Blockchain in healthcare: 3 promising use cases in a sea of skepticism

The Enterprise Ethereum Alliance aims to develop a standard for a distributed ledger to speed up transactions while increasing privacy (Image peshkov / iStockPhoto)
Blockchain technology has the potential to usher in a revolution of information sharing. But its real-world applications are still limited in healthcare. (peshkov/iStockPhoto)

WASHINGTON, D.C.—At the recent Blockchain Health Summit, healthcare CEOs from around the world gathered to learn exactly how blockchain technology could revolutionize the healthcare business.

While conference attendees scrounged for evidence indicating the technology could solve some of healthcare's most pressing problems, they were also forced to wade through a heady dose of hype.

“We all know this terrible thing blockchain; it’s a disease. Once we get it, we become obsessed with it,” warned Tori Adams, vice president of Consensys Civic.

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Indeed, several attendees seemed eager to catch the blockchain bug. More than one healthcare executive came to the conference armed with a business model that didn't use blockchain at all—but, caught up in the excitement, they were eager to learn how the technology might be involved.

Even the HHS Office of the National Coordinator for Health IT showed up, sending branch chief and IT architect Debbie Bucci to speak on its behalf. However, Bucci took a far more measured approach than some of the other speakers, preferring to let the industry come forward with use cases rather than backing any herself.

"I know that there are a lot of working groups, hyper-ledger and other, that are forming to create proof of concepts—working demonstrations of health IT. But is anything real yet? Can I have a hand—is there anybody out there that has something that is on the verge of becoming mainstream in an organization? Are there any health IT projects out there that you know of using blockchain?" she asked during her keynote. 

Two people raised a hand, including one panel participant.

Proponents will eagerly explain why blockchain is a promising solution for health information interoperability. The technology works by using a public ledger to track the provenance of a source of information, then links those sources to update information in a decentralized way.

Because the provenance is ingrained in the information, it is impossible to obscure or miscomprehend what happened to it—that's what made the tech so useful as the backbone of bitcoin, where the sales history of a coin is encrypted into the bitcoin itself.

When you bring this technology into the healthcare space, the applications become obvious. The health system is littered with siloed sources of data. If they could speak to and update each other, it would solve some of healthcare's most prominent interoperability challenges.

RELATED: 70% of payers plan to integrate blockchain by 2019

But there's also a problem: The technology depends on provenance information being public, and regulations surrounding health information are fairly strict. And although ONC may have its eye on a few promising—or concerning—health IT possibilities that use blockchain, it's taking a backseat, letting industry take the lead.

"There was a point in time when the federal government ran the show," Gerard Dache, president of the Government Blockchain Association, during one panel. "Everybody flocked to the federal government and they called the shots, and what's happening is, that kind of central control is slipping away. The private sector is moving very, very quickly, and it used to be that government could tell a contractor 'you're going to do this, this and this. It's my way or the highway.' But when you go to Microsoft or Google, you have a little harder time."

Now, it's up to healthcare companies to demonstrate that blockchain could open up new healthcare use cases that don't violate HIPAA. So far, it's hard to say they succeeded. The convention floor contained a grand total of two vendors pitching products—a rather dismal turnout for a trade show typically stocked with companies touting their wares. Several provider executives seemed unclear as to why they were there at all. 

Still, a few of the pitched use cases did seem to get around the regulatory challenges:

  1. Provider databases and information: The Synaptic Health Alliance, a partnership that includes Humana, Quest, Multiplan, UnitedHealthcare and UnitedHealth's Optum division, is working on a blockchain solution to create a "golden record" for provider information. The group noted that provider databases are frequently out of date and incorrect, making them a pain point for both patients and providers. If the databases were connected with a blockchain, an update to one database could update the others, improving the accuracy of information. Furthermore, that information is not regulated in the first place, making it low-hanging fruit for a group looking to test how blockchain can be used in health IT. 

    RELATED: Humana, UnitedHealthcare launch blockchain pilot focused on provider directories

    Interestingly, even though provider information can be public, the group is developing its golden record through a "private" or "permissioned" blockchain, which would need to authorize users before they can make changes. Mike Jacobs, senior engineer at Optum, said this was both to maintain the integrity of information (avoiding the "Wikipedia problem" of anyone editing information) and to prove a use case for future implementations of private blockchain. 
     
  2. Identity authorization and credential management: Another item on Optum's radar is provider identity authorization. While HIPAA is very strict about who is allowed to view patient data, provider identities aren't covered.

    Optum believes it can integrate blockchain into EHRs by using it to authorize provider identities while keeping all the actual patient data off-chain.

    "The blockchain could or should be used as a means of tracking whose record is accessed and who is supposed to have access to a record," Jacobs told FierceHealthcare. "It might also contain metadata associated with that episode, but not necessarily the details. So, it could be Mike saw the doctor on Oct. 10 and he saw him for a particular condition, but that condition is hidden in the internal EHR system, not on the blockchain."
     
  3. Smart contracts: Self-funded employer health plans have a transparency problem: When they use a large insurer to administer their employees' claims, their contract doesn't allow them to directly view the costs of that provider interaction—even though they are footing the bill. Instead, the insurer bills the employer separately, allowing them to add a markup and keep the difference. 

    Some executives, such as Jerry Beinhauer, M.D., CEO of Appley Health, have identified this as an inefficient middle man in healthcare billing. By building a blockchain between the employers and the providers, Beinhauer thinks price transparency can ultimately eliminate those markups.

    "With blockchain they can enter into direct contracts—peer to peer," Beinhauer told FierceHealthcare. "They can transact peer-to-peer directly, so there's transparency in those payments as well, without an intermediary that can mark it up. And the problem is there's still some level of distrust between those parties, so blockchain takes into consideration all those characteristics to address it."

    The advantage of this model is that it doesn't hit on any HIPAA problems. HIPAA does not require patient consent for the exchange of information regarding healthcare operations and payments. Because the employer is the payer in a self-funded health plan, the law enables employers to see the billing data of their employees even though their contract with the insurer does not.

Meanwhile, a number of other executives had concepts for business plans that involved patient data. Whereas many of these appeared to intersect with HIPAA, a few pitched a model with an interesting workaround: If patients sell their own healthcare data, it no longer falls under the purview of the law.

Consequently, some businesses may begin offering to pay patients for their data—unlike all those companies that acquire data from other information resellers. It's an investment in a whole new world of health information sharing. 

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