by Lynn Carroll, Chief of Strategy & Operations, HSBlox

July 2019 – As value-based care accelerates, the disparate data of traditional fee-for-service doesn’t work. Data silos and a lack of patient integration present challenges for dissemination of data across the continuum of care.  As a result, the reporting feedback loop required for the development and deployment of quality-improvement programs is too fragmented in its current state.

The integration of patient and device-generated data is important to the development of individualized care plans that prospectively address  patients’ specific treatment needs and improve outcomes.  Acquiring a complete picture of the patient requires increased interoperability and permissioned access to patient data on a real-time basis.  This is where blockchain and distributed ledger technology  approaches can make a substantial impact.

Blockchain or Distributed Ledger Technology (DLT)

For our purposes, a distributed ledger (also called a shared ledger, distributed ledger technology, or DLT) is a collection of replicated, shared and synchronized digital data spread across multiple stakeholder sites and systems.  Think of DLT as a network where each participant in the continuum of care has a copy of the same data—completing the picture of the patient and ensuring longitudinal continuity of the patient’s medical record.

The past few years have seen increasing dialogue about blockchain (DLT) and its potential to disrupt the healthcare landscape.  Given multiple healthcare ecosystem stakeholders and disparate systems, the process of sharing data, validating its source and addressing privacy concerns presents many challenges.  As a single source of truth that reduces errors and the need for reconciliation, DLT can simultaneously address patient privacy concerns and value-based care data requirements.  With the use of private permissioned ledgers—where only stakeholders with permission are granted access to patient data—patients are at the center of the data exchange, enabling exploration of a holistic medical record governed by the patient’s consent.

The use of DLT smart contracts (a smart contract is computer code by which DLT network participants, including patients, agree to share information with each other) can help to ensure that healthcare resources and associated spending are targeted effectively to achieve the goals of value-based care.  By integrating patients into an ecosystem that has ever-increasing needs for transparency of treatment and financial options, DLT can help to deliver individualized care programs.

Patient Self-Management

The Institute for Healthcare Improvement (IHI) notes that, “Patients with chronic illness need support, as well as information, to become effective managers of their own health.”[i] To become stewards of their own well-being, real-time access to and exchange of information are critical components of chronic disease management, especially as home-based caregivers and other community resources are increasingly involved in patient care. The ability of patients to aggregate information for themselves and share it with stakeholders is a need that DLT can address.  With further integration and transparency, patients have the opportunity for self-management.

Recently, at HIMSS19 in Orlando, CMS Administrator Seema Verma noted that patients lack information, which limits their ability to make the best decisions for their healthcare. “The current healthcare system is complex, opaque and difficult to navigate.  Patients lack information and, therefore, power about the best decisions for their healthcare.”[ii]  Verma also said price transparency is a top priority and that, “Everything we are doing focuses on our efforts to empower patients.”

Device-Generated Data

Additionally, data generated by medical devices is pervasive and enormously valuable for population health management.  To take full advantage of this information, healthcare providers and the patients in their care need to know this information is reliable.

DLT smart contracts can automate the permissioned disclosure of device-generated data while also providing verifiability of provenance and reliability of the data.  Through the shared ledger, physicians and other patient care team members can access reliable information that includes the history of the device’s calibration and historical readings.  Anomaly readings can trigger permissioned notifications to appropriate team members for immediate action—based on verified data.  In-home monitoring, telehealth consultations and post-acute outreach can all benefit from the use of DLT for data sharing.

In late 2017, the FDA issued final guidance with respect to patient access to data generated by medical devices.  “Providing patients with accurate and complete information about their diagnosis and treatment, including the data collected from medical devices like blood pressure or heart rhythm monitors, allows patients to be better informed about their health and more active participants in their health care decisions.”[iii]  This is strong recognition of the value of device-generated data with respect to in-home care for high-acuity patients, chronic and complex case management and early intervention.

Complete data, better decisions
The healthcare industry remains mired in a years-in-the-making problem with sharing data, with disparate information systems and stakeholders struggling to efficiently and effectively exchange important patient information. Due to its unique ability to function as a single source of truth that reduces errors and the need for reconciliation, blockchain offers a solution that delivers increased interoperability and improved access to patient data on a real-time basis. With more reliable, accurate and up-to-date information at their fingertips, patients and providers will be empowered to make more-informed decisions that lead to better health outcomes.





About the Author

With 25+ years of experience in the healthcare and financial technology sectors, Lynn is a creative leader and innovator in healthcare reimbursement strategy and electronic payments.  Prior to joining HSBlox, Lynn served as Chief Product Officer at Payspan, Inc., where he led the creation of the healthcare industry’s largest B2B electronic payments platform, and technology-enabled initiatives with insurance carriers, healthcare providers, and financial institutions.  With the increasing focus on value-based and population health programs, Lynn is leading HSBlox’s design of blockchain solutions for the healthcare ecosystem.


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