Electronic Health Reporter

By Ben Flock, chief healthcare strategist, TEKsystems.

Healthcare professionals know that blockchain is coming, but there is still some apprehension associated with the technology. The cryptocurrency industry first pioneered this technology and its results have been highly impressive. But when it comes to the healthcare industry, there is a lack of proven use cases, leading to a delay in blockchain’s widespread adoption.

To pull back the curtain on the reluctance to adopt blockchain technology, TEKsystems partnered with HIMSS Analytics to host a focus group of business and technology leaders from the payer, provider, pharma and public sector. The goal: to better understand customer needs and business challenges when it comes to actually implementing blockchain.

Findings revealed that, as most in the industry already know or suspect, there is a limited overall understanding of blockchain technology. However, it seems that this limited knowledge is the foundation for most of the apprehension toward widely adopting the technology. Additional roadblocks that contribute to this apprehension include the lack of impactful use cases, fears of what the unspecified governance of data could mean for compliance, security concerns and industry politics, among others.

There is good news—those who have a basic understanding of blockchain exhibit less apprehension and a more cautious exuberance toward adoption of the technology. As understanding of blockchain grows and more practical examples of its benefits are found, the healthcare industry will become more open to implementing blockchain solutions.

During the focus group, participants discussed proven use cases for blockchain that could be used as industry examples to help increase the general understanding of blockchain technology. The group identified three main use cases that could be implemented in the near term after a short testing period: provider directory updates, expediting the provider credentialing process and prior authorization.

A provider directory was the first use case identified by the focus group. Insurance companies must provide patients with timely, accurate provider contact information and new patient availability. While Centers for Medicare & Medicaid Services (CMS) regulate provider directory services, many of them are inefficient, costly and often laden with manual processes. With blockchain, the provider ledger could be maintained through a proactive, structured, perpetual process enabling open and direct access to provider information on an as-needed basis. Because provider directory information is already public record, it’s a high-result, low-risk proof-of-concept project.

The second possible proof of concept for blockchain is in the provider credentialing process. Physicians, of course, must be credentialed to legally practice medicine. That process involves sharing sensitive information like background information, litigations and score carding information, which must be made available and updated annually. This process is currently lengthy and costly due to the manual updates that are required to keep the log of credentials accurate and up to date. Blockchain technology could automate the entire credentialing process, enabling turnkey interoperability and data transparency. By cutting the time and money that must be spent on credentialing, there is a strong business ROI for this particular blockchain proof of concept.

Prior authorization is another strong example of a rewarding blockchain use case. Currently, patients and providers alike find the prior authorization process complex, costly and frustrating. Moreover, specialty procedures requiring preauthorization often take weeks due to the large documents that must be shared and manually reviewed. Quality of care can be negatively impacted as a result, and administrative costs skyrocket with every delay. However, blockchain could disintermediate the participants in this process and automate decisions, making the process faster as well as more transparent, secure and affordable.

These use cases all share traits that will enable their success. Proof-of-concept use cases and tests must be low risk, achievable in a short time frame and transparent so that decision-makers can watch what is happening in real time. Additionally, it is usually necessary to secure strong IT and business sponsors for these tests to ensure there are internal champions who will better understand blockchain technology and become internal evangelists for adopting it upon a successful trial.

Proof of concepts that can be completed in the short term will help both the teams working with blockchain and internal decision-makers to better understand and address long-term challenges, potential problems and more complex use cases. Blockchain will prove to be an incredibly useful solution to many common challenges in the healthcare industry. Its distributed ledger technology is the answer to the problems that arise when multiple parties must share sensitive data over multiple transactions.

There is enormous potential for blockchain technology, but only through proven use cases and a stronger general understanding of blockchain will the industry be able to avoid the roadblocks encountered today. Blockchain will eventually realize its potential as a major industry disruptor and live up to the hype. But first, industry and technology vendors must innovate around common tools and systems to discover the simpler, more cost-effective solutions that exist on the horizon.