Question 1: What are blockchains?
Blockchains are clever pieces of database technology. These databases can act as common infrastructure for the entities that maintain them – shared “plumbing” through which all forms of data can be transferred – and a mechanism by which those transfers can be immutably recorded. The key components of a blockchain are:
- Network – Blockchain databases are shared by multiple parties, and connecting more than one party forms a network.
- Identity – Each party in the network is uniquely identified. The unique identifier is the mechanism by which other parties on the network identify one another.
- Dynamic – Blockchains are not simply shared storage facilities for static data, but rather transactional environments that enable the direct transfer of data between parties.
- Record – Activity on the network is time-stamped and recorded, producing a chronological record of data transfers.
Collectively, these components inject trust in a network by keeping an updated record of who did what, and when.
Question 2: The financial services industry has taken an interest in blockchain technology. What are the implications for payments?
The financial services industry has taken an interest in these new “network databases” because of their ability to:
- Dramatically reduce the time and infrastructure required to transfer financial assets by removing reliance on intermediaries
- Automate many of the back-office processes involved
If everything – identity, authorization, transfer, verification and settlement – can occur in one trusted environment, current processes and workflows are disrupted. From a payments or asset transfer perspective, blockchain technology enables value to move seamlessly like data between entities on the network. In an industry that relies so heavily on intermediary messaging, combining processing and settlement can dramatically reduce the time between payment initiation and payment completion.
Payment rails that leverage network databases could have significant revenue cycle management implications for payers and providers as well, and inject much needed transparency into the reimbursement process.
Question 3: Do the applications extend beyond financial services?
Databases store and manage data, and value is just one data type. Network databases such as blockchains are designed to manage a network of participants and facilitate the transfer and permissioning of data between those participants.
For health care — an industry with a myriad of stakeholders managing millions of records and data points on a daily basis — the ability to efficiently share information across stakeholders and do it in a way that preserves fidelity and confidentiality of data is paramount. By providing a trusted environment for recording and exchanging data, blockchains could fundamentally change how:
- Payers and providers share claims information
- Provider data is updated and matriculated through a network
- Medical records are shared and updated through the care continuum
- Population health data is aggregated and analyzed
- Clinical trial data is recorded
- Prescription drugs are tracked and monitored through the supply chain
Question 4: How can network database technology such as blockchain enable a system for managing a patient’s medical record as she moves through the care continuum?
The foundation of any blockchain-based network is identity. Each participant on the network receives a unique identifier that is subsequently incorporated into any record of activity the participant is involved with on the network, similar to how email messages are associated with the email address of the sender.
The second feature relates to the namesake of these network databases – chains. A chain of transactions (or in this case, appendages to a medical record) is time-stamped and immutably recorded in the database. Over time, this process produces a chronological picture of a patient’s medical history.
Question 5: How should health care organizations be thinking about blockchain in the context of data management?
One of the challenges that the health care industry faces over the next decade is managing the increasing volume of data created by electronic medical records, payer claims, pharmacy data and connected devices. The shift from fee-for-service to value-based pay is likely to result in physicians and health systems forming clinically integrated networks spanning across states and regions. A push for a more holistic approach to health care means that data sources need to be connected and analyzed in new ways. Building systems for managing and accessing these disparate data sources, and ensuring interoperability of those systems, will be the challenge.
Blockchain technology is not the silver bullet, but it can be a network enabler, providing a foundation and set of technology standards that connect providers and support the applications used by clinics, hospitals, pharmacies and insurance companies to manage the wealth of data created by the industry.
Question 6: With a growing importance on privacy and confidentiality of patient information, is blockchain technology mature enough to deal with the regulatory burdens?
Blockchain is nascent technology. While there are inherent features that support the argument that blockchains could be one of the most secure databases available, education and iteration is required before this technology is ready to support the demands and volumes of the health care industry.
Question 7: Where should new innovations such as blockchain be in an organization’s technology portfolio?
A technology portfolio should be thought of as a fabric with many interwoven threads. Blockchain is one technology that offers enormous potential, and health care organizations should understand how it could impact the industry. There are opportunities and synergies that can only be realized when explored alongside big data, artificial intelligence and connected devices. For example, a blockchain may be used to manage a network of connected medical devices. Similarly, a provider network may leverage blockchain technology’s ability to connect and manage disparate data sources to form a more complete view of a population’s health.
Health care is a dynamic environment. The goal posts are shifting and providers and payers alike are looking for ways to remain competitive while delivering quality care. In this environment, the importance of being connected and flexible cannot be overstated, and technologies that enable network building and interoperability should be explored.