With the advancement of information technology to store large amounts of data, it is not surprising to see databases becoming the backbone of modern healthcare systems. As such, a good metric to evaluate our healthcare system is data interoperability, which is defined as “the ability of systems and services that create, exchange and consume data to have clear, shared expectations for the contents, context, and meaning of that data.”(Mehta, 2021) In 2015, the Office of the National Coordinator for Health Information Technology (ONC) reported that only 29% of hospitals in America have achieved data integration with other providers(Besheti, 2018). Often, healthcare providers do not share the same data formatting, and that has led to valuable insights that could have been derived from the data to improve the overall healthcare ecosystem to be lost. Furthermore, the lack of integration increases the probability of medical errors which is one of the top 3 leading causes of all deaths in America(Anderson & Abrahamson, 2017). It is clear that there is an urgent need to improve data interoperability within the healthcare sector, and one possible way is to explore how modern technologies like blockchain could be used to bridge the gap.
Before exploring how modern technologies can be used to resolve the issue of data interoperability, it is important to appreciate the complexity of the problem that the healthcare sector in some countries are facing. In a large country like the USA, there are currently “hundreds of government certified EHR(electronic health records) products”(Reisman, 2017) with varying metrics and this intensifies the difficulty in creating a format that all healthcare providers can use to share data. To compound the problem, it is unfortunate that certain stakeholders in healthcare have a vested financial interest in obstructing the flow of healthcare data. For example, in a survey responded by HIE(Health Information Exchange) leaders, 50% of the respondents have claimed that “EHR vendors routinely engage in information blocking practices either by designing products with limited interoperability or by charging high fees for providing HIE capabilities”(Reisman, 2017). Clearly, the barriers to data interoperability remain high and current measures are insufficient to address the problems faced by the healthcare sector.
To circumvent the current conundrum, start-ups like MedicalChain have leveraged on disruptive technologies like blockchain to create a smart healthcare ecosystem. While the implementation of blockchain is not ubiquitous at the moment, the result so far has been promising. MyClinic, an application developed by MedicalChain, has reported an increase of 600% of their user base last December(MedicalChain, 2022). Over 5 million healthcare professionals have their profiles published on MyClinic which is a sign that the application has been gaining traction among the healthcare sector(MedicalChain, 2022). Consequently, this burgeoning growth rate experienced by MedicalChain can be attributed to the “smart medical ecosystem” that is undergirded by blockchain technology.
The ecosystem is achieved by placing the patient’s electronic healthcare record on the network and having any updates made to the EHR be recorded as a transaction. The most “comprehensive version” is available to the patient and this ensures that any licensed healthcare provider who needs to view a patient’s EHR will be given the full updated report. Furthermore, data is no longer segregated in silos but accessible to any healthcare provider that has been granted access. This helps to reduce the possibility of any medical errors, optimizing the patient's outcome as a result.
Another unique aspect of using blockchain technology is the collaboration between major stakeholders in the healthcare sector, facilitated by MedTokens. For example, patients who are seeking medical consultations will pay MedTokens to the doctors and grant the doctors access to their medical records(MedicalChain, 2017). Next, patients can grant insurance companies access to their medical records for payment settlement and receive tokens in return(MedicalChain, 2017). Insurance companies can better monitor patients’ health records and this reduces the possibility of fraudulent claims. Similarly, pharmaceutical companies can also reward patients with tokens if patients grant researchers access to their health records for research purposes(MedicalChain, 2017). Unlike in the past where data is scattered among multiple healthcare institutions, data is now consolidated in the hands of the patient, and patients have the power to decide whether to monetise this data. Furthermore, healthcare organisations also benefit from greater cost-savings as operations become more streamlined. The ease of sharing medical data coupled with financial incentive helps to promote collaboration between major stakeholders and this has a profound impact on the entire healthcare sector.
While the benefits brought about by blockchain technology to address the issue of data interoperability is appealing, experts have a legitimate concern that sensitive healthcare data on the blockchain network will be exposed to non-concerning individuals and this represents a violation of one’s right to privacy(OECD, 2020). Furthermore, stigma is associated with certain medical conditions like depression and this means that a healthcare system that runs on a public network will discourage people from seeking healthcare(Anne L. Stangl, 2019). Hence, it is necessary to ensure that safeguards are employed to ensure that sensitive healthcare data is accessible to authorized individuals only. As such, modifications have been made to protect patient’s privacy. For example, the blockchain network employed by MedicalChain is private and only licensed healthcare providers are granted access to the network. In addition, health records on the blockchain are encrypted and stored in regulatory-compliant databases, adding another layer of protection for sensitive healthcare data. (Floyd, 2017) As such, data stored on the blockchain is secure and the privacy of patient’s data is not sacrificed just for the sake of greater efficiency.
Overall, the gradual integration of blockchain technology into the healthcare sector signifies a paradigm shift in the way we view healthcare data management. Under MedicalChain’s business model, healthcare data is no longer stored in silos and the patient is being accorded with more power to share their data with interested healthcare providers. Clearly, patients have greater control of their own data under this new model and this marks a significant departure from how healthcare data is being managed previously.
With that in mind, healthcare authorities need to be judicious with the integration of blockchain technology as unforeseen problems may arise from the new model. For example, patients may share their data with research institutions without understanding the potential ramifications that may occur. Hence, it is important that patients are educated on this novel technology and how to utilise it responsibly(OECD, 2020). Authorities should also study the feasibility of maintaining the blockchain network once the number of patients and healthcare providers increase exponentially.
Therefore, there are still many gnawing questions surrounding the use of blockchain and perhaps potentially more in the future. Rash implementation of blockchain technology on a nation-wide level may contribute to a slew of problems and this will cause more harm than good to the society. As such, it is vital that authorities direct more investment in researching and stress-testing the system before launching it to the public. Stakeholder communication is key to understanding any concerns they have so that the system can be tailored to the society’s needs(OECD, 2020). After all, the healthcare sector is composed of a myriad of stakeholders that have varying needs and there is no one size fits all approach to create a robust healthcare system. A successful implementation of blockchain hinges on the authorities’ ability to introduce a comprehensive framework that can complement this novel technology. I believe that a judicious implementation of novel technologies will help to address the issue of data interoperability, bringing the society a step closer to achieving a robust healthcare system.
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MedicalChain. (2022). Inside MedicalChain Issue #27. https://medicalchain.com/en/inside-medicalchain-issue-27/
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