Some complex technologies are best left to the IT Department, under the philosophy, "I don't want to know how to build a car; I just want to drive one." Blockchain is not one of those technologies. As it becomes more mainstream, blockchain will impact a healthcare provider's operational processes, HIPAA compliance efforts, and clinical policies. There may be no need to know how it works but all healthcare providers will appreciate knowing what it can do for them.
We spoke with Lynn Carroll, Chief of Strategy and Operations for HSBlox, an Atlanta-based team of healthcare, financial technology, and digital supply chain management professionals. He describes blockchain in lay terms, focusing on what it can do, not how it works.
"Our company is focused in three broad areas of the healthcare ecosystem," he began. "We are a Value–Based Reseller of population health systems. Second, we secure and transmit patient permissioned data among patients, their caregivers, and their care team members. And third, we deploy machine learning, using Distributed Ledger Technology (Blockchain's formal -- and more descriptive -- name), to distribute analytics results on a permissioned basis."
Where these three foci intersect, you find healthcare's need to securely transmit patient data from one care locale to another, as the patient moves through the healthcare system. Carroll believes physical, technological, and competitive obstacles to sharing patient data can be overcome with distributed ledger technology.
You have already heard of the version officially known as Public Blockchain. This is the Distributed Ledger that made crypto-currency possible, the primary example being BitCoin. But public Blockchain is not appropriate in healthcare, banking, or any other industry where security and privacy are at issue.
The other version, Private Blockchain, is based on permissioned rather than public ledgers. (For the basics on how distributed ledgers work, see HCTR, 4/18/18, "Blockchain 101")
"In a common healthcare case," Carroll explained, "we have participants in transactions that have a common business interest, are in established relationships with each other, and who seek more transparent, auditable transactions. Blockchain gives them a way to do that without extra overhead."
Carroll drew us a step-by-step word map to explain the way a private Blockchain enables this. He calls the mechanism a "smart contract." The agreed upon conditions of the private interactions are operationalized in self-executing Blockchain code. When a new piece of data arrives in the ledger, the smart contract "sees" the triggering information and replicates it to the appropriate ledgers in the Blockchain according to the contract's permissions and rules.
As a network model, a private Blockchain has a finite number of authorized participants. Each participant has a complete copy of the ledger and each ledger has auto-executable code. As patient information is sent, say, from a hospital to a home health agency, those new transactions are recorded according to established parameters in the smart contract. When particular trigger events are recognized by the contract, the transaction and its content are replicated to specific participating nodes.
For example, there might be ten participants in a particular concern -- perhaps members located at a hospital, a post-acute provider organization, a physician group, etc. -- Maybe everybody needs a copy, or maybe only three of them need it. It is all governed automatically by the smart contract. There is no danger that any patient data can be accessed by bad actors outside the Blockchain, nor is there danger that data can be leaked outside of the Blockchain. HIPAA compliance is handled by the smart contract.
When will this technology come knocking on your door? Carroll sees a current struggle to introduce Blockchain into healthcare. "Healthcare moves slowly," he reminded us, "partly because there is so much misinformation out there. People hear that Blockchain has an issue with latency, or scalability, causing it to introduce workflow delays. But that is a problem in a public Blockchain; it does not impact the private type. Why? Replicating to 30 nodes is not as subject to latency as replicating to 3 million nodes."
Admitting Blockchain in healthcare is a new and unfamiliar concept, Carroll tried to help our understanding with a couple of analogies. First, he suggested, to see the consensus building more clearly, think of the smart contract as a notary service that validates entry of the transaction into the ledger. The notary is an additional node, a peer to the nodes managed by people, that permits or denies every request to exchange data in the ledger.
If baseball is closer to your experience than notaries, look at the way the Blockchain works to avoid setting up a centralized authority. The smart contract node is like the entire crowd empowered to reach consensus on whether an umpire’s call was right or wrong.
Carroll's company, HSBlox, furnishes the healthcare industry with a range of services. After it was acquired by Broadridge Financial, the new parent invested in the enterprise by bringing in experts in healthcare, machine learning, and Blockchain. Today it is bringing this expertise to bear by building what it calls solution-centric Blockchain to help with bundled payments, revenue cycle management, referral management, and other areas where privacy and efficiency are primary concerns. The company has spent the last 16 months building enterprise scale solutions for specific healthcare problems, with open APIs, and is now bringing them to market.
©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. firstname.lastname@example.org