Blockchains, a new mechanism for trust in the e-world, are a mathematical concept invented in 2008 that have broad applicability to any market that networks billions of people and demands high security—including healthcare. More than $1 billion of private investment in blockchains has already been made in the financial sector. Because of their demonstrated power, cost-effectiveness, and private-sector adoption success, in 2016 the question of blockchains in healthcare is no longer if, but how.
Blockchains use cryptography to replace institutional authority with a consensus of tens of thousands of networked computers called “miners.” In payment transactions, this means that trusted money is no longer a government or corporate monopoly. Now money can be created and protected from forgery by anyone, anywhere. This makes blockchains particularly useful in situations where government is weak, corrupt, or uncooperative, including the developing world and refugee situations. No bank? No problem. As long as you and the person you are trading with has a smartphone and an Internet connection, payment can proceed directly between the two parties.
As in the world of finance, trust is at a premium in healthcare. It is often the limiting factor in access and interoperability. “Health record data blocking” is put in place by hospitals and health information exchanges that claim our trust and, like banks, are in a position to sometimes exploit that position. Blockchains promise to eliminate the role of these trusted intermediaries in securing and sharing health records and put that power directly into the hands of doctors and patients. Taking hospitals out of the equation will impact clinical practice and medical research as well.
When it comes to getting and using personal health data, trust is involved in:
- identifying the patient that is the subject of the data,
- identifying the user requesting patient data,
- recording and auditing the authorization to release the patient data,
- establishing the authenticity of the data that is being released,
- paying the service that offered the patient data,
- controlling and auditing that the shared data was used as expected.
All six of these separate trust issues involve one or more institutions. Blockchain technology could replace all of them with math. Like all math, blockchains are non-proprietary and open source, so they can be used and extended by anyone. All that’s needed is a community of willing participants. Dozens of publicly accessible blockchains already exist. The six areas of healthcare trust will use some of them and introduce many new ones. Because blockchains are not controlled by a particular institution or group, and often are not subject to regulation, they sometimes enter a market at spectacular speed.
The impact of eliminating the hospital EHR from the role of trusted intermediary will be felt by physicians, patients, and the healthcare industry in different ways:
- Physicians will be able to sign on and write an order directly into a patient’s chart regardless of where the chart is located. This works as well for telemedicine as it does for in-person visits.
- A truly patient-centered health record will enable practice innovation as physicians, other clinicians, labs, and pharmacies organize to see patients at home or in convenient care centers because they no longer depend on costly hospital infrastructure to manage patient information and payment.
- Health plans will help promote this shift and will become more directly accountable to patients and physicians.
- The blockchain’s ability to track contributions of the individual members of the care team will reduce fraud and distribute payment for services more transparently than today’s secret contracts between health plans and hospitals.
- Patient-centered longitudinal health records and patient-directed health information exchange will blossom as blockchains remove the hospital as the root of trust.
- Care coordination, including medication reconciliation, accessibility of advanced directives, clarity of pending orders, follow-up for different aspects of the care plan, access to second opinions and decision support services, and even billing and explanations of benefits will be completely transformed when physicians, hospitals, and home health care services come to the patient instead of the other way around find out here.
- Medical research will benefit as longitudinal patient records will be more accurate and complete.
- Finally, separated from the hospital’s control, patient-centered health records will be trusted with much more intimate social, environmental, and family data and will be able to enforce more personal and diverse privacy requirements.
Aside from their direct impact on physician practice and the physician-patient relationship, blockchain technology and patient-centered health records will also have a broad range of secondary impacts on such areas as security, identity management, single sign-on, anonymous and privacy-preserving services, directories of services and provider quality transparency, and even the way capital flows to fund healthcare start-ups. Blockchain technology, like phones or the Internet that came before, is just another tool for connecting people to each other.