Josh Schoeller, senior vice president and general manager at health IT risk solutions company LexisNexis Health Care in Alpharetta, Ga., discusses the potential advancements blockchain can deliver to the healthcare industry as well as his thoughts on security risks the technology poses.
Responses have been lightly edited for clarity and length.
Question: Where is blockchain in healthcare now and how will it develop in 2019?
Josh Schoeller: Blockchain technology's promises to connect multiple data sources, track any and all transactions across the chain and then publish the resulting information to stakeholders, is appealing. In healthcare, this translates to having the ability to connect, manage, audit and update a myriad of data types across disparate systems and stakeholders quickly. The story is still being written on what blockchain can deliver to our industry. But one thing is for certain — a healthcare technology that enables data sharing will require high-level data governance and validation.
Q: What do you think will be the most significant blockchain applications in healthcare over the next five years?
JS: Proponents claim it will transform them and the quality of care they provide and pay for, with better ways to store information and share it among providers, payers and patients — and even pharmacies, pharmacy benefit managers, pharmaceutical manufacturers and distributors.
Blockchain-enabled outcomes-based contracts may better connect costs and clinical results. For example, blockchain could play a part in improving auditability, provenance tracking and control for clinical trial managers by automatically aggregating, replicating and distributing data. As well, blockchain could reduce patient documentation errors and problems with conflicting data from multiple entities, and it could minimize hacking.
Q: What do health IT leaders at hospitals and health systems need to know about blockchain today?
JS: Blockchain's design doesn't suit all of healthcare users' needs. A blockchain network is designed to be transparent; there's no mechanism for hiding a transaction. That means everyone could see a patient's protected health information, for example, so blockchain isn't compliant with the Health Insurance Portability and Accountability Act. Also, everyone could potentially see details of each payer member’s provider networks.
Control issues exist, as well. If a patient is unable to authorize access to his or her data in an emergency, who else will be able to? Blockchain was designed for transactions, not data, so sending it tends to eat up a ton of bandwidth. That means it's slow, which also possibly limits its use for emergency services.
Data quality is still fundamental. If data isn't correct, the errors will immutably persist. This is a problem when the largest driver of the blockchain business model design is trust. Because of the misinformation that occurs naturally, while blockchains are independent, they'll likely require outside central authority for validation purposes, especially around identity and location information.
To participate in future Becker's Q&As, contact Jackie Drees at jdrees@beckershealthcare.com.