Tag Archives: blockchain ledger

Healthcare Interoperability

A Beginner’s Guide to Healthcare Interoperability

There’s no denying that the newest trend in healthcare is the idea of “interoperability.” It’s the headline of every news story, and it’s on everyone’s lips coming out of HIMSS. But, it’s easy to gloss over it, to think of it as a new way to say “synergy” or “Big Data.”

What is Healthcare Interoperability?

However, the truth is interoperability is more than just the newest jargon — it’s another way to say “communication.” And as all healthcare clinicians know, communication is the most important element of treatment. The communication between the patient and the doctor, the communication between nurses and doctors changing shifts, and the communication between the various healthcare providers.

So, when the smartest folks in the healthcare industry push the importance of interoperability, what they’re really talking about is a way for patients’ records to be more accurate, more compatible, and more easily accessible.

But how can healthcare providers, hospitals, and doctor’s offices implement interoperability?

Find out how artificial intelligence, legislation, medical computers, and policy changes can all cooperate to create a more transparent (and cheaper) data sharing system.

Unifying the Health Record

You may have been told in high school that something is in danger of going “on your permanent record.” Well, as it turns out, there is no permanent record. Not for copying your friend’s homework, and not for medical records, either.

Each time the third nurse you’ve seen during a single visit has asked you for the fifth time if you’re allergic to anything, you know that EMRs need a serious overhaul. Luckily, there are systems in place to do just that.

Option 1: Embracing the blockchain. Combining one buzz word with another may sound worrisome, but blockchain can actually be a great potential road towards interoperability. What’s the main hurdle of interoperability? HIPAA regulations, and the very real fear that a patient’s digital file could be swiped or cracked by malicious parties during a transfer.

One of the main issues is that many health record files are stored in “read-only” formats to prevent tampering. However, read-only formats don’t play well with databases that needed to access the original file and pull categories out. This is done for protection, but it also creates format wars AND sucks a ton of time from admin, who has to transfer many of the data fields manually.

Blockchain, on the other hand, uses a distributed ledger, spread across multiple locations, to ensure that patient records cannot be accessed or altered by anyone but those authorized to do so. The data doesn’t have to be stored in “read-only,” because every attempt at tampering is foiled by blockchain’s tracking system. The data is encrypted, and even if somehow a malicious actor was able to break in, the entire system would register that the copies on every other computer connected to the blockchain don’t have the changes, registering the transaction as both fraudulent and easily traceable.

Change Healthcare has already implemented a blockchain network designed to streamline hospital processes with the ultimate goal being a “single point of truth.”

The “single point of truth” is really just another way of saying interoperability: if everyone is pulling patient data from ONE location, there’s no need for an array of conflicting file formats and record systems.

Option 2: Using open APIs. This is more on the programmer side of things, but if you’re trying to understand how to implement interoperability better, it’s good to know what you’re looking for.

An API is an “application programming interface,” and an open API is one that is designed from the ground up to facilitate sharing. It means that the processes underpinning a program (or app) are modular, and can share an abstracted version of the data. What this means in layman’s terms is that the open-API program can still share data with other programs without “giving up its secrets,” or releasing proprietary code to an outside source.

The idea is to combine accessibility with security, another key feature of any interoperability campaign. When shopping around for EMR programs, an open API should be high up on the list of priorities.

What is Healthcare Electronic Data Interchange?

Electronic Data Interchange, often abbreviated as “EDI,” defines a set of standards, technologies, file formats, and transmissions methods for moving sensitive data from one point to another.

Healthcare EDI is referring to those methods used specifically for transfers like medical records, payments, medication information, and the like from one EMR computer, medical tablet, or even mobile phone to another. Healthcare EDI must conform to HIPAA standards, of course,

Adhering to EDI standards has proven benefits. For one, security is increased, because the EDI standards are tried-and-true, and conform to HIPAA codes. Secondly, processing documents is ultimately cheaper: studies have shown that healthcare facilities saved anywhere from $1 to $2 dollars per claim just by switching to EDI. That may not seem like a lot at first blush, but considering the thousands of claims and documents pouring through the healthcare industry at any given time, the savings are quite significant.

