According to the Edelman Trust Barometer, America is suffering from a serious trust issue, and one of the areas which Americans seem to have the least faith in is their healthcare system. According to a recent New York Times article, in 1966, more than three-fourths of Americans had great confidence in medical practitioners, compared to as little as 34 percent today.
Many argue that the US healthcare system is deeply flawed and is designed to benefit medical providers and insurance carriers first, and patients last. Compared to other developed economies, the cost structure of healthcare in the US remains opaque and governed by non-disclosure agreements, back-room negotiations, and contracts negotiated by insurance carriers and healthcare providers. This leaves US citizens with little personal choice in their healthcare decisions or how their personal data is managed and forced to risk living without coverage or pay through the nose for treatments and prescriptions.
In other parts of the world, such as Africa, Asia, Eastern Europe, and Asia, where corruption in the public and private sphere has been a problem for decades, administrations are leaning on a range of new technologies –such as the blockchain — to hold organizations more accountable. Advocates argue that when applied in the healthcare industry, blockchain technology can help realign the power balance between consumers, and the healthcare providers they choose.
So what could the US learn from other countries who are using blockchain technology to tackle their trust issues:
1. Improving accountability
According to a recent study by John Hopkins Medical, medical errors rank behind heart disease and cancer as the third leading cause of death in the U.S., accounting for as many as 250,000 deaths each year.
However, the study also highlights that it is nigh on impossible to place an exact figure on the number of deaths caused by medical errors, because the coding system used by the CDC to record death certificate data doesn’t include factors such as communication breakdowns, diagnostic errors and poor judgment, which may put lives at risk.
While we are yet to see an application rolled out, the blockchain offers a secure, transparent means of logging patient interactions with medical professionals. Any treatment which took place, or any medication which was prescribed, could be stored on the blockchain used as evidence in any cases where the medical error was suspected.
We have already seen the blockchain improve accountability in the logistics industry, as individual players on the supply chain, from farmers to restaurants, are able to monitor the conditions in which foodstuffs are stored throughout their journey.
To counter the global problem of dangerous counterfeit drugs, earlier this year, tech giant Tencent, partnered with a number of local Chinese authorities to offer a blockchain solution which ensures that medication is not tampered with during delivery. In many developing countries in Asia, Africa, and South America, counterfeit drugs comprise between 10 percent and 30 percent of the total medicines on sale.
This technology increases accountability for pharmacies but also reduces the possibility of unscrupulous medical practitioners blaming counterfeit drugs for ineffective treatment. Blockchain healthcare startup Doctor Smart is trying to tackle this issue with its AI-powered system which checks any prescribed medication for relevance, compatibility with a patient’s previous medical records, and possible drug interactions.
However, to really put the pressure on medical professionals to do the best job possible, with every patient, the US could look to examples such as Robomed Network which has already launched in Russia and Dubai and connects more than 9,000 patients with 30,500 healthcare services.
The startup aims to ensure accountability of care, by creating a model whereby patients pay for real healthcare results, rather than simply paying for care received with no consideration for quality, as seen in the US. The platform uses smart contracts to connect healthcare providers and patients, and patients are only required to pay if their health improves as a result of treatment or medication.
While this solution does not hold doctors directly accountable for their actions, it does hit them where it hurts if they don’t provide the best care: in their pockets.
2. Improving accessibility
The health system in the US is privatized, meaning that each individual health center or doctor’s office effectively functions as a separate business. And a major flaw in this system is that like in any other industry, different businesses with the same product, and model, are going to compete, rather than cooperate with each other.
When it comes to the sharing of patient healthcare records, this can become a real headache for Americans if they try and switch providers, or are forced to seek medical assistance when away from their home city.
The Obama administration gave billions of dollars in incentives to encourage health practitioners to comply with new electronic healthcare records (EHR) rules, in hopes of motivating medical providers to share and exchange patient records with each other more. However, as Nicole Fisher argues in a recent Forbes article, “the result has made EHR vendors rich, but patients have seen little improvement in interoperability or access.”
Considering that EHR doesn’t seem to be working, the US could look abroad for inspiration, either copying countries like New Zealand which stores all citizen’s health records online or by harnessing the power of emerging technologies like the blockchain.
Storing medical records on the blockchain — an incorruptible, decentralized digital ledger — would allow patients to access, and share their personal healthcare records from anywhere in the world. It would also offer doctors and health institutions a quick and secure manner of accessing, storing and sharing public health data, which is less cumbersome than existing EHR systems.
In Eastern Europe, Iyro, a Slovenian startup is trying to tackle this issue, by offering globally interoperable medical data with openEHR archetypes, to allow patients more control over their own data, and allow them to share their own medical history with any doctor, anywhere in the world. The Estonian Government also recently partnered with startup Guardtime to use blockchain technology to secure the health records of over a million citizens, as part of its Estonian eHealth initiative. Aside from storing the data in a safe manner, which is almost impossible to hack, the partnership aims to increase accessibility of health data to citizens themselves.
The potential benefits are considerable, not just in the sense of allowing citizens to regain control over their own personal information, but also by creating a huge wealth of health data stored online. In March of this year, the Israeli government approved a National Digital Health plan which will create a digital database of the medical files of some 9 million residents and make them available to researchers and enterprises.
The government insists that utmost care will be taken to secure data online, and that data will only be used by citizens who have given their permission. This data could potentially be used by third party technology and research organizations for data-mining, to advance the field of medicine, and highlight illness trends amongst certain demographics.
3. Improving security
The only way that initiatives like the Israeli National Digital Health plan will work, is if people truly believe that their healthcare records are going to be stored in a secure manner, and only shared with reliable, ethical third parties for the purposes of medical research.
Considering that the US has seen some of the largest medical data breaches in history, gaining this trust from the US public may pose some challenges. A 2017 survey by Accenture highlighted that as many as one in every four Americans have been affected by healthcare breaches and that as many as 50% then fell victim to medical identity theft as a result.
The UK based Medical Chain thinks it has the answer. Using the blockchain based tool, the patient has total control over who can see their data, and what they can see. In the case of a hack, the fact that the data can only be accessed using a user’s private key means that the encrypted data would be unreadable to hackers. The tool has already been trialed with the British National health service (NHS), and a number of hospitals are already using its digital discharge function.
On a similar thread, in China, e-commerce giant Alibaba has partnered with local Chinese authorities, such as the city of Changzhou, for a project called Ali Health, which uses the Blockchain to secure patient healthcare data. The move of a large global corporation like Alibaba into the blockchain healthcare space is reassuring, as the company has the R&D budgets and talent to push forward the technology much quicker than research funded by governments around the world.
So, while American medical providers and insurance companies are unlikely to push for more transparency and accountability by themselves — and risk ruining the sweet deal they have right now — one can only hope that with time, forward-thinking political administrations will look to positive examples abroad to pull ourselves out of this healthcare quagmire we are now in.
Learning from the examples of countries who are dealing with the trust issue head-on, harnessing the power of emerging technologies could offer Americans the high quality of care they deserve, and control of their own data, all for a fair, competitive price.
Bo Vargas, CTO, and co-founder of BitMed, the no-cost telehealth provider which offers premium and on-demand healthcare services online.
