Why is it that black hats are happy to hand over our healthcare data in exchange for Bitcoin? There is probably utility in understanding why the people stealing our healthcare data leverage blockchain technology as a mechanism for capturing revenue for their “services”. And if data breaches don’t justify the means, how about our ability to make quality healthcare decisions? As the health IT ecosystem pulls structured information out of unstructured narratives to support a variety of analyses and user needs, a format for such metadata context will prevent information loss that can hamper the completeness clinicians need for sophisticated decision-making. In a previous post, we covered the centralized databases that house patient information across our healthcare system. Now that we have over 95% penetration of Electronic Health Records in United States hospital settings, what technologies exist to exchange health information more effectively from those centralized systems and what are the higher order consequences of the technologies that will allow us to do that?
The Office of the National Coordinator (ONC) laid out a 10-year roadmap in 2014 that established some of the major guard-rails for healthcare data exchange to be successful in the United States. From HITECH through the 21st Century Cures Acts, the standards being mandated to allow for data exchange across provider organizations are becoming more unified, thank you Graham Grieve. Direct Transport Protocol is a standard that health information platforms allow for Consolidated Clinical Document Architecture (C-CDA) exchange between provider organizations. It’s a mandate by ONC at this point. However, the ultimate owners of healthcare data have no consistent means of managing their healthcare information across the healthcare continuum. What technologies will allow us to begin shifting workflows with the patient at the center?
The opportunity for immutability, availability, and security are tremendous with blockchain. From micro-payments to credentialing services, the information that a payer, provider, or patient needs to effectively communicate and manage care can be facilitated through blockchain technologies.
Let’s take the patient experience for example. Health literacy and care plan understanding are two of the biggest drivers of an overall healthcare experience. Said another way, information is the most critical driver of our overall experience. Removing barriers for patients to focus on getting better as an experience only benefits providers if by nothing else than the contracts they’ve absorbed from payers. From HCAHPS to CGCAHPS, ADEIT is not just lip-service within the core values of healthcare providers nor their reimbursement models. Blockchain can facilitate access to information that will push our outcomes more in align with the goals set out by MACRA and the lot as a result of better patient experience.
For providers too, wouldn’t it be cool to verify your credentials across healthcare organizations with a couple of clicks? What about reducing the friction of enrolling every single provider across 20 different health plans? Revenue Cycle Management (RCM) providers offering credentialing and enrollment services would be able to leverage provider data across insurers instantaneously. Oh, the humanity!
Quietly, there are organizations recognizing the importance of planting the seeds for this technology to be leveraged at scale in the future. Zocdoc allows end-users to quickly find real-time appointments with providers in their surrounding areas that accept their insurance as “in-network”. We go to the movies and have Uber pick us up at pre-scheduled times, why not healthcare too? The Synaptic Health Alliance is moving towards Provider Data Management (PDX) as a stepwise function of this kind of technology. And, even HHS is running some versions of this technology for contract procurement processes within their HHS Alternative initiative. Along these veins, the down-side risk of instituting blockchain within procurement processes, provider data management, and patient scheduling is a strategic glide path to patient and provider generated health data.
First do no-harm, that is why the aforementioned processes are ripe for innovation through blockchain. Additionally, the pure economics of this technology make a tremendous amount of sense. Talk to any healthcare CFO in the country and reducing labor expenses is probably at the top of their list. Considering hospital labor expenses make-up over 50% of most hospitals’ budgets, it’s a fair place to evaluate. The bottom-line is the opportunity to reduce frictional healthcare expenses is immeasurable with blockchain. This is where higher order thinking really becomes part of the conversation though. After all, being both productive and humane is a very delicate balance in the healthcare arena.
Finally, blockchain technology affords us the flexibility to phase in adoption across siloed processes, a la PDX. Higher order thinking on the downside should be centered around topics like; the data requirements to communicate a patient’s longitudinal health record given the energy consumption to verify new hashes today. Ensuring privacy within private blockchains let alone public ones and verifying the accuracy of new transaction data, to name a couple more. These concepts and others are critical to administering a blockchain based on integrity. Let’s do it right the first time. How about it Meaningful Use?
So, what is the most extensible, backwards compatible, and cost-effective of the current technologies to begin building our nation’s public and private networks? This crowd takes a pretty good run at which specific type provides us the most leverage long-term. To bag a line from someone that actually has something to say (If Pulp Fiction isn’t in your top 5, we should talk), information is really the only difference between our experiences in the world.