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We all know that the current health system is not sustainable.
It's too expensive, the service payment model is being challenged and our aging population requires quality. With healthcare spending approaching 20% of GDP – it's trillions of dollars! – we can not bear much more. Worse, it is generally accepted that $ 500 billion of this expense is not necessary.
Everyone is looking for a solution: a silver bullet that will transform the health industry from one day to another; a mechanism that can put an end to fragmentation, unlock and make significant data of patients hosted in "silos", often traditional databases, reducing costs and improving quality.
A dynamic "distributed" ledger can simply unlock the silos.
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Blockchain could be the answer. While still far away, the secure distributed digital ledger system that powers Bitcoin promises technological advances that could serve patients, providers and insurers in ways that will improve quality and efficiency. Blockchain is not new. It has long been known in the science of management information. These are the new blockchain applications that are making headlines.
If this promise is fulfilled it is complicated and is a matter of will.
Nothing will change health care unless we do it the right way
Blockchain technology in the healthcare sector is expected to be worth over $ 5.6 billion by 2025, according to a recent report. And this is exactly the problem.
At the moment, we are seeing many new players in space, but they are not focused on turning blockchain into a potentially universal solution. They are focused on getting a piece of those $ 5 billion.
We all know that change in health care is slow. Usually it takes cycles of at least a decade for real and sometimes longer change to occur. Startups looking to bring the blockchain into health care may not be willing or able to wait that long.
Beyond the time horizon, the real change can not happen in the health sector – whether we are talking about blockchain or anything else – until we step back and consider if we are approaching change in the right way. It's like good urban planning, where you have an idea how things will come together in the future.
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When it comes to setting standards, a division of the National Academies of Sciences, Engineering and Medicine has offered Six Domains of Health Care Quality, a great start for guidelines in the application of blockchain integration. The benchmarks are that any innovation is safe, patient-centered, timely, effective, efficient and fair. Adherence to these quality guidelines will help ensure that blockchain or other technologies are part of a significant long-term solution and not just another flash in the pan.
Considering technological applications, I like the approach that Ewout Kramer took on at Health Level Seven International, a non-profit organization dedicated to setting standards for integrating technology into health care delivery. . HL7 was the driving force behind the "FHIR" health data interoperability standard. In a recent paper, Kramer noted the practical application of the blockchain. He said: "Health care is very suitable for the blockchain because many data is still stored in data silos at hospitals, doctors, health insurances and other institutions. … Cryptographic technology can enable safe exchange, so they communicate with each other. "
The real topic for blockchain in health care: use cases
In health care, quality is everything. Unlike other sectors, the higher the quality of health care, the lower the final cost. Higher quality care is associated with fewer visits to the office or hospital and less need for high-cost procedures.
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Blockchain, just like everything else in the health sector, should also be measured by the fact that it is improving the quality of patient care.
And just as the distributed block book of the blockchain grows, I believe that providing the value of the use of blockchain technology in the health sector will be built block by block. However, a critical component is collaboration from the perspective of stakeholders, to include patients, providers, payers, regulators, etc.
We take one of the most difficult and common problems to solve in the health sector: drug monitoring and prescriptions.
Patients rarely receive all their prescriptions from a single pharmacy these days. They could go to different places, cross Canada to save money, pay cash for some and go through insurance for others. They can also take other over-the-counter medicines that could affect their prescriptions.
Doctors do not have a single snapshot of this model when a patient enters the door. The closest possible is when a patient comes in with a bag full of all drugs.
A centralized ledger powered by a blockchain, which "points" to various data sources of authorized patients, could offer a solution to track drugs and prescriptions, assign an identifier to each patient and track each drug in real time, updating the ledger with every transaction. This would provide an immediate benefit to physicians, reduce costs by simplifying data sets and improving patient care quality.
This is just a case of use, of which there are many, and the value of blockchain in the health sector will be demonstrated when these types of incremental use cases are shown to improve quality.
Blockchain is fundamental, non-destructive
There is a potential future in which blockchain technology can bring the structure to the proprietary and unstructured databases we have today in healthcare and create a form of meaningful interoperability through disparate systems.
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This is partly due to the "shareable" nature of the blockchain distributed book structure. In particular, the cryptographic blockchain register is shared and resides in several secure locations, updated in real time in all locations.
But it will take a long time, probably decades. The potential is there, but channeling hundreds of millions of dollars into investments in search for a quick return will not take us to the future we would all like to see.
We need to consider making more mature decisions on integrations, which will require a longer and more nuanced approach to make blockchain a real turning point in the health sector. It's more than possible, but there's a lot more work to do.
Charles Moore is an informatics and founder of Moore Advisors, where he provides business consulting and private equity transactions to health and corporate services is Manufacturing companies.
