Healthcare Blockchains, What’s the Deal?

In 2008, 9% of US Hospitals had an electronic health record system (EHR, EMR); today, over 96% of US Hospitals have an EHR system. The arms race in healthcare information technology adoption since The HITECH Act has created a patchwork quilt of systems to communicate our nation’s healthcare data. The double edge sword of a free-market system. This is not much ado about nothing; it’s critical that patients and providers can effectively communicate and access their health information. We’ve come further with clinical data capture and exchange in the past 10 years than any time since Hippocrates. The pre-eminent challenge in 2019 is the extensibility and backward compatibility of the software technologies underpinning the current healthcare systems of record. The frameworks some of these programs were built on are literally from the 1960s. Blockchain technology as a concept (decentralization) only makes sense given the time sensitivities of emergent healthcare events alone; however, second and third-order thinking is critical to implementing this concept into healthcare.

EHR software in healthcare today operates more like in North Korea than in Switzerland. So, is it even realistic to begin incorporating a decentralized model into ever-expanding workflows dependent upon centralized models? To centralize or decentralize, that is the question. Cerner and Epic dominate the large health system EHR space, with Epic Epic specifically capturing the lion’s share of new adoptions. Interestingly, our nation’s defense systems (VA and DOD) will be working on their $16B adoption of Cerner’s health records over the next decade or more while the rest of the major free world hospitals seem to be looking towards Epic. Others operate in the smaller hospital marketplace, but most hospital beds in the future will be covered by Cerner and Epic. Given those centralized databases are not going anywhere for the foreseeable future, the interplay here has to be the middleware systems (Redox, Crimson, Mirth, etc.) that are the plumbing for these disparate systems interactions across the U.S. healthcare ecosystem.

Another feather in the blockchain cap, innovating for usability is not the only place that healthcare research dollars must be spent. Vendors have to develop towards the most productive workflows for end-users and adhere to the ONC/CMS standards (MACRA, HIPAA, LOINC, ICD, etc.), and for good reason. The certification criteria for EHRs and complimentary systems take immeasurable human capital. Blockchain as a technology offers significant benefits to managing the integrity of our healthcare information. Having instantaneous access to an immutable account of your longitudinal history through a token or the like is akin to how our banking system operates today. A stateful piece of end-user software that is persistent.

Here is the uptick, the FAANG gang and the like are looking towards this massive part of our nation’s GDP as an opportunity, as they should. While it’s certainly been tested before, the HITECH Act has finally created the opportunity for some of the most influential business operators in human history to start accessing, aggregating, and stratifying personal health information across the United States and other developed nations.

Several EMR vendors are creating marketplaces to open their software packages up to third-party developers to develop tools for patients and providers to gain better access to information. It’s a start. Think of these marketplaces like you would your iTunes or App Stores. To be sure, like the limitations that any oligopoly imposes on consumer marketplaces (Microsoft, Android, and iOS restrictions), these organizations filter third-party app developers’ access accordingly.

Salesforce is highly touted as the world’s #1 CRM, which it is. Amazon is the world’s #1 e-commerce retailer, which it is. These same organizations are quietly building healthcare infrastructure for managing vast amounts of healthcare operators’ business processes. There is no reason these organizations cannot continue to innovate and impose their will on the healthcare ecosystem. Apple, in its own right, is making access to that information more accessible than ever before for end-users and will only continue to drive the disintermediation of personal health information through its applications. Today, there is no mint.com for our health and wellness data. Who will be the first organization to deliver an aggregated longitudinal history to our mobile devices?

Blockchain technology provides a host of pros and cons. In part II of this series, we will dive into those aspects of the current and future states of technologies that enable healthcare information exchange. From data availability, Patient-Generated Health Data (PGHD), immutability to voluminous clinical data, verification of new transactions, and privacy. Thank you, General Data Protection Regulation.

The concepts defining blockchain are nowhere more critical than our nation’s healthcare system. It will take the likes of the FAANG gang to revolutionize how we manage and exchange personal healthcare information. Some food for thought, there is a high probability that my data was one of the 80 million records that Blue Cross dumped into the stratosphere in 2015. At this point, why can’t consumers use the tools in all other aspects of their lives to manage personal health information more effectively?