In my previous two blog posts, I provided a technical overview of Blockchain, a secure, distributed database technology. I used a Blockchain-based personal health record (PHR) system as an illustrative example to explain how the technology applies to healthcare. A PHR is composed of a series of documents, which fits well with Blockchain’s design, so it makes a straightforward example. However, as Matt commented in a previous blog post, a data storage technology is only useful to healthcare if it can enable the full gamut of use cases, including population health management.
To understand the relevance of Blockchain to the full gamut of healthcare use cases, it is necessary to go beyond the technology and understand how Blockchain’s organizing principles differ from traditional infrastructure. A great way to do that is with an example from the financial industry.
Bitcoin vs. Traditional Commerce
Money is a way of representing value, and it only works because there is broad agreement on how currency is valued. Historically, the way to gain this consensus was for a powerful central authority – typically a government – to establish and control the currency system. Over time, the central financial authority has grown to include a federation of governments, banks, and other powerful institutions that record, coordinate, validate, and ensure the accuracy of financial transactions. Trust in these institutions leads to a reliable infrastructure for conducting commerce.
Bitcoin, the electronic currency built upon the Blockchain architecture, demonstrates that a trusted infrastructure – not the centralized concentration of power – is the important part of that equation. Bitcoin provides all the same core services as the traditional financial system on a distributed, peer-to-peer infrastructure. Trust in technology, like trust in institutions, allows for a reliable financial infrastructure.
Blockchain vs. Traditional Data Structures
Commerce is not the only place that a trusted technology can replace a trusted institution to provide a robust infrastructure. Blockchain can power just about any database that requires authoritative record keeping without creating a centralized place to store and validate the transactions. But without the centralized transaction store, how can applications be built that efficiently operate on a large set of transactions? Or in the context or healthcare, how do you effectively manage population health if transactions are divided across a peer-to-peer network instead of stored in a centralized location?
Population health management has two components: measuring the outcomes of a group of individual patients (e.g., incidents of influenza) and influencing patient actions to help make the outcomes more favorable (e.g. recommending annual flu shots). Measuring outcomes requires a fairly small amount of data, but influencing actions typically requires more context – essentially the entire patient record. Population health management systems tend to be built on a centralized stack because that's the most convenient way to provide both types of data with currently available technology.
There is another way to use technology to achieve population health goals. Providers and payers can measure outcomes based on diagnosis or billing data. They don't need to have the complete, longitudinal patient record to construct these measures. The rules for managing an individual patient's health need to operate over the complete patient record, but those can be implemented in an app on the patient's mobile device, rather than in a proprietary system that holds a central copy of the data.
Under this model it's possible to essentially make the patient the “data platform.”
Putting the patient in control of their complete medical record has a number of benefits.
- They always have their entire medical record available
- They don’t have to trust an institution to be the steward of their data
- They can still participate in population health initiatives
- Patient engagement is increased
When will a shift like this occur? Time will tell. But now it's at least a possibility given new technologies like Blockchain.