Michael Gagnon, executive director of HealthHIE Nevada
RENO, Nev. — The healthcare industry is abuzz by the potentials of a nascent technology building momentum by each click of a mouse: blockchain.
According to a 2017 Black Book Market Research survey, nearly 20 percent of hospital leaders and 76 percent of health insurance executives are either thinking of using blockchain technology or are already doing so. Further, IDC Health Insights reports that one in five healthcare organizations would adopt blockchain by 2020.
Definitions of blockchain vary in complexity, but at its core the technology is a carved-in-digital-stone, decentralized and transparent record of all transactions through a peer network.
Commonly know for being the foundation of bitcoin, blockchain is already being implemented in other fields, including, among others, the freight and logistics industry, real estate, and financial services. The latter has benefited the most from the technology, according to the Silicon Republic, which reported that banks using blockchain save up to $12 billion annually.
This all begs the question: Why is blockchain on the brains of many in the healthcare industry?
Above all, providers, payers and digital developers are touting the technology’s potential for securely, privately and comprehensively tracking, storing and sharing patients’ medical records.
All told, according to a study by Frost & Sullivan, blockchain is estimated to save the healthcare industry up to $100-$150 billion yearly by 2025.
Sure, there are prototypes toying with blockchain — like MedRec, a decentralized record management system to handle Electronic Medical Records (EMRs).
However, despite the promise and hype surrounding the technology, blockchain adoption in healthcare, compared to other sectors, has lagged.
“Many people jumped on it thinking, hey, this could be the Holy Grail for the hospital industry, especially with medical records,” said Ron Fuschillo, CIO at Renown Health in Reno. “And as you look at the landscape, it feels like blockchain is kind of a buzzword right now. And it feels as if some organizations may be moving forward much faster without perhaps understanding what that outcome might be.”
Fuschillo said Renown took a “deep dive” look at blockchain roughly a year ago to see what, if any, opportunities existed for the Reno-based healthcare network.
The short answer: none — at least not yet.
“From our standpoint, we sort of put it up on the shelf and said, I think we just need to wait until this matures a little bit,” he said. “And more importantly, we just couldn’t invest that time and energy because we didn’t see the payoffs.
Added Renown CTO Jeff Jorczak: “It’s too vague for us to try to build something on it. There’s not a compelling use case. But any of that can change.”
One of the hurdles blockchain in healthcare faces is the fact that everyone would need to be convinced to participate, said Fuschillo, before adding, “Technology in healthcare is very proprietary-based.”
“The integration is very challenging — everything would need to support it to make it successful,” he continued. “So if just Renown had it, that would be such a small benefit to a small population where we want more standards. If I’m over in Connecticut on vacation and I have an issue, I want that data accessible. But that organization (in Connecticut) then would also need to embrace blockchain and have the means in their EMR to take that information in … and that’s a long ways away, I believe.”
That said, one of the things that blockchain may address is cyber attacks, according to Fuschillo and Jorczak. Specifically, blockchain is a counter to integrity-based attacks; that is, modifying data in such a way that is not traceable.
“If someone tries to hack in and create a transaction that is false, it won’t have enough momentum to infiltrate the network,” Jorczak said. “It’s a really unique technology in the way it works — that there is no central authority and that’s part of the security that’s built in.”
Added Fuschillo: “And that’s why it’s — we won’t say bullet-proof in IT — definitely proven to be very successful from the standpoint of having strong security posture.”
This is partially why Michael Gagnon, executive director of HealthHIE Nevada, a statewide community-based Health Information Exchange, feels that blockchain could be used for a nationwide patient index, rather than storing and sharing medical records.
For starters, security risks aside, Gagnon said the size of medical records are too large to be used effectively with blockchain technology.
“Medical records are verbose and large and have a lot of texts,” he said. “Imagine having to look through tens of thousands of records to add up all the parts of a medical record. It won’t scale to do that.”
Gagnon co-authored a paper that was recently published online in a peer review journal called, straightforwardly, “Blockchain in Healthcare Today.”
“The idea is a mechanism for how to share the location — not the medical records, but the location — of medical records in a nationwide system,” Gangon said in a phone interview with the NNBV. “We’ve long had an issue here that it’s challenging to find out where a person’s medical records exist across the whole country.”
As such, Gagnon, also a member of the Strategic Health Information Exchange Collaborative (SHIEC), is proposing a blockchain-based record locator service. Blockchain, he submits in his paper, offers the opportunity to ensure that a complete record of a patient’s medical record is available to the patient and clinician regardless of where the patient received care.
“We really need to participate in this,” Gagnon said. “Because we potentially have records on people who, when they come to Las Vegas and get ill or get hurt, their primary care doctor back home might want to know about that, especially if they were put on some kind of medication while they were there (in Vegas).
“So it’s very important to do. It’s important to do very securely, but also in a way that recognizes that access is crucially important.”
