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Blockchain as a Technology

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1. Introduction

A blockchain is a chain of records, called blocks, used to maintain a cumulatively growing list of digital transactions, such as electronic healthcare records (EHR) or electronic medical records (EMR) in the healthcare industry. Each block contains a timestamp and a digital signature, and links to a previous block. The blocks also contain a nonce, which is an integer used during the mining process. The nonce fortifies the block from hackers or unwanted users by making the integer as unique as possible and extremely difficult to re-run or reuse.
Blockchain is poised to make our digital transactions more efficient by removing intermediaries from the process. Forrester’s “Top 10 Technology Trends to Watch: 2018 to 2020” report predicts that by 2019 “a viable blockchain-based market will be commercialized.”

2. Why blockchain matters

Industry disruptor

No central authority or third-party transaction verifiers such as auditors, legal services, payment processors, brokerages and other similar organizations needed to verify trust and the transfer of value

Less oversight and fewer intermediaries save costs

All participants have access to a copy of the ledger, eliminating the duplication of effort

A smaller number of participants can use it privately by deploying a “permissioned blockchain” to control who participates in transaction activity

3. How can blockchain help healthcare?

In a recent survey by PwC, financial services is a leader in blockchain development, at 46%, compared to energy and utilities (12%), industrial products (12%) and healthcare (11%).2 Although the benefits of blockchain are multifold, we still need to evaluate and identify transactions that are a natural fit for this technology. Because blockchain is immutable, trustless, decentralized and distributed, it holds the potential to disintermediate processes, optimize workflows, cut operational costs, eliminate duplication of work and fight fraud. All of this improves transparency in the healthcare industry, saving billions of dollars.
Blockchain can benefit healthcare in the following ways:

Claims and billing managementransfer of value
Blockchain implemented in the claims adjudication and billing management process will help all parties be aware of their share of the projected cost for a service. It can further reduce administrative costs by automating the billing and insurance related (BIR) activities.

Medical data management.
Blockchain can improve interoperability and secure the exchange of healthcare information. The ability to track patients in real time improves care coordination, which is also a fundamental requirement for value-based and cost-effective care.

Reducing fraud.
Fraud costs the insurance industry more than $80 billion annually.3 Blockchain can help determine if a submission is valid, mitigating fraudulent activities by securely pulling data from multiple sources at any point in a transaction.

Health research and clinical trials
An estimated 50% of clinical trials go unreported.4 Using time-stamped records and results, blockchain advancements can address selective reporting and the manipulation of results, which will reduce fraud and errors in clinical trial records.

Tracking counterfeit drugs.
Pharmaceutical companies incur an estimated annual loss of $200 billion due to counterfeit drugs.5 Blockchain could create a “single source of truth” surrounding the movement of goods and help maintain integrity by tracking each step of the drug supply chain at the individual drug/product level.

Securing protected health information (PHI).
From 2015 through 2016, 140 million patient records were breached, affecting more than 27 million patient records.6 Apart from hacking and ransomware, 43% of such breaches (192 incidents) were internal due to insider error or wrongdoing.6 The existing healthcare IT architecture may not be sufficient to monitor and secure connected devices (internet of medical things, or IoMT). Using blockchain can alleviate privacy and reliability concerns.

Reducing healthcare costs and improving transparency with blockchain
Today, the healthcare industry is using automation and artificial intelligence (AI) across the payer and provider landscape. While payers can significantly reduce costs and improve efficiencies with robotic process automation (RPA), providers are using AI-powered systems to improve the accuracy of diagnostics and create seamless patient experiences. As the healthcare industry gets smarter about the use of data analytics and starts adopting automation and AI-powered solutions, many innovative and expedient solutions will be implemented across the industry. But the real benefit will come from adding blockchain technology to this AI-powered system, what MAH HEALTH 8 Estonia, Europe. www.MAHhealthcare.com I www.MAH.healthcare PASSPORT calls AI-blended blockchain. Let’s put this into context. Although the healthcare industry has been adopting electronic transaction systems over the last 20 years, manual transaction processes still account for roughly $10 billion USD and Eligibility and Benefit verification accounts for more than half of this spend.7 Several factors contribute to this, including convoluted rules that actually decrease efficiency, complex administration costs primarily associated with BIR, gaps in care coordination such as fragmented care delivery processes, and loss of continuity of both patient data and provider assessments. Other challenges include recent changes in the legislative landscape, namely the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Patient Protection and Affordable Care Act (ACA). Introducing blockchain solutions and weaving in RPA across the provider, agent and payer landscape can have a tremendous impact on the healthcare industry. The blockchain solutions can bring much-needed efficiency and transparency by making every transaction unique, immutable and accessible in real time, while automation can bring in speed and cost efficiencies. Such a system can ensure patients are better informed of projected costs, because payers and providers will have all the data (both historical and current) at hand. It will also enable accurate reporting, hitherto a difficult task, because all data will be available and processed in near real time. Together, blockchain and AI-powered systems can drive down overall costs, significantly reduce BIR and, most importantly, root out fraudulent transactions. This can improve the customer experience by expediting overall system performance from days or weeks to minutes and even seconds.

Medical records also prove critical for research. The ONC's report emphasizes that biomedical and public health researchers “require the ability to analyze information from many sources in order to identify public health risks, develop new treatments and cures, and enable precision medicine”. Though some data trickles through to researchers from clinical studies, surveys, and teaching hospitals, we note a growing interest among patients, care providers and regulatory bodies to responsibly share more data, and thus enable better care for others. In this work, we explore a blockchain structure applied to EHRs. We build on this distributed ledger protocol originally associated with Bitcoin. The blockchain uses public key cryptography to create an append-only, immutable, timestamped chain of content. Copies of the blockchain are distributed on each participating node in the network. The Proof of Work algorithm used to secure the content from tampering depends on a “trustless” model, where individual nodes must compete to solve computationally intensive “puzzles” (hashing exercises) before the next block of content can be appended to the chain. These worker nodes are known as “miners,” and the work required of miners to append blocks ensures that it is difficult to rewrite history on the blockchain. Our MAH Health passport blockchain implementation addresses the four major issues highlighted above: fragmented, slow access to medical data; system interoperability; patient agency; improved data quality and quantity for medical research.