Considerations for Planning Healthcare Blockchain Adoption

July 18, 2018 - Healthcare blockchain is rising as organizations find ways to apply the technology to improve their business and in turn improve patient care.

Payers are currently using in the healthcare blockchain as a way to securely track transactions with providers. And now the latter are beginning to implement blockchain as a way to smoothly exchange information among different health systems.

Obesity PPM, a population health and disease management service located in the nation’s capital uses blockchain to collect accurate information on patients to give clinicians better insight into obesity and what causes it. Former Obesity PPM CEO and health IT subject matter expert Heather Flannery played a large role in expanding the use of blockchain for population health and exploring the factors that contribute to obesity in patients from different geographical locations and backgrounds in the United States. 

Achieving clinical integration across healthcare specialties has posed a significant challenge from an IT infrastructure perspective.

“Enabling orchestration of clinical and business processes across organizational boundaries within healthcare delivery and under different payer environments has been challenging,” Flannery told HITInfrastructure.com. “Through all of that you can imagine how distributive ledger and blockchain technologies were in my laser focuse as key enablers of missions that I’ve been working on for years prior to the availability of this technology.”

READ MORE: What Does Blockchain Mean for Health IT Infrastructure?

Blockchain works well with the Obesity PPM business model as a managed service for health system customers. The company essentially acts as a custodian of a large volume of health system data, according to Flannery.

“Before blockchain we’ve orchestrated business and clinical processes, computed on that data, engaged the patients through many modalities on that data, and coordinated complex care,” Flannery explained. “Each of our health system customers is located in a different geographic area. They have a different payer mix, different demography of patients, different prioritized disease states, different business opportunities, and different research agendas. They’re all discreet and they’re part of different ecosystems.”

In order to be seen as a value-add for healthcare systems, Flannery needed to confidently address interoperability issues by presenting blockchain as an impactful and vital tool that will help complete their goals.

“I needed to make sure that I could go to my health system customers and tell them that it makes sense to add a blockchain systems,” said Flannery. “That I can enable blockchain end-to end without the customer needing to do a single thing because I’m already managing their data. I’m already computing on and administering their data and engaging with their patients.”

Obesity PPM added blockchain as a service to the health IT service providers had already purchased. However, Obesity PPM could not orient their business around one blockchain framework or platform. Working with different health systems spread across the country meant that they would be administering and running different business and clinical processes. A single patient could have their data move on and off multiple blockchain solutions and Obesity PPM needed to deliver visibility to their customers.

READ MORE: Why Blockchain May Not Be the Solution to EHR Interoperability

In 2014 different toolsets began to emerge that made distributed ledger architecture possible.

“Prior to 2014 if you wanted to do any kind of development work it had to be at an engineering level, protocol level, network level, and application development versus using the kinds of developer tools that most of us have become accustomed to. It was a little bit out of reach early,” Flannery explained.

“My infrastructure at Obesity PPM was built on the salesforce.com cloud,” she continued. We had integrated 18 different applications into that salesforce.com health cloud and did a tremendous amount of custom development over many years and had very sophisticated analytics. Even some getting towards prediction earlier than most. I had invested in IT infrastructure that couldn’t be removed from the discourse when evaluating how to take advantage of blockchain technology.”

Flannery was in need of an efficient and cost-effective technology that would work strategically in the Obesity PPM Salesforce.com environment. Blockchain vendor Daps.ai ended up being an early supporter of Obesity PPM’s blockchain efforts.

“Dap.AI built a blockchain application management tier,” said Flannery. “It was a suite of tools that made it easy to write and administer smart contracts, and connect with blockchain nodes on multiple clouds with Azure and AWS both supported. We sewed this up in our development environment and ran test cases on both Ethereum and the Hyperledger Fabric.”

Following successful testing, Flannery began negotiating with the organization’s health system customers to conduct a production-level pilot using their data.

Once tests were run the overall focus shifted away from solutions for engineering data exchange solutions to facilitating data privacy and security. How could the data remain secure when it was being shared efficiently among health systems?

“Blockchain is not a technology that makes any sense in isolation, but rather in collaboration and community,” Flannery observed. “That’s where the focus has been. There are productive dialogues in progress about actually using the technology, but for many organizations it is too early from their point of view. There are too many pieces of regulatory uncertainty in privacy and compliance. It’s just slightly out of reach when dealing with actual patient data versus provider credentials, or supply chain, or logistics and things like that.”

Flannery is part of a blockchain workgroup with the goal of expanding knowledge of blockchain throughout the healthcare industry and proving the usefulness of the technology to the future of health data exchange. The group drives and advances realistic uses for blockchain in healthcare.

“The blockchain work group collaborated on a peer-reviewed publication which was exciting to be a part of,” said Flannery. “This was one of the reasons why I have this perspective about how many challenges are still before us with respect to being able to use this technology for clinically integrated care coordination across organizational boundaries. I’m excited about working on those barriers.”

Health IT vendors and providers should look at the big picture when considering a future with blockchain. Sometime one method or tool will not be enough to support a fully functioning distributed ledger solution.

“Often times when there’s an early adoption an organization wants to just try something minimalist and small,” Flannery concluded. “The challenge with that is blockchain needs to be tested as a functioning ecosystem of entities and organizations, and if you want to test anything you still need to pull that network together.”

“I would encourage that if a healthcare delivery organization is thinking about doing something with blockchain, they should be thinking about doing it with at least a handful of their key partners. Just a healthcare delivery organization on their own is not the best way to conceptualize the value of the technology.”