Can blockchain succeed where EHRs have failed?

Throughout history, the sharing of information has been a precursor to progress. The printing press and, centuries later, the internet exponentially increased our ability to access and share knowledge, ushering in new eras for science and society as a result. And yet, these revolutionary inventions met their match in the modern medical record, the documentation and distribution of which has only grown more Byzantine and frustrating for all involved.

Fortunately, the emergence of blockchain may offer us new hope. This technology, more closely associated with the financial world, may possess the power to do what paper files or EHRs could not: offer a seamless and secure way to capture, track and share a patient's entire medical experience.

Blockchain's key innovation lies not in a new format or vehicle for information — like a printed book or a computer screen — but in a radical new approach to oversee and manage data in a decentralized way. Doing so could greatly help us empower patients in their own care and lead to better medical outcomes.

Put simply, too many institutions have too much authority over the medical information they possess, and there is too little cooperation between them. In today's world, patients see dozens of doctors in their lifetime, undergo countless tests and procedures, all captured and filed in a host of disparate systems administered by each respective care organization.

Under this arrangement, a patient's medical history is a puzzle that must be pieced together anew at each interaction in the healthcare journey, often requiring as much detective work as medical expertise. This patchwork approach has been inefficient at best and dangerous at worst. A study last year found medical errors were the third leading cause of death in American hospitals, many of which could cite a lapse of properly sharing information as a contributing factor.

EHRs were supposed to solve this problem, but over a decade into the concerted and well-intentioned push to utilize them, many of even their most ardent supporters are expressing exasperation, if not conceding defeat. Recent studies have shown as much as 70 percent of practitioners have described their EHR efforts as not worth the investment.

The main roadblock to the success of EHRs has been interoperability — in essence, agreeing to a common system for all these repositories of information to interact. Both from a technical and organizational perspective, the challenge has been to get different centralized system owners to cooperate with each other, while at the same time, retaining their authority and security over their data.

Blockchain makes it possible to try a different approach. Using a decentralized, encrypted ledger, the technology provides a method for any entity to access and append information, if given the right permission. There is no need for cooperation between system owners because no one owns this system.

Imagine a magic book in which an authorized person could write, then that page would be stamped with the time of entry and locked in place, unable to be edited. When needed, the book would appear, and providers, patients, payers could review that page and all those before it, and then fill in other pages, providing one continuous log of an individual's care history. But it's not magic; that's exactly what blockchain does.

Of course, someone would have to be in charge of granting access and otherwise ensuring the ledger was used appropriately. That person would be the patient him- or herself — a massive shift in the distribution of responsibility for medical information. The potential differences in the healthcare experience could be stark.

To give one example, when visiting a doctor, the patient would not have to wait for that provider to contact another provider and receive permission to review records, then wait longer for those records to be sent and reviewed. The patient would grant the initial doctor access to her blockchain, and immediately her entire medical background would be at the provider's fingertips.

Aetna strongly believes we need to center the health ecosystem around the patient, and we see blockchain as a potentially valuable tool to reorganize the healthcare industry in that direction. Increasingly, we view our job as helping to structure the healthcare of individuals in a way that helps them achieve their aspirations for better, more cost effective care. Through our new innovative AetnaCare initiative and partnerships with accountable care organizations, we are creating many more touch points for patients and encouraging a shared responsibility in managing their health.

Personalized health approaches, like AetnaCare, depend on two fundamental pillars for success. The first is the seamless interoperability of data and information that is actionable by the patient and benefits all the participants in the health ecosystem that engage in offering interventions to advance an individual's health and wellness, beginning in the home. The second is a move to value-based reimbursement that creates shared financial risk and rewards for the organizations that offer those solutions. Supporting a personalized health ecosystem through value-based contracts has been achievable, but the opportunity for truly seamless patient-centric health information remains an aspiration.

As a nation, we spend more than any country in the world on healthcare, but do not have the comparative health outcomes that reflect this investment. One-third of the $3.1 trillion we spend on healthcare is wasted on both administrative and clinical inefficiencies. Arguably, in many cases the root cause of this waste is the inability to create interoperable information systems on par with other sectors of our economy. Tragically, we are not only missing the opportunity to more efficiently utilize healthcare dollars on crucial social, behavioral and environmental determinants of health, but we are also experiencing unprecedented burnout of our clinical workforce due to the enormous unnecessary complexity in managing ever-increasing amounts of health information.

It is inevitable that the health system will undergo a transformation that mirrors the changes seen in other industries over the past several decades. Blockchain offers the potential of an interoperable, consumer-focused health ecosystem that could incorporate not only traditional sources of clinical and administrative information, but also the Internet of Things, real world clinical evidence, genomics and pharmaceutical supply chain adherence. To keep track of all these interactions, and to make informed decisions based on information they generate, it will be crucial to have a way for all these learning to be stored and shared quickly, easily and accessibly. After decades of consolidation, it is time the healthcare industry examined models that redistribute the ability to do so and catch up to the rest of the modern age.

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