Blockchain can provide physicians with ready access to patients’ electronic health information

Healthcare providers are under constant pressure to improve patient experiences, and many believe they can achieve this through value-based healthcare—a model where providers’ revenue is dependent on patient outcomes.

Unfortunately for providers, the current structure of the industry means they regularly work with partial copies of medical records, fragmented between different institutions and IT systems – and many are still on paper copy. Fragmented or incomplete patient records can reduce the quality of care, with Philips’ patient safety survey reporting that 91% of physician leaders say better access to critical patient data impacts the speed and quality of a doctor’s response; which also impacts revenues in a value-based healthcare model.

Blockchain has real potential to impact a patient’s healthcare experience

Blockchain has a range of applications in healthcare, but despite the potential—the industry struggles to pass the prototyping stage (Exhibit 1). Infosys found that 92% of Australians believe doctors should have ready access to patients’ electronic health information, leading to the firm exploring a range of blockchain solutions. One application that providers anticipate could be very effective is storing patients’ medical records on blockchain and ensuring doctors have continuously updated information, which should massively improve a patient’s medical experience.

Exhibit 1: Healthcare fails to move beyond the prototype stage with blockchain

Source: HFS Research 2019

Healthcare Providers recognize the demand for more efficient electronic health records, but they haven’t made the infrastructure available

In 2018, Microsoft, Amazon, Google, IBM, Oracle, and Salesforce jointly acknowledged that the frictionless transfer of medical data would enable a better patient experience.

Health Level Seven International (HL7) has pioneered this since 1987, supported by providers and governments in over 50 countries. It developed Fast Healthcare Interoperability Resources (FHIR), encouraging providers to store patient data in a standardized format to allow instant information exchange without sacrificing quality.

While FHIR has helped with interoperability, the project is at the mercy of the masses—if too few providers adopt the standard, it will have little effect. Historically, healthcare providers don’t like to cooperate—a critical success factor of any blockchain initiative.

Institutes can use blockchain to give patients control of their own data and drive the patient experience

Blockchain holds great potential to store patients’ medical data, the key features that make it a suitable being:

• Decentralization: Rather than storing medical data on a centralized server, it will be stored on a decentralized peer-to-peer network. No organization can claim ownership of the medical data so patients will have complete control over their information. According to Pew Research, Ninety-three percent of adults say being in control of who can access their information is important to them.
• Public key cryptography: Firstly, the doctor sends a patient their public key, to which the patient encrypts their medical records. They then send the records back to the doctor, who can decrypt them using their private key. This peer-to-peer process gives patients complete control of who can access their data.
• Smart contracts: When a patient agrees to any medical test, a smart contract could automatically update the results on their blockchain medical record. Records would update in seconds, and providers would always have access to the most up-to-date copy.

Smart contracts could slash physical administration time and allow for an increased patient focus.

According to the ACP, Physicians spend half their time doing desk work. Blockchain-stored health records could facilitate smart contract roll-out to dramatically reduce this time wastage and allow them time to focus on higher value patient-related activities. Once a medical test has been complete and the results uploaded to the blockchain, a smart contract could be triggered—automatically adding the data to a patient’s medical record. Doctors can thereby be certain of a complete medical record, saving critical time and cost repeating tests. By cutting down the 49% of doctor’s time spent on desk work, time can be better dedicated to patients and improving their experience.

Decentralizing patients’ medical records benefits providers beyond patient experience.

Storing, maintaining and securing something as valuable as medical data comes with a hefty price tag. Decentralizing health records means providers would no longer have to pay expensive storage costs, as they would be stored on the peer-to-peer network. Furthermore, decentralized medical records will improve security—with advanced encryption and no single database vulnerable to breaches, studies have found providers stand to make significant savings, as data breaches in healthcare cost an average of $408 per capita.

There are significant hurdles providers must overcome before managing health records with blockchain.

If healthcare providers hope to improve patient experiences with blockchain, it’s important they understand it won’t be a smooth transition. The first hurdle is the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Introducing blockchain could add to the existing confusion surrounding the risk analysis requirements of HIPAA. Furthermore, HIPAA prohibits the use of mathematically derived encryption of protected health information, going against the core of blockchain technology. GDPR is another—it demands that enterprise must be able to erase an individual’s data, whilst blockchain on the other hand, is immutable.

Exhibit 2: The 90-9-1 Enterprise Blockchain Adoption Challenge

Source: HFS Research 2018, the blockchain reality check: where we are and what can we expect in 2018?

Providers must also consider the public’s lack of blockchain knowledge, they may be less-than-willing to take a leap of faith and store their most sensitive data on an unknown technology (Exhibit 2).

Bottom Line: Patient experience must be the top priority the healthcare industry—providers must overcome the hurdles to take full advantage of blockchain record management

Undeniably, there are a range of hurdles providers would have to overcome, but blockchain could be the technology to offer the interoperability needed to efficiently manage medical records and drive a focus on patient experience. They must remain realistic in their expectations and understand that disrupting existing business models is a long-term goal for blockchain. If they hope to survive a value-based healthcare model they must seek short-term wins through alternative blockchain applications, (Exhibit 3), with their eyes firmly on the prize of a future where health records are decentralized.

Exhibit 3: Blockchain has a range of applications in both healthcare and life sciences.

Source: HFS Research, 2019