David Houlding is Microsoft's chief health officer and president of the Blockchain Society in the Healthcare Task Force of the Healthcare Information Systems and Management Society. Here, he discusses blockchain technology and its potential to improve IT interoperability in health care, fraud prevention and more and what to expect in terms of increased use of blockchain in 2019.
The answers have been slightly modified for clarity and length.
Question: where is now the blockchain in the health sector and how will it develop in 2019?
David Houlding: 2019 will be really interesting in terms of blocking blockchain pilots, published case studies and in-depth analysis by health organizations about what worked well. It will be a watershed moment for the blockchain, because more suppliers, payers and others stand up and attest to their cases of blockchain use, the pilots and corporate values achieved, more organizations will gravitate towards those cases of use, we they will join these consortia and those networks will grow. Blockchain is very much a network technology, so it benefits from the network effect. Therefore, the more organizations connect, the greater the value. The hard part with blockchain is creating the consortia of health organizations, obtaining their buy-in and building their trust to the point where they are willing to link their business systems to blockchain and transactions. Once this is done with an initial use case, it is relatively easy to add additional use cases, further exacerbating the network effect.
Q: What do you think will be the most significant blockchain applications in the healthcare sector over the next five years?
DH: Keeping in mind that the hardest part of the blockchain is building the consortium – the network of healthcare organizations willing to use blockchain to collaborate – existing business-to-business networks represent short-term opportunities for blockchain. Existing networks can use outdated technologies, such as faxing, to centralized hub-and-spoke architectures, such as clearing houses or exchanges. Blockchain can quickly add value to these networks by enabling real-time collaboration, without a central intermediary and related delays and costs, on common data in a shared ledger, as well as a shared logic in the form of smart contracts. Blockchains also avoid any central point of error, avoiding vulnerabilities in centralized architectures to availability attacks such as distributed denial of service attacks. In addition to exchanges of health information and clearing houses, existing B2B networks also include supply chains for medicines and medical devices, provider directories, and provider credential networks. Blockchain also has great anti-fraud potential.
Health care is burdened by multiple types of fraud, from fraud related to medical claims to prescription, professional, financial and other frauds. The FBI estimates the annual cost of health fraud in the United States at tens of billions of dollars a year. Most types of fraud involve the modification or cancellation of transactions for fraudulent gain or the creation of new fraudulent transactions. Blockchain blocks the first two attack vectors because blockchain transactions are immutable. Blockchain transparency also helps to improve the rapid detection of new fraudulent transactions because such transactions are visible throughout the consortium in real time, rather than being buried in a central database silo that only people have access to and vulnerable to collusion.
Q: What do the blockbenches of blockchain hospitals and healthcare systems know today?
DH: Without interoperable systems, organizations will struggle with blockchain efforts and will end up with the inclusion of different blockchain data in different formats, creating an intricate Web even more complicated. To reach its full potential, blockchain data must be of high quality, accurate, complete, up-to-date, consistent and legible. Blockchain represents an opportunity and a forcing function for health IT interoperability. However, there is no need to reinvent the wheel, and the good news is that blockchain can exploit and exploit a large part of existing interoperability standards, such as Integrating the Healthcare Enterprise and expiring standards such as HL7Fast Healthcare Interoperability Resources.
The most difficult part of creating blockchain is the creation of consortia of health organizations: the construction of the buy-in, the creation of trust and the obtaining of organizations to the point where they are willing to connect their systems and to carry out transactions on blockchain. Blockchain makes sense in terms of a network of healthcare organizations wishing to collaborate on a destination use case, with a defined business value and making targeted and secure data sharing. Our recommendation from [HIMSS Blockchain in Healthcare Task Force] is to target existing B2B networks or consortia where you already have partnerships with organizations. There, with confidence and buy-in – at that point – Blockchain can prove himself without hitting the main obstacle that blocks so many blockchain efforts.
The pioneers who lead the blockchain with existing B2B networks in the short term and complete those pilots with recognized and respected health organizations who are willing to certify the commercial value of the blockchain, will have the advantage of the first move and a solid beach from which to climb, both in terms of the size of the consortium and the number of use cases on the blockchain. Over time, we will look at the size of blockchain and the wealth of data they contain to expand, paving the way for richer smart contracts and automation, and – in the longer term – leading to advanced capabilities such as decentralized autonomous organizations.
To attend the future Becker question and answer session, contact Jackie Drees at [email protected].
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