How does ownership of EHR result in disruption of third party payors?

The ownership of Electronic Health Records (EHR) as they exist today will not result in disruption of third party payors. It is an individual’s ownership of his/her own Personal Health Record (PHR) in the form of an original, digitally secured, encrypted blockchain platform combined with a cryptocurrency payment method that will give third party payors pause.

A Personal Health Record (PHR) is a collection of information about your health.[1] This includes information from doctors’ names and phone numbers to allergies to dates of illnesses and surgeries, family history, living will or advanced directives and immunization history.[1]

Personal Health Records are not the same as electronic health records (also known as Electronic Medical Records, or EMR).[1] The latter are owned and maintained by physician offices, hospitals or third party payors and include visit notes, test results and more added by the provider.[1] Today, individuals have access to their personal health records through a number of avenues:[2]

● First, there are PHRs subject to the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. These are offered by a covered health care provider or health plan and give individuals access to some or all of their health records maintained by the entity. This means you may not have access to your entire record and it may not be a comprehensive record because it possibly may not be automatically updated with new information, and is more than likely housed within an EMR of the practitioner’s choice. Therefore, the PHR is not portable and can’t easily be taken with a patient if switching healthcare providers or health plans.

● Second, there are EHR systems that are offered by an employer or a PHR vendor that is not a HIPAA covered entity. These PHRs are governed by the privacy policies of the offering entity, which begs the questions of how your information will be protected and the entity’s ability to share your health information with contractors and other business partners.

These methods fall flat in providing individuals with rapid unfettered access to their own secure, comprehensive medical history. They also hinder seamless communication among providers in treating the individual and hand-offs when multidisciplinary team care is implemented, particularly by providers in different systems.

In the United States, total national health spending per capita (3.6% from 2010–2016) is growing at a faster rate than GDP per capita (2.9% from 2010–2016).[3] In addition, 8% of healthcare spending is related to administrative costs incurred by private and public insurers compared to 3% in comparable countries, according to a JAMA study.[4] This 8% excludes billing and insurance-related activities by billing and physician offices, the inclusion of which brings spending on administrative costs up to about 14%. Governance and administration spending per capita in the U.S. is $752 compared to the next highest Switzerland at $271 and the lowest in the study France at $37.

An individual’s ownership of his/her own Personal Health Record (PHR) in the form of an original, digitally secured, encrypted record on a blockchain platform can reduce these administrative costs through integration with existing EMR systems, or as a standalone record archive accessible to stakeholders on the same main chain. Moreover, with the introduction of a cryptocurrency payment method, a direct Patient-to-Provider (“P2P”) transaction is possible as a substitute or complement to health insurance claims. The estimated costs of billing and insurance-related activities can range from $20 to $215 depending on the type of visit or procedure.[5] This reduced administrative burden, cost savings and immediate reimbursement has the potential to allow healthcare providers to rethink the costs of services. It also has the potential to change the role that third party payors play in many of our lives.

[1] https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/personal-health-record/art-20047273

[2] https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/special/healthit/phrs.pdf

[3] https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/#item-health-spending-growth-slowed-now-pace-economic-growth_2017

[4] http://www.modernhealthcare.com/article/20180407/NEWS/180409939

[5] https://www.ncbi.nlm.nih.gov/pubmed/29466590