Blockchain. The distributed ledger technology has considerable promise in healthcare and, as so often happens with emerging technologies, it’s being hailed as something close to a cure-all for just about everything.
From cybersecurity to electronic health records and data interoperability, to supply chain and clinical trials, even patient engagement. They’re all been named as potential use cases.
But what about the challenge of patient matching? Can blockchain cure the woe of successfully identifying the same patient throughout an intricate web of information systems?
Those are big questions and the answers come down to this: Blockchain is not in and of itself a solution to the challenge — but it can play a supporting role in helping to line up the same records for the same patient under a single patient identifier.
Blockchain: Data accessibility, integrity, interoperability
Blockchain can be designed to help meet the needs of master patient ID as long as there is consensus on what the requirements should be, said Brad Pedrow, a director in the healthcare and life sciences practice at professional services firm Grant Thornton.
“As a technology, blockchain can provide the data integrity, security, accessibility and interoperability of the most demanding requirements of the healthcare community,” he said. ”The evolution and implementation of blockchain solutions across many industries is gathering momentum to solve all kinds of problems. Once there is agreement on a starting point for patient ID, blockchain can be designed to meet those needs and be flexible enough to keep up with the pace of change.”
By itself, blockchain does not address the challenges of a master patient ID – blockchain is a valuable component of solving issues related to the reliable, accurate and permissioned exchange of patient data, including the establishment of master patient ID, said Lynn Carrol, chief of strategy and operations at HSBlox, a vendor of blockchain, machine learning and master patient index technology.
“To solve patient-matching challenges, a solution should use machine learning to analyze and consolidate patient data from multiple systems, such as EHRs, medical charts, e-prescribing technologies, clinical documentation solutions and revenue cycle management platforms, to create longitudinal patient records that can be transparently shared among a patient’s care team, optimizing care coordination,” he said. “The patient-matching solution then is combined with blockchain to disseminate the relevant patient data to all parties who have permission to view it.”
The primary challenge in accurately matching patient records to a master patient index is the lack of a global or universal patient ID. As a distributed ledger, blockchain can keep track of what’s changed in a patient record and even assign a universal patient ID — but it cannot identify the correct patient unless all systems that would interact with this central blockchain database can supply the correct universal patient ID whenever a change is made to the patient record, said Gregg Church, president of 4Medica, a health IT vendor that markets, among other things, a master patient index.
“This is unlikely to happen anytime soon,” he said. “Once that global patient ID is available for each patient, and recognized by all systems, blockchain can potentially become a backend technology for the interoperability portion of aggregating patient data and tracking the unique identifier. But who will establish the block to begin with? That’s just one of the many questions surrounding the true feasibility of blockchain for patient data exchange and patient identity matching.”
How blockchain can help with patient matching
Blockchain is certainly a technology with many applications. If blockchain is not the solution to master patient ID, then the question with master patient ID becomes where can blockchain be applied to help.
Many hospitals and health systems have a requirement that patient data – perhaps in the form of an HL7 transaction – must be passed to multiple EHR systems. To accomplish this, patient data is passed to a master patient ID system, where it is matched with a master patient ID that serves as a unique identifier for each individual patient.
“Once a match is confirmed, the patient data could be automatically replicated and routed on a permissioned basis via a smart contract on blockchain to the individual EHRs, eliminating duplicate patient records,” said Carrol of HSBlox.
On another front, the global standards organization GS1 already has in place a solution for the creation of globally unique patient IDs, but it has not yet been universally adopted. Governments such as in the UK and Denmark already have in place their own systems for a national patient identifier.
“So even if the blockchain solution creates new globally unique IDs, either the master patient ID solution or a master EHR solution will need to store references to IDs in other systems to facilitate a single EHR consolidating all of a patient’s health information,” said Pedrow of Grant Thornton. ”It seems unlikely we’ll reach agreement on a global, master EHR solution in the near term, so the burden for linking all the EHR solutions together would fall on the master patient ID system.”
"Still to be worked out are the identifiers for the health records systems. Standardizing on the data identifiers will require coordination and time."
Gregg Church, 4Medica
IDs for patients and EHRs
The types of ID information the blockchain would need to store would include both IDs for the patient and IDs for the health records systems, Pedrow said. IDs for patients will include data such as name, cell number, birthdate and maybe even biometric data, he added.
“Still to be worked out are the identifiers for the health records systems because they could include data sources such as a healthcare provider’s EHR, a personal smartwatch, a home computer and a physician’s office filing cabinet,” he said. ”Standardizing on the data identifiers for these sources will require coordination and time.”
But here again, the blockchain can be used to track the unique patient identifier, said Church of 4Medica.
