Serving the home health, home care and hospice industry since 1999.

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by Tim Rowan, Editor

Healthcare relies on legacy systems and is ripe for disruption by new technologies. One of the nagging problems ready to be disrupted is the lack of a secure platform to store and share data. Aging healthcare systems are also vulnerable to attack because of outdated infrastructure.

Ironically, the solution to each of these challenges may come not from some new, stronger firewall but from a "revolutionary" technology that was first proposed in 1991. At this year's HIMSS conference, there were three buzzwords hyped in every keynote and every acre of the exhibit hall: blockchain, artificial intelligence, and facial recognition. We tackle the easy one first.

Blockchain is a distributed, transparent, peer-to-peer network that has the potential to help healthcare organizations safely store medical records and, at the same time, share them with authorized caregivers in far-flung locations, while certifying the integrity of the data. This will improve data security and can even help improve accuracy and speed of diagnosis.

What is blockchain?

Simply defined, blockchain is a distributed ledger technology. It happens to be the platform that underlies Bitcoin. Proponents say blockchain makes electronic interactions transparent, democratic, decentralized, efficient, and secure.

Originally conceived in 1991 to create digital timestamps to prevent mission-critical documents from being back-dated or otherwise altered after reaching final form, the concept was set aside for two decades until it was adopted by Satoshi Nakamoto in 2009. For the uninitiated, Nakamoto may be a person or the pseudonym of a group. Either way, "he" was the inventor of Bitcoin.


Think of Blockchain as a distributed ledger that is open to anyone. Think of each ledger entry as a "block" of data. Once some data has been recorded inside a blockchain, it is very difficult to change it. Because it is distributed, there is no hub or central storage server where the data resides. It resides essentially everywhere, on a peer-to-peer network, with every authorized user of the information. If data is changed by one user, the thousands of other copies remain unchanged and can reliably be judged to be the authentic version. This consensus makes it very difficult to tamper with data while making it very easy to share.

Each block has three components. The data itself, a hash (lengthy string of code that uniquely identifies the data), and the hash of the previous block in the chain. In this way, every block is linked to the blocks before and after it. Alteration of the data in one block changes that block's hash, an act which is instantly detected by the block that holds the other copy of the altered block's hash. Hence, fraud is virtually impossible.

For the more technically oriented

Blockchain is a persistent, transparent, public, append-only ledger. It a system to which an individual can add data but not change data already present. It does this through a mechanism for creating consensus between distributed parties that do not need to trust each other. They just need to trust the mechanism by which consensus is created.

Blockchain in healthcare

The challenge presented by the Triple Aim is how to allow patient data to follow patients as they move from one care center to the next. In the case of in-home care, how do home health nurses and therapists, home health aides, and hospice nurses gain timely access to the latest hospital or ACO data and, when necessary, transmit an updated version of it back to the hospital or ACO or to another care institution?

The obstacle to this goal has always been, and still is, healthcare organizations do not all use the same electronic medical record and competing EMR vendors are either unable or unwilling to create the electronic pathways that would make life easier for competitors. Even Epic, which seems to have a mission to become the only hospital EMR system, is not yet ubiquitous. Even if it were, it would still have to interface with home health, home care, hospice, nursing home, and rehab hospital systems.

Blockchain, therefore, might be the long-sought solution. With no central data depository, no one person or organization owns the data. Anyone authorized, presumably by the patient, can access it. What is more, because data integrity is guaranteed by consensus of the entire group of authorized users, every attempt by one actor to add to or alter any piece of data is automatically challenged by every other actor on the network. In theory, it ensures that no one can force the blockchain to accept an entry on the ledger that others disapprove of. As a peer-to-peer network, it can maintain updates to the ledger and then verify those updates in such a way that is impossible to defraud and impossible to alter after the fact.

The normal course of evolution of disruptive technology is from the inventor to large industries such as finance, transportation, and inventory management, then to large healthcare systems and finally, within a period of time that can range from five years to a generation, down to post-acute care. Blockchain might be different. It is plowing through healthcare like a runaway locomotive, partly because it actually does solve healthcare's most vexing problems. It would be a good idea for leadership in post-acute care to assume they will need to wrestle with it closer to the 5-year end of the range than the generation end.


©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.