AN OPPORTUNITY TO ADDRESS MANY COMPLEX CHALLENGES IN HEALTHCARE
Blockchain provides us with a tremendous opportunity to overcome challenges that exist in the healthcare industry today, including interoperability, security, integrity, traceability and universal access.
Security in healthcare industry encompasses various aspects based on integrity of data maintained in an organization. Tampering and security breach of healthcare data is a growing concern for many healthcare organizations. It is difficult to tamper with data present in blockchain as it requires validation from different nodes in the chain. Blockchain offers inbuilt security features as the data in blockchain is encrypted with private key of the sender and only intended recipient can decrypt data using key from the sender.
Blockchain’s distributed ledger and immutable transactions helps ensure data integrity while encryption of data enhances data security across the network. With the implementation of Blockchain technology, multiple instances of obsolete patient data with various stakeholders are replaced with single source of up-to-date information of patient information. Patient is the custodial owner of data controlling who has access to PHI information.
Managing access to patient data across healthcare entities is a challenge where Blockchain can help. Blockchain ensures that required data is present at every node and is available for use to the authorized entities based on the access rights provided through smart contracts or other mechanisms.
COST OF MAINTENANCE
Maintenance of a typical healthcare information system involves various operations including but not limited to performing backup storage services, having recovery mechanisms in place and ensuring up to date fields. In case of blockchain, data is distributed across the network and there is no single point of failure leading to inherent backup mechanism.
Also, a single version of data is copied on every node of the blockchain. This reduces transaction volume that occurs between each information system reducing the burden on the healthcare ecosystem. Blockchain with its distributed ledger technology has captured the markets attention for its data handling capabilities with respect to decentralization and security. With its relatively successful implementation in the financial domain, various industries are now realizing its benefits and are exploring the potential of blockchain in their respective domains. Healthcare is one such industry looking at unlocking the benefits of blockchain. Several opportunities exist in healthcare wherein blockchain can help improve interoperability and privacy of patient health data.
BLOCKCHAIN FOR ELECTRONIC HEATH RECORDS) (HER)
The ideal scenario with EHRs is to maintain a life time medical record and be accessible to the care team including physicians, lab technicians etc. at the point of care and on time. In current implementations of EHRs, patient data is stored across different organizations throughout the patient’s lifetime. Few sections of a patient’s medical record like medication problems and diagnosis are recorded by the physicians and they continue to retain stewardship of those sections after a patient’s treatment. In a blockchain implementation, a patient holds the stewardship of medical record and physicians will be given access on a need basis through “smart contracts”.
One of the issues EHRs face currently is maintenance of records accurately involving correction of any erroneously recorded data. Apart from ensuring data integrity, different providers and hospitals system face interoperability challenges leading to ineffective data sharing, if any at all. The lack of coordination in data management and exchange leads to health records being fragmented. Blockchain framework can help alleviate data fragmentation issues across healthcare entities. With blockchain implementations for EHRs, members of a private, peer-to peer network can share the block content with appropriate viewership permissions, while the original member maintains ownership of the data shared. In addition, blockchain supports “smart contracts” which are basically self-executing contracts with the terms of agreement coded in them. Smart contracts allow automation and tracking of state transitions like viewership rights or new record creation in a system. To guarantee data integrity, blockchain includes cryptographic hashing of records. The care team can add new records to a patient’s profile, while the patient decides which provider views the information by authorizing them. This ensures patient and provider engagement and helps in the evolution of patient records. Blockchain architecture is built on principles of decentralization and cryptography, which could contribute to more secure and highly interoperable EHR systems.
BLOCKCHAIN IN CLINICAL RESEARCH
While there has been a considerable advancement in moving medical data from paper to digital records, the healthcare industry is still working its way through issues regarding sharing of patient data across providers and organizations. Throughout their lives, patients may move cities, change health plans, switch their healthcare providers for their treatments. Most of their detailed medical records tend to remain in silo with the individual facility or provider. Furthermore, each medical entity would have saved patient data in their own storage structure and semantics. This leads to hurdles when it comes to sharing of the data.
