A blockchain-based information exchange could remove friction and costs presented by intermediaries in existing health information exchanges, according to a Deloitte white paper [PDF] on blockchain’s potential benefits for health care titled, “Blockchain: Opportunities for Health Care.”
The white paper was written in response to the Department of Health and Human Services’ Office of the National Coordinator (ONC) for Health Information Technology ideation challenge—The Use of Blockchain in Health IT and Health-Related Research. Deloitte’s was among 15 papers selected from a field of over 70 submissions from a range of individuals, organizations and companies addressing ways blockchain technology could be used in healthcare.
15 Winners Selected
The winning white papers were chosen based on creativity, ability to inform and foster transformative changes in the industry, and their proposed solutions or recommendations for market viability.
The relevance of the government’s call for white papers is that it serves as an official acknowledgment of the technology.
Use cases already demonstrate the benefits of blockchain technology’s decentralization, trust disintermediation, enhanced data integrity and lower transaction costs, the Deloitte white paper noted. The exchange of health records and exchange data using the protocol, Integrating the Health Care Enterprise (IHE), offers a way to address medical records accessibility and system interoperability.
The paper examined the technical requirements for health care systems to meet the standards that will support the envisioned National Health Information Network.
Blockchain Targets Pain Points
Blockchain technology offers a distributed framework to improve the integration of health care information across uses and stakeholders. It addresses existing pain points and provides a more disintermediated, secure and efficient system.
The paper listed six Health Information Exchange pain points and corresponding distrubted ledger opportunities: establishing a trust network, cost per transaction, master patient index, varying data standards, limited access to population data, and inconsistent rules and permissions.
Four Key Questions
Deloitte’s blockchain framework offers a guide for organizations interested in the technology. Four key questions can guide blockchain decisions: 1) when to initiate blockchain pilots, 2) how to design use cases, 3) when to strengthen the system through smart contracts, 4) should they deploy consortium, permissioned or permissionless blockchains?
Not all problems call for a distributed ledger solution, the paper noted. The four conditions in which blockchain helps are: 1) multiple parties create transactions that alter information in a shared depository, 2) the parties have to trust the transactions’ validity, 3) the intermediaries are inefficient or not trusted, 4) improved security is required to ensure the system’s integrity.
Once an organization decides to initiate a blockchain, the next step is to design use cases. The primary uses cases are: 1) authenticate and verify information, or 2) transfer value.
Use Case: Data Access
Prescrypt, a proof-of-concept developed by Deloitte Netherlands in collaboration with SNS Bank and Radboud, provides patients full ownership of medical records, enabling them to revoke and grant provider access to personal data. Providers can then authorize prescriptions on the blockchain. Organizations can verify a patient’s prescription history, genetics data or digital identity.
To deploy a blockchain solution, organizations can opt for a permissionless blockchain like bitcoin, a permissioned one restricting access to a select group, or a consortium like R3. Deployment also requires a blockchain protocol, the supportive technology to guide the structure and application development.
The protocol will influence the scope of applications and the number of participating users.
Platforms such as Ethereum offer the means to create decentralized applications on top of the blockchain architecture.
Hyperledger is an open-source initiative to provide a platform for corporate blockchain platforms.
The opportunity also exists to improve the health care information system using smart contracts that execute automatically when conditions are met. The application uses algorithms to customize conditions to determine when value should be exchanged or an event should be triggered.
Not A Panacea
Blockchain is not a substitute for an enterprise database, the paper noted. Its solutions are not suited to high volume data requiring total privacy and immediate access within an organization. Instead, blockchain solutions record specific transaction data to be shared across a network in which collaboration and transparency are critical.
Blockchain technology has potential in the U.S. health care realm, the paper stated. A consortium blockchain could realize national health information interoperability.
Such a blockchain could create a transaction layer for all organizations. It could also advance the U.S. Department of Health and Human Services (HHS) goals to standardize health care information by creating a transaction layer that stakeholders can securely collaborate on.
The Office of the National Coordinator for Health Information defined critical components for nationwide interoperability. Current technologies do not fully address these requirements since they are limited in the areas of privacy, security and interoperability. The current health care records are disjointed due to lack of common architectures.
The flow of information from the patient to the health care organization every time a service takes place need not end at the individual organizational level, the paper noted. Health care organizations could direct a standardized set of information to a nationwide distributed ledger transaction layer. The information would then be universally available through the blockchain private key, allowing patients to share their information with organizations more easily.
The blockchain’s proof of work, cryptographic public/private key access, and distributed data bring a new level of health care information integrity.
All organizations connected to the blockchain can have their own copy of the health care ledger. If a block should be adjusted, 51% of the network participants would need to approve the change, as every copy would have to be updated to reflect the change. This strengthens security and limits the risk of malicious activity.
Patient Care Outcomes Research (PCOR), one of the successful blockchain use case, conducts patient safety event reporting, clinical research, adverse event identification and public health reporting. And because of the blockchain’s security and privacy properties, PCOR researchers can access a single source of information that maintains integrity of the health care information for every patient.
Challenges To Consider
Various organizational, technical and behavioral economics challenges exist before organizations nationwide can adopt a health care blockchain.
A network of interconnected computers (nodes) are required to supply the computing power to create blocks once a transaction is submitted.
The ledger cannot directly store abstract types of data like MRI images or e-rays. Such data requires links to a separate location.
Further support could be required to encourage organizations to adopt the technology and participate in a network. While some organizations are testing the technology to verify and track medical records and claims internally, blockchain will be stronger when the number of users increases.
Forecasting the costs of operating a blockchain within a private enterprise or among a consortium of partners is difficult. To understand the costs to meet HHS and partner needs, targeted experiments and common blockchain guidelines are required to test the technology with a view to scale.
The Case For Experimentation
Experiments with blockchain technology could help HHS determine what it can accomplish. The experiment design should address holistic work stream problem sets with transactions crossing various parties from creation to archival storage.
Following the experiment through complete transaction cycles will allow developers to address friction points and determine areas of advantage before nationwide implementation.
Images from Shutterstock and HHS.