Dr. Muney at AMG (left), my primary care provider is scanning my QR code, verifying my identity and instantly receiving payment using the SeeThru payment platform (I am on the right: patient 001) at my first ‘blockchained’ doctor visit

3 Things I Learned From “Does Data Transparency In Healthcare Really Matter” — June 20th Conference Call

A conversation with CEOs of Amchart and SeeThru about how self-sovereign, transparent, secure healthcare data looks like



1. Our Healthcare Data Will Be Treated Like Money

Since the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, nearly all the U.S. health care system has migrated from paper charts to electronic health records (EHRs). This effort certified by the Office of the National Coordinator for Health IT (ONC) and incentivized by Centers for Medicare & Medicaid Services (CMS) proposes a meaningful use of EHRs with the intent to:

  1. Improve quality, safety, efficiency, and reduce health disparities
  2. Engage patients and families in their health
  3. Improve care coordination
  4. Improve population and public health
  5. Ensure adequate privacy and security protection for personal health information

(Latest Meaningful Use version for 2019 can be read here and here)

But though this shift should have been transformative, current EHRs are largely digital remakes of traditional systems (provider-driven) and suffer from poor user interface, significant cyber-security vulnerabilities and lack of interoperability (I wrote about this here and here).

Self-sovereign (patient-driven) EHRs (like Iryo or Amchart below) are a breakthrough, not by improving centralized solution user interface (like athenaHealth), security (Citrix) or interoperability by pulling disparate data through smart contracts (MedRec), but by fundamentally changing the way we procure, curate, extract, manage, permission and own our health data.

Our health data in the future will be treated like money. It is a personal, valuable, yet accessible asset that is held in a secure wallet, for immediate use, anywhere, anytime.
Amchart Wellness dapp can be found on Android and IOS. The self-sovereign personal EHR will come out in September 2018

2. Blockchain Provides The Price Transparency Consumers Need And Deserve

Almost half of Americans with private insurance are covered by high deductible plans (HDP) at an overall out-of-pocket cost of half a trillion dollars(!). With 2 out of 3 unable to pay their medical bill (99% when the bill is over $3000) and outrageous surprise medical bills that run into hundreds of thousands of dollars, I cannot not help but think of the U.S. Healthcare system as a ‘Burmese gray market’.

In 1988 I visited Burma (now Myanmar) for a week and upon arrival I was allowed to exchange only $100 into 2,000 Kyat (pronounced ch-yat). After I found out that I could barely pay my 1,500 Kyat one-way trip to the city, the bus driver offered me 50,000 Kyat for my used pen and another 10,000 for my socks. I survived the rest of the week by selling my belongings to money changers in the gray market.
Although the US healthcare market does not run an illegal, unreported or unrecorded black market economy, price opacity (the use of the Chargemaster), prohibition on drug price negotiation (Medicare part D) and exorbitant service fees are causing consumer uncertainty and bankruptcy, similar to conditions found in an informal gray market.

Furthermore, beyond the need for solutions like cost comparison tools (Amino, BlinkHealth, ClearHealthCosts, GoodRX), transparent provider marketplaces (ZocDoc, Solv), or both (SeeThru, beta launch early 2019), hospitals, provider groups and payors must change their current (some would say also predatory) practices and adhere to a Financial Bill of Rights that includes:

  1. The right to an itemized bill in plain English
  2. The right to never receive a surprise out-of-network bill
  3. The right to accurate information about the provider network in my insurance plan
  4. The right to a stable network (no changes during the year)
  5. The right to be informed of provider conflicts of interest
  6. The right to be informed in advance about any facility fees
  7. The right to see a price list for elective procedures
  8. The right to be informed of cheaper options
  9. The right to know that a disputed bill will not be sent to a collection agency

3. CryptoHealth Solutions Create By Design A Collaborative Ecosystem

Not all technological changes in Healthcare can or should use distributed ledger technology. EHRs already can be improved with a goal-directed design rather than a problem-oriented approach, emphasizing goals, needs and values of patients and clinicians, thus avoiding the frequent use of EHRs as ‘glorified’, automated billing platforms (below).

(Source)

However the use of self-sovereign EHRs and P2P payment platforms using distributed ledger technology (Amchart and SeeThru are currently offering their solutions in tandem), reflect a deeper change in overall consumer behavior. More than convenience, efficiency and immediacy, people want agency, control, transparency and trust when accessing healthcare, without compromising the quality of the clinical encounter.

“Everyone is going digital. This is not just a millennial trend”. Doctor.com 2018 report

Finally, the idea to concentrate on the patient experience (patient-centric) and realign incentives (Value-Based-Purchasing) in a highly-regulated, data-rich, friction-full, multi-stakeholder environment is not new. However blockchain solutions are not patient-centric, they are patient-driven and this is an important distinction.

CryptoHealth solutions do not only change how stakeholders interact with each other, but change the stakeholders themselves. Patients become mindful of their data, providers aware to cost, hospitals accountable to outcomes and payers responsible to the financial impact of their practices.

This inter-dependence created by decentralized solutions force patients, doctors, hospitals and payors to inter-act not as players subsumed by a collective, or as stakeholders driven by self-interest alone. The network effect of decentralization creates a committed, collaborative and ethical community or as the 19th century French poet Charles Péguy said:

“The Revolution Is Moral, or Not At All”

Again, enjoy the conference call recording here


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