By Tomio Geron
In the continuing push for affordable health care, one of the
biggest stumbling blocks is still the confused and error-filled
manner in which electronic data is shared among doctors, insurers,
hospitals and patients.
One solution could be blockchain technology.
In the current tangle of incompatible records systems that
typifies U.S. health care, incorrect information can creep in when
patient data gets re-entered multiple times by doctors' offices,
insurers and hospital staff. Big errors can seriously affect the
quality of care that patients receive, small discrepancies can
result in wrongful denials of insurance coverage, and errors of all
types add to the system's cost.
Blockchain, by contrast, puts patients, insurers and providers
all on the same page. With a low-cost and decentralized-ledger
approach to managing information, blockchain technology gives all
of the parties in the provision of health care simultaneous access
to a single body of strongly encrypted data, and it creates an
audit trail each time data is changed, helping to ensure the
integrity and authenticity of the information.
Eventually, blockchain could be used to provide a secure and
accurate medical history for every individual patient. MedRec, a
blockchain system in development at the Massachusetts Institute of
Technology, is designed for patients to be able to manage their own
records and give permission to different doctors or providers to
access and update the records. With MedRec, if a baby has been
given vaccinations by different doctors, for example, all of that
information can be accessed from the blockchain, says Andrew
Lippman, senior research scientist at MIT and associate director of
the MIT Media Lab. MedRec is testing the system using anonymized
data from Beth Israel Deaconess Medical Center.
Success of the system -- or any similar system -- will depend on
large numbers of providers and doctors opting in to the program.
Other companies in this space are focusing on technical formatting
and overcoming compatibility problems between different systems.
What is lacking from those efforts, Dr. Lippman says, is a way for
consumers to easily and securely access their records and have
control of their own records -- something that MedRec, by using
blockchain, promises to do.
Processing claims
While MedRec aims to include all patient health data held by
medical providers, other projects are already using blockchain on
different pieces of the health-care system -- for instance, to
improve the insurance-claims process, the accuracy of
health-care-provider directories, or the ability to verify doctors'
licensing.
In January, Change Healthcare, a Nashville-based health network
of 800,000 physicians, 117,000 dentists and 60,000 pharmacies,
introduced a blockchain system for processing insurance claims.
While not all providers in the system are using it, the shared
ledger of encrypted data represents a "single source of truth" for
those providers who are, says Emily Vaughn, blockchain product
development director at Change Healthcare.
All involved parties can see the same accurate information about
a claim in real time, rather than having to send data back and
forth, says Ms. Vaughn. This relieves a patient from having to call
multiple parties to verify information. And each time data is
changed, Ms. Vaughn says, a record of it is shown on the digital
ledger, identifying the responsible party. Any changes also require
verification by each party involved, again enforcing the record's
accuracy.
"You know at what stage in the life cycle the claim is in," says
Ms. Vaughn. With all parties working from the same data, "there's a
shared understanding of what the next steps are."
Change Healthcare declines to say how much money it is saving
with its blockchain system, which can process roughly 50 million
events daily. But according to Ms. Vaughn, the savings will come
from eliminating previous efforts required in the reconciling and
verifying of data among companies.
The company also is exploring building other applications that
could run on the system, such as automated processing of claims and
new ways to improve the digital verification of patient and
provider identities without endangering patient information.
Ms. Vaughn says the blockchain system and its decentralized
design represent a step up in security. "Because the [data] log is
replicated across many computers instead of managed by one central
computer, it's more resistant to attack and manipulation," she
says. Hence it is more difficult for hackers to take over the
network. If any one computer is hacked, other separate computers
using the blockchain would still have accurate information.
Provider directories
Another area where blockchain could be a big help is in
maintaining the accuracy of online directories of doctors and other
health-care providers.
Doctors groups, hospitals, insurers and diagnostic companies all
tend to maintain their own online listings of contact, practice and
biographical details. But it is expensive and time-consuming for
each company to continually check, verify and update the records in
its directory. Many insurers, for example, try to verify this data
quarterly.
A group of companies in April announced a pilot project using
blockchain to reduce these costs. The companies are Humana Inc.,
MultiPlan Inc., Quest Diagnostics Inc., and UnitedHealth Group
Inc.'s Optum and UnitedHealthcare businesses.
"Each insurance company has their own islands of information
with no bridges," says Mike Jacobs, senior distinguished engineer
at Optum, which works on digital and data-based innovations for a
range of health-care services. "What this alliance is trying to do
is create bridges to allow sharing of that information," says Mr.
Jacobs.
One report estimated that it collectively costs $2.1 billion a
year to maintain provider directories using current methods. But
Busy Burr, vice president and head of health-care trend and
innovation at Humana, estimates that 75% of that cost could
potentially be saved using blockchain.
The goal of the pilot program is for providers to update their
information themselves into the blockchain, where it can be viewed
by all parties in the network. Every company participating
benefits, and there is no proprietary information shared that the
firms have to fear their competitors will use. Companies could
potentially be fined if information is inaccurate, Mr. Jacobs
says.
Currently the alliance is focusing on data such as doctors'
address, specialties, phone numbers, and whether they accept new
patients. Eventually the group wants to add other critical data,
such as doctors' credentials or state licenses.
"These kinds of collaborations are some of the things we most
need in health care to help solve some of the problems that are
most pressing in our industry," Ms. Burr says. "We think if we
could create a single source of proof for that data, a huge amount
of cost could be taken out of the system."
Along the same lines, the state of Illinois is looking at a way
for hospitals, including in other states, to use blockchain to
quickly check the licensing status of a provider, a typically
cumbersome process. Nashville-based startup Hashed Health developed
a proof of concept of this system for the state, but the project
needs more funding to be built, says Bryan Schneider, secretary of
the Illinois Department of Financial and Professional
Regulation.
Mr. Geron is a Wall Street Journal reporter in San Francisco.
Email him at tomio.geron@wsj.com.
(END) Dow Jones Newswires
May 28, 2018 22:18 ET (02:18 GMT)
Copyright (c) 2018 Dow Jones & Company, Inc.
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