The last benefit is to (surprise) interoperability. EDI sets a standard, and the more healthcare providers and facilities follow those standards, the more, well, standard they become. When everyone is on the same page, the book isn’t terribly hard to read.

According to Markets and Markets, the EDI market value will increase by over 1 billion dollars by 2022. This massive market penetration should have enormous benefit to any attempts at standardization as well.

Breaking Down Interoperability

When it comes to understanding and implementing interoperability, remember the key ingredients:

  • Hardware standardization: Avoid the format wars. Install long-lasting, compatible medical PCs and medical cart computers that can talk to each other.
  • EDI: Make sure your file formats and transmissions standards all fit the EDI recommendations.
  • Blockchain: Look into distributed ledgers to maximize security and accountability.
  • Open API: Invest in programs that are designed to be compatible and future-proof.

These are just a few of the starting places, so contact Cybernet today to learn more about medical hardware, compatibility, and EMR solutions.

blockchain ledger

Healthcare IT and the Impact of the Blockchain Ledger

Cryptocurrencies have been trending in the news lately because of their volatile market price, security, and popularity. Investors and money moguls alike have dumped “real” money into the cryptocurrency market, turning fiction into fortune with an intangible concept of data that holds wealth in today’s world. Believe it or not, the blockchain ledger—the decentralized network of recorded transactions for bitcoin—can actually have an application towards the HIT market. It may sound strange to apply a cryptocurrency concept to something as far related as HIT, but going into the detail of what the blockchain ledger represents and how that can apply to healthcare isn’t as far-fetched as some might initially think. Here’s why.

A bit of background: the blockchain ledger is a decentralized database that records several encrypted transactions. These transactions reside on a peer-to-peer network, sharing all data between all computers—it presents a huge advantage over a centralized database network. If the central database in a network were to fail, all the data within that network would be lost. The peer-to-peer network of transactions is a stronger data integrity model because any computer failure on the network doesn’t affect the overall integrity of the data—all “nodes” of the network serve as a full record of the blockchain ledger, making data loss or corruption nearly impossible. All nodes have neutral authority. The popularity of cryptocurrencies has skyrocketed because of how highly secure these blockchain ledgers are. It’s a data interchange concept that arose out of the 2008 stock market crash when individuals lost faith in banks that used a financial system functioning similarly to a centralized database network.

So how does that fit into healthcare? Think of the blockchain ledger as an entire ongoing record of everyone’s healthcare records, and any device that records a metric for healthcare—total mileage ran, for instance—can be considered a transaction on that blockchain that cannot be altered. A visit to the doctor could record a person’s age, weight, lifestyle habits, hereditary complications, diet, and other health factors, and then record that into the blockchain as a permanent “transaction.” It may be possible to record all health-related information from a person’s birth to any given moment in time. A physician could access the HIT blockchain and compare a patient’s entire health record with that of thousands of other patients that fit their near-exact health and lifestyle record. Misdiagnosis and improper medication could virtually disappear.

It’s not only a matter of reducing misdiagnosis or improper medication either—physicians are sometimes without the complete picture of when treating a patient. They’re only able to evaluate a patient’s health via what they can sample. For example, through phlebotomy a physician finds that a patient has a huge vitamin C deficiency and symptoms align with scurvy—the patient is diagnosed with scurvy and given vitamin C supplements. That can be recorded as a blockchain transaction and be used for further diagnosis in the future from any other physician. Every future visit to the doctor for an evaluation can improve by giving the physician a more complete snapshot of a person’s health. Patients won’t require as many evaluations. Plus, the future of healthcare may evolve into the ability to predict disease based on evaluating comprehensive trends in health. Imagine predicting cancer in people 60 years ahead and tailoring entire lifestyle habits for future at-risk cancer patients to avoid the disease. Not only that, but imagine if there’s a patient with a disease that doesn’t match with similar patient records. Perhaps this unmatched disease is something new that requires research, learning, development into new medication, and higher healthcare standards.

