The technology used to validate bitcoin transactions could become a powerful tool for health plan chief medical officers. The methodology, called blockchain, has the potential to improve the sharing of medical records, care coordination and fighting fraud among other benefits.

Initially underpinning bitcoin, blockchain is a digital data ledger distributed securely across a network of users. The ledger is arranged in data batches called blocks that use cryptographic validation to link themselves together into a continuous chain. Data is then distributed across a cloud network where it can be accessed and updated by the disparate stakeholders for use in care coordination and health management.

The use of blockchain was expanded within financial services in brokerage, digital banking, money transfers, ATM and several other areas. Health IT leaders and health plan CMOs should increasingly collaborate on the potential of this capability in the following areas:

  • Medical records
  • Population health management (PHM)
  • Patient-generated health data (PGHD)
  • Fraud prevention
  • Global operations

Medical Records

Providers and payers need to better coordinate data sharing across what is now a fragmented national healthcare system. This lack of interoperability presents a significant challenge in both the cost to manage and maintain medical records, and the ability to use those records to coordinate care.

Blockchain technology could become a standard platform that offers authorized payers and providers decentralized access to patient medical records through a cloud network. This approach to data access and sharing could improve care coordination, as it would allow physicians and plans to collaborate on specific, condition-related information from a patient’s medical record.

In the current environment, patients must consent to share their entire medical records or none at all. Instead, access could be based on conditions, types of care (emergency, acute care, wellness, etc.) or other population health data.

Most current EHR systems have limited capabilities to provide conditional consent, which could be overcome with the effective use of blockchain medical record data management. Data can be collected from web and mobile apps and then recorded in blockchain systems by using REST, API or HTML form submissions.

The technology is more scalable, tamper proof and time stamped, making health data more secure. By removing the central point of failure, it is nearly impossible to “hack” the blockchain electronic medical record. Some are even predicting the obsolescence of health information exchanges (HIE) and all-payer claim databases (APCD). Eliminating the middlemen tends to increase data security and reduces the cost, time and resources required to manage compliance for new record sharing models.

Population Health Management (PHM)

Once data is linked and sharable through blockchain technology, it becomes a powerful tool in population health management, especially the areas of member participation and provider coordination and supervision with a strong focus on avoiding re-admission and improving post-discharge care.

Blockchain can result in longitudinal health records that contain every episode of care, in every location it was delivered, from childhood to old age according to leading healthcare literature. This full view of health history helps mitigate clinical risk, improves care quality and empowers individuals to have full control over their long-term health records. Based on this knowledge and supportive advice from care managers, health care consumers can choose PHM programs aligned to their needs, the financial parameters of their benefits and the overall cost of care.

" Blockchain can result in longitudinal health records that contain every episode of care, in every location "

CMOs can couple this data with analytics to identify and manage at-risk individuals or member populations using a much broader range of clinical information.

Patient-Generated Health Data

Health plan clinical leadership should also evaluate the area patient-generated health data, most commonly associated with wearables and other devices, for blockchain patient and member management.

Value alignment for blockchain will occur with the integration of wearable technology devices and medical records.

Blockchain applications place personal and patient information into the hands of an individual.

Electronic provider visit applications, individual monitoring tools (sleep patterns, heart rate, glucose) and other “internet of things” (IoT) devices can all be polled and stored into a blockchain health repository and transaction outcomes platform. By using their profile information, the member has full control of their medical insights and can select the information to be shared and viewed by providers. This model lifts the costly burden of maintaining a patient’s medical history away from the hospitals or other facilities; eventually cost savings will make it full cycle back to the patient receiving care. Therefore, the CMO needs to work with the care management team to evaluate and implement consent assessments that allow the ability to gain the required information. Doing so would prove helpful in managing individuals in disease and case management programs who use monitoring devices to assess their conditions or day-to-day activities. This can be important in managing patients who participate in health plans’ chronic care management or disability programs.

Fraud Prevention

The health plan CMO needs to be aware that one of blockchain’s most wide-ranging applications will be to reduce Medicare fraud, which has cost nearly $30 billion over the past two decades.

Because open ledger technology, such as blockchain, provides a complete audit trail of transactions, clinical leaders expect it can reduce and eliminate prescription and billing fraud, while preventing security breaches that drive patient identity fraud.

Fraud will be further hindered as individuals and organizations are only entitled to access certain information, and changes to data within a chain must be agreed upon collectively by all appropriate parties on the chain.

Current Initiatives/Startups

  1. Guardtime partnered with Estonian eHealth Foundation to secure more than one million patients records by integrating Guardtime’s keylesssignature infrastructure blockchain into the foundation’s Oracle database.
  2. Gem, a company focused on blockchain technology, launched Gem Health with Philips as its first partner to promote collaboration, and plans blockchain based healthcare applications, according to CoinDesk.
  3. Australian start-up Brontech created the healthcare platform Cyph to create for secure ways for healthcare providers to communicate private information safely
  4. MedRec is a system, currently in development, that will manage medical records and censuslevel data through the Ethereum blockchain.
  5. San Francisco-based Blockchain Health Co. uses blockchain technology to allow patients to directly share their health information with medical researchers.
  6. Pokitdok aims to enable seamless communication among payers, health systems and technology companies
  7. HealthCombix is an incentivized, blockchain-based community care coordination platform for ACOs and managed care organizations that leverages behavioural economics, social networking, cryptocurrency rewards and telehealth.
  8. PointNurse is a seed-stage ondemand nursing app designed for consumer-focused engagement, referrals, triage and telemedicine, among other additional services.

Recommendations

Blockchain is still a nascent technology in the healthcare industry. Health plan chief medical officers and other clinical leaders would still be wise to learn about the technology and create opportunities to evaluate it. Because blockchain deals with how data is structured, CMOs will need to collaborate closely with IT leadership and review existing medical data systems.

Below are five areas where Chief Medical Officers can begin their assessments of block chain:

  1. Assign a resource to begin evaluating opportunities in the blockchain EMR space
  2. Collaborate with the finance function to evaluate the use of blockchain data
  3. Initiate an evaluation of your current care management system’s integration with blockchain data and associated digital interventions
  4. Begin the dialogue with industry influencers to determine the hierarchy of impact for blockchain efforts and data management
  5. Consider where and how to pilot the use of blockchain data

References

  1. https://www.linkedin.com/pulse/ blockchain-technology-solutionhealthcare-peter-b-nichol
  2. http://searchhealthit.techtarget.com/ podcast/Blockchain-in-healthcare-isquickly-becoming-a-reality
  3. http://arstechnica.com/informationtechnology/2016/11/what-is-blockchain/
  4. https://www.beckershospitalreview.com/healthcare-information-technology/8-blockchain-healthcare-startups-to-know.html
  5. https://www.healthit.gov/sites/default/ files/5-56-onc_blockchainchallenge_ mitwhitepaper.pdf
  6. http://searchhealthit.techtarget.com/ news/450303012/Blockchain-inhealthcare-getting-a-lot-of-attention
  7. http://www.cio.com/article/3042603/ innovation/blockchain-applications-forhealthcare.html

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