A decade ago, we could never have contemplated clinical and medical health records leaving the network of payer and provider infrastructures. Cloud was a plausible future but there were several concerns around safety, rightful use of patient data, and health data security in general. Those concerns are still real but mitigated on many fronts by using the right technology. In 2012, when Estonia became the torchbearer in eHealth and launched Blockchain for Healthcare, much of the perception was that the initiative was too far ahead of its time. Today, 99% of health data is digitized and 100% billing is electronically accomplished in a country with a population of 1.32 million (2019 data).
Most payers have a strategy in place to become all-digital health plans within next three to four years. While efforts are well into mature stages of enabling the best possible member experience, there exist some significant deterrents. The most daunting challenge is about enabling seamless care coordination, given that healthcare is managed by so many different stakeholders across the value cycle with care transition steps along the way. Improving trust levels between healthcare entities and scalable, distributed data exchange driven by interoperability are vital to successful digital health programs.
Blockchain is inherently wired with three central schemes of zero knowledge proof, distributed digital ledgers, and immutability of records – all of which are amenable to the building blocks of an efficient care coordination service mosaic. Consider the fundamental concern about PHI security and privacy related to medical records. Leveraging ZKP and quadratic equations, the verifier could verify specific elements without even revealing the whole transaction and hence it would be impossible for any actor in the healthcare value chain to fully construct the clinical history of a member. This is a big leap that the healthcare industry needs today to drive the ethical use of members’ most private health data.Likewise, distributed ledgers can give ownership of isolated segments of a member’s health journey without requiring the physical record to move anywhere beyond its current location, thus enabling transparency while simultaneously preserving the dynamicity of the health journey.
The immutability aspect guarantees that the record can at no point in time be altered without being transparently visible to all other stakeholders in the chain. That coupled with audit and traceability of every action would make healthcare fraud or data breaches extremely difficult.
Another interesting dynamic of blockchain is that it is built for interoperability and has the capability of unchaining clinical systems that reside in their own silos. Top that off with the ability to use smart contracts, which could define immutable transaction logs of all known exchanges of a patient’s health record. They could be further augmented through FHIR consents, which could be represented in smart contracts too, offering the member full flexibility to modify the consent levels as needed. Some of the longstanding problems in the industry, such as Medicaid churn or coverage continuity as beneficiaries constantly exit and re-enter due to eligibility changes, can be addressed to a large extent by defining smart health profiles. In the longer run, artificial intelligence could influence the inception of completely new healthcare financing models on the back of medical blockchain. Although still nascent, blockchain has increasing claim to fame, given the focus on digital health and more federated healthcare services with an openness to embrace newer care delivery and coordination models. Blockchain is here to stay!
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