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Each interaction within the healthcare system generates critical patient data that needs to be available across hospitals, practices, or clinics. With the HITECH Act of 2009 and ACA 2010, Electronic Health Records (EHR) became the norm to collect patient information. Consequently, the industry witnessed a surge in the amount of patient data collected and stored. Despite the progress in digitalization of the healthcare system, the industry faces many challenges due to the lack of a standardized framework for seamless communication & interoperability between medical systems & software. Some of the challenges are:
- Lack of API standardization for patient data access
- Limited patient access to health records and data
- Permission conflicts to access information from different data sources
HIMSS and Interoperability
The Healthcare Information and Management Systems Society (HIMSS) developed a set of definitions of interoperability. HIMSS classifies interoperability into four levels.
- Foundational (Level 1) establishes the inter-connectivity requirements needed for any system or application to send and receive data securely from one another.
- Structural (Level 2) defines the format, syntax, and organization of data exchange, including interpretation at the data field level.
- Semantic (Level 3) provides for standard underlying models and codification of the data. With these definitions, users can get a shared understanding and meaning of the data.
- Organizational (Level 4) addresses the governance, social, legal, policy, and organizational considerations to create secure, seamless, and timely communication. These components enable shared consent, trust, and integrated end-user processes and workflows.
Understanding the need of the hour, several standards were introduced. These standards are categorized into five categories: vocabulary or terminology standards, content standards, transport standards, privacy and security standards, and identifier standards. Each of these standards is used to process patient information and improve the overall coordination and delivery of healthcare and data transfer regardless of application or market supplier.
Blockchain for Interoperability
While interoperability is the ability to see and access data across various systems, several standards, governance mechanisms, and data quality are used. The varying use of data standards can affect interoperability. Amidst the challenges that healthcare continues to face to create seamless interoperability, blockchain is slowly emerging as the technology that could be the solution to address these issues. Broadly, blockchain can be implemented in five primary areas to:
- Manage Electronic Medical Records (EMR) data
- Protect healthcare data
- Manage personal health record data
- Manage point-of-care genomics
- Manage EHR data
Using public-key cryptography, blockchain provides a mechanism to protect the data from forgery or tampering. The success of blockchain technology in healthcare is directly related to how different blockchain networks are established to interact and integrate with a foundation of a secure, permission-based framework for data exchange.
Blockchains in healthcare can be used to replace the centralized server system for the transfer of data. Primarily, blockchain will help with
- Disintermediation of databases to improve visibility of patient information
- Removal of central authority to manage database reducing hacking attacks
- Immutability of transactions
- Validation without the involvement of any central verification agency
Several organizations in the US are launching new initiatives and prototypes to address the issues related to EHR interoperability. Some of them are:
- US HSS encouraged Blockchain in Health IT through an ideation challenge, “Use of blockchain in health IT and health-related research.”
- HL7 created Fast Healthcare Interoperability Resources Specification (FHIR) for EHR exchange.
- MIT Media Lab and Beth Israel Deaconess Medical Center tested a blockchain-based working prototype, “MedRec.”
Benefits of Blockchain in Healthcare
Blockchain technology has proven to help integrate scattered healthcare information across service providers. The use of blockchain can help healthcare providers with the following benefits:
- The sharable private key enables seamless switching of patients between providers.
- Digital ledger technology reduces instances of unintended data sharing.
- Promotes clinical research, improve adverse event reporting
- Smart contacts eliminate the need for intermediaries, thus improving efficiency and transparency.
- Default encryption in blockchain enhances data security.
- A single system of health records offers faster diagnosis, affordable patient care, and reliable diagnosis communication without mistakes.
- Interoperable electronic health records with a single transaction layer enable the use of uniformed authorization protocols and smart contacts.
- Builds reliability, trust, and transparency of patient consent and data management during clinical trials
- Enables mobile health apps and remote monitoring of Electronic Medical Records (EMRs)
What is the future of Blockchain in Healthcare?
The rapidly changing landscape of the healthcare and life sciences industries needs a technology that can keep up. Although blockchain has proven its capabilities in mitigating issues related to trust and collaboration, major healthcare players still have a long road ahead. To enhance the usability of Blockchain in healthcare, HHS should establish a blockchain framework to coordinate early adopters of the technology.
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