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Part 1: Navigating the Blockchain Landscape – Opportunities in Digital Health

Much of the promise of blockchain comes with its potential to disrupt and change how healthcare works, a position leading to questions and concerns among the healthcare community – including HIMSS members - on what blockchain-driven disruption might look like. With that in mind, HIMSS has recently established a work group to examine blockchain distributed ledger technology and its potential implications for the healthcare information and technology community. The work group, composed of payers, providers, vendors, and other interested parties, has set out to visualize the effects of that disruption.

How to approach blockchain

Many healthcare practitioners want to know how to approach the use of blockchain, which is where the work group is focusing its time and energy. With numerous vendors and solutions, and ideas in the market mix, it can be difficult to envision what blockchain actually means for health. As with any new technology, the tremendous amount of hype may overshadow existing blockchain efforts.

The HIMSS Blockchain Work Group is looking to provide thought leadership, best practices and key use cases for how blockchain technology might affect the healthcare ecosystem in the future.

We have quickly established initial teams focused on

  •  evaluating these best practices,
  •  reviewing the vendor landscape, and
  •  providing guidance to our HIMSS community on what types of healthcare challenges blockchain might impact.

We also reviewed four critical concepts of blockchain that we feel HIMSS members and the healthcare community want to understand.

  1.  What would a blockchain network look like in healthcare?
  2. What does the overall landscape of blockchain companies look like in the healthcare industry
  3. How does blockchain work within the existing health IT infrastructures that payers and health systems currently have in place?
  4. How does blockchain impact organizational changes currently occurring in healthcare?

Blockchain as a network

How blockchain restructures the idea of a network signifies one of this technology’s most powerful features. The core tenets of blockchain technology — a decentralized and encrypted way of distributing, sharing, and storing information — is incredibly appealing in healthcare and changes how we use and get health data.

Many of the blockchain applications that have been or are under development take the blockchain network concept and apply it directly to healthcare challenges that many know well. These are

  • eligibility and enrollment,
  • claims adjudication,
  • care management and coordination, and
  • interoperability of clinical health data.

Many scenarios exist where health data, an asset in its own right, becomes the main currency of exchange, or a “cryptocurrency.” It will be interesting to hear more about the uses of health data on a blockchain, as we approach HIMSS18 and see blockchain applications in action.

The broadening blockchain landscape

With the explosive growth in blockchain cryptocurrencies, many companies continue to move into the blockchain solution space across the financial services industry (which has grown into a subindustry called “Fintech”).

In healthcare, we have seen a similar explosion in startup activity that is fueling new market demand and giving health systems, payers and others involved in healthcare a surplus of options on what is possible using blockchain. This is creating a level of confusion for health systems and providers that may be accustomed to working with established large vendors in healthcare and traditionally leery of engaging with startups as part of their broader health IT infrastructure strategy. Our work group is looking to change that viewpoint by providing guidance and ideas on what the blockchain landscape looks like.

A rapidly increasing number of startups and established companies across the globe have already initiated extensive business operations around blockchain and building niche and platform applications that can integrate directly into health IT infrastructures. This represents an opportunity to open new doors and change how healthcare operates, specifically with a change in the mindset of storing and sharing healthcare data to create new ways to design and deploy digital health applications.

It is the intent of the HIMSS Blockchain Work Group to explore these different vendors and approaches and to look at how blockchain startups are evolving. No one player is the focus in the work group – due to the quickening pace of companies becoming “blockchain-ready” – we want to highlight the general ideas and best practices that have begun to emerge.

Blockchain as a complimentary strategy

Look at blockchain as a complimentary strategy, rather than in isolation, as a new technology that will transform and eliminate a decade of health IT accomplishments.

Many of the existing blockchain solutions work in coordination with cloud, the Internet of Things (IoT), Artificial Intelligence (AI), and other emerging technologies to fully leverage the advantages of a distributed ledger and the inherent advantages of blockchain technology.

We often hear the question - How does the idea of blockchain technology in healthcare differ from interoperability, in terms of discrepancies between theory and reality for implementation? As our discussions and research evolve, the workgroup will explore concept of complimentary technology to other existing technological approaches.

Both established vendors and newer startups are exploring ways to integrate blockchain into their existing technology offerings

  •  making distributed ledgers available in the cloud,
  •  running distributed ledgers that incorporate smart contracts to analyze data patterns, and
  •  finding ways to enable healthcare “cryptocurrencies” on existing healthcare networks.

In each of these approaches, blockchain, as the enabling technology, automatically does not disrupt the business of healthcare, but complements solutions already in place.

We consider the HIMSS Blockchain Work Group as a starting place to identify the best practices and patterns that will enable blockchain as an effective technology in the healthcare enterprise.

In the future, we look forward to finding opportunities to solicit input and hear from the HIMSS membership and healthcare community on what blockchain means to their organization and business processes and, if feasible, how their organization implements blockchain.

Organizational and behavioral changes

The greatest potential of blockchain may be its ability to empower patients to own and gather their own data. In many ways, the promise of blockchain lies outside the current way we think in health IT, serving as a direct challenge to siloed, centralized data approaches.

However, it is important to understand that much of the change in healthcare comes from within and not driven by a change in technology. As the HIMSS community has learned, behavioral and cultural changes supported and driven by technology promise the greatest overall improvements for healthcare. Simply implementing a technology alone and waiting for change to occur is not enough.

As part of behavioral change, we also need to look at how blockchain fits into the existing policies and standards that have been painstakingly established as part of the healthcare ecosystem, with a consensus achieved through months and years of work among vendors, providers, standards development organizations and health IT experts.

Specifically,

  •  What standards will evolve as blockchain begins to gain maturity and widespread use?
  •  How can blockchain align to those standards, or even potentially improve them?

The HIMSS Blockchain Work Group is exploring how many of the behavioral and cultural changes identified by HIMSS members across other work groups and task forces will apply to blockchain. Two of the key areas of focus will be on the increased prevalence of application program interfaces (APIs) as a way to access data, as well as an increased focus on security, which is a key feature of blockchain and offers new ways for organizations to secure their health data.

As our work group progresses in its work, we will be providing more insights on potential blockchain use cases, success stories from healthcare vendors in the field, and a forum for new ideas on how blockchain would work within healthcare.

What kinds of questions and thoughts on blockchain does the HIMSS community have? We want to hear from you! Contact interop@himss.org to share your idea or to learn more about getting involved in future HIMSS blockchain activities.

 

New this year at the IHE Connectathon is the Blockchain Plug-a-thon and at HIMSS18 blockchain solutions and education will occur at the Interoperability Showcase and the Innovation LIVE areas within the exhibition hall.

 

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