Re: Blockchain in healthcare panel questions


Karan Verma
 

Hi Rich

It would be hard to add something that is out of the scope of the three initial questions that you listed because they are concerned with the why, where and how of the application of this technology to healthcare. I’ll try and list some questions that I’ve thinking about and maybe that would add value to your preparation for this conference, however, please let me add a disclaimer that I don’t consider myself any wiser for posting them and I hope that I can get some answers to these and improve my understanding of where we can go with this technology. 

In my opinion, the crux of the problems that U.S. healthcare faces today can be encapsulated into the cost of care problem, quality of care problem and the coverage problem. And these three problems are connected. I will try and list out these problems in brief, which will help lead into the promises of blockchain technology to solve these problems and then pose questions that may inform us regarding applying it successfully to achieve the end goal of better healthcare. 

The cost of care problem can be broken further down into the over utilization of services problem, the high cost of services problem, and the high administrative overhead problem. There is over utilization of services in healthcare today as shown by these examples: about 3 in 10 tests are reordered, 30% of the patients who visit the doctors office have their files missing and because doctors, practicing defensive medicine, order tests and services which might not be needed. It has been argued that over utilization is also a result of misaligned incentives for the providers and the data-brokers involved. Especially, in cases of patients with comorbidity, the patient data residing with one provider is not available to another one. 

Which leads directly into the quality of care problem. Since provider don’t have access to a longitudinal health record for the patient; they have no choice but to have their patients fill out forms. And, there is risky reliance on the patient to remember their health history, which in several cases has proven harmful for provider, patients and ultimately everyone since we all share the cost. And on that note, consider that every provider fills out 20k forms each year and the healthcare industry in total pays for 15 billion transactions on the fax machine.  

Again, providers don’t have access to the longitudinal health record because of the misaligned incentives of the data-brokers in the healthcare ecosystem. It has been argued that the interoperability problem in healthcare is a business model problem. The cost of care also affects the quality of care in the sense that there is not enough incentives for most providers to practice preemptive/preventative health which is the major cause of concern for health of people in America in my opinion with 1 in 3 suffering from obesity, 1 in 3 from diabetes, 1 in 4 from cardiovascular problem, 1 in 5 from mental health problems - all that can be root-caused to behavior & lifestyle and further lead to other more serious health issues. Having more sick people further exacerbates the problem as there are limited number of doctors who can see them and we loop back into the cost of care problem and quality of care problems because small number of physicians charge higher salaries and don’t have enough time too see patients. 

The coverage problem is that either most people in America don’t have coverage or are not directly involved in choosing coverage because they get it form their employer, medicare or medicaid. Which again loops back into the cost of care problem because there is over-utilization as people don’t pay for these services directly. A more fundamental disturbing truth is the very existence of the payer, separate from the provider and the consumer, which leads to administrative burdens for all parties involved through costs of pre-authorizations, billing, claims, disputes, waste, fraud all adding to the cost of care problem, quality of care problem and ultimately since there is expensive care at low quality, the coverage problem. 

All of these problems bubble up in the form of metrics like, low life expectancy for Americans, high infant mortality rate, high rate of preventable diseases and the most glaring one - an expensive healthcare system paying ~20% in GDP for healthcare that works worse than other countries who pay much less. 

While there have been solutions proposed to these problems viz. new forms of coverage and new provider payment models, I think they don’t have the disruptive potential of blockchains. The central promise of blockchains is in decentralization which for the healthcare industry means disintermediation, reduction of waste, smart incentives, trust amongst stakeholders and hence reduction of fraud. Which could mean a lot and I think can change the industry in many ways but I realize that this post is already going much longer than I intended so I’d jump right to the questions that I’ve been thinking about. 

  • How can blockchain technology, today, help in coordination of care amongst multiple providers for a patient with comorbidity? What are the roadblocks there? 

  • What are the ramifications of issuing and verifying provider credentials through the blockchain? 

  • How are the data-brokers in the healthcare industry responding to this technology - the HIEs, EHRs, EMRs, population health managers. What are their next steps? 

  • Why is the industry still using fax and lengthy pre-authorization processes? What is the trust problem there? 

  • Should blockchains be applied depth first or breadth first. In, other words, should be try to fix entity specific problems (provider, payers, employers) or patient specific problems i.e. create blockchain solutions for a specific condition which is more problematic due to the nature of the US healthcare industry?

  • Are there particular types of health problems (mental, cardiovascular, diabetes etc.) which cause more waste in the industry than other and should be tackled first? 

  • How do we apply Blockchains to incentivize healthy behavior and promote preventative healthcare and wellness? Is there any work going on in the industry on that front? 

Best, 



On Wed, Oct 3, 2018 9:29 AM, john.sarazen@... john.sarazen@... wrote:
Rich, et al.

While not an active poster here, as a dad and technologist in the Seattle area, I've been following this thread with considerable interest. Here is something that I'm aware of that might be useful - logistics serialization in pharma & healthcare (and lots of other domains as well). A few links below, but the salient point is that blockchain, as inefficient as it is now, can help improve the state of supply chain serialization substantially. Since mothers' milk is a supply chain issue, "serialization-as-blockchain," as the technologies get better, is worth some discussion? Hope this is useful.

John Sarazen

References





On Wed, Oct 3, 2018 at 8:32 AM Rich Bloch <richardbloch@...> wrote:
Good Morning All,

A bit of an odd question to pose, but I thought I'd crowd-source this to those much wiser than myself.

I'll be moderating a healthcare panel at an upcoming blockchain summit in Seattle later this month (http://blockchainnw.com/). So, I'd like to ask if you have any questions about the use of blockchain in healthcare that you'd like to see answered if you were sitting in the audience.

Some initial questions:

- What makes blockchain technologies particularly valuable in the healthcare space?
- Where do you see blockchain most appropriately utilized?
- What are some of the barriers to entry with implementing blockchain technologies in the healthcare space?

I'll post this request over on the chat channel (https://chat.hyperledger.org/channel/healthcare-wg), so please respond there when possible.

Thanks for your help

Rich


Richard Bloch
Principal, Business Learning Incorporated
Systems & Software Engineering
Seattle, Washington USA
   206.588.6054 - work 
   425.417.8255- mobile 
    www.businesslearninginc.com



Karan

Join healthcare-sig@lists.hyperledger.org to automatically receive all group messages.