Blockchain has been making big waves across healthcare, heralded as the technology that’s going to save healthcare.
The excitement is understandable. Just about every segment of healthcare is fragmented — almost to the point of dysfunction. What better way to bind it together than via a digital ledger that affords the ability to securely, privately, and comprehensively track health records? It’s compelling — and it seems healthcare is ready to move full speed ahead with blockchain.
Is blockchain the technology that’s going to fix healthcare’s many problems? Potentially. But not now. Not even close. Before we can fix healthcare with blockchain, we need to break down the barriers that are preventing blockchain from fixing healthcare.
The Synaptic Health Alliance pilot has been a cue about blockchain’s future in healthcare. Led by healthcare giants Aetna, Ascension, Humana, MultiPlan, Optum, UnitedHealthcare, and Quest Diagnostics, the program plans to use blockchain to reduce administrative costs and improve data quality. Early this year, other big-time players — Aetna, Anthem, Health Care Service Corporation (HCSC), PNC Bank, and IBM — announced a new collaborative that will leverage blockchain technology to enhance interoperability and transparency in healthcare. Many smaller partnerships continue to follow suit.
A 2018 Deloitte blockchain survey found that of the more than 1,000 executives polled worldwide, 74 percent of all respondents said their organizations see a “compelling business case” for the use of blockchain. Nearly 40 percent said their organization would invest $5 million or more in blockchain technology over the next year, and more than 60 percent think they’ll lose competitive advantage if they don’t.
It doesn’t pay to be the guinea pig
The moving parts of blockchain evolve around a ledger with records that are widely distributed and available. Where things get challenging for healthcare is that a critical mass of users and data is necessary to make blockchain work well. If the users checking or inputting data are few and far between, then there’s no data to rely on. There needs to be wide adoption — enough people using blockchain in healthcare so that there is enough data to make it effective. However, in healthcare, no one wants to make the first move as it doesn’t always pay to be the guinea pig.
Sure, the big alliances mentioned above are setting the stage for establishing a standard for blockchain’s use across specific industry areas, but it’s early. Furthermore, these folks are developing standards that will work for their own very specific purposes but not necessarily for organizations spanning outside of their customer base, i.e., you and me and a lot of other people. Herein lies another big challenge.
Take physician credentialing, an area where blockchain is expected to grow over the next year. Because there are so many unique ways organizations credential, it’s difficult to provide any one given standard in credentialing or, for that matter, anywhere in healthcare and expect it to work for all parties involved.
The fact is that all the data to credential providers is disparate — living in different boards, different states, and in different organizations — some private, some public, some nonprofit. All of this data is driving a standard that has no uniformity. It is very specific to the source of data, and there is no aggregation standard or way of building consensus across multiple facets right now, making blockchain exceedingly unrealistic for this purpose. Even more daunting is trying to get everyone to agree to and adopt that standard once it is created, not to mention all the subsequent changes that will be made to that standard over time.
A hefty investment
There is no free framework to utilize blockchain right now; therefore, healthcare organizations will have to shoulder the cost for the technology that is both expensive and rapidly changing. “Not just financially expensive, either, in terms of updating or replacing IT systems to efficiently use the technology, although there’s that. But also in the work it will take to change ways of thinking and adjust long-ingrained workflows,” reported Healthcare IT News.
No guarantee of a standard, adoption, or consensus in the space creates a barrier to entry. For most companies, you’d have to be a large enough entity (like the big guns I mentioned above) that can afford to invest money in driving the adoption of your standard to meet your needs.
The smaller companies that we’re seeing, for example in the credentialing space, aren’t going to throw big dollars at doing blockchain if the price isn’t more affordable to do so.
What’s at risk for healthcare?
Perhaps the pilot programs the big alliances are running will test the waters enough for the rest of us, helping to create solutions to some of the roadblocks halting the widespread and imminent use of blockchain in healthcare — or at the very least, answer some of the really good questions that are being raised as to it’s being a cure-all.
From a credentialing standpoint, the risk is substantial. If you’re using blockchain, you’re pulling data from a ledger. You’re trusting that if a physician has 100 data points that the ledger information is correct — that whoever checked them last pulled the right data. This is a massive liability for a hospital — trusting a ledger as a primary source verification. If a hospital has the wrong information and it ends up being inaccurate, any sort of litigation or monetary loss will fall on that hospital, not the source that provided the data.
It’s a process issue — can an organization trust that all of a physician’s information has been input correctly? The risk is too great if it’s wrong.
That’s the risk of blockchain versus pulling all of those data sources into a central repository. You’re not trusting a ledger (what accountability do these ledgers even have?), but you are trusting the connections are there and that the single data source is correct. You are going straight to the source of truth. At the end of the day, you don’t need the ledger if you are going straight to the source with the same amount of effort. Instead of clicking a button and checking the ledger, you are clicking a button, and all the sources — all the data — are being pulled in automatically.
Blockchain has potential in healthcare. However, the barriers to adoption for players outside of the majors are real and unmet with solutions to overcome them. The majority of healthcare’s serious problems are issues over expediency and accuracy, not a technological answer that lets incomplete or inaccurate data live in infamy.
About Richard Rupp
Richard Rupp is the SVP of Product at Modio Health. Rich has years of startup experience — excelling in lead product and technology roles with Ancestry, Inflection, QuinStreet, and Niku. He is passionate about his profession, family, music, and the environment.