Blockchain

AAHKS Digital Health Committee
 
Digital Health White Papers

A blockchain is a digitized, decentralized, public ledger of all cryptocurrency transactions. Constantly
growing as “completed” blocks, the most recent transactions are recorded and added to it in
chronological order. It allows market participants to keep track of digital currency transactions without
central recordkeeping. Each node (a computer connected to the network) gets a copy of the blockchain,
which is downloaded automatically.

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Originally developed as the accounting method for the virtual currency Bitcoin, blockchains – which use
what’s known as distributed ledger technology (DLT) – are appearing in a variety of commercial
applications today. Currently, the technology is primarily used to verify transactions within digital
currencies; although, it is possible to digitize, code and insert practically any document into the
blockchain. Doing so creates an indelible record that cannot be changed; furthermore, the record’s
authenticity can be verified by the entire community using the blockchain instead of a single, centralized
authority. Source: Investopedia (https://www.investopedia.com/terms/b/blockchain.asp)
Blockchain’s application in healthcare can be extensive, with examples outlined below:

Patient medical records

Most people have access to just a sliver of their health history, but blockchain could help pull together a
lifetime of transactions from multiple health systems, pharmacies and health plans. This information
could be processed into readable information for a patient’s own use or converted into records that can
be read by a variety of electronic medical records systems. Links to detailed information about
procedures, encounters, diagnoses, claims and prescriptions could be added over time, and access to
this information could be managed by the patient or the patient’s designees.

Clinical trials and registries

Using blockchain, companies can securely share data generated by clinical trials, such as patient
demographics and information about adverse reactions. Interim results could be shared with sponsors
and regulators. The technology also can help manage and track informed consent across multiple sites,
systems and protocols. Blockchain could be used to collect, build upon and share patient data profiles
across multiple trial sites—even virtual trial sites as they are developed. If applied to consent
management, blockchain could give the patient control to grant access to other researchers who might
access their data in the future.

Insurance authorization and claims

The ability to ensure that claims are accurate, and to spot fraudulent claims, is particularly important in
Medicare and Medicaid where payments must be coordinated between payers, providers, the federal
government and banks. A smart contract could be used to show proof of adjudication. For example, the
act of a patient checking in for a clinic visit, or logging into a virtual appointment online, could be
confirmed by the health system’s financial or clinical systems. This transaction could be combined with
others from the same clinic that day and uploaded to a blockchain that is accessible to the health plan.
An employee at the health plan could see the completed transaction and reimburse the health system
accordingly. Claims review could be streamlined because encounter data would be accessible and easily
verified on a blockchain. Health systems and physicians also could connect with health plans to
determine information about a patient’s health coverage, or to verify patient demographics.

Source: PWC (https://deloitte.wsj.com/cfo/2018/04/12/five‐possible‐uses‐for‐blockchain‐in‐health‐care/)

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