Healthcare and you, Is this it?
With blockchain’s tantalizing benefits becoming clear to the healthcare industry, the movement beyond data silos and low value physician timing has begun. This article will walk through the pain-points in the industry and the exploratory steps being taken to overcome them.
Imagine you’re sick. Your physician’s about to prescribe you antibiotics, but before they finish writing the prescription, they ask if there’s any medication they should know about. You strain your mind, but just can’t remember the name of that long, scientific drug your specialist put you on a year ago. So instead, your prescription is delayed and blood work is ordered to determine if there’s any adverse drug interactions.
Imagine you recently changed physicians. They ask if you have any family or medical history they should know about. You do, but the notes are locked away with your previous physician — impeding your new physician’s ability to gain a holistic picture about your health.
These aren’t cases isolated to the imagination, these are daily realities.
Each year in Canada, over 50% of Canadian patients are referred to a specialist, and 30% undertake a laboratorial test. Canadians seem to switch physicians quite a bit, with 35% switching every 5 years. In an environment with such high referral rates and change, managing communication between healthcare providers becomes essential for managing patient outcomes.
Currently
Long gone are the days where individuals walked around with their own health record. Nowadays, the physician keeps a file on the patient. This transition marked a turning point in healthcare communication.
In 2001, the federal government created Canadian Health Infoway Inc (Infoway) to begin the transition from paper into digital. Over $2 billion was poured in from the government to be invested in Electronic Health Record (EHR) systems with the hopes of creating a more accessible, interconnected digital system with hopes of ultimately benefiting the patient.
The results are seemingly impressive: 40% — 75% physician adoption rate between the provinces, 100% digitization of X-rays, MRIs, and other imaging services in hospitals, and 97% digitization of lab results. But while health information has become increasing digital, the majority of patient benefits remain offline.
EHR
When one delves into EHR, comparing its intentions with its impacts, some eyebrows begin being raised.
Sixteen years have passed since the Federal Government first begin promoting EHRs, yet adaption remain far from completion. The remaining physicians are not seeing the touted benefits and using physicians are seeing the hidden costs of implementation.
Reduction of Physician-Patient Time
The way the patient describes their symptoms; voice inflections, hand gestures, eye contact serve as crucial information in condition assessment. The amount of time an individual spends with the physician is already short, but it’s made shorter when physicians need to spend increasing amounts of time inputting details of their interaction. Time efficiency has been long touted as a benefit of EHR systems, but recent findings say for every hour a physician spends on clinical time, nearly double that time is spent on EHR and desk work. A survey of 600 doctors conducted in 2016 by Deloitte reveals that that 70% of physicians think that EHRs reduce their productivity — an opinion that’s stayed consistent since 2014.
While office work is necessary for a physician, the amount of time currently spent is not. Time consuming data entry and lack of a patient-centric user interface are top contributors to inefficiency. To add to it, clinical time manually spent manually entering information between devices due to lack of medical device interoperability was another top contributor. In fact, survey results cite 62% of physicians want interoperability, and 57% want improved workflow from their EHR systems.
These problems aren’t just isolated to frustrated physicians, but also reduce the quality of care a patient receives.
Data Silos
Perhaps the hottest word in the healthcare industry: silo. When the Canadian government invested in Infoway to develop EHR systems, Infoway developed a guideline for developers in order to receive funding. The result was an explosion of EHR systems — systems that aren’t able to share information.
Consider the number of medical fields physicians can specialize in — about 84 in Canada. Each of these specialities have different workflows and information to record. Specialized systems exist for these doctors to best capture their workflows — resulting in each system holding a piece of pie about the patient — passed only by request via paper, phone calls, fax, and mail. Generalized systems on the other hand, while integrating better with lab data, takes a one-size-fits-all approach, resulting in inputting time increasing several fold.
Even when data is available to be shared, the quality of captured data is often low. A study of captured data found that many practitioners used their EHR’s as an electronic paper record, neglecting advanced features and foregoing potential benefits to the patient. The completeness of captured data also varies amongst clinics, contributing to low quality of health condition records, resulting in further difficulty sharing data between groups.
Together, scattered data, specialized systems, and low quality of data keep information patient information locked, unable to be leveraged for better health outcomes.
Blockchain Technology
So how does a financial tool contribute value to the medical world? The answer doesn’t lie in Bitcoin itself, but in the technology behind it. The idea behind blockchain is simple — multiple sources add information called blocks in a chain-like fashion, complete with time stamps. Once the information is inputted, it’s permanent, creating a ledger of information that’s accessible by nodes in a network.
Bitcoin uses this technology to track the flow of money. When applied to medicine, it creates a system where different devices can add blocks of information to create a lifelong picture of a patient. This kind of system uses a distributed ledger, synchronising data from specialist systems, different EHRs, and decreases low value imputation time to maximize the amount of time physicians can spend with patients.
Systems like these are in the works.
Californian startup, Gem, has created an operating system using a blockchain network. A network that eliminates the need to standardize the EHR system used by physicians and organizations. It instead, serves as the bridge between data sources and the blockchain. Using blockchain platforms Ethereum and Hyperledger, it’s built a consortium style blockchain to limit the access to a pre-selected set of nodes. Each node stores its data off-chain, providing only a record in the distributed registry. To provide additional security, access controls can be associated with an identity, regulated by each individual user. In doing so, complete control over whose able to read and write on the chain is created — protecting the sensitive healthcare information.
Blockchain is a foundational technology — not revolutionary when isolated, but when applied, has the potential to become the bedrock of economic and social systems. When incorporated into healthcare, it becomes possible to massively disrupt. The interest demonstrated by corporations and regulatory bodies is telling about the impact blockchain will have on the industry. The U.S. Food and Drug Administration recently partnered with IBM’s Watson Health, an advanced AI, to integrate info from EHR, clinical trials, genomic data, health data, and wearable device data. Gem itself has partnered with Philips to explore this space. Micah Winkelspecht, Gem Founder and CEO, predicts a slow but steady evolution towards complete adoption.
Across the Atlantic, Tieto is the first to test this concept. As the industry leader of EHR software in Scandinavian countries, it enjoys over 60% market share. It recently unveil plans for a blockchain system in May 2018 in a partnership with Gem, harnessing blockchain’s power to record and connect — promising unprecedented healthcare benefits. Tieto aims to put ownership of data back into the individual’s hand — to give the individual control over what the data should be used for. This vision is a step beyond connecting systems, it’ll leapfrog the olden days when individual carried their own paper health records, to giving individual the choice to derive more value from their health.
In the age of analytics, data is the holy grail. Pharmaceutical companies have long struggled with finding the right people for clinical trials. With control back in individual hands through blockchain, these companies just found a new partner: individual patients. Creating an additional node is simple, allowing companies access to anonymous data not only generates additional income for the individual, but drastically speeds up the drug approval process — a symbiotic collaboration.
On a society level, the use of analytics allows for deep dives into population trends. The U.S. Centre for Disease Control (CDC) recently partnered with Gem with the vision of managing population health; creating an early detection warning system. Applying statistics and understanding the health of society as a whole allows the healthcare system to finally move away from being reactive — becoming truly preventive.
Benefits to EHR use definitely exist, but there’s no shortage of challenges. It may be years before projects like these begin to show results, but the promise of systems built on blockchain is tantalizing. Alignment of governments, organizations, and individuals can together ensure the benefits of intersystem communication and individual control are brought to life.
