Solving the Interoperability Issue in Healthcare IT Systems with Web 3.0
(This article was inspired by one of the products championed by one of my GovTech teams i.e. HealthCerts. You can read more about their work here, here and here in a three-part series. It’s not meant to debate the ethics behind data ownership, but more to explain how Web 3.0 is well positioned to solve many issues, of which healthcare messiness is just but one. Writing helps to crystallise my thoughts for better discussion at the workplace.)
Recently I’ve been thinking about Web 3.0, and the power of decentralised systems. Having worked in the healthcare sector for over 3 years, it is an issue that plagues many of us at night, causing huge implementation issues and an inability to keep up nimbly with policy change. The issue is the same in Singapore and in many other countries, so definitely not pointing any fingers here.
The Origin of Non-Interoperability in Healthcare
Typically, the story in most healthcare systems goes like this:
- The government, or some central authority, is interested in healthcare coordination and referrals across doctors, providers and settings.
- Unfortunately, patients themselves are ill-equipped to manage their own healthcare plans and data.
- This is seen as a market failure, and investments are made at central level to design some sort of central data management system known as a Client Relationship Management (CRM) system. Central authority becomes the custodian of data.
- However, healthcare landscapes are usually very fragmented , run by various bodies or settings with different needs — this results in multiple CRM systems, each with their own legacy code or data frameworks.
As a result, patient data is scattered across the ecosystem, rather than being consolidated in a single IT system.
In most countries, in fact all, the holy grail of healthcare IT systems is to develop a single consolidated mother-of-all system that captures every single healthcare credential of each citizen. This allows data to be propagated from central level across every single healthcare provider, allowing care to be coordinated seamlessly.
Possible? No. Practical? Nah. It’s beyond the scope of this article to explain why consolidation is impossible and a technical nightmare, but just consider unifying a fragmented landscape of public and private healthcare providers, who offer healthcare to different segments of the population. Some of these organisations may also be charity organisations, and some even foreign players. Capabilities and agenda vary widely — consolidation is a pipedream!
Can we solve the interoperability problem?
Solving the Interoperability Problem: Healthcare Data Portability
What appears to be an intractable issue actually goes away quite simply once you consider the concept of decentralisation. It’s a paradigm shift really, but let me break it down:
- Rather than having a central authority build a data repository and act as the data custodian, we facilitate data democritisation by allowing citizens to own their personal healthcare data.
- The need for a central data repository vanishes, and citizens bring their data with them wherever they go.
- As a result, the data flows with citizens from healthcare provider to healthcare provider, achieving the same cascade of info as a central repository could.
In other words, we allow for data portability.
But what stands in the way? For quite some time, it has been both tech and policy-legislation. Lest we turn this into a policy debate, let’s focus on the tech problems one needs to overcome:
- Data Management: how will citizens be able to store and manage their own healthcare credentials and care plans on their own? Is there some sort of wallet to help them with this?
- Data Security: as a healthcare provider who needs access to the healthcare info, how will I know that the data is tamper-proof and belongs to the individual?
- Data Sovereignty: as government, how do I ensure the persistence of validity of such healthcare data even as healthcare providers come and go?
- Data Sharing: how will citizens be able to share their data and give consent to healthcare providers? Build another system for this?
Does anything above look familiar?
Enter Web 3.0 & Decentralisation
If your heart shouted “Web 3.0!”, you have found a friend in me. Wallets, tamper-proof data, persistence of validity and peer-to-peer sharing of data and consent are the very properties of Web 3.0 solutions.
- Imagine a system of healthcare data issuance in the form of certificates, that are transacted peer-to-peer.
- These certificates are stored in digital wallets, with unique identifiers. Each person owns the right to his data, and manages his own data. This removes the data management problem and the data storage problem.
- When each person moves across healthcare providers, certificates are transacted together with the implicit consent of the person. This removes the data sharing problem.
- Even as healthcare providers come and go, the provenance and ownership of the certificates can be verified against the blockchain. This effectively removes the data security problem (obviously I’ve glossed over the security issues of blockchain systems, but robust blockchain systems are known for being practically impractical to hack).
Are we any nearer to such a solution than we were in the past decade? Have we forgotten the inherent benefits of data portability?
You decide folks. :)