In the recent past, a number of healthcare blockchain start-ups have come up. However, these blockchain start-ups have found themselves a chunk of the healthcare space they want to fit in; for example, PokitDok and Patientory which focus on EMR space and Gem which focuses on reimbursement. There are also blockchain start-ups that provide solutions that cut across verticals like Guardtime for security and Chronicled for supply chain management (SCM) and Internet of Things (IoT). Apart from the traditional solutions mentioned above, companies like Curisium, other than providing blockchain-based alternatives to existing solutions, also provide innovative solutions like patient-level value-based reimbursement and smart contracts.
Cutting-edge blockchain-based solutions like patient-level contracts, smart contracts, EHR, and Big Data platforms are transformative solutions that can revolutionize healthcare IT.
They help with achieving value-based care at an individual level and not at a community or a population level. This is done by capturing and assimilating the data at a more granular and patient level. Dealing at the patient level does not mean that access to population data is blocked; in fact, it makes the population statistics more accurate when individual patient data gets aggregated. These contracts can evolve and learnings can be incorporated as more and more data become available.
They are nothing but computer code that is deployed, replicated, and executed in blockchain applications. They also have the ability to update the ledger and make payments. They are aimed at removing the middlemen like pharmacy benefit managers and pharmacies in the healthcare IT ecosystem. Currently, the focus is on making the current healthcare system more cost-effective by removing the middlemen who subsume the benefits.
By leveraging smart contracts, healthcare payers and drug manufacturers can fix the price for the drugs in their formulary and make sure that the manufacturers get reimbursed when patients order prescription drugs that is included in them. The smart contract triggers the payment if certain conditions are met. It also has the ability to deduct the co-pay from the patient if the same has been scripted. Similarly, the providers have contracts setup with healthcare payers and when the patient receives care, reimbursement will be payer to provider and the co-pay will be transferred from the patient to the provider. All the above transactions are permissioned and encrypted and they increase the transparency among the stakeholders directly involved.
There are two types of solutions available in this space, one that acts like a plug-and-play model and aggregates the existing EHR systems (Patientory) and one that acts as an EHR, leveraging the hyperledger fabric (Medicalchain). The cost and time involved in implementing the former is likely to be more significant than the latter. Medicalchain’s solution is more patient-centric, and its solution is accessible. This, when coupled with permissioned access system, will make sharing of health records among the various stakeholders seamless and will ensure that all the activity is logged. While such a solution removes most of the challenges plaguing traditional EHRs, this solution comes with its own set of challenges. There will be a steep learning curve for all the stakeholders involved. Patients should learn to know how they can access and share their PHI and other stakeholders should familiarize themselves with this technology while being open to change.
More data is captured today than ever before. As a result, there are more and more data sets available to be analyzed. Analyzing these data sets in silos will be insufficient to make a significant impact. There is no doubt that the application of blockchain will ensure the correctness and security of data, but the challenge lies in effectively leveraging and managing the data . burst iQ, a newly funded HIT company, has developed a blockchain-based Big Data platform (BurstChain™) that is capable of consuming Big Data from multiple disparate sources, managing intricate permission logic, and perform real-time transactions.
As indicated above, there has been significant progress in the area of blockchain healthcare in the past year. A couple of notable projects that have been brought to the market in this space are as follows:
Simply Vital Health built a product called Connecting Care on its blockchain platform. This product is complaint with the HIPAA protocols and is used as a proprietary API to interact with the Simply Vital blockchain. It is specifically designed for providers and leverages care coordination and financial forecasting to help them make bundled payments and track patients post care. In this scenario, blockchain applications are predominantly used for tracking and auditing.
Robomed Network is an end-to-end decentralized medical network consisting of Robomed EHR, Robomed Mobile, and Robomed Web and connects providers and patients on the basis of smart medical contract. These smart medical contract delivers value to the patients by measuring patient outcomes and accomplishment of clinical guideline.
Although adopting blockchain platform increases the transparency in the transactions, it cannot be as open as the one we have for Bitcoin. Healthcare will require a private blockchain. For the above solutions to be successful, the ability to make unauthorized edits to the ledger should be limited. This can be easily enforced in a purely public Bitcoin blockchain as a very large contingent of network participants would be required to register false transactions. In case of private Bitcoin blockchain, where there are fewer permissioned nodes in the network, registering the false transactions will turn out to be plausible.
Blockchain-based solutions come with their own set of problems, but they are faster, cheaper, and significantly more secure than existing systems. As blockchain applications for healthcare are in its nascent stages, an enterprise-wide application will seem far-fetched and not practical. But being an early adopter of a transformational technology will indeed have its own perks.