HIPAA and The Blockchain Ledger Data

One of the double-edged swords of the blockchain is that it’s being used as a way to remain anonymous when trading cryptocurrencies. That’s why it’s attracted the interest of hackers and malicious individuals. In 2016, a Los Angeles hospital was the target of a complete system hijack from a hacker that demanded 17 thousand dollars in bitcoin. Several of these sudden system hijacks have happened where the culprits demanded ransom in bitcoin because of the nature of bitcoin—it’s not entirely anonymous, but by joining the bitcoin blockchain you can falsify information about yourself and “cover your tracks.”

However, if a blockchain ledger were to arise for healthcare IT, it would have to remain private and under HIPAA regulation. All “transactions” under the HIT blockchain would have to remain anonymous until a patient gives consent to a doctor to view their entire set of records. With a system of data interchange that gives patients the power to allow doctors they consult to view their records, it may be a revolutionizing method of keeping HIPAA violations at bay. At face value it seems like the best technology for healthcare, but there are a lot of potential hurdles and hangups. If a patient requests their healthcare records, how do they access them? If the HIT blockchain is the main method of keeping a comprehensive health record, how will businesses interact with that? Will that kind of information stay neutral to all parties accessing it? With the rise of an HIT blockchain, suddenly we’re stuffing a highly sensitive form of data that must be carefully handled onto a new network of data interchange. If there’s a method of avoiding the privacy regulations for blockchain integration, that would be ideal. It’s a matter of finding out what that method is. For now, a slow evolution into storing medical data onto the blockchain ledger is ideal, but there’s a jungle of rules and red tape to cut through.

Interoperability Revolution

Likely one of the strongest aspects of using the HIT blockchain is interoperability, which is still a sought-after capability when using certain EHR systems. It’s natural for EHR companies to snuff interoperability with other EHR systems in order to sell more product, but sometimes hospitals are at the whim of using the systems they’re stuck with and poor interoperability forces workarounds. That won’t be a problem with the blockchain. Complete and total interoperability is predicted to save HIT several billions of dollars with use of the Electronic Health Chain (EHC), a patient-controlled form of healthcare information that resides on the blockchain. All data gathered through any device that can integrate with the blockchain—whether it be from a pedometer, blood pressure cuff, diabetic testing machines, sleep habit readers, or any possible device that can provide data—can be incorporated within the EHC. This suggests that no matter what physician you see, they have a complete, unbroken record of a patient’s healthcare from the start of recording—perhaps from birth!—to the last transaction recorded, without squabble over conflicting software that won’t communicate.

Healthcare Future with the Blockchain

Medication development often hinges on clinical trial studies that can take several years to complete. Pharmaceutical companies rely on doctors to identify patients that fit specific profiles to contact and ask for a clinical trial study to see how a medication may affect them (hopefully in a positive way). Using the blockchain ledger, the process of a clinical trial can be reversed—patients can willingly sign up for a clinical trial and release their EHC to pharmaceutical companies, reducing research and development time significantly. Instead of pharmaceutical companies finding willing patients to undergo studies, the patients can give access of their entire medical history in the blockchain. The efforts to find a strong sample size for the study may be reduced.

 

By evaluating someone’s entire history of health, hereditary impacts, lifestyle choices, diet, and maybe even their genetic predispositions, physicians can reduce improper diagnoses, find new medical conditions, develop new medications, and understand more about healthcare in the future. Integrating the Internet of Things, the EHC, and total interoperability into the blockchain can push understanding of healthcare to heights never seen before. There are obvious hurdles to full integration and we won’t see full blockchain integration into healthcare at the flip of a switch, but it’s interesting to see where we could possibly take healthcare with this newfound form of data interchange. A current project in the works is called MedRec, a prototype blockchain EHR system that gives patients access to their entire healthcare history for purposes of diagnosis and research. That’s just one prototype coming out of the woodwork lately. The percentage of HIT executives integrating the blockchain into EHR systems has grown since inception, and several new networks have spawned with their own unique structures, paving the way to what might be a complete healthcare information overhaul.