A revolution in health care is underway and it is altering decades of established medical practice. Clinical Health (HITECH) Act of 2009 and Affordable Care Act (ACA) in 2010 have significantly impacted the healthcare. In last 5 years, healthcare industry has witnessed a significant adoption of Electronic Health Records this has led to significant advancements in digitizing the care delivery systems in healthcare. Volume-based medical practices that depended on consultations, tests, prescriptions, hospitalization, procedures and medical devices are moving to personalized and participative care with an emphasis on outcome based models. The good news is that the wealth of available patient data can help achieve these goals by providing physicians and care givers with unprecedented insights and radically improve care delivery. But the silver lining has a grey cloud: Patient data is fragmented across systems and, to further complicate matters, is available in disparate formats. Progress in digitization in care delivery systems has created a growing demand for interoperability that not only support the care continuum but support healthcare in general. EHR interoperability is a critical and necessary step that needs to be taken by stakeholders for improving the healthcare, however interoperability has remained limited and have many challenges like lack of healthcare data standards, insufficient privacy laws, cost and trust among the stakeholders.
The Healthcare Information and Management Systems Society (HIMSS) has developed a definition of interoperability. As per HIMSS interoperability has three levels.
For real machine to machine interoperability of EHR systems, it is important that system fulfill all the above requirements. In addition to above technical requirements, data privacy is a big concern among the healthcare stakeholders, hence any system supporting interoperability of EHR must support permissions, trust and data security.
Blockchain provides mechanism to anonymized data and ensure the data cannot be tampered with or forged. The Blockchain uses public key cryptography to create records that are time-stamped and immutable. Copies of these data records are stored across thousands of nodes on a digital network. Changing these records at each node becomes an impossible task and prohibitively expensive, making the records reliable. The trust network created in this manner is among the most attractive features of the technology
Progress in digitization of care delivery systems has created a growing demand for interoperability that not only supports the care continuum, but also supports healthcare in general.
This is particularly important in an environment of growing connected devices, where security and authenticity of data is a matter of concern. In addition, the owner of the data can, via smart contracts, make data from across provider and treatment sites selectively accessible.
Blockchain’s phenomenal success with cryptocurrencies is drawing interest from the healthcare industry. Primarily, it is the ability of the technology to solve problems of trust, data integrity and anonymization that are of interest to healthcare professionals.
Blockchain does not address the basic technical requirements for interoperability but provides foundation for secure, permissioned framework for data exchange.
INTEROPERABILITY: SECURE DATA SHARING
Any technology that can solve the problem of interoperability in a secure manner has the potential to become a game changer. This is the potential of Blockchain technology. Not surprisingly, it is generating an inordinate amount of interest in the industry. While organizations like Health Level Seven International (HL7) continue to provide standards for data exchange like Fast Healthcare Interoperability Resources (FHIR), blockchain could provide the right interventions. (See Table 1: Potential Impact of Blockchain on Healthcare).
Two aspects of blockchain technology are of interest to the healthcare industry: Permissioned Blockchains and Smart Contracts. A Permissioned Blockchain maintains the privacy of the data and makes the data accessible to actors on the network who are authorized to access it. Smart Contracts are ‘instructions’ on the blockchain that are executed automatically once all the necessary conditions or events are met. This means data can be made available automatically, without human intervention.
All the elements required for successful deployment of blockchains in healthcare already exist: EHR data; FHIR and HL7 that can guide the standardization of APIs to make the data available to everyone in the ecosystem; and Smart Contracts to ensure data reaches the right stakeholders and authorized entities at the right time.
CHANGE AGENT: MULTIPLE BENEFITS
The benefits of making EHR more effective by using blockchain are irrefutable. It will lead to personalized and participative treatment along with outcome based models; it will help researchers create better products at lower costs; it will help in faster and more accurate verification of claims data and improve settlements; it will reduce fraud; and it will help meet regulatory compliance.
These are positives that are difficult to ignore. However, there is little incentive today for care givers and other stake holders to share information. This is because the industry is still aiming for volumes – more patients, more consultations, more tests, more procedures and more hospitalization. When the balance shifts to outcome based fees, there will be incentive to access patient records – it is then that interoperability will become a compelling proposition and blockchain will be the sought-after solution. Already, there is growing consensus that the challenges faced by healthcare can only be addressed by changing the business model. Which means that blockchain becoming an integral part of the healthcare industry is not far away.