“But there has to be one in place to track,” Church said. “Currently, when new patient data comes in, either a human or a patient matching technology must do the initial work of matching this data to the right patient record. That’s not something blockchain can do. But paired with a master patient index solution that identifies which record this data belongs in, blockchain could conceivably update or enrich the patient record with the new data.”
"Currently, many patients lack this trust, as does the U.S. federal government. A 1998 ban preventing the expenditure of federal dollars on creating a unique patient identifier remains in place."
Brad Pedrow, Grant Thornton firm
Blockchain and ID challenges
While blockchain can help in solving the master patient ID issue, it faces challenges in being successfully applied. These range from EHR interoperability to patient assistance.
“Solving the patient matching challenge and automatically distributing the data via smart contract on blockchain is a fantastic solution,” said Carrol of HSBlox. “However, the EHR interoperability issue must still be addressed – and that issue is not solved by patient matching or blockchain. To overcome EHR interoperability challenges, the following two conditions must be met: a universal commitment by EHR vendors to the support of standards such as HL7/FHIR is required, and universal commitment by EHR vendors to open APIs also is required.”
Blockchain can be a solution because the challenges are surmountable from a technical capability perspective – the blockchain design efforts underway for EHR, patient ID and even beyond the healthcare industry eventually will result in an architecture and model that can succeed, said Pedrow of Grant Thornton.
“The bigger challenge is how to change the mindset of patients regarding the benefits of consolidating and sharing their personal health data into one master record so they are willing participants in the adoption,” he said. “The greatest hurdle is not what blockchain technology can actually do – it is the human factor and our role in the solution.”
The patient needs to trust the data is secure and immutable so they’ll voluntarily share information in the blockchain, he added.
“In addition, we need to trust that those individuals with permission to access it are using the data in only the ways patients have entrusted them to,” Pedrow said. “Currently, many patients lack this trust, as does the U.S. federal government. A 1998 ban preventing the expenditure of federal dollars on creating a unique patient identifier remains in place.”
Blockchain: here or hype?
One big challenge facing blockchain and its ability to help resolve the master patient ID issue is the hype surrounding blockchain. So another question healthcare CIOs must ask is: Do I trust blockchain to help, or is this just hype?
“We love advances in technology and looking beyond where we are now,” said Church of 4Medica. “But it is far from clear how blockchain technology solves healthcare’s most persistent problems, especially the data silos problem. We do see promising use-cases in the areas of tracking changes in patient records and claims. However, we have yet to see any use-cases that have actually solved problems at a large scale.”
At some point, the hype will settle down and healthcare will find really good use-cases for blockchain, he said. But it’s difficult to see how the original purpose of blockchain technology – to cut out the middleman – is going to work in healthcare, he added.
“Permission and access controls are still issues, and in terms of a patient record powered by blockchain, someone is going to need to be assigned control,” he said. “Bottom line, we still see the need for a master patient index, with a global patient ID stored in the blockchain for tracking purposes.”
A long and painful road
Blockchain is indeed over-hyped – but it deserves the hype so long as CIOs understand that the adoption curve is long and painful, said Pedrow of Grant Thornton.
“Technically speaking, we soon will succeed in balancing the demands for speed, cost, privacy, proof of work, centralized control, processor demands and governance with blockchain,” he said. “The industry continues to innovate new blockchain improvements such as ‘Proof of Stake’ and ‘Scaling’ to achieve a more efficient way to validate transactions and reduce the processing power needed. But the promise of blockchain will never be realized if we don’t overcome the hurdle of trust.”
The public must believe that blockchain can operate in a secure and reliable fashion, he said. Good publicity is coming from blockchain applications in banking and moving into social innovation, politics, media, entertainment, airlines and life sciences, he said.
“However, bad publicity is undermining the public’s confidence,” he added. “Blockchain is difficult for people to understand, so when any one blockchain receives publicity for being hacked, it creates the perception that all blockchains are insecure. We need a continued series of blockchain successes and education around how it works. Blockchain offers great promise, and we all play a part in developing the technology and social momentum to see that it succeeds.”
Whereas the tech may by hyped, blockchain’s promise is not, insisted Carrol of HSBlox. Applied appropriately, rather, blockchain holds tremendous disruptive potential for healthcare.
“Blockchain addresses the challenges of real-time data disclosure and dissemination in the areas of claims administration, care team integration, process automation, pricing transparency, value-based program administration, chain of custody in clinical trials, drug provenance and a host of other issues,” he said.
The master patient ID problem is a case in point, he said.
“When combined with probabilistic record linkage using machine learning,” he said, “blockchain is the secure and real-time automated notification and replication solution.”
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