The concept of Electronic Health Records (EHR) and its application has been employed since the early days of the modern computer. From Lockheed’s pioneering Clinical Information System to the Decentralized Hospital Computer Program (DHCP) employed by the federal government and the mandated necessity for compliance to the Health Information Technology for Economic and Clinical Health Act (HITECH) in 2004, EHR’s growth stemmed from information age where the medical industry needed to catch up with the times.
Today, EHR applies to medical records, software, cloud platforms employed by medical exchange programs, hospitals, independent clinics and health care providers that all feature a system, software or cloud-based platform to manage a patient’s health record. The market for an EHR platform is in no shortage of vendors, distributors and open-source developers that all offer a different EHR system with its host of features.
In this case, market diversity has shaped the problems posed on EHR since its conceptualization:
Interoperability – Different platforms employed by different medical programs cannot effectively pass or process EHR and in some cases, the files are not recognized by different EHR systems. Even with HITECH’s certification program in accreditation of EHR systems, the market and its sheer number of vendors has substantially created an interoperability problem.
Usability – Even with EHR software maturity and its mass adoption, issues of usability still persist where health administrators are still coming to grasp on how to effectively govern an EHR enabled system:
- Which fields are required
- System Navigation Problems
- Button Label Nomenclature
- Lack of Proactive Support from Vendors on Literature and Resource Materials
Transition – Transitioning towards a new EHR platform has a window time average of six to eighteen months, according the survey published by the Physicians Practice where more than half (55%) of the providers stated that it has taken them that long to transition fully into an EHR platform.
Patient Experience – The lack of participation of patients on EHR and onset feedback narrows the system to only providers and medical programs.
While the problems persist on EHR for both health information and medical administration, blockchain has made significant progress within the health industry. According to Statista, 15% of blockchain enabled systems are in commercial deployment and 35% are in stage of production proofing from 2017. By 2020, 25% of blockchain enabled health systems will be commercially deployed while production proof of blockchain as a test case will rise from 35% from 2017 to 45% in 2020.
While blockchain presents a significant leap of technology, it does not claim to be the silver bullet to all the EHR problems. Rather, blockchain takes into account the existing problems found within the EHR platforms and build a better, more efficient and more secure platform that introduces the following improvements:
- Distribution and Shared Ledger approach – Real time collaborators on health can read, make changes on records without the danger of serial overwrite that are often difficult to retract upon the case of write errors.
- Automated Process Push – Blockchain allows to automate a number of processed that are blocked together that consists of a chain of process. Under blockchain, medical billing is processed in real-time, minus the costly redundant process based on the real time use of diagnosis, treatment and prescription extensions for the medical billing to process itself based on a strictly monitored process.
- Information Security and Integrity – Despite a distributed ledger, the EHR is encrypted and its parts are distributed across the ledger where vulnerability is lessened as each record is hard to read, write or copy through illegal access because each record is encrypted and distributed across ledgers.
In the current EHR systems employed by today’s medical exchanges, blockchain presents a number of improvements that is based on solving the existing challenges:
Interoperability – Blockchain is a complex system that requires a steep knowledge and technical skills from data engineering, process automation and development. Often, the success of a blockchain and its proof of concept towards a successful test case require a consortium to enact. Compare it to the many standalone EHR softwares, blockchain is exponentially harder to develop.
Consortiums such as Hash Healthcare, Ebleema and Medicalchain, for example, are making it possible for blockchain in healthcare and health information by paving the way with their blockchain enabled systems for health. With the resources and essential participation required by blockchain to mold a successful operations model, proof of concept, test case and use case, blockchain enabled health care is starting on the right pivot as it is spearheaded by medical organizations that are developing blockchain to comply with government, regulations and compliance.
The fundamental building block of blockchain is hashed information which comprises block data. Much of the focus on blockchain for health information is based on interoperability, where both specialized and hybrid Application Programming Interface (API) are deployed across the system in dedicated fashion for processing, communing, storing and retrieving data. Unlike the many EHR software in the market, which was built on the proprietary system as a business model, the blockchain system as products by consortiums are focused on interoperability for enabling medical exchanges to collaborate on patient data in a secured environment.
Usability – With health consortiums pushing a large blockchain system that is open for enlistment, partnerships and business opportunities, usability is another pillar standing besides interoperability. On making blockchain enabled health systems workable within a large population of collaborators, there is a focus on guidelines when it comes to the user workflow, system navigation, user-interface and standardized terminologies. As blockchain consortiums push a blockchain product that is introduced with a huge number of collaborators that is still growing in adoption, the wide-scale adoption sets the bar on how systems and their onset menus are designed.
In a consortium dominated ecosystem that is based on interoperability, the lack of diversity is actually a good thing. In today’s diverse EHR ecosystem, branding, identity and core terminologies in-house are factors that affect the design and workflow of the proprietary health information system. This leads to several deviations on standard menus, navigation and overall design of the system.
Transition – Similar to EHR, transitioning to blockchain will also take considerable investments on time, knowledge and resource for healthcare organizations. However, the transition will have a much more detailed onboarding process designed to engage, immerse and design an operations response to the many scenarios involving the periodic governance of blockchain enabled health information systems.
In signing up with a consortium or blockchain alliance, they have a trove of resources, case studies and network referrals on the proper assimilation, onboarding and governance of blockchain. Health organizations are assured of a clear, systematic and well-documented set up for the governance of blockchain health systems due to the precedence of successful test and use cases.
Patient Experience – From a patient’s point of view, a blockchain enabled health information system also encourages the proactive participation and engagement of patients as platforms such as Medicalchain. Medicalchain guarantees that patients take ownership of their health and patient records that are under the governance of medical experts and physicians that are all collaborating on their health outcomes.
With medicalchain, patients can verify and double check on which parties have access to their records as the guarantee of top level encryption, distribution and real-time collaboration allows for accountability on health record outcomes.
Ingrained Blockchain Transition
Going back to Statista’s projections, 50% of healthcare organizations are still “not sure” about how blockchain figures within the industry. However, insights based on the study suggest that a decision involving blockchain transition will significantly reduce the “not sure” group by 2020 and 2022, while the test cases and commercial deployment will further increase.
Going over blockchain, the technology helps in resolving the administration problems that are incurring high cost and poor patient outcomes across healthcare in countries such as the United States of America. Through collaboration, consortiums are being formed. Recently, the health consortium of Humana, MultiPlan, Optum, Quest Diagnostics and UnitedHealthcare have launched an initiative to harness blockchain to effectively improve the quality of data and diminish administrative expenses on healthcare. However, blockchain won’t solve the problems based on the deeply ingrained weak administration, systems governance and poor knowledge within the organization — should it carry over from the existing system to the blockchain enable health system.
When transitioning to blockchain, much of the focus is on technicalities from IT to other resources but in reality, the focus should first start with the identification of problems stemming from governance, health administration and challenges on EHR. This is a prelude to the decision framework on how a customized and uniquely defined blockchain system helps improve the current state of the organization’s health information outcomes.
DynaQuest, a Health Information Management Outsourcing company in the Philippines, is among the providers that have a good track record of supplying outsourced health administration services through working with healthcare organizations in identifying their cost drivers, process stoppers and other business challenges in crafting a unique outsourced service based on customized roles and process applications. With blockchain, DynaQuest works with a number of blockchain accelerator programs to form an effective network that consists of consultants, administrators, developers and specialized support.
DynaQuest Technology Services Inc.
19/F Uptown Place Tower 2 11th Drive
Uptown Bonifacio 1630 Taguig City
+63 2 2241862
+63 2 403 1495