Across the healthcare spectrum, there is a great deal of uncertainty and unfamiliarity when it comes to how blockchain technology could be applied. While most would agree that the industry can benefit from leveraging blockchain in various ways, one recent report points to how it’s potential in precision medicine is gaining traction.
The report, from New York City-based consultancy Frost & Sullivan, examines the global healthcare crisis, looking closely at chronic disease, aging populations, and rising costs, while exploring the challenges inherent in precision medicine—including the big data conundrum, interoperability, cybersecurity, value-based care reimbursement, data ownership, and healthcare consumerism. As such, the researchers believe that blockchain technology can be the solution to many of those issues and is the missing piece in healthcare digital transformation.
Greg Caressi, senior vice president, transformational health at Frost & Sullivan, recently spoke with Healthcare Informatics about the report’s key takeaways, the role that blockchain could have in precision medicine, and other use cases for blockchain in healthcare. Below are excerpts of that interview.
What was your motivation for exploring the role that blockchain could have in precision medicine and elsewhere in healthcare?
We are an analyst consulting firm, so we’re always looking at new technologies as they are being brought to market, and at companies doing interesting things in this space. And part of our job is to look at what real opportunities there are within those technologies to apply them in real-world use cases, to figure out what the monetary value of those applications are, and to separate hype from reality.
So we did a study on blockchain about a year ago where we spoke to a wide number of companies. It is a technology in its infancy and it has been applied in certain use cases in other industries, and there were some in healthcare already underway at the time. So we talked to vendors, users, other industry experts and blockchain experts, and put together our research as what we saw as the top use cases and the most interesting companies in this space.
What has your research revealed thus far?
For providers, it hasn’t been really taken up in healthcare. The pharma industry is certainly doing things, and you have seen the recent payer announcements around blockchain utilization for processing claims. It fits well there. Providers are exploring this, and it was about a year ago when I was speaking to a group of hospital CIOs, and some of them didn’t know what blockchain was or hadn’t even thought about applications in their settings.
So early adoption applications are in the provider world will be a little bit more down the line, and right now it’s more around transactional exchanges of information, such as claims adjudication and drug supply chains, other than in Estonia, where a national medical record concept is being tried. But that isn’t mature in the U.S. market and it would be unlikely to get adopted here. When you [think about] moving into the 2019 to 2021 time period, you can start looking at IoMT (Internet of Medical Things), medical device information, and clinical trials, which do involve providers who will be participating in that, though they won’t be the originators.
Some folks have tried putting together exchanges that would involve providers making service lines available when they aren’t fully booked, sort of like Priceline for healthcare services. You have entities that are able to give access to that exchange for their employees or members to get access to services, but that is probably more in the post-2020 range.
You mentioned the top use cases for blockchain in healthcare that you researched. Can you explain those in more detail?
We identified what we thought were the five biggest use cases in terms of just dollars: the biggest one was for drug supply chain, so the ability to remotely audit the drug supply chain. That is the biggest opportunity where pharma can have the ability to trace back in their supply chain down to the API level, and see when there is an issue with a product that does demand an audit and/or recall. They can be precise in terms of where that manufactured lot comes from.
The others we identified as in the top five as far as earliest adopting and impact in terms of dollars included claims adjudication and billing management, and we have seen payers announce they will use blockchain for that purpose since we have published the research; and clinical trials and population health research where you are trying to collect data from a wide range of participants. And this impacts precision medicine because as you look at precision medicine trials, you’re looking at having access to more defined populations that are going to be more dispersed. You get the ability to access them quickly to collect data, validate that data, and have all of the trial protocols documented and adhered to, so there is value in clinical trials that can be done through blockchain.
And then health data exchange is another use case we researched, though there are limitations. Genomics data, for example, doesn’t fit well within the blockchain since the volume of data becomes too large in the current technology models.
And then there is cybersecurity. When we talk about the Internet of Medical Things, the ability to have locations where data can be included from a number of sources, and limitations on access, and have data governance and control within blockchain, is one of its strengths. When you think of Bitcoin transactions, and you think of IoMT, and all that data, you can have all those pieces of data to be securely accessed by those given rights, and then others can give inputs as well.
Speaking of the health data exchange use case, we’re hearing from some people who think that this is an unrealistic application, and then others who are very hyped up about it. Where do you stand?
I was on a panel at a recent digital health event and they asked us what is the most overhyped technology, and blockchain was the winner. It’s getting more press than it has use cases that will be rolled out. But health information exchange is one of the areas where you have the biggest challenges. There aren’t a lot of incentives in place for those that control the data today—which are generally the hospitals and health systems—to share that data outside of their own users. Of course, there is a lot of value in care coordination, but in an ACO (accountable care organization) or similar model, there usually already is a way to exchange some level of data.
As you look at more people inputting and drawing on that information in a broader sense nationally, then maybe you start to see more value there. In the U.S. right now, we don’t have a way to tag that information. So if you have data input from where you live currently and are traveling and have to go see a doctor, and you lived somewhere else 10 years ago, we don’t have a way to make sure that “you are you” in all of those locations. There is no master patient index at a national level and that’s a barrier we need to figure out in the U.S. for data exchange overall. It’s not surprising that Estonia is the first location giving this a shot because it’s a small market and they do have the ability to tie that same-named person through an identification code that everyone has agreed to use.
There are also other issues around terminology, and regulatory concerns that providers will be nervous about every time they share information. So while it is supposed to be secure, some loss or theft of information, like we have seen through Bitcoin, adds psychological and technical barriers. I would not expect data exchange to be [blockchain’s] first use.
In a lot of ways, many say that blockchain works best when lots of players are involved, but the realty is that the implementations we see today are those where we have a single enterprise driving it for a reason or a defined set of partners. Whether it’s a pharma company tracking their supply chain or a payer looking at claims adjudication, it’s a defined set of players and usually one big entity that sees value and drives the system—just like Walmart drives a system out to all of its suppliers. It’s easier to get someone to drive the bus and then force someone to come along.
How important is it to discern fiction from reality when working with vendors who might be saying that this is the next great thing?
It’s very important. There is a trust factor, a need factor. While we all recognize the need for interoperability, [stakeholders] are working on other approaches they have already invested in. So there is not a huge appetite for throwing those out the window. For providers, a large [motivation] for health information exchange is to do analytics on that more holistic patient record and understand who’s at risk. And analytics doesn’t fit well with a blockchain. Blockchain is great at being able to have a “track and trace” of a transaction, but it’s not a data repository system that allows you to go in and run analytics on that combined set of data. You have to be able to pull the data back out to do that.
Can you offer any blockchain predictions for the next year or two?
I think as you see some of the entities that are adopting it, as they see value out of it, you will see things happen quickly in the pharma and payer markets. So that’s the immediate future: drug supply chain, identity verification and management, and claims adjudication. Hashed Health is working on a way to check licenses of clinicians. That’s a transaction model that fits well in blockchain. We believe that those transactional models will create value by the end of next year.
The next wave includes clinical trials, where you have applications potentially tying into the requirements for unique identifiers within medical devices—again, more transaction. But for the broad applications, in terms of shared medical records, it will be post-2020 before you will see a widespread recognition and push to adopt them that goes beyond just a few examples here and there.