While financial services and shipbuilding industries have rapidly implemented blockchain, the healthcare industry may soon follow its own path as it seeks to increase efficiency and security, reduce costs and expand services with distributed ledger technology.
In essence, blockchain could help remodel health interoperability by serving as next-generation middleware that combines health data with decentralized, distributed and immutable qualities, according to a new IDC Health Insights report.
Accordingly, by 2020, 20% Health organizations have moved beyond pilot projects and "use the blockchain for operations management and patient identity".
Blockchain interoperability could support data exchange, offering an alternative to current health information exchanges (HIE); essentially, it will act as a meshed network to transmit secure, almost real-time data to patients for health professionals, pharmacies, insurers and clinical researchers, according to IDC.
While blockchain may be shift from test cases to production systems in other sectors, its adoption by health care has been slowed by the emergence of technology coupled with major regulatory and security issues, data harmonization and availability of blockchain resources, says the report.
The United States Department of Veterans Affairs (VA) – generally the leader in early technology implementation – was also slow to immerse their toes in generalized accounting technology. (VA was one of the first users of electronic medical records or EHR.)
Last year, the agency's IT department published a research paper on the attributes and vulnerabilities of the blockchain. He noted that the encryption used to protect the blockchain itself and to communicate between system elements provides integrity on users' messages or between server nodes.
"Ensures that participants can see the parts of the ledger relevant to them, and that transactions are secure, authenticated and verifiable", states the VA document, noting that with "authorized" blockchains, users must be registered before to be able to add or review records.
To date, however, the VA still has to test the blockchain related to its massive health care system.
However, a small number of health professionals are beginning to consider technology as a way to leave interoperability problems.
While there is some degree of network interoperability between health service providers, pharmacies and insurance companies through various frameworks such as HIEs, they have had "varying degrees of success and penetration ", said IDC. He cited inborn flaws that include "limitations in the interoperability standard or protocol itself, workflow and differences between entities, blocking information and technology requirements."
Two major HIEs – CommonWell Health Alliance, a 'trade association working for interoperability in the healthcare sector and Carequality, a public-private partnership created to establish a common framework of interoperability, has been successful in creating solid industrial bases for data exchange with the support of EHR sellers.
"And this is facilitating a somewhat limited form of exchange based on queries [data]," said Mutaz Shegewi, research director of IDC for the transformation strategies of the IT provider. Shegewi was referring to the ability to search for secure information about patients online.
"So I do not think that they are insufficient, but there are limits in terms of how many of them can make the exchange of health information oriented around the long term," Shegewi said.
The problem is multifaceted, but mainly stems from the lack of unified standards, frameworks and data protocols that encompass health facilities and industry as a whole, according to Shegewi.
"It is the variety of EHR systems and interfaces, data sources and uniformity in workflows," he said. "It's a great enigma."
Blockchain as "the only source of truth"
Because it is a transparent electronic ledger that can be shared among a group of authorized users, allowing everyone in the group to see the latest data almost in real time, the blockchain it could improve the discovery of patient data across a broad spectrum. It can also take advantage of the open and compatible FHIR interface (Fast Healthcare Interoperability Resources), a set of standards that will be available in all major EHRs to consolidate lifetime clinical records from several EHR providers.
(The FHIR interface is also at the heart of Apple's new Health Record, a mobile application that allows patients to extract data from multiple EHR systems.
Acting as a mesh, blockchain could accelerate the distribution of clinical data while using FHIR to standardize data format, patient profiles and secure encoding-level indices, according to IDC.
"It does not affect the way in which data is transmitted or data rules or anything that would bring data to the next level – cross-linked work or skeleton for it, "said Shegewi.
Blockchain could, for example, play a supporting role in a variety of sectors: enabling shared statistics on population health, research of clinical studies, d
Not only can it record any event, such as a diagnosis or treatment of the patient, prescription of drugs or pay chucking insurance in chronological order, but can archive events as immutable records. With blockchain, additional data points can be added, but the previous entries are unalterable. So in essence, it offers only one "truth source" for anyone authorized to view data on the online network, according to Shegewi.
"Blockchain paves the way for interoperability to happen at some point, is more decentralized, more permanent, more transparent, more accessible," Shegewi said.
But this will not happen from one day to another, especially in a highly regulated industry that is necessarily cautious about how it handles sensitive patient data.
