Why bother with blockchain in healthcare?

As healthcare systems are trying to even further distribute care towards patients homes and other environments, even more information systems are being added to the already existing set of different databases. In the absence of data standardization the problem of interoperability will be even bigger.

Interoperability is complex

If you ask a computer scientist about interoperability, you will probably hear something about syntax and semantics and how systems can exchange data. And even this, by itself, is not a trivial task to achieve. In fact, healthcare is probably one of the last industries where data lock-in based business models are still the norm and data is held hostage by different IT companies. In Slovenia, a country of 2 million, eight EMR providers offer solutions for a total of a 10 million EUR market. Then there are also laboratory information systems providers, pathology information systems providers, etc. And each provider developed its own data model that captures some/all the data points that occur in the business processes that are the core activity of each organization. Processes are often not defined regarding standard operating procedures and can be very different from organization to organization, even from doctor to doctor. Even more, the processes can also be dynamic and ad-hoc which suggests we cannot prepare a common process model that would describe them precisely. As healthcare systems are trying even further to distribute care towards patients homes and other environments, even more information systems are being added to this set of different databases.

Interoperability is REALLY complex!

In Europe, national legislation often follows that of European Union and currently, major activities are in progress that will enable patient mobility. You will be able to visit a doctor in any EU country, and he will be able to get your basic set of data from your home EHR translated and transcoded into his native language and coding systems that are used in his country. For that to happen, serious work had to be done to prepare a legal framework that would enable the cross-border exchange of patient data that would work for all the member states.

The European Interoperability Framework describes interoperability in healthcare addressing not only technical and semantic layers but also the process, organizational and legislation layers. If you want to have the data to be equally structured and understood, you need to have similar processes that are executed in similar organizations. And the legal grounds need also to be aligned.

To talk about interoperability, one needs to be aware of a far broader context that the concept describes. Especially in healthcare.

Blockchain in Healthcare

It is believed that this technology will have a profound effect on healthcare, especially on medical data management, drug development, supply chain integrity, claims and billing management, medical research and data security. In fact, it will potentially have such effect in any use case that can solve some of its issues by using a distributed ledger. But it is certainly not the magic stick or the silver bullet for solving interoperability. Not even at the technical level let alone on semantic and higher level aspects of interoperability. But why blockchain then?

The IRYO approach

I listened to Vasja Bočko, CEO of Iryo at a recent event, and he pointed out the two main benefits of blockchain technology that could make a difference in healthcare.

Vasja Bočko at the meetup for the Slovenian community, Ljubljana, 7.2.2018

First, trust and transparency — so, no more cover-ups from central authorities that patients are supposed to trust.

Second, Incentives for adoption. The token economy could spark adoption due to having incentives for all stakeholders, including the patient.

In my opinion, this is truly a practical use of public blockchain technology that will, together with open standards (OpenEHR), open source, and innovative, user-friendly security, give us a new kind of experience that has not existed so far.

P.S. If anyone promises to solve interoperability with blockchain, please turn away and find something else to do or invest in.

My background is primarily in software development and backend architecture. Additionally, I specialize in behavioral sciences. Creating ICT solutions that aim to promote positive change in human behavior is a special interest of mine. I currently work in a leadership position on the national eHealth board of Slovenia. I’m directly involved in creating the overall architecture and implementation of the national eHealth platform, as well as maintaining and improving the national EHR database. I’m also in charge of fostering relationships with representatives of different IT and healthcare networks within Slovenia in order to improve collaboration and improve research. I’m currently leading the group in charge of the latest national Cancer prevention program.

I have a B.Sc in Computer science and currently working towards a Ph.D, primarily focusing on medical interoperability, architecture, and the design of artificial intelligence systems within healthcare.

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