Why Patients Should Embrace Blockchain

A few years ago, as a senior executive at a global healthcare data and consulting firm based in Shanghai, I was intrigued the first time I heard about Blockchain. Here’s a secure, distributed database technology rapidly maturing in the finance industry, coming out from the shadows of the dark web into a mainstream digital technology.

Often with emerging technologies, experts and thought leaders praise its transformational potential for the healthcare industry with a lot of optimism and hype.

They remarkably align on a handful of use cases for healthcare which can be categorized into 3 themes: securing a pharma company’s supply chain or clinical trial audit trail, optimizing the delivery of drugs or healthcare services for a patient within the provider — payer — pharmacy value chain, and solving the healthcare data interoperability challenge.

The two first categories can be described as “cross-industry” Blockchain use case adaptions to healthcare. Any supply chain can be improved by using the hack-proof, audit-trail attributes of Blockchain, and the “disintermediate the middleman” potential of Blockchain can indeed streamline the current tedious administrative process for authorization and claims processing. Although interesting to explore for achieving process improvements, they hardly can be qualified as “transformative” at an industry level: in healthcare, transformative should mean saving more patient lives and improving the population’s health significantly.

What about the third one, using Blockchain for healthcare data interoperability?

Providing a physician with his patient’s comprehensive medical history across his care centers is one of the holy grails of healthcare. With this information, caregivers are able to provide the best treatment option for the patient, let alone avoid potentially catastrophic safety mistakes like prescribing a drug the patient is allergic to. This will undoubtedly save more lives and improve the overall population’s health. So how can Blockchain achieve this?

The decentralized and distributed architecture of Blockchain fits well with the similarly fragmented landscape of our medical records, so we can easily envision a Blockchain node interfacing with each care center EMR (Electronic Medical Record), and retrieve from there our bit of medical record, and chain this bit with all the other bits to reconstruct our comprehensive medical history.

We can also see the fit between sensitive medical data subject to complex privacy regulations such as HIPAA with Blockchain’s strong data integrity properties.

Also very appealing is Blockchain audit-trail capabilities that can be used to trace every authorized or un-authorized use of our medical records.

So there’s a good technical fit between Blockchain and patient medical records, and patients can have peace of mind their valuable information is well protect.

But I think Blockchain can benefit the patients in a much more impactful way.

Blockchain is often viewed as a “democratic” technology as it gives the power back to the user: no central authority to dictate rules users don’t want, no middlemen who takes a cut out of your transaction or slows things down, no third party that makes decisions or takes action on the users’ behalf. How does this translate into healthcare where the user is the patient?

Healthcare is unique in the sense that patients — as consumers of the system — are the least empowered than in any other industry. In most developed countries, patients do not directly pay for the health services they receive, either the government or their employer are the payers. Because of this, patients accept the limited choices given by the payers and the restrictions on their services received in terms of provider choice, number of yearly encounters, or drug prescriptions. These constraints are actually getting tighter and tighter for patients as booming healthcare costs due to aging population and growing chronic diseases drive the payers to impose more restrictions on the patient.

The other unique aspect of healthcare is the imbalance of power between the patient and the doctor. The dialogue is very often a one-way street where the doctor delivers the care without always listening to the patient’s concerns, offering him several alternatives or tailoring the care to the specific requirements of the patient. An extreme example of this can be observed in emerging countries where doctors deal with up to 200 patients a day, that’s a 2 to 3 minute encounter with hardly any dialogue.

There are good reasons for this: unless the patient is himself a trained healthcare professional, it’s hard for the patient to have a clinical discussion on equal grounds with his doctor and question his wisdom, so the knowledge inequality creates a natural imbalance in the relationship.

But there’s another reason for this imbalance, it’s the information inequality.

Doctors have medical information patients don’t have and while theoretically, patients are entitled by law in most countries to access their medical records, it’s practically very difficult to do so: either the process is tedious and lengthy (“please fill those 3 forms for requesting your medical records”), either the patient has to pay for it (“there’s an administrative fee of 50 cents per page”), or the format is inconvenient (“please provide your fax number, we’ll send it there”).

Inequality of information is a big issue, because information is the prerequisite for the patient to make decisions on his most important asset, his health. The patient has to be able to seek a second or third opinion, look for alternate treatment options, understand how to change his lifestyle and nutritional habits, and the basis for the patient to have meaningful discussions with his caregivers and make the best decisions on his course of action is to have his full medical history.

Blockchain can help bridge the inequality of information gap for patients.

With Blockchain nodes deployed against the EMR systems, patients would request their medical records using HL7 (a healthcare information interoperability standard), essential medical information is then stored into Blockchain and organized into a meaningful medical history. The patient has full ownership and control of his medical history in the sense he manages who can access which part of it. This is what we demonstrate with our PatientTruth™prototype (www.embleema.com).

Blockchain will empower patients to take charge of what should be their most crucial information asset. However, this benefit in itself will not be sufficient for the patients to play an active role in retrieving their medical records: remember this can be a very tedious process. There needs to be additional incentives for the patient to reward him for doing so: providing government-funding to the patient is one option, similar to the CMS Meaningful Use funding this past decade for providers to equip themselves with EMRs in the US, health systems and payers could also fund as the same medical history information can drive cost savings (e.g. avoid duplicate tests) and additional revenue (e.g. keep the patient in-network) for them.

With its ability to close the information inequality gap, Blockchain has tremendous potential to re-position the patient in the center of healthcare and empower him as a consumer of the system like in any other industry. The benefits are huge, well documented and truly transformational: more lives saved, a healthier population, a more preventive than curative system. While we can assume the technology will scale over time and the interoperability standards become more widely used, the potential will be fulfilled only if the healthcare funding model shifts towards the patient and provides him a meaningful incentive to be the driving force in closing the information inequality gap with Blockchain.