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Why Blockchain May Not Be the Solution to EHR Interoperability

Lack of patient interest in maintaining their own records and data retention could prevent blockchain from curing EHR interoperability.

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By Elizabeth O'Dowd

- Blockchain is causing a stir in healthcare as organizations look to the technology to solve the EHR interoperability and data security issues that have plagued the industry for many years.

The potential for healthcare blockchain has been widely viewed as positive especially when it comes to the perceived advantages the technology has for secure data sharing.

Entities are showing genuine interest in blockchain and are currently working on projects for future adoption, according to Hyperledger Executive Director Brian Behlendorf.

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.”

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

The most general use of blockchain in healthcare is using it for EHRs and putting the patient at the center of his or her own care.

Behlendorf elaborated that patients are generally growing used to managing their own everyday electronic records, such as bank accounts and Bitcoin, and will be interested in managing their EHR the same way.

One of the biggest potential downfalls of blockchain in healthcare though is the fact that patients may not want to be in control of their records, according to VMware Senior Healthcare Strategist Chris Logan.

“The healthcare organization is just a holder for that data, we don’t own it,” Logan explained to HITInfrastructure.com at VMworld 2017. “At the end of the day ownership is back on the patient to request that information or store the information as they see fit. From a compliance perspective including certain mandates healthcare providers have to conform to, this is where blockchain falls a little flat.”

“People don’t want to own their records and that has been proven time and time again if you think about the personal health records that were available to people many years ago,” he continued. “How many people actually took advantage of it?”

READ MORE: Healthcare Blockchain Frameworks Emerge as Demand Rises

Patients becoming the center of their own care and controlling how their EHRs are distributed only works if the patients are willing to use the EHR tools provided to them. 

Blockchain may also cause concern in healthcare when it comes to data retention periods. Organizations only store patient data for a set amount of time.

If a healthcare organization has a patient record, the organization may choose to keep certain data (i.e. case studies and diagnoses) for future use in analytics. All of the other data is disposed of because the organization is not obligated to keep it.

“If I apply blockchain as a theory to health records, they live on forever which defeats the purpose of my data retention period,” Logan explained. “It’s tough for a healthcare organization to apply blockchain to records that are going to live on forever. That could be very harmful there could be a big risk involved with that.”

Blockchain may not be the interoperability solution for EHRs it’s built up to be. However, that doesn’t mean that there aren’t other uses for blockchain in health IT infrastructure.

READ MORE: Healthcare Blockchain Set to Digitally Transform Health IT

Blockchain does have utility elsewhere and can potentially be applied to clinician service delivery as a way for IT administrators to ensure clinicians are accessing the correct tools.

“If you look at the future of delivery around VDI within containers, blockchain could be a potential opportunity to ensure the container’s security by writing to a ledger,” said Logan. “We know what the known state is so as the clinician accepts that ledger and pulls it out it should match the known state. If it doesn’t match, we don’t give it to the clinician.”

“It’s preventing harm from happening in the operating environment so we bring it up and run it without having bad things happen on the back end,” Logan continued. “There’s utility there, it just hasn’t been fully fleshed out yet.”

Many vendors and healthcare organizations are looking to blockchain to cure interoperability issues but using it for EHRs can’t really work unless there is a national patient identifier, Logan explained.

“Until we have a national patient identifier, blockchain is worthless,” he maintained. “How am I supposed to know it’s your record at the end of the day, if I don’t know it’s you? One of the biggest problems healthcare organizations have is identifying the patient when they come into the organization.”

Blockchain may have potential in healthcare as many projects are working on building models that can successfully be deployed. Even so, organizations need to consider that blockchain may not be the future solution to all EHR problems.