By Connor Smith
Healthcare is frequently mentioned on the shortlist of industries that are expected to be transformed by blockchain technology. Supporters of this assertion have a range of reasons for arguing that blockchain can improve healthcare but most tend to revolve around improving health data security, immutable claims tracking, physician credentialing, or putting patients at the center of care by taking charge of their own data. However, there are many who argue that healthcare is not ready for blockchain or that many of its theorized use cases could be better addressed using other technologies. There are good arguments to be made on both sides and, when considering the complexity of healthcare and nascency of blockchain, it can be difficult to discern what projects are ‘hype’ and which can actually drive meaningful impact.
We at Consensus Networks are bullish on the potential of blockchain in healthcare, but we also pride ourselves on taking a pragmatic view of projects to realistically assess what is feasible and what is not. This past week, we were fortunate enough to attend the inaugural Blockchain and Digital Transformation in Health in 2020 summit in Austin, TX, where our CEO Nathan Miller presented on the work we have been doing with HealthNet and developing highly secure information architectures in a regulatory environment. The Conference was hosted by the Austin Blockchain Collective in conjunction with the Dell Medical School at University of Texas Austin. There were presentations from industry and academia alike accompanied by an open discourse about the state of blockchain in healthcare, what is actually feasible, and identifying a path forward for the technology as healthcare starts its digital transformation. It was an absolutely great event with high quality information and a pragmatic assessment of the state of the industry, and we’re here to share our top three takeaways with you from the event!
1). Blockchain EMRs are not ready….. At least not yet in the U.S
Throughout the short lifespan of blockchain projects in healthcare, there have been several attempts at a blockchain-based electronic medical record (EMR) that is owned by a patient and shared with providers as needed, the most popular of which is probably Medicalchain. Medical records hold a wealth of information about an individual, containing everything from a person’s medical history to their demographic, identity, and insurance information. However, to date, medical records have been largely owned and controlled by the health systems they reside within. Aside from issues of data sovereignty and controlling who has access to that information, having isolated data silos has a decidedly negative impact on patient outcomes, especially in the U.S. Competing EMR systems are incapable of communicating well with one another. Thus, if a patient goes to multiple providers that all have different EMR systems, the data for those visits will likely never be aggregated into a single, cohesive file and instead remain as isolated fragments. This makes it nearly impossible for a provider to know what care has been administered to a patient previously and leads to billions of dollars being wasted in redundant testing, unnecessary procedures, or in the worst scenarios patient death from improper care.
A blockchain-based EMR would enable the patient to own his or her own medical record, which they would likely hold in some form of mobile application. A patient could then control who has access to their record and have the guarantee a provider is seeing her most up-to-date record as any changes would be reflected in that copy immediately. All transactions would be immutably recorded on a blockchain, and once the visit was finished the patient could revoke the physicians access. Conceptually, such a notion sounds appealing. However, one of the biggest takeaways from the conference was that such a future is far off in the U.S and requires a societal shift and fundamental rethinking of data ownership to get there.
Dr. Aman Quadri, CEO of AMSYS Blockchain and AMCHART, was one of the speakers in attendance at the event. The product he is building, AMCHART, is a blockchain-based EMR that is currently undergoing testing in India, and even he was skeptical of its prospects in the U.S. Dr. Quadri said that the reason they have started seeing AMCHART adoption in India is because people there already have a mindset of data ownership. They take responsibility over their data so a platform like AMCHART extends their current capabilities in a way that is beneficial. Dr. Quadri said that for AMCHART to have impact in the U.S it would require patients and health systems alike to change how they view and approach handling data before their could be a marked increase in value to patient care. He said that American patients have been conditioned for decades to blindly trust their data with medical providers, so shifting that view will be no easy task.
2.) Use Cases Are Emerging Around Care Coordination, Identity, and Data Sharing
The projects being spearheaded by the talented Dell Medical School faculty, visiting academics, and industry representatives in attendance covered a wide range of applications in healthcare, spanning both population health and the clinical setting. While the individual problems these solutions address vary, the common thread amongst most of them was that they centered around care coordination, identity, and data sharing applications. The consensus seemed to be that blockchain could help lay the foundation for a web of trusted access to data with the patient at the center of care.
