Last Tuesday, live from the Health 2.0 main stage in Santa Clara, an audience of nearly 2000 saw blockchain at work in healthcare, arguably for the very first time. My VP of Engineering, Tim Dunlevy, and I gave a demonstration of DokChain, PokitDok’s implementation of blockchain for healthcare.
I also announced that Dartmouth Hitchcock Health System, Adventist Healthcare, Microsoft and GE Healthcare, among others are joining us to ultimately define the future of blockchain in our industry through the Blockchain Alliance.
My co-founder and CTO, Ted Tanner, Jr. shared some context on how we’re approaching blockchain when he spoke at the Microsoft Worldwide Partner Conference this summer. He published a deeper dive just a few weeks ago and elaborated on that during a panel discussion at Health 2.0 last Monday. It involved Kaiser Permanente’s Chief Health Information Officer, John Mattison; Adrian Gropper, the CTO of Patient Privacy Rights and Serica’s CEO & Founder, Taariq Lewis. The panel was moderated by Caterina Rindi.
For those who couldn’t make it to Silicon Valley, consider this post your blockchain field report.
Defining Blockchain in Healthcare
Simply put, blockchains are a highly secure network coupled with a distributed database, also known as a distributed ledger. At its essence, a blockchain is used for recording network transactions and runs on standardized rules for writing to the ledger and accessing its information.
Why are we introducing blockchain technologies to healthcare now? The shift to value-based care wasn’t just a shift in economics, it was also a shift in the kinds of technologies required to deliver those economics. It is no longer sufficient to provide interoperability and data exchange to and from EMRs. To accurately capture a patient’s complete episode of care you must connect a highly distributed network of different participants and record all transactions relevant to that patient, some of which may now take place outside the EMR.
In addition, this diverse network of participants must now exchange data in real time, around the clock, to efficiently deliver patient care. Add to that the explosion in device and user generated data that can be analyzed for relevant information and we have completely outstripped what the scale legacy manual processes and 1990s health IT architecture can provide.
Realizing the immense value from a real-time, distributed network like blockchain requires a new class of artificially intelligent (AI) agents, which you may have heard called “smart contracts.” These applications can orchestrate automated business, analytical, and contractual processes on the blockchain at a scale only recently made possible through advances in processing power and efficiency. Participants in a blockchain network can encode and host their most common business processes and contracts on the blockchain as these smart contracts. Whether it’s a BAA or a patient on-boarding process, the blockchain acts as a safe, auditable, always-on coordination mechanism for executing smart contracts which explains why we’re spending a lot of time on them at PokitDok. There’s no such thing as a 9-5 workday, holiday or weekend for blockchain. As my co-founder put it, “Blockchain is invisible. It's going to be the new CPU, and it will be everywhere," running all the time.
PokitDok built DokChain, a healthcare-enabled implementation of the blockchain, to provide a secure network connecting all the stakeholders in a patient’s care, from EMRs to the sensor in their asthma inhaler, and the pharmacy where they bought it. DokChain records all valid transactions across a secure, distributed network, stores the location of relevant data, and maintains and verifies access grants to that data so that all the transactions necessary to confirm and pay for an episode of care or other healthcare event can be securely tracked, verified, and shared.
But, What About APIs?
We still need APIs like those built by PokitDok and others to connect the participants in this distributed network with the blockchain and with each other. In addition, the important services provided by these APIs can be hosted on DokChain for consumption by all network participants, as well as executing smart contracts of their own. Each of the over 4000 third party applications currently built on PokitDok’s APIs, the 500+ insurance companies we connect to, and all registered healthcare providers will be able to connect through our APIs to the DokChain and its smart contract services once DokChain is public.
The Demonstration on Tuesday, September 27, 2016
On the Health 2.0 main stage, we showed one of the first use cases for blockchain in healthcare: A simple eligibility check. I rowed crew, studied karate, and taught snowboarding in an earlier life and it’s catching up with me. It’s time I go to the doctor and have him check out my knee. So I ran an eligibility check to see if my insurance will cover the procedure and if I’ve met my deductible.
I used our PokitDok Eligibility API to call an eligibility smart contract hosted on the DokChain. The call, in turn, verified my permissions and executed a 270/271 request for benefit verification to Cigna on my behalf. Then, in less than a second, Cigna returned my real-time benefits information. Throughout this transaction, orchestrated completely by a smart contract on the DokChain, Cigna did not have to change anything in its EDI gateway in order interact with the DokChain or complete its response to my request for eligibility information.
The information returned from my eligibility check is not stored on the DokChain. That information is stored with Cigna and “off-chain”, securely in the PokitDok Platform. Access grants to that data, however, are hosted on the DokChain, managing access to my eligibility data in accordance with PokitDok’s BAA with Cigna and my, the patient’s, permissions. An immutable record of this transaction and the pointer it contains to the data’s storage location is written to the DokChain for future access, verification, and sharing by me, my physician, or any other network participant who satisfies the appropriate access criteria.
Why Is This Important?
To date, interoperability has been addressed as an afterthought between legacy EMRs that were never designed to be interoperable. This won’t scale in an always on, data-driven world and it certainly won’t connect to the machine learning and artificial intelligence technologies PokitDok and others are applying to derive and execute on the insights necessary to deliver value-based care. DokChain offers interoperability, support for current and emerging data standards, and strong encryption baked into a transactional architecture accessible to ALL healthcare stakeholders, from physicians and their EMRs, to sensors and devices, putting the patient at the center of the care team they want to ensure the outcomes they need.
As this post is going out, my co-founder, Ted Tanner, Jr. is set to take the stage at Schermerhorn Symphony Center in Nashville. He is participating on a CTO panel at Distributed Health alongside Andrew Beal from Ernst & Young, Tierion’s Wayne Vaughan, Jeff Cunningham of Informatics Corporation of America, and Andrew Keys from ConsenSys.
We recognize successful blockchain implementations in healthcare require diligence, panel discussions like these, and a collective effort.
We think DokChain is the first step in making that future, a reality.
- Introducing Our New CEO, Joe Murad - July 11, 2017
- DOKCHAIN TAKES THE STAGE AGAIN - AT HEALTH 2.0 JAPAN - December 9, 2016
- DokChain Makes Formal Debut At Health 2.0 - October 3, 2016
- McKesson Ventures Makes Strategic Investment in PokitDok - February 17, 2016
- 2016: The Year of the Business of Health - January 7, 2016
- Exciting News from PokitDok! - August 18, 2015
- The Unintended Side-Effects Of Health Reform: Increased Consumer Responsibility And Decreased Provider Revenues - April 29, 2015
- Top 5 Predictions for Healthcare Consumerism in 2015 - January 8, 2015
- MedTechVision 2014 Patient Keynote: Part Two - September 12, 2014
- MedTechVision 2014 Patient Keynote: Part One - September 10, 2014
Tags: Blockchain, Dev, Health Innovation