Blockchain: A Strategic Approach to Healthcare Data Democracy
Healthcare involves a diverse set of stakeholders who contribute to the overall care of a patient. Patients, particularly those with chronic conditions, need to consult with well-qualified, experienced, and outcome-based specialty doctors. In addition, patients depend on affordable and comprehensive healthcare plans to cover their healthcare expenses. Providers, with the increased legislative and regulatory requirements on value-based care, have to find new ways to spend more time with patients. Payers are increasing their investment in care coordination and wellness activities to control costs.

Healthcare stakeholders leverage proprietary and commercial off-the-shelf (COTS) information systems to manage patient- and provider-related information. Reports indicate that roughly $2.1B is spent on redundant provider credentialing activities, as each payer goes through the process of vetting and validating providers within their network. Conversely, providers spend more time on the administrative side to provide the same information to multiple payers, leading to increased costs and reduced provider to patient ratios. Providers also spend more on the administrative costs, estimated to be 20 percent of the preventable costs, when they end up spending time on collecting patient information that is not tracked by their electronic healthcare system. This healthcare diversity and the system disparity highlight the need to have a collaborative healthcare ecosystem that is patient centric and empowers patients to be in control of their health.

Blockchain, as a business and technology framework, provides the foundation required for creating a collaborative healthcare ecosystem that is built on partnerships and mutual benefits between the healthcare stakeholders. At C-HIT, we are working with customers to optimize their operations, particularly as it relates to managing provider profile information through the power of blockchain.

“Blockchain becomes a strategic tool to build a secure and integrated, collaborative network ,” says Ram Kovilvenni, chief innovation officer at C-HIT. “We believe blockchain will have a profound impact on reducing administrative burden by decreasing repetitive activities across the healthcare industry.”

So how does blockchain work? Blockchain works on the basis of decentralization where every healthcare transaction (e.g., patient information update, provider credential) is vetted by all participants, or nodes, on the blockchain network. In other words, there is no “single” authority in blockchain, and each participant maintains their own ledger of transactions.

To map this to the healthcare industry, we will consider two examples:

  • Provider Credentialing: As a payer validates a provider’s credentials, the validation is performed by all participants, which leads to more robust security and integrity. And at the end of the provider credentialing process, all participants have a copy of the credentials for that provider. This eliminates the need for that provider to undergo that process again when they join another payer’s network.

  • Patient Health Information: Blockchain can help promote healthcare data democracy and data interoperability by making a patient’s healthcare information across the entire continuum of care available to the patient and in an easily consumable manner. In the blockchain world, patients will have a 360-degree view of their health information, with full ownership of that data. Patients can track the information being accessed by any participating provider. Patients can also grant access to their information to participating providers. Providers, who act as the guardians of the blockchain network, validate every patient transaction (e.g., every patient encounter, lab report, medication), which leads to the increased security and integrity of the patient’s health information. The blockchain network uses a “consensus” mechanism to allow for a “block” of transactions to be added to the network and each block is chained with the previous one. In other words, the chain of blocks provides the “audit trail” or “provenance” of the patient’s information.

According to Kovilvenni, the power of blockchain relies on its ability to:

  • Bolster the security nature of the validity in the provider information.

  • Cut significant administrative costs from providers performing redundant activities and supplying the same information to multiple payers.

  • Improve the integrity of provider information as it is updated in the network.

The evolution of a unified and personalized healthcare system can have a profound impact in our society. Our vision relies on providers seeing healthcare data not as an administrative burden, but rather as a way to improve the quality of care at a lower cost to the patient.