Tamara StClaire, Digital Health Advisor,
BaseHealth

If you follow technology in healthcare, you have likely heard of blockchain. But even if you are aware of the platform, it may not have truly hit your radar as possibly having near term impact. In fact Gartner puts blockchain at the peak of inflated expectations – speculating it will be another 5 to 10 years before it reaches mainstream adoption. However, there are a number of stakeholders that are working to defy Gartner’s predictions by attempting to put blockchain into commercial use within the year.For those of you new to blockchain or wanting an update, blockchain is a shared, immutable ledger of online exchanges. It creates a log of events that are unchangeable – preserving data integrity and security throughout the transaction. Blockchain relies on established cryptographic techniques to allow each participant in a network to interact without preexisting trust between the parties. It emerged in 2009 as the foundational trading platform for bitcoin. (Here’s a video from a recent talk at Google explaining blockchain further.)

One possible reason that some parts of the healthcare industry are ignoring the blockchain clamor is that there’s lots of talk about the platform and perhaps not enough talk about the problems it can solve. Most experts agree the following healthcare challenges can be addressed via blockchain:

•Master Patient Identifier - the very nature of blockchain incorporates the equivalent of an MPI. It uses private and public identifiers to create a singular, secure method for ensuring and protecting a patient’s digital identity.
•Autonomous Automatic Adjudication – using what is sometimes described as the killer app of the blockchain, smart contracts will have the necessary logic embedded in them to automate the provider, health plan and member agreements so that claims can be processed automatically and in real time
•Interoperability - data stored on the blockchain could be universally available to specific individuals or organizations. It offers a means to interoperate since all users of a network can access that network and all pieces of information are both verified and show the history of transactions.

Other game-changing uses are supply chain management, clinical trials, and unleashing data for research – to name a few.

Stakeholders are starting to align and collaborate in unique ways to bring together the ecosystem and brain trust that will realize these new applications. In 2015, Tierion was the first company to complete a blockchain healthcare project via a partnership in Philips Blockchain Lab. ONC launched an ideation challenge to explore how the technology can advance interoperability and privacy needs (the agency announced the 15 winning whitepapers last August). Humana has been very vocal about the promise of blockchain; their CEO, Bruce Broussard, stated in a LinkedIn post, that blockchain could be transformational for healthcare, particularly with regard to payments and payer contracts.

Innovative startups are playing in this space; a few that are cutting a wide swath in the industry are:

Gem – has established a partnership with Philips to explore how blockchain technology can support a patient-centric approach to healthcare. The company plans to build out a private blockchain to develop enterprise healthcare applications
• Healthcoin - is a blockchain-enabled platform for diabetes prevention that allows employers, insurers and governments to incentivize and manage their population's lifestyle change through a rewards program that is biomarker-based.
• PokitDok - has established the DokChain Alliance, a collection of industry representatives spanning healthcare, financial services, and technology verticals, with the goal of driving intelligent and dynamic computational automation into the healthcare industry, including the processing, sharing, and decision-making components of both clinical and business transactions.
• Blockchain Health - a software company that uses blockchain technology to create a connection between medical research and users allowing users to share information directly Even with this rosy outlook, we can’t ignore the challenges that still exist. Two major technical concerns are: how analytics will be performed when data is on the blockchain and the amount of energy required for proof of work. (Both are important keys to scalability.) The two challenges are being tackled aggressively by academia and industry with many POC’s highlighting potential answers. From an adoption perspective, the industry’s inertia, ethical use of data, versus privacy and industry standards are a few of the top concerns.The blockchain will not replace, but will re-architect many incumbent systems to remove friction and provide for new business models and greater efficiencies in healthcare. Overall, blockchain may be the industry’s chance at a mulligan. It’s time to bring healthcare infrastructure into the future.