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The technology has the potential to streamline healthcare delivery.
It’s a new concept and a buzzword cropping up in financial circles: blockchain. And it’s a technology that promises to disrupt the healthcare industry and how many physicians practice medicine.
Blockchain technology, in many ways, is like Google Docs, the online platform where a group of users can contribute to and edit a shared document to create a record of information-but perhaps a bit more sophisticated.
Blockchain, often associated with cryptocurrency and digital trading, is a cooperatively maintained repository for information. The technology enables multiple users to upload and share information to provide a single accurate collection of details using a blockchain database, according to Mike Jacobs, senior engineer of Optum, a business unit of UnitedHealth Group.
Physicians should be aware of the technology, because it could potentially improve healthcare delivery through sharing information. For example, blockchain can aggregate health records from other providers for more effective healthcare delivery that isn’t tripped up by, for example, health insurance claims getting denied due toinaccurate patient data.
Looking at it more closely, the blockchain users could be multiple companies, such as medical provider groups and health insurance companies, who want to access the same information so insurance claims can be processed and paid efficiently the first time. Some small bits of information can be stored on the blockchain itself, but the rest of the data is kept in existing user’s computer systems or “off-chain”-in other storage locations.
In this case, the blockchain stores information about transactions, such as the time stamp and where the data lives. To gain access to data, users must have a special password. “You want to have the two ends of the transaction have the same information for it to happen in a frictionless way,” says Jacobs.
A ‘single source’
So what’s the use of this new concept in medicine? Take the example of insurance claims. Currently, numerous problems often come up when processing claims, because details about provider contacts, provider information such as an in-network designation, and/or insurance rules regard- ing coverage can all result in data that don’t match up among companies’ databases.
“It results in islands of data that are intended to cover the same information but can fall out of sync,” Jacobs says. “It causes problems, phone calls and faxes ensue, and there are many questions about, ‘Why was this claim rejected?’” Blockchain can provide a single source of accurate information, thereby avoiding such problems, he says.
Blockchain is also known as distributed ledger technology. Just as a person keeps a ledger when paying bills, blockchain is the same-only in an electronic format, says Debbie Bucci, IT Architect with the Office of the National Coordinator for Health IT, a part of HHS.
“Multiple workers or participants are writing to it at one time, and they can craft different transactions one at a time and can’t erase it.” Writing to the blockchain means users can contribute to it at the same time while having access to the same accurate data at the same time.
While different parties add to the blockchain, the information itself remains in its original location whether that data is in an EHR or some other storage mechanism, notes Corinne Proctor Boudreau, senior solutions manager of physician experience of MEDITECH, an EHR vendor based in Westwood, Mass.
“Neither the blockchain or any particular entity takes a copy of and owns the data,” she says. “The distributive nature helps ensure data is stored where it originated from and in an unaltered state, thus providing a true historical record.”
Blockchain in healthcare
Blockchain’s healthcare applications are still emerging. In April 2018, five large healthcare organizations-Humana, the MultiPlan PPO network, Quest Diagnostics, United- Health Group, and Optum-announced a blockchain project to incorporate provider data, such as name, address, specialty, and phone numbers, into one comprehensive database.
The goal is to run a pilot among the five companies through October, with results released in November and December, says Lidia Fonseca, MBA, MBI, chief information officer of Quest Diagnostics. Fonseca sees the alliance as a model of collaboration for quality improvement.
“It’s exciting and a great example of where companies are willing to cross company boundaries to bring benefits to the industry,” she says. The alliance hopes to help reduce some of the administrative burden for providers so that they can spend more time with patients and less on administrative tasks, Fonseca says, while also decreasing payment times.
Those tasks, which include time spent on phone calls and faxes to find out why claims are denied, added an estimated $2.1 billion across the healthcare system, according to statistics compiled in 2016 by the nonprofit Council for Affordable Quality Healthcare, which studies how to streamline the business of healthcare.
Opinions differ on whether blockchain can help healthcare. Some feel strongly that the concept can bring many benefits. Others think it’s too early to say whether blockchain can have an impact.
On the “benefits” side is Robert Chu, MEng, MCS, founder and CEO of Embleema, a Metuchen, N.J.-based healthcare blockchain network that launched a public beta release in mid-July. It allowspatients to share their medical histories with providers, and in future versions, with pharmaceutical companies seeking subjects for clinical trials and, potentially, with health insurers.
Embleema secures data so providers can see a complete medical history without the need for patients to fill out forms at every visit. Pharmaceutical companies seeking patients for new clinical trials will also be able to search Embleema’s database in the future to find candidates.
“All data on the blockchain is fully controlled by the patient and will show a complete trail of who accesses that data,” says Chu.
Others are more skeptical.
“At this point, nobody has actually proven that blockchain will work in healthcare,” Bucci says. “I don’t think anyone has clearly demonstrated what patients will see or get out of it, nor has the industry been successful, beyond proof of concepts or small target pilot demonstrations, to link multiple hospital systems. It looks like a potential solution to a security problem, but nobody has implemented it for that purpose, as of yet.”
Though blockchain may be difficult to understand, it is gaining momentum in healthcare and other industries such as finance. It’s a way to improve the accuracy of information shared among different users that can ultimately lead to better patient care and less time following up on inaccurate insurance claims, allowing physicians to spend more time with patients and less time on administrative tasks.
“Ultimately, it’s another tool in the box,” says Boudreau. “As with any tool, it is better suited to some uses than others.”