Blockchain Not a Cure for EHR Interoperability

By James D’Arezzo, CEO, Condusiv Technologies.

Jim D'Arezzo
Jim D’Arezzo

Much has been written about the prospect of using blockchain technology as a key component of achieving EHR interoperability. It has been widely reported that 55 percent of surveyed hospitals indicated a desire to initiate some sort of blockchain program within the next two years.

However, as with many game-changing approaches, the devil is in the details. Blockchain technology presents a huge challenge when it comes to impact on the data center–whether that data center is on premises, in the cloud or a hybrid cloud configuration. The tsunami of data added to the already overwhelming amount of required information could swamp a healthcare organization. In addition, the performance decline from this mass of information may negate the positive aspects of using blockchain for EHR interoperability.

Let’s first look at the positives. Defined by the Office of the National Coordinator for Health Information Technology (ONC), interoperability under the health information technology arm includes three specific functions. First, it involves the secure exchange of electronic health information without special user effort. Second, it “allows for complete access, exchange, and use of all electronically accessible health information for authorized use under applicable state or federal law.” Third, it prohibits specific information blocking, the act of “knowingly and unreasonably” interfering with the exchange and use of electronic health information. If implemented properly, blockchain can meet these requirements exceptionally well.

Now for the challenge. Blockchain is slow. In the most recently available study, the Bitcoin network — the largest and most widely tested application of blockchain technology — achieved maximum throughput nearly 50 times slower than PayPal and 14,000 times slower than VisaNet. If blockchain-based applications come in on top of the already staggering load of data handling required of IT in the healthcare sector today, the danger of major system slowdowns, and even system crashes, will increase dramatically. In the healthcare environment, these IT disasters could have life-or-death consequences.

What to do?

Healthcare IT managers are already challenged by application performance. The speed (or lack of it) of pulling up electronic health records, medical images, test data and the growing use of advanced predictive analytics data is already daunting. Many medical practitioners are already frustrated by slow data performance.

The answer is to get the existing house in order first. Actions, such as an equipment refresh, network upgrades and I/O optimization, will significantly improve performance. Of course, budget is a major consideration, but to use an analogy, there is no point in planning to double or triple the traffic on an already congested, crumbling freeway system and expect everything to flow nicely. There are solutions that are extremely cost-effective that can boost performance 50 percent or more without a hardware or network upgrade.

The fact is, between 30 percent and 40 percent of application performance is being robbed by small, fractured, random I/O being generated because of the Windows operating system (any Windows operating system, including Windows 10 or Windows Server 2019). Windows is an amazing solution used by a reported 80 percent of all systems globally, but as the storage layer has been logically separated from the compute layer and more systems are being virtualized, Windows handles I/O logically rather than physically, meaning it breaks down reads and writes to their lowest common denominator. This creates tiny, fractured, random I/O that results in a “noisy” environment.

If a growing number of virtualized systems are added into the mix, overhead is created (known as the “I/O blender effect”). The bottom line: much of performance degradation can be solved by software. Rather than buying a “forklift upgrade” of new hardware, many organizations are offloading as much as 50 percent or more of their I/O to dramatically improve performance. Applying a software solution also helps IT managers avoid the disruption of migrating to new systems, rip and replacement of hardware, end-user training and other challenges.

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