This blog explores health informatics—a collaborative activity connecting people, process, and technologies to produce trusted data for better decision-making.
By Amanda Wickard, MBA, RHIA, CPHI
While Blockchain is still a new concept to many in healthcare—myself included—it has its merits when it comes to changing the way healthcare shares information and processes data. “Public health and blockchain really do belong together,” said Jim Nasr, chief software architect at the Centers for Disease Control and Prevention’s Center for Surveillance, Epidemiology, and Laboratory Services in an interview with MIT Technology Review. “Moving data from one peer to another in a secure manner, in a compliant manner, and in a transparent manner—as quickly as possible—is a key part of the public health business model.”
The most easily relatable explanation of Blockchain technology that I have encountered uses the process of updating a Word document to that of a Google Docs document. With Word, only one person can make changes at a time and the information is sent back and forth for review. If you’ve ever worked with a group of people in a Word environment, drafts get lost and it is difficult to determine who has the most up-to-date copy. With Google Docs, updates can be made in real time by multiple people; there is one document that everyone is using. Blockchain works in a similar manner. It is shared, continually updated in a reconciled database without a centralized hub. Decentralization is one of the ways that blockchain increases security, as hackers do not have one place to target to get information—there could be thousands, each requiring its own key to access the data.
Updates to patient data is processed much like the way Google Doc edits are processed, in that requests to edit information or make a change are sent out to each member of the authorized community to confirm the transaction before the information is updated in the dataset. Once this “block” of information is approved and locked, it is added to the “chain” of events already established. The patient is put back into the center of their care by setting parameters on what information is shared with whom; the private blockchain community has more control over what is added to the data, helping to eliminate bad information needing to be reconciled, merged or even acted upon in a time of care.
Many payers will not pay for claims where patient information has discrepancies. Using blockchain technology and streamlining the patient matching and identification process can help claims get paid, and information that does not seem to fit can be identified and reconciled quicker. Ask anyone that has ever had to merge a medical record number on a patient or had to update someone’s name in the master patient index; the identification of patients across their lifetime is a somewhat difficult task. Improper identification could lead to incorrect treatments, medication errors, and issues with payment. Blockchain could link organizations and square away the information about their patients, ensuring that everyone is on the same page. Not to mention that providers have the information that they need—when they need it—and can be confident that the information is correct, thus eliminating the frantic nurse call to the HIM department that the patient is in the room and the doctor needs the records.
Let’s think about this for a minute; we know that getting information updated and changed in the medical record is, to say the least, difficult. Not a lot of providers want to go back and make edits to something they have already touched, and if the data in question is someone’s health record, the patient would be responsible for making the appropriate notifications and then monitoring to ensure the edits are actually made. How likely is it that this is going to happen? Patient portal adoption in patients of mixed demographics and age groups has had a slow uptake; I would assume the same would happen with the monitoring of a patient’s information changes… but you know what happens when you assume.
One of the most important aspects of blockchain technology is the potential benefit to providers when caring for patients—having the ability to see the medications and issues that the others are prescribing and treating and collaborate on the care of the patient. A study from the American Journal of Managed Care in 2015 found that 77 percent of patients have found discrepancies or errors in their active medication lists. These are potentially huge patient safety concerns and make doctor visits more stressful for the patient. When you receive the home medication list written on a napkin, it’s hard to determine when certain medications were added to the patient’s regimen and why. Blockchain eliminates the silos of information that reside in varying health record systems and enables the care coordination process to be able to work for the patient and the providers.
Blockchain technology has the potential to expedite patient payments by linking payers, providers, and healthcare organizations to improve claims processing and reduce the amount of fraud that slips through the system. For this to be successful, there must be broad adoption of blockchain technology that encourages universal data sharing and willingness for providers, patients, and health plans to trust one another with their sensitive information and trust one another to do their jobs—and do them correctly.
There are many advantages to the increased usage of this technology for healthcare and the continuum of care, as well as for those HIM professionals that like to get into the weeds of information and data. There could be some really interesting jobs created by implementing blockchain technology and leading the initiative to discover and correct discrepancies in patient information.
Bresnick, Jennifer. Top 4 Ways to use Blockchain for Healthcare Data Management. HealthIT Analytics. April 18, 2017. https://healthitanalytics.com/news/top-4-ways-to-use-blockchain-for-healthcare-data-management.
Bresnick, Jennifer. Five Blockchain Use Cases for Healthcare Payers, Providers. HealthIT Analytics. October 10, 2017. https://healthitanalytics.com/news/five-blockchain-use-cases-for-healthcare-payers-providers.
Heath, Sara. Patient Portal Adoption for Older Adult Patients Reaches 50%. Patient EngagementHIT.
Orcutt, Mike. Why the CDC Wants in o Blockchain. MIT Technology Review. October 2, 2017.
Comer, Dominque et al. Usefulness of Pharmacy Claims for Medication Reconciliation in Primary Care. American Journal of Managed Care. July 16, 2015. https://www.ajmc.com/journals/issue/2015/2015-vol21-n7/usefulness-of-pharmacy-claims-for-medication-reconciliation-in-primary-care?p=1.
Amanda Wickard is director, health information management services department at Wood County Hospital.