In the United States, aggregators such as Mint.com have already dis-intermediated banks and now own the ‘last mile’ of the customer banking relationship, disrupting traditional players.
Having worked in healthcare technology for the last 20 years, this rings bells for me around the area of ‘patient or citizen relationship management’.
By that, I mean the way that health and care organisations interact with citizens and patients. In an ideal world, I would expect them to use the data they have to develop and manage their relationships with citizens and patients. This would focus specifically on improving their health and wellbeing and delivering better outcomes at a reduced cost.
You can imagine a scenario where a disruptor such as Apple, Google or Samsung obtains access to someone’s health information by consent, in a similar fashion to ‘open banking’. It would then be able to amalgamate it with information around lifestyle (eating habits, sleeping, exercise), genetic makeup, preferences and health and care details. With this insight, it could help manage long-term conditions, new health problems or just suggest preventative advice.
But it could go further. It would have the capacity to monitor how people are doing (blood pressure, heart rate, blood sugar, medications). It would also enable patients to update information and share it with relevant parties. Alerts could be sent, and patients would get help when they needed it.
Patients (or citizens) would always be confident that the data is shared securely with their consent and only with the people or organisations that they have approved. It would be easy to see who has accessed the information and to track what has been done to it and by whom.
In summary, it is a solution that is central and tailored to patients’/citizens’ needs and they can be confident that it is taking a holistic view when recommending and driving solutions to improve their health and maintain their wellbeing.
As in the banking sector, it will only be a matter of time before third party and independent service providers will build the capabilities to enable them to aggregate health and well-being information in this way. Such providers will need to support security measures such as encryption, strong client authentication and auditing to keep healthcare transactions and information secure. These solutions will need to be scalable and efficient with high availability and reliability.
Healthcare solution providers such as Electronic Health Records (EHRs) will need to offer services that can be consumed by external third parties and think more creatively about how to use such independent services for their own offerings.
The blockchain approach, best known as the schema that underpins the Bitcoin ecosystem, might just be the overhaul that healthcare is looking for. It allows digital information to be distributed but not copied and whilst it relies on it being in one location, it is available from different sources.
Medrec, for instance, has developed a solution that provides patients with one-stop-shop access to their medical history across multiple providers. It uses smart contract data structures that are stored on the blockchain and associate references to disparate medical data. It has developed ownership and viewership permissions and record retrieval location. This provides an immutable data-lifecycle log, with complete auditability. It is notable that the raw medical record content is never stored on the blockchain, but rather kept securely in providers’ existing data storage infrastructure.
But the blockchain approach will not be achieved overnight. Although there is a great deal of thinking and some development that has already been done in this sector, there are several steps that will need to be taken before such a vision can be achieved.
For instance, the digital maturity of the information held in health and care organisations will need to increase significantly.
Mechanisms to integrate and inform data from different sources inside and outside health and care organisations will need to be established.
Only then can we imagine a scenario where this information can be augmented with fitbit, wearables, insideables, eating and sleeping habits, physical activity, research, genomes and genetics to build a complete picture of citizens and patients.
The final step is to make this information available securely to end users in a way that they gain insights about their condition and lifestyle and offer advice and guidance that can improve their health and wellbeing.
It is good news, therefore, that blockchain is being considered as part of solutions to improve the health and wellbeing of patients and citizens, otherwise some ground breaking and revolutionary opportunities could be missed.