These hurdles are partly due to nature of the data in question (Protected Health Information) or to prevent information blocking during exchange. This not only has an implication on treating patients efficiently across multiple organizations, but also hampers the field of clinical research, which requires real life medical data to conduct research and test their hypothesis in real world scenarios with real world data. Clinical trials need patient data which is de-identified. Consolidating and de-identifying patient data takes significant time and effort, which leads to a considerable cost.
A critical factor in attaining higher accuracy in outputs of clinical research and trials is the availability of large sets of real life de-identified raw data, analysable datasets for secondary analysis and meta-analysis. Polls show that majority of consumers are open to sharing their medical records for analysis and research on the assurance that their privacy is maintained, and the data is secured.
APPLICATIONS OF BLOCKCHAIN IN HEALTHCARE
With trust being built into a Blockchain database, there is a high degree of transparency. Records are publicly writable by anyone and owned (stored) by no one, with security of data being provided through encryption. Using private and public key cryptography, a shared ledger can facilitate information sharing and a community driven clinical study. Patients can directly control their medical data and rights to grant or withdraw data access to care givers and organizations. Such a platform would be a vital in helping research organizations get direct and secure access to a vast repository of holistic and accurate clinical data.
BLOCKCHAIN IN DRUG SUPPLY CHAIN MANAGEMENT
One of the main challenges in the pharmaceutical industry is the transparency and security aspect of supply chain management. Pharma companies incur losses in millions annually due to counterfeit drugs. Pharma companies deal with products that directly impact the lives of their consumers which is why efficacy and safety of product is paramount. The journey of the product from manufacturer to consumer has multiple stages: transportation, handling, storage, redistribution, retail. Things can go wrong during these stages, from simple human error to malicious intent (fraud). In a conventional system, it can get difficult to identify the problem as participants in the supply chain may usually maintain their own records and may share their information usually just one level up and one level down the chain. Furthermore, if these records are paper-based, they are more prone to errors. These factors further delay investigations to identify the issues with drug supply chain.
Additionally, with governments and consumers demanding transparency in the supply chain for such products, companies have worked towards maintaining an open or transparent supply chain system. Depending on one organization to track irregularities still isn’t fool proof.
Blockchain helps in addressing the supply chain issues by providing a distributed ledger which is shared among all the stakeholders within the supply chain. The records entered in the blockchain at each stage in the supply chain are immutable, permanent and decentralized. This in turn removes the vulnerability of introducing errors or fraud. Counterfeit drugs are reduced by maintaining a chain of custody log that lets organizations track each step of the supply chain at an individual drug or product level. With a blockchain system in place, even the end consumer now has all the information regarding the product right from creation to consumption.
BLOCKCHAIN IN CLAIM AND BILLING MANAGEMENT
One of the losses in healthcare which needs to be eliminated and avoided is fraudulent claims and billing. Medical billing-related fraud is still very common in the healthcare space. Some of the very common healthcare frauds are providers claiming charges for non-performed services, overcharging the actual services, performing unnecessary services for patient medical condition,
misrepresenting non-covered medical services as services which are covered for obtaining claims money and covering financial loses.
Efficacy and safety of the product is paramount. The journey of the product from the manufacturer through the many intermediaries involved to verify, and the consumer has multiple stages: transportation, adjudicate the claim information, to ensure there is handling, storage, redistribution, retail. There will be less time lag for claim processing and reduce the wrong during these stages, from simple human error administrative cost for providers and payers. A typical to malicious intent (fraud). In a conventional system, the process of claim adjudication involves a lot of time and can get difficult to identify the problem, as parties involved for in the supply chain may usually maintain their own claims processing. Blockchain system helps reduce records and may share their information usually during the claim, one level up and one level down the chain.
Adjudication and payment processing activities. Furthermore, if these records are paper-based they are more prone to errors. The blockchain solution can automate the process resulting in them being less prone to errors. Paper-based factors further delay workflows, but with blockchain, all the parties involved can share investigations to identify the issues with drug supply in a single copy of the contracts and billing-related chain.