“Blockchain technology may not be the panacea for healthcare industry challenges needs but it holds the potential to save billions of dollars by optimizing current workflows and disintermediating some high-cost gatekeepers.”— Kamaljit Behera, Analyst
If you’ve ever been to the doctors, the urgent care or emergency room—you are painfully aware of all the documentation that was completed. It starts with check-in. Then with your initial nurse assessment, and perhaps there’s an x-ray. You may be given a cup for a urine sample. All completed before you see the doctor. Then—after seeing your doctor, you may be referred for an MRI.
What you may not be aware of, are all the departments involved in one visit. Your medical chart will reflect the initial doctor’s office location as one department. If you had lab services another department is noted. With the MRI—yet another department.
Overall, the medical center has to manage the records from all the departments for all patients. Let’s take this one more step. If you are referred to another doctor for follow-up, the new doctor will want to see your medical records—and thereby request a copy or access to your medical records. Herein lies the complexity of interoperability.
Interoperability of the Healthcare Ecosystem
Healthcare Information and Management Systems Society (HIMSS) defines interoperability:
“Interoperability is the ability of different information systems, devices or applications to connect, in a coordinated manner, within and across organizational boundaries to access, exchange and cooperatively use data amongst stakeholders, with the goal of optimizing the health of individuals and populations.”
The goal—of the healthcare ecosystem is to optimize health by providing the right patient data and information from each healthcare provider—will need to better understand and address the health of individuals and populations. (HIMSS)
Underpinning the electronic health record (EHR) ecosystem is a complex set of data structure requirements that specify and define interoperability. This begins with the building blocks of information to be exchanged between disparate systems by establishing the inter-connectivity requirements. Today, most hospitals have installed and deployed EHR systems. They seamlessly store all patient records electronically. However, they are centralized. The data is controlled by a number gatekeeping systems which can make the ease of transferring data from one healthcare entity to another—cumbersome and costly.
According to HIMSS, the organization and interoperability is dependent on a number of factors. Interoperability should create the data structure, or building blocks of information exchange between disparate systems. The system must format the data exchange by setting up messaging standards to ensure uniform movement of the patients’ medical records from one system to another. It must enable the ability of two or more systems to interpret and use exchanged data. And it should include technical components—as well as policy, social and organizational components.
The drive to create a uniform and accessible health records system is a daunting one. Interoperability is at the core of any system that seeks to share patient data at the behest of the patient. Blockchain shows promise to offer solutions to the challenge. While it may not be the panacea to cure all the interoperable ills, nonetheless it promises to offer a significant contribution.
EHR and Blockchain
Blockchain has the ability to deliver an efficient, cost-effective, reliable, and secure system for patient record transactions—creating a good deal of enthusiasm in the healthcare space.
In a report released by Frost & Sullivan Transformational Health Industry analyst Kamaljit Behera offered the following assessment.
“Burgeoning connected health devices and the need to protect against data breaches make blockchain, with its ubiquitous security infrastructure, the obvious foundation for emerging digital health workflows and advanced healthcare interoperability. It creates an additional trust layer through unique distributed network consensus that uses cryptography techniques to minimize cyber threats,”
Dhaval Shah, writing for Medical Economics observes there are many who believe that blockchain’s “potential to resolve healthcare interoperability challenges”—can be disruptive and a game changer. However, Shah remains cautious due to the nature of the current healthcare database systems.
— HiManny (@MannyMcoy) July 22, 2019
Blockchain Addresses Current Interoperability Challenges
There are a number of challenges to healthcare interoperability. One of the key challenges is that healthcare provider entities are at various stages of systems maturity. There are varying levels of maturity with the “quality of the data, governance mechanisms, or adopted standards,” adds Shah. The industry has a number of standards for data exchange the entity can choose from—such as Fast Healthcare Interoperability Resources or FHIR , the CDA, or the HL7 2.x standards. These varying standards directly affect the ability to develop interoperability among the entities.
Blockchain can help overcome these challenges by using APIs to access data. It achieves standardization of data formats thereby enabling seamless data transmission—regardless of the EHRs’ ability to communicate with various data standards.
Will blockchain be the solution for healthcare interoperability? That remains to be seen. Raj Sharma, Co-founder and CEO of Health Wizz—directly working with the implementation of a blockchain solution says that he’s seen blockchain provide the requisite architecture and infrastructure to share patients’ health data.
“But it can do nothing to provide interoperability of medical records where the requirement is to convey clinical intent across institutional boundaries.”
Clearly the healthcare space is in need of technical advances that increase efficiencies and lower costs wherever they can be lowered. Blockchain may be just one of many solutions.
If you liked the topic of this article be sure to check another one similar by clicking here -> Can South Korea and Taiwan be a Blockchain Model for America?