In the U.S., the complex nature of health payment and records systems has been well documented. This is widely viewed as a key bottleneck in a healthcare industry saddled with soaring costs, spotty care and barriers to patient access.
For a broader perspective on what can be done to address these issues, we turned to consultant and blockchain researcher Brennan Bennett. Bennett is the founder of Blockchain Healthcare Review, an online forum that examines the intersection between blockchain technology and the future of health information technology (HIT) data governance. Here he offers a few thoughts on the unique opportunity that blockchain solutions offer in creating new frontiers for consumer payment and medical records systems.
What are your views around blockchain technology and its potential to deliver efficient patient payment systems?
It’s been exciting to see a number of promising use cases emerge in the patient payment space involving the blockchain. An example of this is the use of distributed technology to help facilitate payments from a health savings account (HSA) that a member may have with a payer. From a business automation perspective, if a patient’s plan information was on a blockchain and able to function as a smart contract, the system could as a payment option automate deductions from an HSA account. That looms large in terms of payment cycle automation because it would allow for the efficient management of claims and Rx formulary checks — simplifying the arduous task of calculating who owes what to whom based on the coverage of any given patient plan.
And what about blockchain technology and medical records?
For medical records, the sky’s the limit. Patient-mediated data is a big win for blockchain [technology]. It could actually go a long way toward solving the use case of a patient who needs to switch payers or provider networks because he or she switched employers — a pressing matter in the current GOP ACA revamp. Moreover, the idea that any one provider can have limited or full access to a patient’s entire medical history based on their need to either add information to the record or examine it for their own analysis is a giant leap forward in healthcare when considering how many non-consumer siloed systems fumble around the same process today.
Then there is the case where patients will have the ability to utilize a service that allows their medical data to be utilized anonymously for medical research purposes. Here, patient data could be appended to broader clinical data sets for population health and genomic trend analysis research. Moreover, this data could also be very useful through machine learning algorithms that allow a macro viewpoint of a patient’s health history or patterns details.
Amid these potential advancements, what sort of challenges exist in terms of the adoption of blockchain technology in the healthcare space?
The biggest challenge is getting everyone on the same page in terms of how to assess what aspects of the blockchain ecosystem they should invest in. There are some who want to build internal systems as well as those who want to move forward really fast with established vendors. Reasonable arguments exist for each approach, but the resources needed to justify which choice is the better one are vastly different.
What about the problems currently facing our nation’s healthcare system around interoperability?
Right now, lack of interoperability is driven by lack of universal coding adoptions. While HL7 and FIHR, among others, are making great strides in this space, codifying all that’s been recorded in all medical fields and enabling it to be interpreted through EMRs is a huge challenge.
So are there other advancements taking place in terms of addressing this issue?
CDISC is tackling this on a larger global perspective by addressing the very difficult task of codifying use cases like mood disorders and traumatic brain injury. At the end of the day though, real interoperability will come when machines, not just humans, can communicate Internet of Things (IoT) data to a patient record on a blockchain. You can see companies like Philips already developing these use cases in their own blockchain lab, which is nice to see considering they build machines like MRIs that will be communicating the clinical data.
There have been a number of high-profile IT security breaches involving hospitals and their consumer information. What role can the blockchain play in mitigating these sorts of intrusions?
Ransomware is truly a problem, as is the intrinsic value of medical records on the dark web. While a stolen credit card number could go for a few dollars on the black market, a medical record could go for much more and, when sold in bulk, can really cause disruption.
The blockchain firm Gem uses an approach that’s widely considered a plausible alternative. Their health data blockchain works to store access permissions, which can then deliver credential-based access to information.
What about the possibility of digital currencies one day becoming a recognized method of payment for healthcare services?
Possibly. I don’t see it out of the realm of possibilities in terms of incentivization purposes. If, for example, a giant payer with millions of members wanted to incentivize the members [not just] to share personal health data with them (which they already do via surveys and mandatory health screenings), but to actually buy things on a branded marketplace, then maybe a Humana Coin or Kaiser Coin could come into play. Centers for Medicare and Medicaid Services (CMS) guidelines would have to undergo a complete overhaul if that use case were to ever materialize, but in essence, the business logic is already in place.
Can you offer a use case of what this might look like?
If, for example, a patient-mediated use case was put into play — let’s say for the sake of argument that a fictitious concept called Humana Coins could be earned by not only linking your blockchain IoT devices but also sharing your patient file with in-network providers. This would create a scenario where interoperable point of care and back end business logic (i.e., bundled payments) become more seamless. Problem is, Centers for Medicare and Medicaid Services (CMS) guidelines for programs like Medicare are very restrictive on monetary incentives. That being said, and I know this would be a stretch, I could also foresee an exchange service where a member could exchange Humana Coins for, say, Ethereum or BTC. I have no idea [what] the regulatory stipulations would be behind that, but regardless, monetary incentivization is absolutely the biggest way to get members involved to share personal health data. Payers would have to get creative from an entrepreneurial sense if they are ever to create their own economy of scale via branded cryptocurrency.
What about these incentives being applied to the release of patient information for research purposes?
Sure. This scenario I just discussed could circle back to a member selling scrubbed data from their blockchain EMR to research programs. For example, Humana has their own health outcomes R&D wing called Comprehensive Health Insights (CHI). It’s a subsidiary that’s located on their corporate campus in Louisville, but they essentially provide consulting services based on the troves of scrubbed data from multiple Humana business units. Because they are neither a payer or provider, they could in theory offer ETH or BTC. If a member is appending all sorts of IoT and/or clinical data from point-of-care interactions that CHI would not normally have access to via Humana’s internal data lake, then this could be an opportunity to get their hands on more data than before.
Finally, what startup players in this payments and medical realm show promise moving forward?
MedRec is I think leading the pack currently just because their model incorporates myriad aspects of what we’ve been talking about. Gem is another innovation organization working on the matter. Two other examples that are adding valuable dialogue: RadBit and Cyph MD. At the end of the day, all of the progress being made in this space has a very promising future.
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