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by Michael Scott, Mar 21, 2017

Building A New VA Healthcare System, Block by Block


veterans affairs

There continues to be a flurry of media attention about persistent problems facing the V.A. health system. As the largest integrated health system in the U.S., the system serves 8.76 million veterans annually at over 1,700 care sites. It is also the nation’s largest provider of graduate medical education along with being heavily involved in medical research, employing a staff of over 340,000.

As the backbone of medical care for veterans, the VA system suffers from an inefficient bureaucracy replete with antiquated systems, red tape, understaffed medical teams and an entrenched workforce culture. There have been scandals about systems backlogs and reported wait times of several months for routine visits.  A report released by the RAND Corporation, part of a congressionally mandated examination of the delivery of healthcare to veterans, documents many of these shortcomings as well as opportunities for change. 

Secretary of Veterans Affairs Dr. David Jonathon Shulkin, a Trump appointee, will be the central figure tasked with restoring confidence in V.A. health system performance. Dr. Shulkin, who has a background in managing large hospitals and healthcare services, will inherit a bureaucracy with a $182 billion budget. He has stated that restoring “pride, public trust, and confidence in the VA” is one of his main objectives.

New Advancements Around the Block

The efficiency, security, integrity and transparency inherent in blockchain technology has been well documented. For this reason it is seen as a potential elixir for the cumbersome and inefficient systems bloat facing the VA health ecosystem. 

Blockchain solutions are at an interesting juncture at present in terms of real world applications. Much of this is tied to speed bumps around the commercial development of blockchain solutions that can deliver a real world patient care model.

In 2017, Hashed Health, a Nashville-based company, has emerged as a key player in fueling blockchain’s adoption in healthcare. Their entrance amid the continued woes at the VA couldn’t have been more timely. 

Hashed Health CEO John Bass is so confident in blockchain’s potential to create a sea change within health systems like the VA, that he’s built his new company upon it. Says Bass: "The VA, like any other large health system, faces a range of IT issues that blockchain has the potential to solve. Certainly, the problem around veterans' wait times for health services has drawn lots of attention. Blockchain would be an ideal audit and compliance tool to ensure that policies are being followed to deliver care to veterans in a timely manner.” 

Innovation is not new to the VA.  In a crowning achievement more than 25 years ago, the VA developed and integrated VISTA, the Veterans Health Information Systems and Technology Architecture, which at one point was among the most advanced health information technology systems globally. 

Unfortunately for U.S. veterans, there has been a digression in these sorts of innovative systems. The prevailing practice of forwarding documents back and forth via mail or courier in today’s digital age is just one example of this. This is where the blockchain might hold promise given its value as a data structure. Here documents can be time-stamped and signed utilizing a private key to create an immutable record of the transactions. 

These promising developments around the intersection between blockchain and healthcare are beginning to raise eyebrows in Congress.  Last year, U.S. Representative David Schweikert of Arizona offered a bold proposal suggesting that the leaders at veterans affairs strongly consider employing blockchain to track medical appointments. He has since emerged as a vocal champion for the technology, even suggesting during a Chamber of Digital Commerce event that "this is going to create a revolution.” 

Consultant and blockchain researcher Brennan Bennett, founder of Blockchain Healthcare Review, an online forum that examines technical innovation in blockchain technology and health information technology says that issues like appointment delays that continue to plague the VA ecosystem could be addressed through the use of the blockchain. Says Bennett who has closely observed Hashed Health’s progression as a major player in this space: “Blockchain has great utility in terms of serving an immutable audit trail. However, it's important to understand that in a case like this, blockchain can really help facilitate data stewardship on top of keeping immutable logs about wait times.” 

He cites the following example:  “A blockchain-enabled system would timestamp a patient file and log not just that the patient requested to see X doctor for Y reason, but also when they wished to see them. These variables would we used to build the foundational business logic for a scalable solution that would compliment the way the VA is structured.” 

Continues Bennett: “When says a two month window passes, a timestamp could then trigger an automated alert, which then could activate a smart contract. Ideally, the blockchain system would have smart contract logic capabilities that not only allows it to deliver an alert to the VA and patient (i.e. sync with smart phone calendar apps), but also communicate patient availability to local area providers.” 

Taking it a step further, notes Bennett, the private provider could then request key level access to view all or part of the patient's medical record from the VA and review/append their clinical actions/notes/follow up instructions. Once that interaction is complete,  he says that the VA network would receive the updated file, replacing the outdated file on the ledger. 

“At the end of the day, it's about validation of action. In other words the blockchain would validate what actions have been taken by what party, (patient/VA/private provider) and enable the right people to get the right data on a predefined timescale set forth by VA rules and regulation.” 

Concludes Hashed Health’s Bass: “It is for this and many other reasons that blockchain solutions should be at the top of the list for the VA, when they begin to explore the integration of commercial health IT software.”