Betting on Blockchain, continued from page 6 eliminate fraud. “Just like any system, it’s only as good as the data put into it. It won’t stop fraudulent data that was put in from the start but would be easily visible if manipulated once in.” All three legal experts agreed back office functions have seen the most blockchain activity thus far. “It’s a powerful tool to reduce transaction cost because most transactions can be replicated, and it allows you to replicate them in a more efficient and less costly manner,” said Ehrenfeld. Johns said some of the first functions utilizing blockchain technology are the ‘low hanging fruit’ applications that are easier to roll out with more complex uses to come as technology and legal hurdles are addressed. Still, she said, the movement is rapid. “The conversation is not so much about education now. It’s about use cases and where do we start and where do we go?” she noted of making the leap to the next level of deploying blockchain in healthcare.
“The holy grail of blockchain is medical records,” stated Johns, who added a number of regulatory concerns must first be addressed. However, she said, the potential for improved communication … and, in turn, improved quality and safety … is too great to be ignored. “Is the promise of blockchain the ability to connect across the continuum of care? The answer is a resounding, ‘yes.’
How that happens, time will tell,” she said. Ehrenfeld noted one of the major upsides to using the technology with electronic health records is its decentralized nature, which allows participants across the chain to access information from different locations. Everyone from a patient’s internist to specialists to an urgent care provider seen while on vacation could potentially have access to the EHR and pertinent clinical information including medication allergies and co-occurring conditions. However, he noted, “Once you start putting someone’s health record on this chain, if someone hacks into it, you have a huge issue. Security becomes that much more critical.” Data is, of course, encrypted … and Ehrenfeld pointed out those using blockchain in a clinical setting face the same issues as an individual office with protected health information. In both cases, a strong cybersecurity plan should be in place that looks at processes, risk management and action plans in case of a breach. “The treatment you have from the protection and response side is similar to existing protocols but will ultimately have to be tailored and enhanced to account for blockchain technology.”
Sloan said there are a number of barriers to broadly implementing blockchain ranging from regulatory concerns
with existing laws to inertia. “Historically, the healthcare industry has been one of the slowest adopters of technology,” he pointed out. “Is it better now than 20 years ago? Exponentially so, but I still think it’s going to take a little bit longer than people think.” Sloan noted it isn’t the young, nimble companies that are the issue in deploying blockchain. “It’s that you have to get so many disparate groups on board – providers, payers, regulators – it’s a lot of mouths to feed.” Johns said scalability is an issue and noted many potential applications aren’t readily available, as the underlying technology doesn’t currently exist. “We can see what is possible, but we’re just not there, yet,” she said. Ehrenfeld reiterated the barriers are different on the clinical front where there are more variables than with back office functions. “You are taking the art of medicine and trying to marry that with an executable and replicable set of activities,” he pointed out. Working through complicated medical scenarios and permissions are key reasons Ehrenfeld thinks it will take more thought and time before blockchain is widely deployed on the clinical front. “I have no doubt someone will figure it out, I just don’t know what that looks like, yet.”
While there are multiple hurdles to
overcome, blockchain is increasingly being considered as a way to innovate business functions. Johns, Ehrenfeld and Sloan all three said it was easy to see the allure of the technology in the healthcare setting. “It adds efficiency and integrity to any system that involves data moving back and forth between multiple parties,” Sloan pointed out. “Anyone in healthcare can probably think of a dozen areas where a blockchain network could save time, save money, reduce errors and add transparency … and that’s powerful for healthcare.” Ehrenfeld echoed those thoughts, saying, “It’s a powerful tool to achieve these results, but the devil is going to be in the details.” Johns noted, “Some entities are calling what they’re building a blockchain when it isn’t at all … but that’s okay. It’s still innovative and offers more efficiency, greater transparency and improved security.” She continued, “Even if blockchain isn’t your answer – and often, it isn’t – that’s okay. It has still forced you to look at your infrastructure, existing procedures and even policies in a fresh way. Blockchain technology can inspire those conversations.” Johns added, “I think it would be a mistake to ignore this. Even if you are a skeptic, you should pay attention. It would be naïve to say this is a passing fad. It’s not a matter of if … it’s a matter of when … and that answer will depend on the use case.”
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Memphis Medical News July 2018