Still Bullish on Blockchain: Experts Give a Lay of the Land

Oct. 25, 2018
Although there are still more questions than answers regarding the impact that blockchain technology will have on healthcare, many health IT experts remain convinced of its promise.

Although there are still more questions than answers regarding the impact that blockchain technology will have on healthcare, many health IT experts remain convinced of its promise.

One of these “bullish on blockchain” folks is John Halamka, M.D., CIO of Boston-based Beth Israel Deaconess System. Halamka, who is the editor of the Blockchain in Healthcare Today journal, launched earlier this year, frequently mentions the Gartner Hype Cycle—known for representing the maturity, adoption and social application of specific technologies—when discussing the latest and greatest health IT applications. Just where exactly blockchain— a distributed ledger that it is durable, time-stamped, transparent and decentralized—sits on the hype cycle can be debated, but Halamka, for one, certainly is optimistic on its potential.

Speaking at the Convege2Xcelerate healthcare modernization conference, held October 24 at Columbia University, Halamka stated how blockchain could speed up the progress of health data exchange. “The reluctance to exchange data has nothing to do with technology. It’s about psychiatry. Having a trust layer that is immutable will help with those issues,” he said. Looking at the challenges with clinical informatics, especially with issues around the exchange of health information, while the technology frameworks “have mostly been good enough, and standards have emerged, the policy and governance side of things needs to be [figured out],” Halamka said at the event yesterday.

Halamka, who noted that he led approximately 200 health IT meetings for the Obama administration, as he was co-chair of the national HIT Standards Committee, said that whether it’s accomplished through the government or the private sector, “the real [health data exchange] challenge is the capacity to track where your information has begun and where it has been distributed to. Society, at this moment in history, is beginning to think that there is something to blockchain,” he said. “And if they end up believing in it, and it’s publicly available with openness and transparency, it has an opportunity to change our reluctance to share our information with these various stakeholders.  Without this, it will be hard to move forward with interoperability [efforts],” he added.

The innovation event, which focused primarily on blockchain and telehealth, also had a number of other health IT leaders give their thoughts on the promise of blockchain in healthcare. Brian Behlendorf, executive director of Hyperledger, an open source collaborative effort created to advance blockchain, noted that some of healthcare stakeholders’ consensus goals include: wanting to see patient-centric health information sharing; data-driven clinical decision making with informed patient consent; insurance determination; and the reduction in drug costs.

“In order to achieve these, and make a dent, we need blockchain technology. You have two components—distributed ledgers and smart contracts—and you can build on top of those,” Behlendorf said, adding that blockchain technology will facilitate a network of ledgers, meaning that patient data would not be put directly on blockchains. “We can use ledgers to verify the integrity of this data.”

Indeed, this is how some experts clarify the difference between blockchain technology and heath information exchanges (HIEs). While HIEs hold the electronic patient data all in place, 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 disastrous impacts.

Behlendorf also cautioned that use cases that show the effectiveness of blockchain are still in the very early stages in healthcare. “Blockchain is essential, but it will not solve everything,” was the consensus take from the health technology leaders yesterday.

Being at the event yesterday made me think of when Healthcare Informaticsfirst included blockchain as one of our Top Ten Tech Trends last year. I’ll specifically point out this explanation from Chris Kay, chief innovation officer at the Louisville, Ky.-based Humana, who offered a specific example of blockchain’s prospective use in healthcare: “Imagine that you go to the doctor today and get a blood test, but you need to see a specialist, so a referral is made. But your health records don’t come with you; you show up to the specialist as a new patient. Here, you get a poor customer experience with a lot of friction in that system. But what will it look like in a distributed ledger world where there is cryptography and trust built in such that you as a consumer has a note on the blockchain that contains your health records? The provider who was contracted with an insurance company has the payments and scheduling on separate notes. As that provider makes a note, or does a procedure or a surgery, that becomes an indelible block on the ledger. You are building your health history over time.”

Offering another example of its potential impact, Wired  ran a terrific piece last year in which the author primarily spoke with Halamka, who gave 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 the 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,” Halamka said.

Of course, it’s important to keep in mind how early healthcare is on its blockchain journey. Most people in the know, with eyes and ears on the ground—and I think Halamka himself would be included in this sentiment—believe that there simply aren’t many provider-focused blockchain pilot projects in production at this time.

To this point, in a recent interview with Healthcare Informatics, health policy researcher Tim Ken Mackey, an associate professor of anesthesiology and global public health at UC San Diego School of Medicine, and who was also at the healthcare event yesterday, noted that blockchain “is really primed for proof of concept development, but often the hard part is translating a proof of concept into something that can go into production and can be used by multiple parties, and that’s where the most benefit comes from blockchain; if you are allowed to share data, but keep ownership of it and have provenance of the data and trust in that data. Getting to that phase is going to be harder,” he said.

But still, things are moving forward. Earlier this year, five prominent healthcare organizations—Humana, MultiPlan, Quest Diagnostics, and UnitedHealth Group’s Optum and UnitedHealthcare—announced they would be launching a blockchain-based pilot program with the aim to improve healthcare data quality and reduce administrative costs. The organizations said they would be specifically examining how the technology could help ensure that the most current healthcare provider information is available in health plan provider directories.

So, while full-stage deployments of blockchain technology in patient care organizations might still be a year or two away, if not more, it’s exciting to see some of the industry’s brightest minds continue to tout its promise.

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