Blockchain. The technology of distributed accounting books has a considerable promise in the health sector and, as often happens with emerging technologies, it is hailed as something like a cure for everything.
From cybersecurity to electronic medical records and data interoperability, to provide chain and clinical studies, including patient involvement. They have all been named as potential use cases.
But what about the challenge of patient adaptation? Can the blockchain cure the misfortune of successfully identifying the same patient through an intricate network of computer systems?
Those are big questions and the answers are reduced to this: Blockchain is not in itself a solution to the challenge – but it can play a supporting role in helping to align the same records for the same patient under an identifier of a single patient.
Blockchain: accessibility, integrity, interoperability of data
Blockchain can be designed to meet the needs of the master patient ID as long as there is consensus on what the requirements should be, said Brad Pedrow, Director of Practices of health care and life sciences at the professional services firm Grant Thornton.
"As a technology, blockchain can provide integrity, security and accessibility of data and interoperability of the most demanding health community requirements," he said. "The evolution and implementation of blockchain solutions in many sectors is gaining momentum to solve all kinds of problems.After reaching agreement on a starting point for patient identification, the blockchain it can be designed to meet those needs and be flexible enough to keep pace with change. "
By itself, blockchain does not address the challenges of a patient master ID – blockchain is a valuable component for solving problems related to reliable exchange, accurate and authorized patient data, including the creation of the patient ID, said Lynn Carrol, head of strategy and operations at HSBlox, a supplier of blockchain, machine learning and master index index technology.
"To solve patient matching challenges, a solution should use machine learning to analyze and consolidate patient data from multiple systems, such as EHRs, medical records, electronic prescription technologies, clinical documentation solutions and revenue cycle management platforms, to create longitudinal patient records that can be shared transparently between the patient's care team, optimizing the coordination of care, "he said. "The patient matching solution is then combined with blockchain to disclose relevant patient data to all parties who are allowed to see them."
The main challenge in carefully pairing patient records with a patient index is the lack of a global or universal patient ID. Like a distributed ledger, blockchain can track what has changed in a patient record and even assign a universal patient ID – but can not identify the correct patient unless all systems that would interact with this central blockchain database can provide the correct universal patient ID every time a change is made to the patient's medical record, said Gregg Church, president of 4Medica, an IT health care provider who markets, among other things, a master patient index .
"This is unlikely to happen soon," he said. "Once the global patient ID is available to each patient and recognized by all systems, blockchain can potentially become a back-end technology for the interoperability part of aggregation of patient data and tracking of the & # 39; unique identifier But who will set the block to start? This is just one of many questions regarding the real feasibility of blockchain for patient data exchange and patient identification. "
How blockchain can help with patient correspondence
Blockchain is definitely a technology with many applications. If blockchain is not the solution to master the patient ID, then the question with the main patient ID becomes where the blockchain can be applied to help.
Many hospitals and healthcare systems need patient data – perhaps in the form of an HL7 transaction – to be passed to multiple EHR systems. To do so, the patient's data are passed to a master patient identification system, where it is combined with a master patient ID that serves as a unique identifier for each individual patient.
"Once the correspondence has been confirmed, patient data could be automatically replicated and routed on an authorized basis through a smart contract on blockchain to individual EHRs, eliminating duplicate patient records," said Carrol of HSBlox.
On another front, the GS1 Global Standards Organization already has a solution for creating globally unique patient IDs, but it has not yet been universally adopted. Governments, as in the United Kingdom and Denmark, already have their own national patient identification systems.
"So even if the blockchain solution creates new globally unique IDs, you will need the master patient ID solution or an EHR master solution to store ID references in other systems to facilitate a single EHR that consolidates all health information from a patient, "said Pedrow of Grant Thornton. "It seems unlikely that we will reach an agreement on a global EHR solution and master in the short term, so the burden of linking all EHR solutions together would fall back on the master patient identification system."
"Still to be resolved are the identifiers for the medical records systems. The standardization on data identifiers will require coordination and time."
Gregg Church, 4 Medica
ID for patients and EHR
ID information that the blockchain should have stored would include both patient IDs and IDs for medical records systems, said Pedrow. Patient IDs will include data such as name, cell phone number, date of birth and perhaps even biometric data, he added.
"The identifications of medical records systems still need to be processed because they could include data sources such as a supplier's EHR healthcare system, a personal smartwatch, a home computer and a doctor's file," he said. "The standardization of data identifiers for these sources will require time and coordination."
But even here, the blockchain can be used to track the patient's unique identifier, Church of Medica said.
