system. Across the healthcare ecosystem different entities have their own data stores and they exist independent of each other. The inability to share data across these silos has for long lead to administrative delays, higher cost of care and consumer frustration. It is estimated that the US health care industry spends more than $2.1B annually to maintain provider databases and 75% of this cost could be eliminated with a “single source of truth.”

As lines continue to blur across the health care sector, data accuracy and sharing are becoming the linchpin of cost containment. Blockchain, with its promise of creating a common source of data for organizations across the healthcare ecosystem is now seen as the solution to this complex problem.

Simply put, blockchain is a digital ledger of transactions that are chronologically recorded and tamper resistant. It is a chain of data or transactions linked together by cryptographic signatures, stored in shared ledgers, and supported by a network of connected processes called nodes.  

Blockchain technology enables participants in a group to securely share information while providing complete transparency in terms of who exchanged what and when. This information instead of being stored in a single location is stored across multiple nodes, which makes it extremely difficult to tamper with or delete. To understand this better, let us consider an example of a blockchain network implemented for a group of insurers to maintain provider information. If one of the insurers calls up a provider and updates their information, this information becomes available to all other insurers who are part of the network. This is beneficial for everyone, as it reduces the effort for all other insurers and the provider.

Reimagining healthcare with Blockchain 

Blockchain technology emerged more than a decade ago as the backbone of the digital currency bitcoin, but the healthcare sector has woken up to its far-reaching impacts only in the last 4 years. Some of the areas where blockchain technology can make a huge impact include: 

Real-time access to health records for informed care delivery: By ensuring easy access to data, blockchain can help improve care coordination among different service providers. This can be quite useful especially in case of emergency, wherein care providers can retrieve the entire medical history of the patient, even if it exists outside of their data network and thus make quicker and more informed decisions about the right care path.

Secure sharing of electronic health records, powering clinical research: Blockchain technology provides health IT systems with a single transaction layer, where organizations submit and share data with the help of a secure system. It thus has the potential to address current interoperability challenges that can enable individuals, health care providers, health care entities and medical researchers to securely share health data, including radiographic images and any other supplementary data. This information can be masked and utilized in conducting clinical research.

Remote monitoring: With an increase in the adoption of Internet of Things (IoT), there is a deluge of health data that is being generated. It is estimated that 40% of IoT technology is utilized in healthcare, more than any other sector, making up a $117 billion market. This huge amount of data needs to be recorded and conveyed in a secure manner in order to gain relevant insights and suggest appropriate treatment measures, specifically for remote care. To make this possible, Blockchain provides a trusted and unalterable log of transactions that can help in making this possible.

Speed up and simplify the revenue cycle: As the focus of the health care system shifts from fee-for-service model to value-based care, providers have to deliver improved healthcare services at low cost. However, this is easier said than done. In a traditional revenue cycle, when a provider creates a claim, they typically send it to one or more clearing houses or networks. From there, it goes to the payer for approval, who in turn would then initiate payment from their own financial institution to the provider. In this complex workflow, multiple systems are trying to communicate for the same event. Blockchain can provide a shared ledger that each user can view as per permissions and thus speed up the entire process. Smart contracts can also be used to capture the specific terms and conditions of the insurance contract and automate the approval process.

Challenges and considerations for adoption of Blockchain

There are lot myths that exist around blockchain. Healthcare organizations are currently experimenting with the technology, trying to understand how it can be effectively utilized and what internal changes may be required to derive the maximum value. In doing so the following aspects should be considered 

Privacy: The traditional Blockchain paradigm is complete transparency but in health care not all transactions can be completely transparent for everyone. Private information on a chain is by definition visible to all other network participants. Hence, storing personal health data on chains raises concerns around disclosing details and identities of patients, providers, suppliers, supply chain management, and management of dynamic patient consent to data uses, as data cannot be erased or altered. 

Liaising to enable sharing of information: Blockchain is most useful in cases where organizations share information and help automate mutually beneficial practices. This requires formation of alliances, which can only be established on a foundation of a shared culture, trust and cooperation with competitors. 

The need for established standards for Blockchain adoption: Healthcare is a distributed system wherein there is usually a lag in technology adoption. To add to this, different entities handle records differently. Hence, without a streamlined system, it is difficult to pull different entities together to accept change. The problem of interoperability between the large number of blockchain networks is mainly due to a lack of industry-wide universal standards for various blockchain protocols. Such standards can help enterprises collaborate on application development, validating proofs of concept, and sharing blockchain solutions.  

Regulatory and compliance considerations: Primarily, blockchain has shared distributed ledgers and in terms of jurisdiction, each node can be a subject of different legal requirements. Secondly, to be recognized as an immutable and tamper proof technology, blockchain needs legal, standardized regulations for authentication purposes. Also, without secure cloud services incapable of corruption at scale, a complete execution of blockchain in healthcare is open to potential security vulnerabilities and legal repercussions. 

Blockchain as a building block for better healthcare

The potential of Blockchain in healthcare is immense. However, to implement and accept this change, the healthcare community must build the technical infrastructure. There are speculations and misconceptions regarding the incorporation of Blockchain within the current healthcare system, and it is pertinent that healthcare organizations deliberately explore and how blockchain can help them leap in their business.

The article is authored by Tahir Hasan, Director, Software Engineering and Lavanya Vuppuluri, Sr. Product Analyst, Product Management, Optum Global Solutions (India)