America is a vast country with a population of over 320 million, and an unequaled diversity. It has what may be considered a laissez faire form of government when it comes to the general welfare of its citizens. The economy is distributed. Thus, markets and will face regulation at the federal, state, county, and in many cases at the city level. Herein lies the issue with healthcare delivery and payment system.
While countries such as Taiwan boasts of a modernized single payer system and best patient practices when it comes to patient care; and South Korea boasts of its technical advances that are applied across the peninsula. Indeed, it has a high standard of medical care delivery. However, Taiwan’s total population is only 60% of all of California, and South Korea’s population is 51.5 million—both countries are rather homogeneous, and do not come close to the scale of the needs of the U.S.
However, making such comparisons seem to be futile. What may work for one country, will not necessarily work in America. America’s healthcare system is inundated with regulation. It’s a disparate industry where hospital departments act as their own entity to provide care for the stomach in one department, or care for pain in another. The degree of specialization results in a referral system that sends patients to specialists within the health care’s own system, or out of system.
A single article on healthcare needs will hardly scratch the surface of getting to the point of fully understanding this industry which represents 17.9% of the U.S. GDP, or 3.5 trillion dollars spent on healthcare in 2017. Solving our national healthcare crises will involve a multifaceted approach. There are no easy answers.
Blockchain: Healthcare Use Case
This is the first in a series of articles I will write to address the needs of blockchain for healthcare delivery. The focus will remain with blockchain as a solution to many of the digital issues that continue to inundate hospital administrators and IT professionals. To begin this conversation, I’ve highlighted three pertinent use cases that the typical nurse and provider are faced with on a daily basis.
Supply Chain—Many industry sectors are looking at blockchain’s distributed ledger technology, immutability, and transparency as being able to track a transaction. The ability to track a drug given to a patient, or the source of an immunization is also a critical aspect of patient care.
“Pharmaceutical companies, manufacturers, distributors, regulators and just about every part of the healthcare supply chain could benefit from the transaction tracking blockchain offers,” writes Juliet Van Wagenen for HealthTech Magazine.
— Juliet Van Wagenen (@Juliet_Tech) July 22, 2017
With blockchain, whenever a one company enters into a “transaction with another company in the supply chain, that transaction would be recorded and validated on the blockchain.”
Blockchain increases the accuracy when following the supply chain. It allows regulators and suppliers to simplify transaction reconciliations and data transfers. The overall integrity of the supply chain is assured against “fake, falsified or substandard medications,” noted Van Wagenen.
Blockchain has the ability to create smart contracts. This is the ability of the code to respond to conditional statements, which will vet conditions for an agreement to be met. Smart contracts are designed to streamline the traditional contract process while adding security to the digital agreement. Mackenzie Garrity, writing for Becker’s Hospital Review highlights three area where the smart contract can be used in healthcare.
Health insurance—Patients can buy insurance with smart contracts. A significant advantage is the ability to eliminate the need to file lengthy insurance claim forms.
Health records—Smart contracts can provide assistance with interoperability between hospitals. Particularly useful when a patient is referred to another doctor, clinic, or hospital. The patient data can be easily moved on the blockchain.
Telemedicine—More and more, patient care is being managed with creative methods like telemedicine. With smart contracts, telemedicine doctors can ensure security and privacy when sharing patient data.
Data Sharing – HIPAA
In the last 20 years, a concerted effort has taken place to move all paper charts to a digital charting system. Known as electronic medical records (EMR), sharing of patient data is easier. A significant part of the EMR system is keeping patient records private to meet HIPAA compliance.
A feature touted by many is the ability for blockchain distributed ledger technology to be transparent. This is an area that still needs to be fully addressed by companies building blockchain solutions for patient records. As noted by Tim Mackey, Associate Professor at UC San Diego School of Medicine, in a journal article for BMC Medicine :
“Decisions need to be made about what type of data will be shared with and among participants, if any, whether data will be stored on-chain, off-chain or on a side-chain, and the type of permission structures that will be utilized.”
Blockchain is filled with promises as a next generation application of digital technology. Indeed, there are many who have suggested that blockchain technology will power the New Internet. Blockchain and its distributed ledger technology has many use cases in fintech, food supply, automotive, and more.
While there are current use case scenarios applicable to healthcare now, it remains to be seen if it can have an impact on healthcare in a way to help streamline data efficiencies and be able to drive down the costs of patient care in any manageable way.
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Tim Mackey, “‘Fit-for-purpose?’ – challenges and opportunities for applications of blockchain technology in the future of healthcare”, BMC Medicine, March 2019.
Garrity, Mackenzie, “3 ways blockchain smart contracts can be leveraged in healthcare”, Becker’s Hospital Review, May 2019.
Van Wagenen, Juliet , “How Blockchain Will Transform the Future of Healthcare”, HealthTech Magazine, December 2018.