"But there must be one on the spot to trace," said the Church. "Currently, when new patient data arrives, a patient-to-patient matching technology must do the initial work to match this data to the patient's correct registration, which is not something the blockchain can do. index of the master patient who identifies the record to which these data belong, blockchain could theoretically update or enrich the patient record with the new data. "
" Currently, many patients do not have this confidence, as well as the Federal Government of States United A 1998 ban that prevents the spending of federal dollars on the creation of a unique patient identifier remains in effect. "
Brad Pedrow, Grant Thornton sign
Blockchain and ID challenge
While blockchain can help solve the ID of the patient's problem master, faces challenges in being applied successfully. These range from EHR interoperability to patient care.
"Solving the patient pairing challenge and automatically distributing data via smart contract on blockchain is a fantastic solution," said Carrol from HSBlox. "However, the problem of interoperability of EHRs still needs to be addressed – and this problem is not solved by patient coupling or blockchain.To overcome the challenges of EHR interoperability, the following two conditions must be met: a universal commitment is required from EHR vendors to support standards such as HL7 / FHIR and also the universal commitment of EHR suppliers to open the APIs. "
Blockchain can be a solution because the challenges are Surmountable from a technical capacity point of view: ongoing blockchain design efforts for EHR, patient ID and even beyond the healthcare industry will lead to an architecture and model that can be successful, said Grant's Pedrow Thornton.
"The biggest challenge is how to change patients' minds about the benefits of consolidating and sharing their personal health data in a single master record so they are willing to participate," he said . "The biggest obstacle is not what blockchain technology can actually do – it's the human factor and our role in the solution."
The patient must have confidence that the data are safe and immutable, so they will voluntarily share the information in the blockchain, he added.
"In addition, we must trust that those individuals with access permission use the data only in the ways patients have entrusted them," said Pedrow. "Currently many patients do not have this confidence, as do the US federal government.A 1998 ban that prevents federal dollars spending on creating a unique patient identifier remains in effect."
Blockchain: here or hype?
A big challenge for the blockchain and its ability to help solve the problem of the master patient ID is the hype surrounding blockchain. So another question that health CIOs have to ask is: do I trust the blockchain to help, or is it just a frame?
"We love advances in technology and look beyond where we are now," Church of 4 Medica said. "But it's all clear that blockchain technology solves the most persistent health care problems, particularly the problem of data silos." We see promising use cases in areas where changes are detected in recordings and in patient requests, however, we have not yet seen use cases that have actually solved the problems on a large scale. "
At some point, the uproar will calm down and health care will find really good use cases for the blockchain, he said. But it's hard to see how the original purpose of blockchain technology – cut the intermediary – functions in health care, he added.
"Permissions and access controls are still problems, and in terms of a blockchain patient's record, someone will be assigned control," he said. "In conclusion, we still see the need for a master patient index, with a global patient ID stored in the blockchain for monitoring purposes."
A long and painful road
Blockchain is really overcrowded – but it deserves the hype as long as the CIOs understand that the adoption curve is long and painful, said Pedrow of Grant Thornton.
"Technically speaking, we will soon be able to balance requests for speed, costs, privacy, job testing, centralized control, processor requests and blockchain governance," he said. "The industry continues to innovate new blockchain improvements such as" Proof of Stake "and" Scaling "to achieve a more efficient way to validate transactions and reduce the processing power needed, but the promise of blockchain will never be realized unless we the obstacle of trust. "
The public must believe that the blockchain can operate safely and reliably, he said. Good publicity comes from blockchain applications in the banking sector and from social innovation, politics, media, entertainment, airlines and life sciences,
"However, bad publicity is undermining public confidence," he added. . "Blockchain is hard to understand for people, so when a blockchain receives advertisements to be hacked, it creates the perception that all blockchain are insecure.We need a continued series of blockchain successes and education on how it works.blockchain offers great promises , and we all play a role in the development of technology and the social impulse to see that it succeeds. "
While technology could, in words, the promise of the blockchain is not, insisted Carrol of HSBlox. Applied appropriately, rather, the blockchain holds huge disruptive potential for health care.
"Blockchain addresses the challenges of real-time data dissemination and dissemination in the areas of claims administration, support team integration, process automation, price transparency, value-based program, chain of custody in clinical trials , origin of drugs and a host of other problems, "he said.
The problem of the main patient ID is a case in point, he said.
"When combined with probabilistic record binding using machine learning," he said, "blockchain is the secure and real-time notification and automatic replication solution."