It's no secret that American healthcare is rife with inefficiencies.
Core functions like data management, billing, clinical research, and patient access are often held together with procedural bandages. The reasons for this are numerous, but the fix in many cases is the same: A decentralized blockchain architecture for healthcare data.
We're not the only organization that realizes this. As Shaun Sutner at SearchHealthIT reports, tech giants like IBM, Intel, and Google are investing heavily in blockchain offerings that can be applied to healthcare. In fact, PokitDok uses Intel's open source Hyperledger Sawtooth as the underlying ledger for our healthcare on blockchain solution, DokChain. Blockchains are one of the major tech stories for 2018, and "the technology has much hope riding on it," Sutner writes.
Where, specifically, do those hopes lie? Who stands to benefit most from the implementation of healthcare blockchains?
Though this is by no means a comprehensive list, there are four clear groups who will benefit from the efficiencies that blockchains will create in American healthcare. Those groups include the executive teams at care providers, payers and insurers, clinical trial sponsors, and patients themselves.
1. Executive Leadership of Providers and Care Systems
As we have previously written, digitizing health records in America is an ongoing struggle. While electronic health records (EHRs) should ostensibly create efficiencies, difficulties with interoperability and onboarding have proved much tougher challenges than lawmakers originally envisioned.
Marvin Dumont, a senior editor at Bitcoin.com, writes that blockchains introduce a path for extracting the long-promised value from EHRs.
The standardized nature of blockchain data will ease the interoperability problem, and the data contained in each block is free from falsification or manipulation. Robert Barkovich, CEO of Health Linkages, explains that providers can now trust the integrity of the data that their systems use. "Blockchain lets us agree on history, even if we don't all agree or trust each other," Barkovich says. "There's no need for a trusted third party -- it's all there in the chain."
Information on a blockchain is far easier to store, move, and manage. "Healthcare organizations and firms can use blockchain for record management and bridge traditional data silos, thus increasing efficiency and keeping business and medical data safe," Jyoti Bharwani writes at Clutch.co. "Blockchain will also streamline the entire process for patients to access their medical records and share the data in a more secure way."
When healthcare data can flow freely and securely, provider-payer relationships improve. Insurers can confidently offer incentives for healthy behavior, because that behavior is documented and verifiable on a patient-profile blockchain.
"Speaking from the position of a health care industry outsider, I would say that payments are ripe for blockchain, as well as creating patient incentive structures for healthy behaviors," says Lee A. Schneider, a partner at McDermott Will & Emery.
The incentive structures Schneider describes could be akin to the safe driver discounts that auto insurers provide to customers. Health insurance customers who demonstrate consistent, verified healthy behaviors -- e.g. an hour of daily exercise, recorded by a fitness tracker and noted on a blockchain-based patient profile -- could then qualify for discounts. This would allow payers to potentially deepen their customer relationships and find new ways to capture value from those relationships.
3. Clinical Trial Sponsors
Like health insurance, clinical trials are another associated industry in which free-flowing health data could prove revolutionary.
In fact, Maria Palombini at the IEEE Standards Association argues that data at the quality, scale, and level of security that blockchains augur could unlock massive sources of value in clinical trials.
At the moment, however, that value goes unrealized because legacy methods of data management force people to prioritize data privacy at the expense of data sharing -- a choice that "has more detrimental effects on patient safety and the future of healthcare," she writes.
Case in point: Patricio Robles at Econsultancy reports that "approximately half of clinical trials go unreported and nearly 90% of trials on ClinicalTrials.gov don't have results." This is a data liquidity problem, but one that blockchains could solve. In doing so, blockchains could get crucial clinical trial data to the organizations that need it.
Many clinical trial directors face an even more pressing problem, however: Trust in their data has been eroded over time. Trials held overseas, for example, might not be subject to the same data transparency laws, and this creates opportunities for unscrupulous researchers to misreport findings.
The transparency of the public-ledger model blockchains offer could fix that, writes Anca Petre, PharmD, co-founder and COO at 23 Consulting. "If companies use this tool they will have to come to a consensus with all the stakeholders in the network before being able to register any information on the blockchain, the stakeholders therefore becoming midpoints taking part in the trial or regulatory organizations supervising the process."
"The advantage of such organization is that the more people defending different interests there are in the network, the more chances there are to only register authentic and reliable data on the blockchain."
In each of the three points above, the central stakeholder has been the patient. This is the person whose healthcare data must be secured -- even at the cost of wider industry learning, and rightfully so.
While blockchains will make it easier for patient data to move from system to system, it is the patients who will control access to the data via simple consent protocols. That's a safer and more scalable model for securing patient data than current systems facilitate.
Why? Because this model makes the patient the primary decision maker regarding their health data, says Anthony Back at The Blockchain Review.
- If a provider wants to share a patient's data with a payer, the patient must consent.
- If a pharmaceutical company wants access to a clinical trial participant's qualitative responses, the participant must consent.
- And if either patient in the previous scenarios needs to revoke access for any reason, blockchain databases would allow them to do so.
Blockchains will empower patients in additional ways. For example, just as they would give providers verifiable proof of any data point's provenance, they would allow patients and consumer advocates to trace a drug's entire supply chain.
Raja Sharif, founder and CEO of FarmaTrust, is building a product to make this easier for everyone in a person's healthcare ecosystem. Because a drug's provenance can be securely recorded and made immutable with a blockchain, Sharif says, a patient can verify -- not merely trust -- that any specific drug is authentic.
Realizing These Benefits
For payers, providers, and other healthcare executives worried about the cost of implementing blockchains, it's important to point out that the technology will not likely replace databases outright.
Blockchain implementation won't require a teardown of legacy systems -- including all of the costs such a project implies.
Rather, David Houlding, director of healthcare privacy and security at Intel Health and Life Sciences, says to think of a healthcare blockchain as "more of a business-to-business middleware." This would provide the connective tissue that allows existing systems to talk to one another much more efficiently.
That's a deceptively profound disruption in an industry where fax machines still do much of that work. Meanwhile, as industry stakeholders begin to explore the core benefits that blockchain technology affords them, new opportunities to create and capture value will arise.
This is what happens when you create efficiencies in industries so full of inert value.
PokitDok is doing its part to make healthcare more efficient and secure. DokChain, our healthcare on blockchain technology, is ushering in major benefits for patients, providers, and payers alike. Read our whitepaper.
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