Blockchain, the technology behind Bitcoin, is poised to make its mark on the healthcare industry.
According to advisory-consulting organization Deloitte, 35% of health and life sciences companies plan to begin using it by 2018.
So what is blockchain and why are some in the healthcare industry so enthusiastic about it?
A blockchain is, simply put, a decentralized, digital public ledger of transactions involving cryptocurrency, such as Bitcoin. The Distributed Ledger Technology (DLT) it employs has begun appearing in a number of commercial applications.
“It maintains a growing list of ordered records, called blocks. Each block has a timestamp and a link to a previous block,” Big Data and business performance guru Bernard Marr writes in a Forbes article titled “A Complete Beginners Guide to Blockchain.”
Blockchain originally was designed to support the internet currency Bitcoin, and is set up to prevent misuse and to establish trust and identity.
Blockchain, Marr writes, “allows anyone to send value anywhere in the world where the blockchain file can be accessed. But you must have a private, cryptographically created key to access the blocks you own.”
When it comes to EHRs, a medical record can be a digital block bearing a timestamp. It cannot be changed, ensuring that the information remains stable. Only those bearing the proper digital keys, the physician, patient and any outsider both deem appropriate, have access. Information can be added, but not changed or deleted.
Potential benefits for healthcare systems using blockchain include:
Clinical Health Data Exchange and Interoperability: Blockchain technology has the potential to create health information exchange systems that are cryptographically secured and irrevocable. This can lead to users having access to historic and real-time patient data.
Claims Adjudication and Billing Management: Blockchain also has the potential to decrease incidents of fraudulent billing since editing information in a block is limited to those in possession of the proper key. It can also help prevent billing errors by removing intermediary players from the process. “By automating the majority of claim adjudication and payment processing activities,” Reenita Das, Vice President of Healthcare and Life Sciences at consultant firm Frost & Sullivan, wrote in a Forbes article. “Blockchain systems could help to eliminate the need for intermediaries and reduce the administrative costs and time for providers and payers.”
Drug Supply Chain Integrity and Provenance: Blockchain also could be helpful in preventing counterfeit drugs from entering the marketplace. Das writes, “A blockchain-based system could ensure a chain-of-custody log, tracking each step of the supply chain at the individual drug/product level.”
Connected Devices: The use of internet-connected health devices is growing at a rapid pace. It’s estimated that as many as 30 billion of these devices will be in use around the world by 2020. Blockchain solutions could aide with issues regarding device data interoperability and ensure the security, privacy and reliability of information in IoT use cases.
Hurdles for Widespread Adoption
For all the pluses, blockchain still could face resistance from large segments of the healthcare industry, according to an article by Healthcare IT News editor Mike Miliard.
First, the 65% of healthcare organizations not chomping at the bit for blockchain includes some that may be genuinely resistant. As a whole, the healthcare industry is slow to adopt technology and, Miliard writes, “may not be ready, from either a workflow or regulatory point of view, for the changes some say blockchain could bring.”
Also, while privacy is considered one of blockchain’s strongest features, healthcare organizations are going to have to integrate complex HIPPA policies into the new technology.
Rules regarding privacy, security, interoperability and healthcare clearinghouses are all part of HIPAA. While the rules may be somewhat aged, with the law having passed in 1996, organizations still have to comply with the regulatory framework. And because a blockchain is a digital record set, HIPAA will challenge the security mechanisms for requirements such as data minimizations and controls within the blockchain, according to the Healthcare IT article.
Further, while interoperability is, along with data security, one of the most highly-touted benefits of blockchain, it won’t be an immediate solution, since aligning all stakeholders is going to prove more difficult than developing the technology.
The bottom line issue, though, is the bottom line, according to Oracle’s director of healthcare solutions Prashant Natarajan.
“What money can it save, what money can it generate, what can it do for the patient?,” Natarajan asked in Healthcare IT News. “If it doesn’t answer those questions, frankly, I think the broad use case doesn’t matter.”
Still, Natarajan says blockchain has the potential to move healthcare away from the mistake-prone, documentation-centered approach to a more flexible, transaction-centered process. Despite the naysayers, blockchain appears to be a near-inevitability.
“We’re definitely at the height of the hype curve. I think there’s going to be about two or three years of disappointment setting in once people figure out it’s not the greatest thing since sliced bread,” Natarajan told Healthcare IT News. “And then they’re going to have to figure out how to build a skilled staff, how to change the mindset and change the existing systems to be able to accept this.”