3 pains of healthcare may extinct thanks to blockchain

06.03.2018
10 min.
title

Trusting is difficult, but it is an integral part of life. We are not superheroes: we entrust other people with our problems, needs, and wishes every day. Yet different activities require different degrees of trust. You may easily buy something on Amazon relying on user reviews only, but renovating your home or taking care of your health hits completely another level of reliance.

Practically, every part of the care cycle is a trust fall for a patient. They need to believe in the right diagnosis, relevant dosing, necessary procedures and positive health outcomes under the shield of protected private information. Providers, in their turn, have to justify the trust placed in them.

Thankfully, the blockchain technology gains momentum, promising to introduce more transparency to healthcare software development and strengthen the patient-caregiver trust without compromising security.

Blockchain in a nutshell

In a recent forecast, Gartner predicts blockchain to yield more than $3.1 trillion in value to businesses by 2030. With this estimation, blockchain aspires to become one of the top must-have technologies in the next two decades. The reasons are rooted in its unique approach to data processing.

A blockchain is a distributed and decentralized ledger that stores transaction records and shares them across a peer-to-peer network of computers, so-called nodes. Each set of transactions (block) gets a unique identifier (hash) and becomes cryptographically linked to the hash of the previous block, creating an unbreakable chain.

Blockchain allows each network user to interact with the information: view it, exchange, and store. Any interaction is visible to the whole network and requires verification from the majority of nodes before the information about it can be added to the chain. This process allows keeping data secure from breaches, enables trustless collaboration and records a trail of all interactions.

Here’s a simple example of an end-to-end transaction within a blockchain:

  • A party requests a transaction.
  • The transaction taps into a peer-to-peer network, spreading across the nodes.
  • Nodes receive the request and verify or reject the transaction.
  • Approved transactions get into data blocks, cryptographically linked to the previous blocks in the public ledger.
  • As soon as the new block is created, the transaction in it becomes complete and permanent.
How Blockchain Works
Data Source: https://blog.g2crowd.com/blog/trends/cybersecurity/2018-cs/blockchain/

3 healthcare areas ripe for blockchain transformation

Blockchain introduces in-built fault tolerance and data encryption to the healthcare ecosystem. Particularly, it eliminates the need to create complex point-to-point data integration systems, seamlessly aggregating bits of information into a clear timeline of events.

The distributed ledger and authentication controls reduce the risk of a security breach and fraud. Moreover, an automatic transaction verification allows eliminating third-party entities from operational processes (claim management, procurement, etc.), cutting administrative costs and accelerating decision-making.

Now, let’s review the areas that can benefit from blockchain most.

Chronic care management

Chronic patients are the major focus of a value-based care approach. They need continuous care services and bear higher morbidity risks in case of an ill-timed medical assistance, incorrect treatment plan or poor care team collaboration. Blockchain can bring clarity and continuity in chronic care.

Longitudinal patient records

Blockchain can transform chronic care management by introducing longitudinal patient records. These records represent a strict timeline of patient history with appointments, lab results, diagnoses, and treatments. Inpatient, ambulatory and patient-generated health data (PGHD) from wearables and medical IoT devices taps into records as well, allowing providers to evaluate the patient progress.

As different EHRs vary in ways of data recording and representation, similar bits of patient information can overlap. The overlap creates an erroneous picture of a patient’s health status, contact data or insurance details, hindering care delivery with extra time and effort needed to sift out the noise.

With blockchain, the entire data set collected from different sources is hashed to a ledger automatically, yielding to a single patient identification. All data bits are verified against previously created blocks, which helps to avoid possible duplication and mismatch in EHR systems.

Care coordination

When a care coordinator identifies therapy, activity and nutrition goals for a patient with a chronic condition, all recommendations comprise a thorough milestone-based and time-bound treatment plan. To succeed with the plan, a patient and their care team have to be on the same page with access to all relevant health data and recent status updates, which blockchain is happy to offer.

Once added to the ledger, the care plan shows chronological care delivery information and patient results connected to it. Each new entry gets authenticated and available to all network peers, which can include the patient, their care team members (even across different healthcare organizations), care coordinator and more.

