Much hype has surrounded the use of blockchain technology and distributed ledgers in healthcare. While some enthusiasm has dissipated, use cases have emerged to test the potential for its use among players in the healthcare industry. A recent article in Blockchain in Healthcare Today, a journal following the potential use of the technology in healthcare, offers predictions from 10 experts in the field.
Contributors to the article include: John D Halamka, MD, Gil Alterovitz, MD, William J. Buchanan, Tory Cenaj, Kevin A. Clauson, Vikram Dhillon, Florence D. Hudson, Manouchehr (Mitch) Mokhtari, Dennis A. Porto, Ana Rutschman and Anh L. Ngo. The experts are members of the peer-review board of Blockchain in Healthcare Today.
Blockchain will become an essential part of consent management in healthcare, enabling easier sharing of information. Consent is currently stored in individual providers’ electronic health records systems, hospital medical records departments, and in stacks of paper on fax machines. Blockchain technology may enable the storage of patient consent for data exchange and privacy preferences and treatments on the blockchain, so they can be accessed by all stakeholders.
Tokenization of non-cash assets
The experts note that a token can represent anything—for example, real estate, a physical object or even an outcome. Thus, tokens may be able to facilitate managing for results or outcomes in healthcare. One startup, Proof of Impact, has started to measure patient outcomes and offer non-governmental entities ways to reduce administrative burdens and enhance the patient care experience.
Under value-based care reimbursement, providers are reimbursed for patient wellness, not the quantity of care they deliver. So an easy-to-use universal payment interface for providing micropayments to patients when they achieve goals/outcomes would accelerate innovation. Similarly, tracking of co-pays and the “litany of employee share of medical expenses” could be simplified with a blockchain-based universal payment interface. Additionally, it could give organizations the opportunity to “buy” outcomes from provider organizations—for example, there could be a marketplace for patients successfully treated for a disease.
Keeping healthcare provider directories maintained by health plans up-to-date is a critical, complex issue facing organizations across the healthcare system. In addition, with more than 1,000 insurance companies in the U.S., filling out paperwork to document provider training and licensure is a nightmare. Efforts are underway to simplify this process; one approach is looking at putting provider demographic information on a permissioned blockchain.
Electrical usage reductions
Improvements to blockchain infrastructure will reduce electricity requirements and enhance speed and scalability—typically cited as some of the biggest concerns about use of the technology. Proof-of-work approaches consume the equivalent of the yearly electrical output of Ireland—building trust through other means will radically reduce the computing footprint. Similarly, transactional speeds will increase and blockchain as a service will enhance ease of use, essentially by “hiding” the complexity of blockchain behind a set of cloud-hosted functions.
Supply chain integrity
In many cases, it’s difficult or laborious to track the authenticity or accuracy of medical supplies. A blockchain approach for the pharmaceutical supply chain could help ensure the integrity of products.
Monetization of data
Resale of data without full disclosure and consent has proven problematic. What if a marketplace for data enabled people who want to contribute data (for some public good, such as clinical trials, clinical research or population health) to be paid each time their data were used? Nebula Genomics, for example, is exploring this idea to accumulate genomic data for the development of precision medicine tools more rapidly.
Integrity of medical records
Ensuring the integrity of electronic medical records is crucially important. In malpractice cases, plaintiff attorneys request historical medical records, and then they often claim the records are faked or altered to remove evidence of medical mistakes. If a distributed ledger technology with unassailable trust were used to guarantee the integrity of the medical record, the burden on providers, IT departments and attorneys would be reduced. The records would not be stored on a chain, just a hash.
Refining of use cases
Education of stakeholders will refine the use cases for blockchain, and that will accelerate adoption. There’s lack of understanding about the technology now, but as its capabilities become more widely known, high-value use cases will be implemented more widely.
Consolidation of blockchain startups
The marketplace of companies offering blockchain is large and filled with more PowerPoint presentations than products. While many of the startups will fade away, those that show promise will be acquired and consolidated.
Date: March 5, 2019