As the Internet of Things continues to reshape the infrastructure of nearly everything, blockchain technology is offering new potential of managing hyper connectivity between devices, software platforms and users.
From improving banking security measures in Canada to monitoring the delivery system of medical marijuana in the US, it is clear that blockchain is gaining momentum in every sector. Furthermore, as an estimated 20-30 billion healthcare IoT devices are going to be used by 2020, according to Forbes, the industry is rethinking the way information is managed. The healthcare industry is also beginning to see the potential for blockchain technology to help manage the exabyte-scale volumes of data generated by electronic medical records, genomic testing, health-related IoT devices, and mobile applications. Blockchain companies, such as Denver-based BurstIQ, are working closely with health systems and care providers to help them maximize data insights and exchange.
It’s fundamental to say that better intelligence helps physicians deliver better care to patients. However, getting that data to the care provider in the most efficient way is much more complicated. Factors like protocols and patient mobility are all obstacles in the process. As Dr. Foster Goss, Emergency Medicine Physician and expert in clinical informatics at the University of Colorado Hospital, pointed out, “patients may receive care at multiple institutions, and information is not shared across these hospitals or facilities.” It can be a challenge to know what test or work has been done for those patients at another hospital, says Goss.
Blockchain-based data systems offer the potential to break down these silos and improve health insights for both for doctors and patients. These insights can help health professionals make better decisions, help biopharma and academic researchers discover new cures, and ultimately help patients become more active in managing their own health. For that reason, health systems and provider networks are exploring ways of leveraging blockchain technology to unlock the knowledge potential of health data.
There are four primary ways that blockchain-based data platforms can benefit care providers and health systems: reducing friction in data exchanges, improving the quality of care, increasing health literacy in patients, and enhancing data security.
Reducing Friction in Data Exchanges
Currently in the US, there are regional health information exchanges (HIEs) such as Epic’s Care Everywhere in Colorado, SHIN-NY in New York, and similar initiatives in other states that work to consolidate data from different facilities. While HIEs are a great step in the right direction, there are a few challenges with this model. First, data access is brokered by the HIE provider, so participating institutions either need to go through the HIE or create traditional 1:1 partnerships if they want to engage directly specific third parties - both of which require time and resources. Second, individuals have little or no access to their own data in the HIE, and can’t do much with their data even if they do gain access. Lastly, most HIEs provide few tools for analyzing or using the data within the system - the data must be pulled off the system in order for complex analytics to be conducted. Some HIE providers, such as CORHIO in Colorado, have begun exploring blockchain as a possible solution to these challenges.
Blockchain-based health data platforms, such as the one built by BurstIQ, address these challenges in a number of ways. Blockchain technology allows data to be managed directly by the owner of the data instead of a broker. Patients, care providers and health systems can directly control who sees their data, for how long, and under what conditions. Data access can be granted and revoked by the data owner instantaneously and at any time. In the case of BurstIQ, the platform manages ownership of and access to every piece of data separately, from blood work to genetic profiles to medication orders, in an instantaneous, autonomous and secure way.
The potential for this technology to reduce friction in the healthcare system is huge. “There would be value in using this technology to exchange information in a secure fashion by permitting healthcare providers to access those data with pre-authorization from patients themselves,” Dr. Goss says. “This eliminates the need to fax information back and forth, obtaining signatures, when this time-consuming process can all be streamlined with digital consent.”
Improving the Quality of Care
Blockchain-based data platforms don’t behave the same way as a HIE, personal health record (PHR), or electronic medical record (EMR). They aren’t limited to the types of data we typically associate with the healthcare system. Medical data can be combined with dental, behavioral, pharmaceutical, genetic, social, IoT, and even purchase history data. And when all of these different types of data are combined together with similar data sets from thousands or even hundreds of thousands of other people, the knowledge power of that data becomes immense.
Machine learning and artificial intelligence allows platforms like BurstIQ’s to autonomously discover correlations between non-clinical data and clinical outcomes, identify clinical workflows that work well and those that don’t, and offer insights that help care providers improve the quality of care they provide. “Anytime you can empower anyone to take control of what needs to be done and when, it will lead to better care,” Carole Guinane, VP Systems Orthopedics at Sentara Healthcare said. “Blockchain technology can mean a coordination of data and information that not only tells the story, but also helps to take out the guess work and mitigate mistakes.”
Increasing Health Literacy
Industry leaders like Guinane believe that patients, even older patients, are becoming more savvy than ever before. Growth in wearables and other IoT devices is very strong, and IoT users understand that the data generated by these devices can help them simplify and improve their life.
However, just as with medical data, IoT data is largely siloed. Blockchain data platforms allow individuals to bring all their data together and use it to make informed health decisions.
