The Internet as we know it today was once a shiny new technology. And like many new shiny technologies, the Internet was misunderstood. Yet what we think to be the Internet—surfing websites, posting messages on Facebook and Googling for answers to arcane questions—is really something called the World Wide Web, a specialized set of services that runs across the Internet.
Blockchain is today’s Internet. It’s a new technology that heralds unprecedented change in communications. When we talk about the applications of blockchain in healthcare, it becomes extremely difficult to accurately apply the term blockchain to any known problem set, because everyone has their own uniquely-defined interpretation of this new terminology.
We suggest that the term blockchain, as more accurately embodying a set of closely related technologies, be instead referred to as blockchain technologies.
Blockchain technologies can be defined as three independent core technologies often implemented and utilized in a concerted system—distributed ledger technology (DLT), self-sovereign identity management (SSI) and cryptocurrency. Here’s a more detailed definition of each technology and how each are at work in today’s healthcare industry.
Distributed ledger technology
DLT is perhaps what most people understand a blockchain to be—a means for permanently recording information across a shared domain. Importantly, the DLT is extremely secure, by way of cryptography inherent in the design of a DLT, so much so that it’s often referred to as a trustless system: transactions can be made without the need for an intermediary, or trusted third party, such as an escrow.
In addition to being an extremely secure system, the DLT also incorporates a great degree of logical programmability, called smart contracts, into its design. Like the contract a lawyer might draw up between multiple parties that defines the rules and conditions for establishing a business relationship, smart contracts are programmable, digital equivalents in a DLT.
Within the healthcare industry, the DLT has been implemented in situations where multiple stakeholders across different domains are required to generate or share information that may not be owned or managed by any one stakeholder. In some cases, that information might be perceived as strategically valuable or conducive to alteration by less than well-meaning bad actors. In seeking a design that natively cannot—or should not—trust stakeholders, a DLT is a good solution.
An example of healthcare DLT solutions includes the Intelligent Health Care Network. Developed by Change Healthcare and launched in January 2018, the Intelligent Health Care Network is the first enterprise grade healthcare solution that utilizes blockchain technologies. The purpose of this solution is to provide more efficient health care claims tracking, processing and management. Change Healthcare’s approach uses a Hyperledger Fabric-based DLT to augment the traditional claims processing workflow, utilizing the DLT’s ability to serve as an immutable audit trail for workflow transactions.
Self-sovereign identity management
SSI, sometimes referred to in this context as simply identity management, like DLT, is often a companion system to a larger blockchain technologies solution. Also like DLT, SSI relies on the concept of managing state across a shared domain. Specifically, SSI is a set of technologies used to permit entities—businesses, individuals or their proxies—to govern their own identity without the need to rely on centralized identity data repositories.
So, instead of having to “log into” separate websites or remote healthcare services, typically each with a unique username and password, SSI permits an end user or entity to very securely and selectively share only those credentials appropriate for that given service. In effect, SSI permits an entity to contextually self-identify, disclosing only what is asked, when it’s asked, and nothing more.
SSI integration in the healthcare industry, like DLT, is still nascent, but growing with promising results. In most instances, SSI healthcare implementations focus primarily around three key entities—the patient, the provider and the payer. SSI serves to grant each entity better management of healthcare data, and importantly, enables for the controlled, contextual sharing of those datasets.
An example of SSI solutions used in concert with blockchain technologies includes HealthID, An early collaboration between Trusted Key and the National Health Information Sharing and Analysis Center (NH-ISAC). The HealthID app places identity management on a patient’s smartphone, which can then be used to securely interact with a variety of healthcare services and websites. So, instead of maintaining one account with a patient’s provider, another account with their pharmacist and another with their payer, HealthID is able to manage all of these disparate accounts through the use of identity management, or SSI.
Cryptocurrency
Cryptocurrency—also known as crypto, crypto tokens or simply tokens—is a system for assigning value to assets of consideration or importance, both tangible (an object, such as a sack of raw coffee beans) and intangible (a service or endeavor, such as a patient encounter at a provider’s office).
Cryptocurrency has been very closely associated with blockchain technologies primarily because of Bitcoin and other digital currency services that continue to flourish and gain notoriety under the broad banner of the term blockchain. Within the context of non-financial domains, the use of tokens, and token systems, places particular emphasis on asset valuation as a means for incentivizing entity participation in the exchange of those assets.
Within the healthcare domain, both digital currency services as a means for electronically paying for services rendered across a healthcare system, and token systems used for incentivization are in use in a number of promising projects.
- Vidamints (VIDA): As part of MintHealth’s larger blockchain technologies based healthcare solution, vidamints are the token system used to engage patients into the active participation and management of their healthcare data. MintHealth patients earn VIDA as a reward for completing healthy activities as directed by their providers or payers and, in turn, are able to redeem VIDA, much as other more traditional loyalty programs work.
- Dentacoin (DCN): Dentacoin is a blockchain technologies platform that expects to deliver increased efficiencies to dentists and their patients. Within the Dentacoin network, DCN tokens work similarly to traditional currency: patients can buy, store or transfer DCN tokens between accounts to manage their healthcare payments. In addition, patients can earn DCN tokens through their participation in two engagement programs called Trusted Reviews and DentaVox, which are market research platforms that gather patient experiences, reviews and feedback.
Blockchain technologies are already demonstrating some promising solutions in healthcare. From each of the three core technologies—DLT, SSI and cryptocurrency—advances are being made to more safely and efficiently share healthcare data, better identify healthcare stakeholders in a much more secure manner, and improve stakeholder engagement in the participation and management of their healthcare.
Richard Bloch
Richard Bloch is principal at Digital Healthcare I/O.
