Friday, August 25, 2017

Four Reasons Why Blockchain isn't the next big disruptor in HealthIT

Don't get me wrong, Block Chain is cool technology, but it is probably NOT the next big disruptor in healthcare.  It's certainly a hammer in search of a nail, but there are so many fasteners in healthcare that we are working with that simply aren't nails.

Fundamentally, Block Chain is a way to securely trace (validate) transactions.  For digital currency, the notion of transaction is fairly simple, I exchange with you some quantity of stuff ... Bitcoin for example. The block chain becomes the evidence of transfer of the stuff.  It's a public ledger of "exchanges".  The value add of the block chain is that it becomes a way to verify transactions.

1. The Unit of Exchange is Different

What's the transaction unit in healthcare?  In my world, it is knowledge related, rather than monetarily related.  The smallest units of knowledge are akin to data types, a medication (code), a condition (code), a lab result (code and value), a procedure (code), an order, an attachment, an address.  Larger units are like FHIR resources, associating data together into meaningful assertions.

2. The Scale of the Problem is Different

Today, there are about 200,000 Bitcoin transactions a day.  If we look at the unit of exchange I mentioned above, a typical CCDA document embodies something on the order of 100 knowledge units.  Let's say there are 150,000 physicians in the US, and each one sees 20 patients a day.  Multiply 150,000 x 20 x 100 = 300 million transactions per day.  To put that number in perspective, Amazon sold about 36 million items on Cyber Monday in 2013.

3. Transactions are Private

When the unit of exchange is an association of an individual (the patient) with a problem, medication or allergy, asserted by another individual (the provider) it's not the same as when it is the exchange is of a disclosed public quantity of stuff between two pseudonymous addresses.  Public ledgers, even with some level of protection behind them, still contain a persistent record of all transactions. After an assertion is made, the effects are pretty permanent, including any damage done, all future assertions to the contrary not-withstanding.  Ask any patient who's every been falsely accused of drug seeking behavior.

4. The Fundamental Problem is Different

The challenge in health IT is not "verification" of knowledge exchanges (transactions), but rather, "enabling" knowledge exchanges between two parties.  With block chain, the question of where to go to "get the ledger" isn't an issue.  In healthcare today, it is.

Block chain is cool tech, no doubt.  Surely there is a use for it in healthcare.  But also, it isn't the answer to every problem, nor specifically the answer to the "Interoperability" problem.  Though right now, you can be assured that it is effectively a free square in your next Interoperability buzzword bingo session.

   -- Keith


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