The care coordinator can access the complete patient data on demand, which allows them to:

  • Evaluate the patient’s current health status with most recent updates.
  • Detect possible side effects.
  • Initiate informed treatment plan changes.
  • Track the patient’s compliance with the treatment plan and intervene if needed.
  • Monitor care team performance and more.

Since all care delivery and patient progress data is available for the team at any time, health specialists stay informed about significant changes in the patient’s status and gain more control over health outcomes.

Being a relatively new source of patient information, patient-generated health data or PGHD is rarely integrated with EHRs. The reason is that EHR systems weren’t designed to process and store massive amounts of data coming from wearables, medical IoT devices, and dedicated mHealth apps.

Since PGHD is currently the most efficient insight into a patient’s health status beyond appointments, it needs to be included in a patient’s record somehow. Blockchain does just that by allowing the user to parameterize it, attribute to a particular patient via a unique piece of code, and then decentralize and distribute it across the network. As a result, EHR stays clean and crisp without hoards of new data, while the patient record becomes more informative with blockchain-powered PGHD inclusion.

Claims & billing management

Apart from chronic care delivery improvement, a shared data ecosystem allows providers to tap into more stable, predictable and streamlined billing environment.

Claims processing

In healthcare, time delays are the worst enemy. It takes a ridiculous amount of time to settle a claim, determine or track co-payments and deductibles. An electronic claim gets processed in a period from 7 to 14 days, whereas a paper one can take from 4 to 8 weeks!

While banks need a few seconds to receive a money transaction request and execute it, 7–14 days for an electronic claim is insanely slow. Blockchain aspires to reduce the time needed for claim processing and further billing to as little as 7–14 minutes via smart contracts.

Regarding claims, a smart contract is a protocol that represents the payer-provider contract terms. Upon claim submission, it is processed and verified automatically in real time with a subsequent billing and payment transfer to the provider.

With this smart-contract approach to claim processing, healthcare organizations won’t need to allocate additional time for calling insurers before each appointment, reminding them about sent claims or logging in to an insurer’s portal to check the patient’s eligibility. All needed verification processes go on the background, automatically and without additional effort.

Billing management

Blockchain’s ability to accurately record tamper-proof transactions can help healthcare reduce the number of fraudulent transactions. Since parties must have current and authenticated identities before a transaction gets approved, the reimbursement process becomes almost bulletproof with little to no chances of suspect claims slipping through the cracks.

With blockchain-powered data transparency and security, payers will be able to access a patient’s record and view approved providers to recognize suspect claims or payment requests that mismatch this patient’s conditions, diagnoses or current care plans.

On the next adoption level, healthcare organizations can use machine learning capabilities to extract patterns in fraudulent claims and improve sensitivity to suspect billing requests.

Supply chain management

Asset management is another area prone to time delays and fraudulent activities. Healthcare organizations are in dire need of removing inefficiencies from supply procurement processes to safeguard more revenue and improve patient safety.

It is critical to gain more control over consumable supplies, including high-value medications and addictive opioids. Healthcare organizations can’t simply enter the value-based care realm and become accountable for patient health outcomes to the full extent if they don’t know where the medications are coming from. Counterfeit medications may have wrong pharmaceutical ingredients or dosage levels, which may inhibit recovery at very least.

With blockchain in healthcare, providers can harness a decentralized asset management system to access a transparent and traceable path of supplies. Healthcare organizations will be able to see the entire supply lifecycle from manufacturing to official distribution and delivery across facilities. Apart from being sure of product origin and authenticity, providers will be aware of transaction statuses and possible delays to plan asset utilization with better precision.

Launching the transformation process

Balancing transparent and secure, blockchain can become the standard for data handling, accumulating, storing and sharing in healthcare. We are hands down for that.

Honestly, not many technologies out there are capable to accelerate value-based care era progress the way blockchain can. It holds promise to:

  • Enable secure access to medical records.
  • Put patients in charge of their data.
  • Improve care coordination and information exchange.
  • Streamline claim and billing management and a lot more.

This digital ledger technology can disrupt many healthcare aspects, and we can’t wait to see its potential unfolded to the maximum.