HIMSS Technology Focus:

Healthcare Looks to Blockchain for Answers


By Jean Phillips, editor

What do digital currency, precise, automated tracking of shipments across the globe and an open healthcare marketplace addressing the growing radiologist shortage have in common? Blockchain, the innovative technology that many experts say will liberate organizations from the chains that bind them to current outmoded, inefficient and unsecure business models. Blockchain technology was a major focus at the HIMSS conference this year.  Healthcare would do well to keep its eye on the block.

Today medicine is confronting an era of profound change and an escalating shortfall of certain medical specialists, radiologists. Perhaps surprisingly, the technology that spawned the bitcoin craze may empower healthcare to overcome the deficit by making the most of existing radiology manpower and resources as well as by addressing many of the challenges that have plagued healthcare for decades.

Blockchain 101

Blockchain technology provides a permanent, immutable digital record known as a ledger of online data exchanges or transactions. Transactions are the blocks, and the ledger is the chain. Blocks are linked together through sophisticated, secure protocols called hashes that are unique to each block and protect them against tampering. The blocks are recorded in the in the digital ledger in the order they occur.
When a blockchain is launched, the ledger is duplicated across a vast distributed network of computers. As blocks of data are added, the computers use the hashes to verify that no prior blocks have been changed. Users add information directly to the blockchain, eliminating any middleman. Because relevant data is aggregated across all participants in a single store, the multiple steps typical of any enterprise for communicating and verifying information are eliminated, while the data remains secure.

As an inalterable record of all transactions, the ledger provides transparency as a detailed audit trail. Additional layers such as contracts and digital wallets can be added, which are efficiently executed using the information already in the blockchain.

Relevance to Current Healthcare Challenges

Today healthcare overall suffers from fragmented patient data often spread among multiple unaffiliated providers in siloed data stores that are accessible only through incompatible IT systems. Administrative, financial and other records supporting patient care are likewise splintered. Healthcare’s inability to efficiently aggregate this information and accurately communicate it where needed—often across institutional boundaries—can delay or prevent treatment and may lead to procedures performed using incomplete patient information—potentially compromising quality of care.

These problems also restrict any physicians who wish to function in a more open and transparent healthcare marketplace—expanding their patient load when desired or passing on those who might be better cared for by other practitioners. The required permissions and contractual relationships in such an open system are difficult to manage. Payment for services, too, would be complex and slow, involving the detailed approvals and documentation required by various insurance providers and other payers.

A particular issue for radiologists and other specialists who consult on cases is their inability of radiologists functioning on multi-physician patient care teams to efficiently share informationc. Adding to the difficulty is the mandate for stringent data security to protect patient privacy through compliance with HIPAA and related standards. All this often calls for complex, costly multiple information sharing strategies and permissions as well as places significant restrictions on how data can be transmitted.

In addition, during a time of a growing physician shortage, accessing the largest pool of appropriate caregivers to treat patients is essential. In radiology, where patients need not be seen face-to-face, the proximity of patients to caregivers is irrelevant, and that pool is significantly large. That’s why teleradiology has been a reality in the field for years. But even in radiology, these complexities continue to make tapping into the available population of imaging specialists a challenge.

Patients also suffer from the state of healthcare today—not only through potentially diminished quality of care but because they are hampered in their ability to obtain their own medical records for second opinions and to shop around for providers they feel offer the skills and experience at the fee levels they seek.

Blockchain Provides Answers

By its very nature, blockchain provides a solution to many of these problems. The technology can link patient and all related healthcare information across providers, payers and other stakeholders and places it in a single repository to create a comprehensive record. With its high level of security, blockchain data can be easily and confidently shared with approved parties—physicians, payers and patients themselves. Moreover, it makes communication around each step of the patient care process—service access, treatment delivery, results communication and integration of information across the continuum of care—fast, simple and streamlined. Again, because data is inalterable and blockchain provides traceable audit trails, all transactions have true transparency for records, billing and more.

Therefore, this blockchain framework can support a far more open and transparent system of practicing medicine, in which healthcare entities can form new and creative partnerships to facilitate efficient collaboration between local, regional, and global healthcare communities. Physicians can operate as free agents if desired and easily take on cases beyond their practice group. In times of a radiologist or overall physician shortage, blockchain helps transcend traditional institutional boundaries to bring medical expertise where it is needed most.

Once parties agree on an engagement—reading a radiology study, for example—the system immediately creates a smart digital contract. This eliminates the delays of paper-based agreements and checks. This also enables immediate payment once the contracted service is delivered. The greater competition among all participants in the open system results in healthcare cost savings.

Proving the Concept

Today, healthcare technology companies are already providing a fully operational blockchain medical imaging platforms. One is serving as a successful proof-of-concept by connecting imaging centers, hospitals and radiologists. The platform provides imaging centers with access to a large selection of contract teleradiologists who will work on demand to fill in staffing gaps. These radiology service providers enjoy flexible new working opportunities and sources of income.

When radiologists sign up, verification of appropriate licensing and insurance credentialing happens quickly thanks to the nature of blockchain. Both general and sub-specialist radiologists participate. Healthcare entities request specific services, and teleradiologists are free to accept the cases they are qualified for and desire. Once an agreement is reached, a smart contract encompassing all this information is initiated and digitally signed. The complete relevant patient history, including images, is instantly available to the radiologist thorough the chain. Once the imaging center or hospital reviews the radiologist’s report, the smart contract executes payment.

The platform also amasses a large store of imaging datasets which is extremely valuable in the development of today’s artificial intelligence (AI) algorithms. Anonymized  data is made available to developers of these algorithms.

Will this innovative technology flourish and help to solve pressing healthcare problems?  Blockchain was a major focus of interest and excitement at HIMSS 2019. Let’s see what HIMSS 2020 brings.