Tuesday, April 26, 2016

Getting on the Blockchain Bandwagon

Face it: health care IT infrastructure is a mess.  After spending tens of billions of dollars to "incent" providers to move to EHRs, they're using them but are not very happy with them.  In a world in which health IT systems should help improve patient care, they're seen more as a burden than as an asset.  We now have millions of electronic records that are still way too siloed, and all too often incomplete.  Worse yet, when those records aren't being hacked, they are being held captive by ransomware.

Enter blockchain.

To the extent most people think of blockchain at all, it is in relation to one of its most prominent users, Bitcoin.  Bitcoin, which has its passionate advocates and equally passionate skeptics, is not synonymous with blockchain.  Blockchain is the technology that allows Bitcoin to operate, but they are no more one and the same than Salesforce.com and Oracle are.   

In layman's terms -- and, trust me, when it comes to this I definitely am a layman -- blockchain is a set of distributed records, or databases, that are shared by multiple parties and which can only be updated by a majority of those parties.  There is no central authority, no central database.  It reminds me of the Internet's distributed networks, which help assure its robustness.

Equally important, in blockchain once a record is stored (or "transcribed"), it can't be tampered with.  For better or for worse, Bitcoin has demonstrated that blockchain does, in fact, assure anonymity, privacy and security.

Blockchain is starting to become more visible even outside of Bitcoin.  Businesses are being told they need a "blockchain czar.  Wall Street is starting to embrace it.  Britain looking into using it for manage the distribution of public money.  The EU is being urged to resist regulating it too soon.  DARPA wants to use it for a secure messaging system (which is how we got the Internet, as you may recall).
Some people think it is the greatest thing since sliced bread -- or, in modern terms, since the Internet.  IBM's Jerry Cuomo says: "Blockchain has the potential to become the technological foundation for all electronic transactions conducted over the Internet."  Similarly, venture capitalist Jalak Jobanputra gushes:  
Once every 20 years or so, new technology comes to market that has the potential to change how we communicate, how we do business, and pushes the boundaries of everything we thought was possible.
In the 1970s, it was the personal computer; in the mid-1990s, the commercial Internet. Now, we are in the early stages of another major technological development called the blockchain.
If they are even remotely right, blockchain is something that we better be paying attention to, and what industry needs its advantages more than health care?

Think of it this way.  Health care evolved in a world where the data, and the transactions, were initiated in the providers' office, made their way to the health insurers' offices, where they were processed, and sent back to the providers, which then updated their records and billed their patients.  Everyone gradually added computers to their part of the process, and started communicating electronically -- ultimately using the Internet -- but the underlying records and processes aren't much different than their 1970's/1980's/1990's predecessors.  Sure, the records are more often electronic, but everyone holds on to their data zealously and shares access to it only grudgingly.

It is thus no surprise that interoperability is a huge problem, and that problem is getting exponentially worse as data is now flowing in from so many sources, such as the new reams of patient-generated data.  E.g., to whom should I send data from my fitness tracker: my primary care doctor, my cardiologist, my health insurer, maybe even my employer?  All of them?

That's not going to work.

We're already beginning to see blockchain show up more in health care.  For example, Gem just announced Gem Health, As they say: "We need a modern infrastructure that unlocks new channels for services to connect, while balancing the need for strong data privacy and security.  Blockchain technology is that infrastructure."

Gem's vision is as follows:
We imagine a future where everyone holds the keys to their healthcare passport, bridging patient care among multiple providers and across borders.  We imagine hospitals hiring more doctors and nurses on a budget recovered from wasted reconciliation expenses.  We imagine labs, wearables, shopping lists, and healthcare apps working together to inform a healthier population.  
Philips is onboard, with the Philips Blockchain Lab joining the Gem Health network.

It's not going to be easy.  Health care has had a hard time agreeing to things like ICD-10 or HL7, much less interoperability standards.  In CIO, Peter B. Nichol points out the need for foundational protocols, such as the Linux Foundation's Hyperledger project is working on  If we thought getting providers to use EHRs was hard, picture trying to get the health care industry onto a entirely new technology platform like blockchain.

True to form, the "HIT standards mandarins" are already showing resistance to blockchain.

However, Mr. Nichol also enumerates a number of companies already jumping on the blockchain bandwagon for healthcare uses, including not just Gem but also Tierion, Factom, HealthNautica, and Guardtime.  It is something that any organization involved in health care can ignore only at their own risk.  It wasn't that long ago that Linux looked like an idealistic approach that major companies would never use, and we've seen how that has played out.

Look, I'm no technology seer.  I don't know if blockchain is going to totally revamp how we store and update data, as its proponents claim.  What I do know is that, when it comes to health care, our current approaches are not getting us to the interoperability that we need, or are doing so only at glacial speeds, and that they allow our electronic data to be increasingly vulnerable.  

If not blockchain, what?

1 comment:

  1. Interesting post. Would be great to speak. Pete Rizzo, editor for CoinDesk: pete[at]coindesk.com