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An inside look at the potential of blockchain in healthcare

Blockchain could be the solution to fix the tricky problem of healthcare data ownership. Longtime blockchain researcher Adrian Gropper, M.D. explains how it could work.

If the challenges inherent in today's healthcare IT arena make you long for the good old days, you may be in luck. Blockchain, an incredibly complicated and far from mainstream technology, could, if done right, uncouple doctors from hospitals, give patients ownership of their health records and perhaps even shepherd in a time when doctors could once again hang out their shingles.

There is no question; it's a big "if," however.

Adrian Gropper, M.D., is the principal of HealthURL, a consulting firm focused on medical devices and patient-centered health technology, based in Watertown, Mass. He's spent the last three years researching use cases for blockchain in healthcare and is actively involved with Health Information Exchange of One (HIE of One), an open source effort to establish standards for blockchain. The goal of HIE of One is to return control of health records to patients and licensed practitioners.

Gropper believes the problems begin with the doctor or hospital relationship. Doctors, he explained in a recent interview, are really the reasons hospitals can make most of their money. "Healthcare is unusual," he said. "Doctors do control much of the economic activity." But in the end doctors aren't really in charge, he explained, because hospitals have control of the patient data. For Gropper, this really is the root of all healthcare IT evil today. Hospital data ownership is at the heart of the interoperability battle -- after all, the data isn't "free" if hospitals own it -- while at the same time it keeps patients (and to a degree doctors) dependent on them.

If there was a way to break the hospital hold on doctors and data, he believes the healthcare landscape would change for the better. Blockchain in healthcare could be the answer, he argues, but it won't be quick, easy or probably even accepted by the mainstream anytime soon. Remember, it took federal intervention to get hospitals to move en masse to EHRs, so imagine what a move to blockchain might entail.

Gropper's concept is worth considering, even if it's a stretch. Here's how it could work: Blockchain in healthcare would give a doctor a choice of where he or she might want to record a note or send a referral or do anything else medical record related. The doctor could use the existing EHR, or choose instead to record the information in the blockchain. This blockchain would be something a patient controls. The patient, in fact, would have complete say over which doctors could access it.

In order for this to work, though, blockchain in healthcare would require ironclad standards around doctor identity, which is an area HIE of One is working on. Doctors might need to present a driver's license, a board certification or perhaps even a medical school diploma in order for the blockchain "bonafides" to be satisfied. This is why Gropper harkens back to the "good old days" when he talks about blockchain in healthcare -- it really is no different than a doctor hanging his diplomas and certifications on the walls of his office.

But notice what's missing in his vision? Hospitals. They're not going away, Gropper said, but "hospitals will no longer be data brokers. They're in the surgery and ER businesses just like they were before we had computers. They're in the medicine business. We don't need to have the people who are doing the medicine also controlling the data."

In his mind, blockchain in healthcare would result in the interoperability -- after all a blockchain is agnostic and can work with anything, in theory -- and the transparency everyone is craving. "Congress is tearing its hair out over interoperability and information blocking and we want to have value-based healthcare, but we can't provide the transparency to support it. Everything in healthcare is too hard."

He acknowledges the mainstream medical community is not going to embrace this idea, but he thinks older doctors -- who remember how things used to be before computers -- would agree with him. And younger doctors and med students, aware of the wave of new technologies like AI headed their way, would rather see hospitals not in charge of them or the cutting-edge tech.

"Blockchain in our model serves to keep the physician accountable in the same way he or she was accountable before computers," he said. "A doctor would publicly put up that shingle and hang a diploma and no hospital was involved. We are literally replacing what we had before we had computers."

As a chronicler of the tech evolution, it's pretty hard to wrap my mind around the idea that "what we had before computers" was a good thing. But at the same time, it's hard to argue that healthcare tech isn't profoundly broken and in need of a huge fix. Will it be blockchain? I guess we'll wait and see, but the potential is intriguing.

This was last published in September 2018

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