- Interest in healthcare blockchain continues to grow as organizations realize the potential data sharing advantages. Blockchain is not currently used in healthcare, but open source projects, such as Hyperledger, are working to develop blockchain standards that can eventually be used in healthcare.
Entities are showing genuine interest in blockchain and are currently working on projects for future adoption, according to Hyperledger Executive Director Brian Behlendorf.
Last year the Department of Health and Human Services (HHS) hosted a healthcare blockchain essay contest in response to vendors approaching the agency and suggesting uses for blockchain in healthcare for provider directories and EHRs. The contest gave HHS a broad pool of examples from vendors and providers alike to get a better grasp on the potential reality of healthcare blockchain implementation.
Submissions ranged from directories of doctor certifications to payment and claims processing workflows.
Coordinating workflows that involve several different parties have always been a challenge in healthcare. Blockchain could be the answer data exchange among providers, payers, and patients.
“Entities are often coordinating data flows between several different parties when processing payments,” Behlendorf told HITInfrastructure.com “Allowing patients to have visibility into processing these payments could be extremely valuable. This is what many would consider to be the Holy Grail; blockchain could be used as a means to enable or better facilitate the transfer of medical records.”
“With blockchain technology we have a chance really put the patient back at the center of health information exchange.”
Behlendorf believes blockchain can take advantage of the healthcare standards community including FHIR and HL7 to contribute to building a mechanism to keep track of a discovery process. Records relating to a patient will be accessible to all parties involved to attest to the truthfulness and accuracy of the data.
“When a pharmacy receives a prescription from a patient, they can see that it was signed by the appropriate doctor at the appropriate clinic because there is an audit trail,” Behlendorf explained.
This gives patients the opportunity to insert themselves into the record sharing process so they can authorize what data is shared based on what information a specific provider requires.
A patient can authorize her primary care physician to share her basic health history such as blood type, and chronic conditions so they can be easily accessed by an emergency care provider. All the while, other more sensitive data, such as HIV test results, remain private.
Behlendorf used the metaphor of a wallet to explain why blockchain fits with modern patient and provider demands.
“People today are growing used to the idea of managing their Bitcoin or their Ethereum like a mobile wallet environment,” he stated. “Patients can potentially do the same thing with their medical records. They can manage them as a collection of data that they could decide to share with others with the integrity checks involved in blockchain technology to know that the data that they receive as well as what they send is verifiable and the exchange is documented with an audit trail. That would make a huge dent in patient acceptance of digitized medical records and perhaps even turn them into drivers of adoption reluctant organizations.”
Healthcare blockchain is currently being developed, but organizations can’t sit idly by and wait for the technology to be developed for them.
“Many of the health IT organizations I’ve met in the past realize that they are fundamentally a technology company and they can’t sit around and wait for IT vendors to deliver perfect finished solutions to them,” said Behlendorf. “They need to be more proactive in understanding where emerging technologies have an impact on their industry and putting aside a small chunk of the money they spend on IT into developing capabilities and skills.”
Hyperledger has healthcare organizations involved in their blockchain development, including Kaiser Permanente and Change Healthcare. Neither have launched a blockchain solution, but they are highly involved in figuring out what they need to do when the first pilot is ready.
“The healthcare companies have moved well into the proof of concept stage,” Behlendorf stated. “Many of them have done internal tests, standing up the solution to see what it’s like to move records around.”
Organizations need to be prepared and discover what challenges may arise when implementing blockchain as part of the health IT infrastructure.
“These things take time, especially if an entity is suggesting that blockchain can be a system that replaces a system of records that they might otherwise use for management of patient records,” he continued. “There will be a barrier to getting to some organizations like Epic or Cerner to adopt blockchain technology. They believe control over that data is essential and their picture of integration is sharing records with other clinics who are also running they’re software because Epic to Epic or Cerner to Cerner is not a hard thing to do.”
Organizations that are focused more on providing quality care and managing their costs and development around that will be more successful when the time comes to implement blockchain in healthcare.
“Adoption of blockchain technologies will be driven organizations basing their development on providing better quality care much the same way the regional health information exchange concept kicked off digital health data-sharing. In some jurisdictions data exchange worked pretty well,” Behlendorf explained. “The problem was it did create silos or islands of data that can hopefully be avoided with blockchain.”
Hyperledger has a healthcare working group that was established last year to guide organizations on blockchain and where it’s headed in the healthcare industry.
“The group shares questions and ideas with the hope that it’ll trigger opportunity for proofs of concept and for pilots, as well as help us understand technologies that could be used equally as well among healthcare, finance, and supply chain settings,” Behlendorf said. “Sometimes there are sector-specific needs that could use our collective ideas.”
The healthcare working group is mainly a discussion forum to share ideas so the blockchain technology developed for healthcare has as many people and organizations developing and improving it as possible. Blockchain cannot be adopted in healthcare if organizations are not communicating, working together, and preparing for it.
“That kind of communication might feel like a lot of overhead, but there’s no such thing as a chain of one,” Behlendorf stated.
Essentially, healthcare organizations need to open up communication and work together to benefit from blockchain.
“For us to really get some value out of changing our data sharing networks to use blockchain, it has to start with a collective set of needs, with a set of organizations saying, ‘We have a common need. Let’s invest jointly,’” he concluded. “Each of us needs to put a little skin in the game and be willing to move outside of our comfort zone to do a real solid proof of concept, a real solid pilot and to move to production and confidently understand the technology. That takes time and conversation.”