Recently, I was sitting with a former co-worker talking about still unsolved gaps in the healthcare ecosystem. We discussed the role a pharma, biotech, or medical device manufacturer plays in supporting patient access to the therapies a doctor prescribes and how difficult it is to get the information needed to support that patient.
The crux of the issue: The lack of trust in the accuracy and rights to the data exchanged between collaborating companies. This dynamic creates the need for unique data stores and redundant business processes to verify information. As an example: Benefits investigation can be performed multiple times, and there is hesitancy to share results—which can differ from each other. A complex web of agreements and contracts surround data exchange, which are often customized and take months and too much money to set up and manage.
This repeats itself with each brand launched and each program created. IT organizations are oversized to accommodate the numerous point-to-point data exchange needs, legal and compliance teams can’t keep pace and clamp down on patient engagement, and many companies can’t afford the dollars or risk associated with proper patient care. Patients get different answers to the same questions depending on who they call, and both HCPs and patients are looking to the manufacturer to improve their experience.
Blockchain to the Rescue
Blockchain is an emerging technology that stores transactional information in a distributed ledger creating an immutable data store that those with the proper rights can access. Users of blockchain write a transaction once and anyone needing that transaction “reads” it from the chain. The cryptographic, and multi-participant validation features of blockchain make it a good tool for disparate parties to trust the underlying data. Smart contracts, native to the technology, support business process automation. It is a great solution to manage an environment in which multiple parties need access to the same information. I think blockchain can do much to solve my colleague’s dilemma.
Imagine a world where anyone interacting with a patient would have access to the information they need to support a patient as soon as it was created. No separate data stores, no custom data exchange, just fast access to the information needed at that point on the patient journey.
Here’s how it might work:
- A doctor diagnoses and prescribes a therapy, and the patient in turn signs a HIPAA release and opts in to programs and channels to support their therapy on-boarding and treatment. These transactions are written to the blockchain.
- That diagnosis, consent granted, and prescription written is instantly available to the patient insurance provider who responds by posting coverage to the blockchain. It’s also immediately available to the manufacturer who can welcome the patient into support programs based on their consent.
- As soon as benefits are posted, the hub, the pharmacy, and the patient are updated simultaneously enabling critical actions around financial assistance, drug fulfillment, and therapy training to initiate.
- At each stage of engagement with that patient, the blockchain is updated so everyone (with proper rights) knows current patient status.
So, what’s improved? This full-information state enabled by blockchain allows multiple points of care to act in concert on behalf of that patient instead of in a linear or worse, duplicative, fashion. The doctor, the payer, the hub, the manufacturer, the pharmacy, and other suppliers are all working from the same data set. They’re able to act faster and with more complete and trusted information. The operational burden around information exchange is dramatically reduced, and all parties can act with comfort knowing patient privacy rights are fully respected. The cost of patient management should go down and access to therapy should speed up.
The Issues with Blockchain
Problem solved, right? So why aren’t we all moving toward blockchain? Well, there are a few reasons.
Since 2008, when ‘Satoshi Nakamoto’ released a white paper called “Bitcoin: A Peer-to-Peer Electronic Cash System,” to today, a lot of talk has been about what blockchain can enable. Many companies are clamoring to build blockchain healthcare capabilities, but very little is ready for production. Innovation teams are testing proofs of concept but seem hesitant to move into full use. The platforms are varied, their capabilities emerging, and support services around the same are limited. Check out Hyperledger and Etherium to learn more about blockchain platforms.
Blockchain reputation was built on Bitcoin and many in healthcare struggle to see the correlation and equate it with privacy risk. While interesting scenarios are being discussed around token-based healthcare systems—check out Hashed Health’s announcement on Bramble as a good example—the scenario I describe above is not a token-based blockchain, and most likely will not be publicly “mined.” Instead the blockchain will be managed within a semi-private environment. While the patient ultimately can be in control of their data on the chain, the reality is the companies supporting the patient will ultimately be the validating sources of patient information. This confusion over public or private blockchain confounds progress.
It Requires Collaboration:
The scenario above also requires that the companies supporting patient care are all aligned on the need to improve how data is managed. They must be willing to embrace the speed of information exchange and the transparency on process that blockchain-enabled patient data management will bring. They must come together to embrace new read and write standards and invest in the new technologies.
Blockchain also has the potential to change the economics and control levied between parties, and some are not in a hurry to change that dynamic. The good news—collaboration is happening! For instance, Change Healthcare offers real-time claims submission and remittance on blockchain and my own company, HealthVerity, offers blockchain-enabled consent management.
I feel confident that blockchain will transform how we manage information and deliver services to patients. For companies looking to participate in this transformation, start thinking about these challenges:
- How can we make it easy for legacy systems to feed a blockchain?
- What are the services needed to support authentication and smart contract creation across parties?
- What are the applications that can support delivery of blockchain data into legacy systems?
- What are the business process tools that can leverage the blockchain?
- How do you evaluate blockchain fit for purpose?
With blockchain, we can improve and speed up our ability to serve patients and practitioners. I urge you all to put a team on it today.