Blockchain terms are widely adopted as core technology in the healthcare sector, which will be a much longer timeline – perhaps well beyond 5-7 years in terms of being central to clinical workflows, "Shegewi said .
The adoption of the cloud is driving interest blockchain
"I think everyone is enthusiastic about the blockchain, the adoption is not a technical problem, but it is taking the foundations because it is a highly regulated, "said John Sculley, chief marketing officer of the RxAdvance start-up, based in Massachusetts, a pharmacy benefit management cloud service (PBM).
The PBM and the pharmaceutical industry are a market to 840 billion dollars, Sculley said, but it largely uses the same technology it was built 35 years ago. "They are still mainframes, like the AS400s: it's still a command line programming Cobol," he said.  Ment re RxAdvance aims to streamline the award process for reimbursements between pharmaceutical companies, health plans and insurers; it is not currently based on blockchain; However, Sculley believes that distributed ledger technology will be critical within five years.
"We are not implementing it now because there are so many regulatory problems," said Sculley, former CEO of Apple and Pepsi-Cola. "So, this is not the fruit for us low, but we understand that it will eventually be mainstream."
Blockchain's ability to create an unbroken chain of data items from the point of origin to the completion of the transaction, and to protect such data through cryptography, offers "a huge advantage for privacy," added Sculley. And "obviously it is more efficient.
" Building more and more systems in the healthcare sector that will be cloud-based is another reason why blockchain will make sense, "said Sculley, referring to online peer architecture. -to-peer on which blockchain
The big tech players, like Amazon, Apple, Google, IBM and Microsoft – even retail giants like Walmart – are aggressively claiming an affirmation in the health sector and in many cases how the blockchain could be applied
Intelligent contracts that can automate manual processes
In addition to solving interoperability problems, blockchain could free up the value of stagnant and silent health data files by serving as intelligent contracts: scripts that they are self-executing according to predetermined rules.
For example, if a patient were to fill in a doctor's office and then, a few yes, afterwards, he would turn to another doctor, an intelligent contract could automate the transfer of patient data according to pre-established rules the patient c
"A big sore point for suppliers and payers is the pre-authorization and control of availability – ongoing processes to ensure that a patient is eligible for an option, treatment or assistance intervention, "said Shegewi. Following predetermined approval rules, smart contracts could verify a patient's documentation to automate this process.
An intelligent contract based on blockchain could also automate payment for a treatment once a health care provider, patient and insurer agree that the treatment was done
Have a transparent platform that uses a standard data model it should also address the blocking of patient information that sometimes occurs between EHR systems.
Since the promulgation of the 2009 HITECH law, which required the industry to adopt EHR, sharing data between different vendor platforms, geographically dispersed structures and non-associated medical institutions have improved; but the transparency of data no. EHR providers still use proprietary protocols to orientate their markets, which means that not all data is shared the same way. In fact, some sellers have been accused of working to ensure that data can not be shared easily.
"The industry is in a better place in terms of opening up and exchanging information and data" Shegewi said. "However, there is some block of information if they can get away with it."
In addition, the blockchain would give patients greater control over their health information, something that stifled proprietary systems.
According to current federal guidelines for Medicare and Medicaid reimbursement, US healthcare professionals are rewarded for achieving performance goals, "while the most important influencing factors (ie patients and their families) are largely excluded from the data equation, "said IDC.
Patients may see another advantage: Because the blockchain can create cryptocurrencies, patients could obtain digital tokens as an incentive to share data.
Awards to share health data
Among those who are seriously trying to block now is the Mayo Clinic and the London Medical Start-up; both are working together to develop a variety of services in the future.
Medicalchain has created a blockchain-based EHR registry that can be used by patients, health professionals and insurance companies for the exchange of EHR information; the first application for its platform was a telemedicine service called MyClinic.com, which allows patients to consult healthcare professionals remotely. The platform also makes it possible to share anonymous medical data with researchers and in return for the Medicalchain cryptocurrency: MedTokens.
Mayo Clinic, which has three major campuses and more than 70 small hospitals, is not currently looking for ways to use blockchain to protect EHRs; He is working with Epic Systems, one of EHR's top five suppliers, to implement a single integrated healthcare system and billing system – a monumental task in itself.
"We will explore various potential benefits of blockchain technology in health care – to bring efficiency and strengthen security in data transactions The agreement [with Medicalchain] has been signed recently, so the explorations are at a very early stage" a spokesman for Mayo said via e-mail.