Introduction to Blockchain in Healthcare

The healthcare industry in the US is favorably situated in a rigorous yet flawed electronic system. Information generated in caregiving activities as well as related billing and insurance processes are redirected to a digital landscape. However, certain pitfalls, be they technical or related to practice, are seemingly inherent to the current healthcare system. Blockchain, however, can prove to be the technology that can overcome these recurrent flaws and launch a new era of efficient and effective healthcare.

Toward Achieving Meaningful Use

The CMS offers incentive payments to eligible professionals (EP) who demonstrate meaningful use in the adoption, implementation and continued development of certified EHR technology under the HITECH Act. Although EPs can are not obligated to participate in the program, in 2015 the CMS has imposed a reduction in Medicare/Medicaid fees. This reduction has gone up from 1% in 2015 to 3% in 2017 and onward. These incentive payments and penalties for not joining the program are the tools the CMS has deployed in order to promote the widespread adoption of EHR systems.
HITECH aims to resolve health disparities and improve the quality and efficiency of caregiving through data capturing (Stage 1) by improving care coordination and exchange of information (Stage 2) and achieving better healthcare outcomes (Stage 3). Stage 1 has, by and large, seen some success but the same cannot be said for Stage 2 where a number of obstacles impede the smooth flow of information, and achieving healthcare outcomes.
When information exchange is made efficient, so is the management of the healthcare process. As many participants are involved in healthcare and are often dependent on each other before, during and after the caregiving process, what is required is effective care coordination[1], which is only possible when participants are aware of their roles and responsibilities. They must also have adequate knowledge about available resources. Communication and information exchange must be established in order to facilitate one’s knowledge of the different participants (and their respective roles) in the healthcare process.
Coordination, as well as the integration of caregiving activities, processes, systems, and information, are integral in delivering the best possible healthcare services and achieving adequate outcomes. However, this is a difficult feat to achieve where caregiving can span role, geography and time, as well as the physical condition of the patient.

Prevalent Issues in the American Healthcare System

The current healthcare system as it operates in the US is hampered by certain obstacles, the most debilitating being that the system itself is disjointed. Caregiving activities and processes vary from organization to organization. The absence of a standardized system makes storing and sharing information across all healthcare organizations inherently flawed, which can have several repercussions for patient care.
Problems in coordination and communication can manifest in a patient’s lack of understanding as to how to make appointments, why they may be referred from primary care to a specialist, or even the necessary steps to take after seeing a specialist. Specialists, on the other hand, may not receive complete information on test results, or why a patient has been referred to them. Primary care physicians may remain unaware of the results and recommendations of their patient’s referral visit. Healthcare staff must conduct their work based on incomplete/unavailable patient data. All these situations reflect an inadequate and deeply flawed caregiving process with poor healthcare outcomes.
Moreover, centralized systems tend to erect even more barriers where lack of coordination and communication is already adversely affecting the caregiving process. Centralized systems particular to one healthcare organization follow their own set of protocols and processes for storing and exchanging information. This information often becomes lost or is inaccessible in its
entirety when a patient seeks care from another healthcare unit for any given reason. In many instances, an organization must either continue the caregiving process from where it was left off based on inadequate information, or restart the entire process and collect information anew. Either method is incredibly time-consuming and costly, and often discourages patients from seeking care from better equipped/experienced specialists. Patients are, in effect, at the mercy of the caregiving organization they first sign up for.
In recent years, the healthcare industry has also been the target of ransomware attacks. Ransomware aims to infect a node or computer, from which it proceeds to spread to and subvert all other linked computers. A centralized healthcare system operates on its own exclusive network where it stores not only patient data but also transaction records as well as other sensitive information regarding the organization. As such, these systems are often without any alternatives or safeguards to ensure that information survives and is recoverable from another source should the primary nodes be compromised. This also raises concerns over patient privacy, which is typically at risk during a ransomware attack. The identifiable data may be snatched, altered or even distributed to other entities.

How Blockchain Works in the Healthcare Industry

Blockchain has its applications and uses in a variety of industries, including but not limited to finance, education and healthcare. With regards to the healthcare industry, blockchain technology holds the potential to transform the landscape of caregiving processes as well as resolve many of its persisting issues.
A simple model for application of blockchain technology suggests that healthcare organizations can redirect clinical records, medical as well as transaction history, and other data pertaining to a patient’s care to their public (non-identifiable) identity on the blockchain via API. The blockchain exists on a public network, however, the patient’s private (identifiable) data, such as their age, sex, etc, cannot be located/accessed as it is secured with a private key held only by the patient. Healthcare organizations and other related bodies can request access to a patient’s private identity and the data through the API, and a patient can choose to grant access to organizations/institutions requesting for it. The data contained in a block is write-once, read-only; that is it is immutable and hence cannot be tampered with or redistributed without express permission from the holder of the private key.
Of course, such an explanation only offers a simplified application, and it may seem useful in theory. Estonia, however, stands as an example of the flawless integration of blockchain in healthcare[1]. Strong security protocols and transparency inherent in blockchain technology have aided in streamlining and boosting healthcare efficiency in the small European country. Sending prescriptions to pharmacists, recommending radiologists, and recovering medical history in referral cases are all be done through a standardized, connected and secure eHealth system.

Benefits of Blockchain in Healthcare

As touched upon previously, blockchain technology can overcome a plethora of obstacles currently impeding efficient and effective caregiving processes. A block acts as a store of immutable data – patient information, transaction records, insurance status and the like – which prevents fraud, double-charging and the loss of information during exchanges. Information is immutable, and in the event that data may be accessed or tampered with, the event is recorded and distributed along the public network. Patients and healthcare personnel can easily log in and track any activity that has occurred on their profile as well as the identities of those who access it. This mitigates the criminal use of information, fraud, malpractice, double-charging, and loss of information.
Healthcare processes can be recorded, creating an extensive patient history that can extend into post-care outcomes. Other processes and activities pertaining to the healthcare industry can be interlinked. Drugs can be checked and tracked from manufacturer to wholesaler to pharmacist to the patient, preventing the circulation of counterfeit drugs as well as illegal sale/use of said drugs. Insurance status and medical coverage can be easily incorporated during the caregiving/billing process, saving time.
Furthermore, blockchain technology circumvents the loss of data that commonly occurs during information exchange across different health organizations. Software incompatibility across already centralized healthcare systems means that information often becomes inaccessible or unreadable, either in part or as a whole. Blockchain technology is standardized and belongs on a public network, meaning information can be accessed by anyone (so long as they have the necessary permissions from the patient) without any loss during exchanges. This aids in streamlining EHRs, and raising efficiency by eliminating coordination and integration problems that plague current healthcare systems.
In effect, it becomes all the easier to ascertain the effectiveness of caregiving activities in a patient’s care history and glean in-depth information regarding healthcare outcomes. By making information easily collectible, available and readable across an industry, it is possible to achieve greater, accelerated leaps in innovation and advancement of healthcare.