Blockchain technologies will enable patient identity matching, identity linking, redundant connectivity, location, and the retrieval of granular patient data to and from any EMR. A recently submitted a proposal paper leads the national healthcare innovation agenda.
A lot has been written covering blockchain and healthcare over the last year. From articles on blockchain applications for healthcare to articles by healthcare industry experts exploring blockchain technology as the solution for healthcare interoperability. In early 2016 Forbes even wrote an article titled, “How Blockchain Could Change the World.”
Government uses of blockchains
Once governments are involved, it’s a pretty sure bet something substantial exists. The Dubai government launched an investment fund focused on the blockchain. The U.K. government awarded a framework agreement to a Blockchain-as-a-Service company, Credits, the blockchain platform provider. Credits won the U.K.’s “Best Blockchain Startup” at this year’s Europas Awards. The French government will be attending a Parliamentary blockchain forum in October 2016. The Denmark government was the 1st political party to use blockchain for e-voting. Of course, this was back in 2014. With Dubai, U.K., French, and the governments Demark exploring blockchain it seems only fitting that the United States government would dip a toe into the potential blockchain has to offer.
Why should governments care about blockchain? First, at the most primary level blockchains are distributed ledgers that can use to build digital trust. Tax systems, property tax, e-voting, contract automation, tracking provenance for imported food supply chains and identify management (passports, drivers licenses, birth certificates, work certificates, state-issued IDs, certifications) all are natural applications for blockchain technologies.
The startup frenzy forgot about healthcare
The world is talking about FinTech. This seems reasonable given that there has been USD $1.2 billion invested in blockchain startups. The majority of these investments have been within the financial sector. The cumulative investment in blockchain likely is double. Several of the stealth mode startup companies were funded with pre-seed or seed money and to-date are staying well under the radar. However, many startups are eager to get noticed and have published formal press releases including: Brave, Coinigy, Netki, Circle Internet Financial, Mediachain, TechBureau, Fluent, Tierion, bitFlyer, Ethcore, Tibit, BitKan, Custos Media Technologies, Bitwala, Bitt, Stratumn, Rootstock, Elliptic, Chronicled, Keza,Loyyal, Chainalysis, Simplex, SurBTC, Blockstream, SatoshiPay, Digital Asset Holdings, Gem, and Zebpay.
The focus has been on the financial markets and out of the public startups, only two (Gem and Tierion) or 7 percent have anything to do with healthcare, and only one startup is primarily concentring on applying blockchain to healthcare (Gem).
Somehow we need to get back the basics of the blockchain and start to dive into real solutions that can root causes of the healthcare interoperability in the United States. The National Institute of Standards and Technology (NIST) in partnership with the Office of the National Coordinator for Health Information Technology (ONC) have opened the ONC Blockchain Challenge. In this national challenge, NIST and ONC requested healthcare and technology innovators submit a proposal paper exploring the “use of blockchain in Health IT and Health-Related Research.”
Micro-identities for better patient care
A paper titled, Micro-Identities Improve Healthcare Interoperability with Blockchain: Deterministic Methods for Connecting Patient Data to Uniform Patient Identifiers focused on patient identifiers. The drive behind this paper was to present a hybrid model, integrating HL7 FHIR, interoperability standards describing data formats and elements. This model also included an Application Programming Interface (API) for exchanging electronic health records using blockchain technologies for better patient access to health information.
Think mico-identities that travel with you and providers that leverage new patient matching logic to remove the need to transfer sensitive demographic information when validating a patient’s identity.
The paper was authored by Peter Nichol and William Dailey, MD. Peter Nichol is an expert in digital, innovation, and healthcare. William Dailey, MD is a practicing physician and Chief of Medical Information at Golden Valley Memorial Healthcare. Together they co-authored a paper for the ONC Blockchain Challenge titled,Micro-Identities Improve Healthcare Interoperability with Blockchain: Deterministic Methods for Connecting Patient Data to Uniform Patient Identifiers.
The proposal paper states that interestingly enough, patients only visited their primary care physician 54.6 percent of the times when they went to the doctor. Where do they go for the other 55.4 percent? The patient would go to another doctor, and that doctor would have no access to the patient’s historical medical records.
Do patient management systems between providers talk to one another? How are clinical treatments shared? What is the process flow to move administrative and billing information to payers? In the United States, the care experience is not integrated each integration is a one-off.
The goal of the Triple Aim is pretty straight forward: 1. Improve the patient experience of care (including quality and satisfaction), 2. Improve the health of populations, and 3. Reduce the per capita cost of healthcare. Unfortunately, progress has been limited, and national healthcare costs are on the rise. Shared-cost and inventive distributed decentralized solutions offer a way out.
HL7 FHIR the primer for healthcare interoperability
The paper provides an overview of HL7 FHIR and identifies HL7 FHIR as a critical piece of the solution.
“Fast Healthcare Interoperability Resources (HL7 FHIR, pronounced “fire”) is a draft standard describing data formats and elements (known as “resources”) and an Application Programming Interface (API) for exchanging Electronic health records….The HL7 FHIR specification allows secure information exchange and is a positive step towards interoperability. HL7 FHIR separates the data structure from the wider problem of entity-to-entity trust, centralized server broadcasting and patient identification and matching spanning entities.”
“Less is more. This adage is true of patient matching: the more discreet items you try to match, the less likely they are to match. Keying errors, pseudonyms, misspellings and the like, impact the conformability of patient data. Also, poor data quality results in searches with no data matches. Successful matching strategies are a proprietary mix of deterministic and stochastic or probabilistic methods. They are proprietary for numerous reasons, which are beyond the scope of this paper. Stochastic methods are commonly used to overcome poor data quality.”
Framework for healthcare interoperability
There is a lot of talk about blockchain for healthcare but not a lot of frameworks that provide a reference to explain the concepts. The papers authored by Peter Nichol and William Dailey, MD communicate a framework to explain interactions required for efficient blockchain supported care systems.
The below interoperability strategic healthcare framework establishes a model for incorporating blockchain technologies into healthcare.
“Accessible healthcare data that is open-sourced but siloed will transition to healthcare interoperability where ubiquitous access to data will be secure and ever-present. In this new healthcare environment, patients will be able to audit each other’s behavior mutually, obtaining provable security of patient health information.”
The proposal paper elaborates on how patient matching identities could be administered.
The ONC and NIST Blockchain challenge is strong indicator the United States government is paying attention to blockchain technology the impact it will have on our national healthcare system.
For additional information the proposal paper titled, Micro-Identities Improve Healthcare Interoperability with Blockchain: Deterministic Methods for Connecting Patient Data to Uniform Patient Identifiers can be downloaded.