How many times a day do you wish you had more information to better help a patient in your pharmacy? Perhaps a recent patient hospitalization looks like nonadherence according to your dispensing patterns. An ICD-10 (International Classification of Diseases, Tenth Edition), code identifying a condition could help you counsel a patient receiving a new medication with multiple indications. Knowledge about recent test results could help you expedite a lagging prior authorization. Similarly, it would be good to know that the immunization you provided was updated in all of the patient’s healthcare records.
The records within our pharmacy management system are accurate and complete for what we dispensed, but there is little or no sharing of relevant healthcare data other than to the pharmacy benefit manager to adjudicate claims, or to a prescription drug monitoring program for controlled substances, as is required by the state. Immunization registries are improving but are not often integrated with other healthcare information, especially for adults.
Would it not be great to have all of a patient’s healthcare data accessible to us via a single process? This concept and need has been around for decades, but they have been elusive to operationalize. Standards for a unique patient identification number were a government focus area in the mid-1990s, but concern over government control, risk for identity theft, and cost led Congress to kill the initiative in 1998. The topic continues to percolate, with major goals being to share healthcare information amongst providers and reduce patient misidentification. A new solution, blockchain, may provide a way to accomplish this long-sought objective and eliminate data silos. HealthITAnalytics has published a couple of good articles about blockchain.1,2
What Is Blockchain?
With blockchain, each of the healthcare providers (ie, member of the patient’s “community”), including pharmacy, holds its own copy of the complete shared dataset for patients. When one wishes to update or change the data, a series of cryptographic criteria are used to verify the entity making the changes. Every member of the “community” (eg, physician, specialist, pharmacist) authorizes the changes, which are then updated to each local copy to reflect the changes. The edit becomes a “block,” or a fixed event, that has been approved and locked into place. As these changes accumulate, each “block” is added to the “chain” of events, hence the name “blockchain.”
What are the benefits of this approach? Each edit has a timestamp indicating when it was added. Members of the “community” retain control over who can edit data. This includes the patient, who could be in control of who adds information and who has access to information. For example, if a patient has a life-threatening condition that requires a health alert bracelet, that information should most likely be available to all healthcare providers. HIV or mental health status, however, may be sensitive information that the patient may want to limit access to.
I like this approach, as a pharmacist and as a patient. It would help to address the issues identified at the beginning of this article. As a patient, it would give me control over what information is added, and to whom the information is available for review. This blockchain concept would be a great way to coordinate care, make better use of healthcare providers, manage costs, and, one hopes, improve outcomes. Medication reconciliation is a good example of how blockchain could provide relevant information to ensure safe and effective use of the most recent medication orders.
The goal is not to replace pharmacy records or a physician office’s electronic health records (EHRs). Rather, it is to augment these healthcare records with new exchange capabilities to provide a more complete, clearer picture of the patient’s healthcare information. This solution is not as far away as it sounds. A 2016 IBM survey of healthcare organizations reports that the majority of organizations expected to have some type of blockchain solution in place within 3 years.3 Because a large infrastructure is not needed, and because blockchain is more of an “access” approach to the data, I think this solution could be in place by 2020 in some organizations.
As with many new breakthrough technology solutions, there are barriers to overcome. For blockchain, concerns to address include:
- Knowledgeable and proactive patients to participate in the process
- Management of the blockchain to prevent duplicate entries, control access, and more
- Interfaces between the various EHR systems, pharmacy, and other health information technology systems contributing to and accessing the blockchain
- Increased workload for healthcare members to authorize all changes made by other “community” parties
- Security is needed to safeguard this information; it has to be protected like your driver’s license and social security number
- Last but not least, who pays for this?
I anticipate you will hear more about blockchain as a technology solution, inside and outside healthcare. This approach is the best I have seen that involves multiple healthcare providers, including pharmacy. Although the concept is intriguing, many challenges remain to be solved and barriers to overcome. Expect to hear more about blockchain as a healthcare technology solution in the future. Stay tuned!
- Bresnick J. Is blockchain the answer to healthcare’s big data problems? HealthITAnalytics. April 27, 2016. http://healthitanalytics.com/news/is-blockchain-the-answer-to-healthcares-big-data-problems. Accessed May 9, 2017.
- Snell E. Why blockchain technology matters for healthcare security. HealthITAnalytics. http://healthitsecurity.com/features/why-blockchain-technology-matters-for-healthcare-security. Accessed May 9, 2017.
- IBM Institute for Business Value. Healthcare rallies for blockchains. IBM. 2016. https://public.dhe.ibm.com/common/ssi/ecm/gb/en/gbe03790usen/GBE03790USEN.PDF. Accessed May 23, 2017.