Rather than being a passive recipient of care services, the right information can help patients take on a much more proactive role in managing their own health. Ultimately, the entire healthcare ecosystem will benefit from this symbiotic relationship between patients and their data. In an ideal world, personal health information should “live” with the patients themselves, Guinane explains. “Instead of data being silo-ed in health systems, patients could have that information in their own hands and choose who to share that information with.”
BurstIQ is taking this approach a step further. The platform incorporates machine learning and artificial intelligence to create insights that a patient may not have discovered on their own. These insights can be used by the patient, their care provider, or the digital health applications and IoT devices they already use to personalize their care, coaching, nutrition, wellness plan, behavioral therapies, and other support services. In addition, the company is developing a digital marketplace in which individuals can discover health-related products, services and research opportunities tailored just for them.
But these types of data platforms are completely new, and the idea of companies using data to personalize products and services still gives some people pause. To get patients on board, blockchain companies and care providers must increase education and awareness - showing patients how this will help them. “It’s about answering the WIIFM (what’s in it for me) questions,” said Guinane. “Help them understand that you can control your information, who sees your information, how your information is used. To be selective and participative about it. I think people would like to do that, but they don’t know how right now.”
Enhancing Data Security
With the amount of data being generated in the process of providing care and the sensitive nature of that data, it is unsurprising that data security is an area of major concern. Despite protocols and redundancies in place, the Protenus Breach Barometer still recorded 450 security breaches in 2016, affecting over 27 million patient records in the US. Forty-seven percent of those incidents were insider-caused and 27% were due to hacking or ransomware.
“We have seen quite a lot of breaches of healthcare data. Whether it’s at an insurance company or a hospital, these breaches are becoming more prevalent,” explains Dr. Goss. “Exploring more secure ways of using and storing data, such as blockchain-based technology, is a necessary step for the future of healthcare.”
Medical data is largely stored in traditional databases, with perimeter solutions (e.g., firewalls) that can easily be breached by reasonably experienced hackers. The data itself is largely unprotected, so once a perimeter breach occurs, the data is compromised.
Blockchain itself does nothing to improve data security, since traditional blockchain models are open and transparent. But companies like BurstIQ are leveraging the distributed architecture of blockchain and adding advanced security layers within the data itself to ensure that data remains safe even if traditional perimeter solutions fail.
Additionally, blockchain-based data platforms would improve security by eliminating paper authorizations and manual data transfers, both of which are prone to error and data loss. But perhaps most importantly, patient engagement improves security by putting patients in the driver’s seat. As an industry, we have to do more to “inform and involve the patients in where that information goes and how it is used in any kind of activity,” Guinane explained. “From a security perspective, when you’re in the know, when you know how it is being used and are a part of it, then it’s even more powerful.”
While blockchain technology has clear value in healthcare, implementing such a fundamental change can be challenging, especially for an industry that focuses on risk mitigation more than innovation. “The healthcare industry in general, tends to be more of a laggard when it comes to adoption across any kind of system,” said Guinane. “We’re conservative, and we need to be when we’re taking care of patients, so we’re not always on the side of early adopters.”
Even so, the potential of blockchain is steadily spurring the industry to explore what the new technology can do. This is evident from the blockchain whitepaper challenge hosted by the US Department of Health and Human Services (HHS) in July, 2016. And health-related blockchain companies are gaining traction quickly.
From gene editing to immunotherapy, significant scientific and treatment breakthroughs are ushering in a new age of healthcare. Blockchain-based data platforms are also a part of the disruption, helping experts in the field access new sources of data, discover new insights, and rethink ways of improving care quality. Coupled with the exponential growth of machine learning and IoT connectivity, care providers and blockchain companies now have the potential to create a knowledge-based healthcare ecosystem with better informed doctors and more engaged patients.
About Dr. Foster Goss:
Foster R. Goss, DO, MMSc is currently an emergency physician at the University of Colorado Hospital and Assistant Professor of Emergency Medicine within the University of Colorado School of Medicine. His research focuses on natural language processing, decision analysis and information retrieval, as it relates to patient safety, communication and coordination of care. He is currently the site principal investigator on the use of natural language processing to identify patient allergy information, a multi-institutional grant between the University of Colorado and Brigham and Women’s Hospital where he also holds a research position. His work has lead to several publications and presentations at national conferences.
About Carole Guinane:
Carole Guinane is a Healthcare Executive. Her specialities include: service line optimization, creation and implementation of bundled payment and coordinated care programs; patient- and family-centered care programs; clinical improvement and center of excellence designation. In addition, she is an incoming member of the Board of Directors for the National Association of Healthcare Quality (NAHQ), the incoming Chairman of the NAHQ Competency Commission, and is an active faculty member with the organization.