With the meteoric rise (and the dramatic fall) of Bitcoin, cryptocurrencies are now part of the main conversation. Blockchain, the technology behind Bitcoin, is advertised as the ultimate solution to problems of sharing, security and transparency, often compared to what the Internet has done for communications. But does the blockchain solve inter-operability in health care?
The inability to share and act on data through the health ecosystem has been a problem for decades – and private, public and government entities have tried to solve it unnecessarily. While the critical nature of data sharing in health care is widely recognized, the most recent KLAS interoperability report has shown that 86% of suppliers have not yet achieved deep interoperability. Many manufacturers continue to implement interoperability protocols that operate exclusively within their ecosystems, building walls around their data assets. Even for suppliers who want to drive the industry forward, it is often prohibitively expensive to drive charges in supporting a common protocol or to develop an open interface for application programs. The result is a heavily concealed ecosystem.
The inability to share and act on data through the health care ecosystem has been a problem for decades.
Health care continues to face difficulties in achieving a deep and ubiquitous interoperability because interoperability is not just a technology problem; it is both a technology and a governance problem.
Blockchain may be able to alleviate the sore points of technology in the following ways.
- Data properties. A blockchain-based solution would allow all health professionals, be they institutions or consumers, to maintain control over their data. The penalties deriving from the involuntary sharing of data and from the fears of incorrect changes would be reduced, since blockchain allows the implementation of an immutable register with granular read / write access registers. Furthermore, it would create a single source of truth for the data and could be verified among the players.
- Security. 35% -40% of currently unencrypted health data would be encrypted by default. Last year alone, over 50,000 patient records were compromised by a series of violations, with multimillion dollar fines for suppliers. If nothing else, the "default cryptography" standard needed to implement a blockchain solution will help mitigate the risk of these data breaches.
- efficiency. Computational logic, in the form of smart contracts, would significantly reduce overall costs. With blockchain data pointers, smart contracts can act as code-based intermediaries that automatically process and act on relevant information between different actors, potentially eliminating release and authorization as we know them today.
But what about governance?  Blockchain-based interoperability solutions will see limited traction (similar to today) if the underlying governance issues are not addressed. Data definitions and other interoperability standards will need to be agreed by the majority of the industry. Fortunately, there has been progress on this front with significant use of Stage 3 and the announcement of MyHealthedata.
In addition, the sector would need to evaluate the various blockchain-based health platforms available today and merge some of those capable. Vendors such as PokitDok, Change Healthcare and Gem are starting to build health blockchain platforms. Others will emerge over time as well. A "war" between these players to shape the market will probably take place over the next three to five years. Just as the Internet needed a common Internet protocol to allow for the use of functional mass, a blockchain focused on health care would also require common protocols. This, along with its technical merits, is the way the blockchain can truly move the needle to interoperability.
Although the impact of blockchain on health interoperability must be determined, industry executives are not encouraged to sit on the sidelines. At a minimum, leaders should understand technology and help shape it with thought leadership in these early days. Humana and UnitedHealth Group are doing just that and have started to explore blockchain-based health solutions. Those who will not participate soon will be left speechless in their response as the industry moves.
Tom Robinson, is a partner, Health & Life Sciences, Oliver Wyman. He was co-author of this blog, which was originally published on OliverWyman.com by Santiago Doria, senior consultant, group of leading consultants and Aditya Lingampally, principal, Health & Life Sciences.