Blockchain enabled Personal Health Record OS — Challenges & Opportunities in Health Care Informatics
Background of EHR/EMR
Digitization of healthcare data was given a huge boost when former U.S President George W Bush advocated it and made the following statement as part of his state of the Union Address (Jan 20, 2004):
“By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.”
The attention it garnered was unparalleled and within the next decade the big Electronic Health Record (EHR) companies were raking in millions of dollars in sales. It didn’t take much time for the price tag to swell from millions to billions for some of these EHR contracts. This is a list of 10 EHR implementations with the biggest price tags in 2017 alone.
As of 2016–17, the Medicare and Medicaid EHR Incentive Programs offered $44,000 in incentives through Medicare and $63,750 through Medicaid, respectively. Some of the limitations of EHR implementations have been elucidated in the article titled — Study identifies costs of implementing electronic health records in network of physician practices, which include -
- Hardware and other IT investments
- Security Tools
- EHR Training
- Lost Productivity and temporary staffing increase
- Customization and Future Upgrades
- Very high cost & annual maintenance fee
To illustrate this point, the EHR implementation projects undertaken by Lehigh Valley Health Network and St. Luke’s University Hospital proves to be quite apt.
It cost an astonishing US$ 200 million, taking an estimated 4–6 years to complete and requiring the labors of approximately 100 workers.
EHR implementations for larger hospitals and medical networks can be undertaken due to the incentive programs and can eventually prove to be viable in the long run.
On the other hand, small clinics and medical centers often have to depend on the larger hospitals and medical networks for EHR services or risk having their Medicare and Medicaid reimbursements cut. Unfortunately, this model is untenable as large hospitals which become 3rd party providers for EHRs often struggled to meet any additional demands.
EHR implementation had several goals but I would like to highlight three:
- Patient’s medical information are stored in silos with different healthcare providers and often a medical practitioner doesn’t have access to the full medical history; in some cases this can prove to be a life-treatening issue.
- Improving administrative efficiency by reducing paperwork and leading to reduction in overall health care cost.
- Healthcare information to be freely available to the person irrespective of the place of treatment.
Drawbacks of EHR
Thus, although EHR’s proved its mettle in digitization of healthcare data in the last decade or so; it fared miserably in ensuring interoperability.
The millions of dollars spent on EHR has also failed to ensure the safety of the medical records as well, as evident from the rise in security breaches of healthcare providers.
According to a recent Forbes report, the electronic medical records of an individual can be worth as much as US $1000 to hackers as stolen medical data is comparatively worth more than an individual’s financial data. Blockchain integration in healthcare can alleviate these issues plaguing the healthcare sector to a great extent.
Blockchain based healthcare OS remedy
Personal Health Record Operating System (phrOS), a blockchain enabled healthcare OS aims to solve the following issues (limiting patient centric healthcare) — Security, Interoperability & Global Access.
Dr. Chen is a pioneer in health informatics in Taiwan having 30 years experience as practising trauma surgeon as well. He is also a Member of the Advisory board for the development of Health Informatics in Taiwan’s Ministry of Health and Welfare.
So, it comes as no surprise when he was invited to speak about this experience at Global Cyber Security in Healthcare & Pharma, held at Radisson Blu Edwardian Heathrow, London, UK on 3–4 May, 2018. The following part of the article is a transcript of his speech at that event!
Taipei Medical University phrOS Implementation
TMUH is located close to one of the landmarks of Taiwan, Taipei 101 in Taipei City. It consists of roughly 800 beds, 425 doctors, 855 nurses, 2300+ employees treating 1.3 million OPD (Outpatient Department) visits, IPD (In Patient Department) 2000 days amongst others.
Medical tourists as well as other International & domestic patients, are attracted to this healthcare facility for the excellent Trauma Care, Critical Care, Centre for Robotics & AI amongst other for seeking specialized care. TMUH has successfully integrated its different systems including Healthcare Standards for documents & records, to sync all 3 hospital branches for smooth operational processes.
