Unchaining the Blockchain

Perhaps the buzziest buzzword of 2017 (with the potential exception of “design thinking“) is BLOCKCHAIN.  Hailed as the answer to all our problems with IT privacy and connectivity across every industry worldwide, I’ve had more blockchain emails, articles, and messages hit my inbox in the last few months than all other “solutions of the future” combined.

Anyone in healthcare leadership whose email address has somehow found its way “into the ether” knows the experience I’m describing – the nonstop flow of messages from vendors, list-serves, and myriad other “experts” around new technologies promising to transform the world as we know it.

While these emails nearly universally wind-up in the electronic equivalent of the circular filing bin, those referencing blockchain have become increasingly interesting over the last six months.  Two of the best long-form posts I’ve read include this one from NEJM Catalyst and this one from Harvard Business Review.

I’ve become convinced that once vendors figure out how to operationalize blockchain – and stakeholders agree to both the costs and significant operational changes required to actually implement solutions based on it – the dynamics and flow of information through healthcare will be fundamentally changed in the same way Netflix permanently disrupted the home video business.

Here’s why… in as non-technical a way as I can describe it:

Our present world of information is built on the siloed universe of depots – segregated companies who own segregated data used for segregated purposes.  Myriad internal databases live within organizations and in many cases form the lifeblood of their ability to function (think a bank’s ledger, a physician practice’s collection of medical records, a grocery store’s inventory, and so on).

Each organization and each database within organizations have individual security and structure protocols, such that even within the same organization it can take an enormous IT lift for databases with complimentary information to interface at all much less in real-time.

In some cases this kind of database segregation is integral to an organization’s business model – the switching costs can be huge when you’re locked into one organization and its collection of databases, and are often large themselves to generate “loyalty.”  Think about whether you’re an Apple or a Samsung smartphone user – even if the alternative brand is cheaper or somewhat better, you’ve probably stuck with whatever personal brand choice you made a decade ago because the thought of rebuying all your apps, transferring your contacts, and figuring out a new operating system are so seemingly daunting.

Blockchain will (eventually) fundamentally disrupt this paradigm – at its core, technologies powered by blockchain free information from the shackles of individually locked systems by enabling real-time sharing, verifying, and updating across systems.  The authors of the HBR article I referenced above describe it like this:

With blockchain, we can imagine a world in which contracts are embedded in digital code and stored in transparent, shared databases, where they are protected from deletion, tampering, and revision. In this world every agreement, every process, every task, and every payment would have a digital record and signature that could be identified, validated, stored, and shared. Intermediaries like lawyers, brokers, and bankers might no longer be necessary. Individuals, organizations, machines, and algorithms would freely transact and interact with one another with little friction. This is the immense potential of blockchain. (Iansiti and Lakhani, HBR)

In healthcare, the applicability of a simultaneously secure and “shared” database updated in real-time across disparate entity platforms will be myriad.

Imagine how much greater our ability to respond to America’s opiate epidemic would be right now if we had instantaneous visibility into every narcotic prescription filled from every pharmacy for every patient across the country.

Imagine how much easier medication reconciliation will be when we have a master medication list for every patient with impenetrable fidelity across electronic medical records, pharmacies, insurance claims, and the patient’s own record-keeping.

Imagine the power we will have as patients when we become the masters of our own personal health records, granting certain levels of read-write access to our individual health blockchains for different entities (primary care, specialist, hospital, pharmacy, post-acute, health plan, etc…) with standardized “emergency access” fields for EMS or ED providers to use for saving our lives if we’re unconscious.

Much like the imaginary advances of the past -think flying machines, video conferencing, and autonomous cars – these too will become commonplace within the next decade.  Like every advance we’ve imagined as humans, they require both breakthroughs in technology and major adaptations in infrastructure to translate from imagination to reality.

Blockchain fundamentally changes the technology of database design – our ability to assimilate this advance in technology into solutions that disrupt the infrastructure of healthcare’s data and delivery systems will dictate whether and how fast these imaginary advances actually reach patients.

So what do you think?  Will blockchain live up to its potential or fizzle like other technologies (think the Segway) that promised to change our lives forever?


1 Comment

  1. A fascinating post about blockchain and its potential!

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