One of the reasons I like reporting on Healthcare Informatics’ Top Ten Tech Trends every year is that as a health IT journalist, I learn so much about tech innovations that are just coming onto the healthcare scene. A case in point this year was blockchain—an up-and-coming technology that many in our industry are fawning over, despite applications of it in healthcare still in very immature stages. Admittedly, I was a tad hesitant to take this story on as one of our Top Tech Trends this year, thinking that most healthcare experts in this area wouldn’t be able to say much about blockchain—best known for its use in the financial sector. Boy, was I wrong!
After interviewing several industry leaders about blockchain’s potential in healthcare, and after attending a few sessions at HIMSS’ all-day blockchain event in Orlando in February, I must say that it’s very difficult not to buy into the hype. At its core, blockchain would offer the potential of a shared platform that decentralizes health data without compromising the security of protected health information. This alone could make real headway in solving two of healthcare’s biggest challenges—interoperability and data security.
Healthcare Informatics’ blockchain coverage essentially started last summer when Senior Contributing Editor David Raths penned an excellent article in which he interviewed Micah Winkelspecht, founder and CEO of Gem, a Venice, Calif.-based startup developing blockchain application platforms. You all should read the piece yourself, but this is what Winkelspecht said about how blockchain could work for a patient who had recently seen a few doctors: “Blockchain would point me to a universal patient case file, with a universal identifier for me as the patient. So no matter which doctor is interfacing with the system, they are recording information against the same universal patient identifier, which is recorded on the blockchain,” he said.
In more recent months, the blockchain “buzz” has only continued to grow. Wired ran a terrific piece in February in which the author, Megan Molteni, mainly spoke with John Halamka, M.D., CIO at Boston-based Beth Israel Deaconess Medical Center. Here’s what Dr. Halamka said, giving a specific example of how blockchain would work with prescriptions. “Say that one medical record shows a patient takes aspirin. In another it says they’re taking Tylenol. Maybe another says they’re on Motrin and Lipitor. The problem today is that each EHR [electronic health record] is only a snapshot; it doesn’t necessarily tell the doctor what the patient is taking right now. But with blockchain, each prescription is like a deposit, and when doctor discontinues a medication, they take a withdrawal. Looking at a blockchain, a doctor wouldn’t have to comb through all the deposits and withdrawals—they would just see the balance.”
When you hear experts such as Winkelspecht and Halamka discuss how blockchain could be used in healthcare, it’s easy to see why many are so bullish. It’s hard to compare it to anything we have seen in healthcare in the past, though the closest match could be health information exchanges (HIEs).
For my story, a few sources brought up the blockchain/HIE comparison, noting that one key difference is that HIEs hold the electronic patient data all in place, whereas with blockchain, separate entities each hold a “token” on the chain. Put in other words, if you as a patient go to four different hospitals, that data is being held separately; no single place is containing all of your information. And, no single entity has a complete view of your information unless you initiate a request and all parties agree to it. On the other hand, with an HIE, various different agencies are submitting data to that centralized exchange, meaning a hack of that information could have catastrophic impacts.
Adding to this thought, Vince Vickers, KPMG’s healthcare technology leader, said, “Blockchain effectively takes out the middle man; conceptually you would not have these health information exchanges that have struggled to get to mainstream. There have been a lot of good efforts in certain states, and some HIEs have done well, but in relative terms, [compared] to the financial services industry—where I can go to an ATM, no matter where I am in the world, and get my money—patient data obviously is very limited in that way. And the HIEs are very slow moving. So blockchain is a really interesting disruptor. When you put it in those terms, that it could potentially, not necessarily eliminate HIEs, but at least change them structurally and provide a new value proposition.”
It’s thus no surprise that a December Deloitte report found that the healthcare and life sciences industries have the most aggressive blockchain deployment plans of any sector, with 35 percent of surveyed respondents saying that their company plans to deploy the technology in production within the next calendar year. And in January, it was announced that IBM Watson Health and the FDA inked a two-year agreement to jumpstart a research initiative aimed at defining a secure, efficient and scalable exchange of health data using blockchain technology. Specifically, IBM and the FDA will explore how a blockchain framework can potentially provide benefits to public health by supporting important use cases for information exchange across a wide variety of data types, including clinical trials and "real world" evidence data.
With all this being said, it’s important to take a step back and realize that full scale development of blockchain applications in healthcare is probably a few years away. The sources I spoke to noted that buy-in from EHR vendors is not a given, trust issues will have to be worked out, and quite frankly, there needs to be more of an understanding about the technology’s many complexities.
To this end, that same Deloitte report revealed that across various sectors, many senior executives still know little or nothing about blockchain. The report implied that there seems to be a general feeling that organizations would be at a competitive disadvantage if they failed to adopt blockchain. But that really shouldn’t be reason enough to push forward; there needs to be a granular understanding of the technology. As KPMG’s Vickers said, “If I went out and asked my innovative CIO friends if they know about blockchain in the healthcare industry, eight out of ten wouldn’t know what I’m talking about.”
So in the end, while there are plenty of issues to be ironed out, it’s hard for me to be anything but optimistic on the potential of blockchain in healthcare. Now, in no way am I advocating for blockchain as the magic bullet to solve all of healthcare’s core problems—the biggest being that $3.36 trillion number of total healthcare spending in 2016. But if you’re telling me that it could be the fabric that ties existing data siloes together? In that case, sign me up.