TMUH has focussed more on the consumer side & research side over the past half a decade and they strongly belive in having a patient — centric approach. The accessibility of the patients healthcare data can not only enhance their understanding of their own health but also is a basic requirement to treat each patient effectively.
Majority of TMIH’s HIS (Hospital Information System) software w homegrown (>80%), which further facilitated the smooth implementation of blockchain based phrOS system. TMUH has offered the following services to its patients for a more holistic patient-centric appraoch:
- Service — Automated Patients Check in & Payment options.
- Automation of Charting system.
- Digitalization of health records.
- Mobile — Mobile apps for charting, patients data, online registration, etc.
- Data driven decision making for reduced medical error & better care.
- Teleholistic services — Telecare & Telemedicine.
Dr.Chen explained further about the prevalent healthcare system in Taiwan which has been notably reported by The Economist — Intelligence Unit.
“..Taiwan is not only the regional health system with the most comprehensive coverage in Asia, but also the one with the most advanced understanding of the importance of using value measures to invest wisely in its healthcare system”
Healthcare Policy in Taiwan in a nutshell -
- A single payer, mandatory healthcare for all the people
- Universal coverage coverage >99%.
- Comprehensive Coverage for ailments — Except Cosmetic surgery, prosthesis, dental processes, limited Cancer liability, etc
- Monthly premium of about US$25.
Unlike the US, patients are free to choose service & doctors by themselves as no gatekeeper policy is in check.
The National Health Insurance (NHI) regulates and allocated funding to hospitals based on insurance claims. Also, in the absence of a patient portal there is no clear & easy way for patient’s access to their own Electronic Medical Records (EMR).
So, although the healthcare data actually belongs to the patient but the patient’s themselves are unable to access it meaningfully. A sad but grim reality! Regulations (like General Data Protection Regulation (GDPR)) and data privacy further limit sharing of medical data, a condition prevalent in the Taiwanese society as well.
Blockchain based phrOS can prove to formally gave patients a tool to own and share their own healthcare data. TMUH had integrated their EMR/ EHR, Personal Health Records (PHR) & the Verification process for data flow with phrOS. Hospitals spends a lot of resources to upgrade their EMR/ EHR system and they wouldn’t necessarily want to do away with it. So, phrOS offers an attractive alternative by being able to integrate with the current HIS of the hospital, which costs a fraction compared to the millions that big hospitals and medical groups spend on EHR installation or upgradation.
TMUH has successfully tested phrOS over the last year in their hospital settings. The confidence to work with blockchain technology implementation in healthcare has led TMUH towards Beta Testing in the following fields i.e — Health Exam Reports, Smart Insurance Claims, Clinical Trials Trials Recruitment & Genomic Profiling dataset. The medical documents & images — MRI, X- Ray, pathological data, etc has been successfully uploaded on the blockchain (last 5 years aggregated data).
At present TMUH is working with Fubon Financial Holding Co. for the development of Smart Insurance claims based on smart contracts on a DApp (Decentralized Application on Blockchain). Currently hospitals in Taiwan have to wait for reimbursements anywhere between 1–3 months depending on the private health insurer. Dr Chen believes this can be drastically cut down employing blockchain technology so that patients can do reimbursement immediately upon discharge.
He also stated that accelerated aging has burdened the Taiwanese healthcare system as around 40% health expenditure is due to the treatment costs of patients over 65 years+ (14% aged population).
Rising NHI Burden, shortage of doctors, nurses & caretakers for long term care infrastructure or chronic disease management can greatly benefit from the implementation of blockchain based phrOS system as well; due to its improved security benefits and flexibility of integration with various applications.
The conclusion from Dr. Chen pointed towards an exciting future for blockchain technology in general and phrOS particularly; while also encouraging people in healthcare to adopt blockchain as a tool for future innovation.
He emphasized that the new tech could only flourish by overcoming adoption inertia, standardizing medical record keeping process along with a helping hand from the Govt. in the form of incentives.
DTCO website — https://dtco.co/en/index.html
phrOS website — https://phros.io/