Dr. Timothy Mercer, a faculty member at Dell Medical School and practicing physician, is exploring ways in which blockchain could be applied to help address homelessness in Austin. His research found that one of the biggest problems for the homeless population in Austin is a lack of any legal form to prove their identity. As a result, they frequently go through the process of proving who they are, which can take weeks to months to complete and delay physicians from providing critical care to the homeless. If the documents are lost or stolen, the process must start all over again. As a result, the average age of death the chronically homeless is 52-56, nearly 20 years less than the global average. Dr. Mercer is exploring ways blockchain and digital identities could be used to ease this burden and accelerate the time to care for homeless persons in Austin. This way, the myriad of stakeholders involved in caring for homeless persons would be able to verify an individual through a web or mobile application and administer care to the patient. The homeless care ecosystem involves many different organizations, all of which must properly authenticate the individual before they can legally administer care. Utilizing a blockchain-based identity application, the different caregivers would be able to verify the individual’s identity through digital documents linked to the patient’s digital identity and legally provide the care he or she needs. This ultimately would place the homeless person at the center of the care and alleviate the inefficiencies pervasive in the current continuum of care for this patient population.
Another interesting application that was highlighted at the event was Tribe Health Solutions use of blockchain in a medical imaging management solution designed for patients. Through the use of blockchain technology and the interplanetary file system (IPFS), they created a platform where patients can store medical imaging data on a distributed file system and then grant necessary providers access when needed. After care is administered, the patient can revoke access to the image and ensure that only trusted providers can access it. This solution aims to help patients overcome many of the problems associated with receiving care for skeletal or muscular injuries. In such tears or breaks, patients oftentimes seek out multiple opinions and are forced to either manage a physical copy of the medical image themselves or wait days to weeks for the file to be transferred to the provider. This not only delays the time it takes for these patients to receive the care they need and start the recovery process but in the worst case scenarios can lead to a worsening of the condition. Putting the patient in charge of the imaging data, allows her to determine who can view the image and when – ultimately reducing the time it takes to receive treatment.
3.) Blockchain Projects Must Start Small in Healthcare and Involve Many Stakeholders
Lastly, perhaps the most prevailing takeaway from the conference was that blockchain projects looking to tackle problems in healthcare need to start small and involve as many stakeholders as possible from the onset. Healthcare is a highly complex industry where ‘moving fast’ and ‘breaking things’ can have significant ramifications on patients, especially when considering that the industry is only now beginning its digital transformation. Dr. Anjum Khurshid of the Dell Medical School at University of Texas Austin and a director of the Austin Blockchain Collective is leading research on a patient credentialing platform called MediLinker. When pressed about the ability to extend the platform into an EMR type technology that could exchange clinical data, Dr. Khurshid cautioned that it’s more important to start small and clinically validate each stage of the product. In an industry that handles high fidelity information and typically averse to new technologies like healthcare, Dr. Khurshid said its important to demonstrate the value of the technology and make it more approachable. He said that the problems in the current healthcare system are so vast that even simple solutions can have a massive impact and that it is imperative to validate the benefit of the technology to patients, providers, and payers alike at each step. Any new, truly innovative and sweeping changes that are to take place in healthcare from blockchain will require all of these parties to work together and identify applications that can drive meaningful value for everyone involved. Healthcare is changing rapidly and only by taking small incremental steps will blockchain be able to integrate with the complex, multi-stakeholder ecosystem that is healthcare.
That’s all for this week! We at Consensus Networks are grateful to have been able to attend this conference and excited about the work going on in Austin to advance the industry forward. We are continuing forward with the development and commercialization of our population health data sharing network, HealthNet as well as smart tools for analyzing health data. If you are interested in learning more about HealthNet or have an idea for a new digital healthcare application you’d like to build, contact one of our experts here today!