Moving to a patient-centric model to health care means moving from a system based around closed formal organizations to one that takes the form of an open network. We are currently recreating the wheel within many different centralized organizations when what we need are networks that use knowledge, resources, and data in a synergistic way. This means breaking down the silos, unbundling capacities and building platforms where those resources can be made available on demand via information-based networks. This requires taking individual capabilities that are currently closed off behind organizational walls and opening them up to usages external to organizational boundaries within common shared platforms.
As it becomes more complex and pervasive health also has to become more integrated. The health system of the future will be an ecosystem of many different actors providing services. On a technical level, we can call this a health platform; open platforms where many autonomous distributed parts are integrated through networks. Modular services that can be configured and reconfigured in different ways to meet the needs of the end-user. A world where anyone qualified can provide a health service and earn health tokens from. These services can take many forms, not just the traditional health services but now we need to consider all factors that add or delete from the health of people. As we start to look at all sides of the equation health platforms have to incorporate both formal and informal aspects; factors that deal with sickness but also promote health building.
In contrast to the top-down model to managing health systems – that results in the formation of centralized organizations – the platform model is designed to facilitate emergence. This is because it is not designed to improve the internal efficiencies of an organization but instead strengthen the connectivity and synergies between a diversity of external autonomous actors, towards realizing self-organization. The platform model is based around a multi-level architecture where a low-level infrastructure of common services is built upon with more specific “applications” which can be connected together as needed. Instead of holding all the components to the system tightly together in a specific arrangement within the confines of one system it works by connecting modular capabilities external to the platform across whole industries.
Building these open platforms starts with building a common infrastructure to enable coordination and interoperability across the whole health system. A critical part of this is opening up data, so that it can be used, reused and shared as needed to facilitate coordination. In this respect, new approaches to working with health data are much needed if a platform model to healthcare is to be realized. Today digital healthcare is based in large part on closed electronic health records. The hope of EHR systems is that with the centralization of data would come better access to patient data, a reduction in medical errors and costs, with patient safety and outcomes improved.
However, the result of implementing centralized data repositories is that patient data often ends up fragmented across many healthcare stakeholders, since different providers often use different EHR systems. Interoperability challenges occur with data silos forming as the data stays where it was collected. Additionally, centralized EHR systems have become easy targets for hackers who have stolen millions of patient records and created disarray with various other forms of attacks. In 2015, over 112 million breaches occurred through IT hacks against healthcare records.1 Many healthcare facilities have as a consequence become wary of sharing or transferring data for fear of further compromises and complications.2
The fact that patient data is siloed, insecure, and stored in different EHR systems which cannot easily exchange information with others means also that there is a scarcity of usable population health data sets across diverse patient populations; important information that is needed to guide any real research and analysis of how the whole system is working. To enable open platforms we need an environment where data can be easily created, accessed and exchange by the relevant ecosystem members. If healthcare data were to be continually collected and assessed independent of physician interactions, health care may eventually be changed to become patient-focused instead, yielding efficiencies, improved outcomes, and lower costs – we need to empower the end user in every way possible and this starts with data, information and connectivity.
In this respect blockchain networks can be a key part of the technology infrastructure enabling this next generation health system. Blockchains are networks of autonomous computers that are incentivized towards maintaining a shared and secure database. As such, they provide a secure and shared computing infrastructure that does not belong to any one centralized organization, but an open network where data is tamper-proof, trustworthy and visible to all as required.
This shared computing infrastructure can form the substrate for distributed health platforms, where no one organization stands in the center but instead a diversity of autonomous actors are able to collaborate within a trusted shared data environment. Blockchain networks are peer-to-peer networks that enable people to hold and maintain their own health records within their own data wallet so that their data no longer resides within the fractures set of data silos of many different organizations.
This model has the ability to make personalized medicine default; treatments that are tailored to an individual based on their health data including medical history and genetics data. As data is critical to the whole system this shift of data ownership from institutions to the individual works to shift the locus of the system in the same direction so that patients are now much more empowered choosing when and to whom they share their data while at any time being able to revoke access. The service provisioning becomes decoupled from the ownership of data, this reduces monopolies and the lock-in effect of siloed information and makes it possible for the end-user to choose their service providers according to their specific needs.
Likewise, these self-sovereign health records enable the movement of data like liquid between stakeholders that need it, patients, caregivers, loved ones, doctors, nurses and between health system to health system. As there is just one record of the data there is a single source of truth that does not need to be endlessly replicated, what each person sees is just what they need to see based upon the permissions the end-user has granted them.
Currently, the average American adult has about 16 doctors during their lifetime meaning they have their data spread across 16 databases with no control over that data, this fragmentation and lack of interoperability gets worse when one’s health needs traverse national boundaries. Blockchain networks can create a protected personal decentralized cloud storage, tied to a global unique identifier that can transcend across state and national boundaries and can be shared through this open source network that is by default global.
Creating a single health database that is own by the end user creates massive data integration across many disparate domains. A blockchain based system can integrate personal and clinical data into one’s own personal wallet, compiling information over weeks and months, diet, telemedicine, home diagnosis, behavioral data, geolocation data, sleep patterns, blood pressure. This starts to give us real contextual information that can be shared with a clinician on-demand or it can even be anonymized and shared on mass for research purposes – anonymized data could be used across credential authorities, regulators, medical schools, labs, providers etc. to improve the quality of the overall system.
Likewise, a blockchain network can be open and transparent, helping to improve trust in the system. Trust is a major issue in healthcare, having one shared and tamper-proof database that retains a list of all transactions and alterations could greatly improve the trust within the ecosystem thus facilitating cooperations between stakeholders. Blockchain networks can create universal patient identifiers that aggregate data across multiple IT systems and integrate it into one global ID, so that we can get a complete longitudinal health record of a patient without having to move it to a central location. The blockchain network becomes that common transactional layer that sits between multiple interacting organizations and it takes out a lot of the inefficiencies and pain points that we all experience in the delivery of healthcare.
The key benefits of applying blockchain to population health data include improved, data integrity, shareability, interoperability, security, integrity, accessibility and real-time information. Basing the system on a decentralized secure network enables a trusted environment that is built around the end user working to facilitate coordination within and along the whole ecosystem towards better overall outcomes.