May 14, 2018 | Written by: Ian Fish and Michael Barnard
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We started our discussion on blockchain use cases for healthcare with an exploration of cold chain breaks, a clear place where blockchain has significant health outcome and cost reduction values. In this blog, the second use case we’d like to explore is that of provider registries.
Healthcare rallies for blockchains: Keeping patients at the center
Today, every Canadian province has centralized registries and other systems maintain provider indexes. These registries are somewhat synchronized through messaging, data loads and other legacy approaches of varying degrees of quality. Physicians have a variety of qualifications, organizations that they are associated with, and permissions for the types of medical procedures and prescriptions that they are allowed to perform. Other providers include clinical nurses, community health workers, dentists and physiotherapists.
With the opioid crisis and other healthcare challenges in Canada, accurate and up-to-date provider information assists with assuring that referrals are to qualified providers and that prescriptions are appropriate to the physician. The potential for out-of-date provider information to cause quality concerns is well understood, and manual and automated efforts of a variety of types are expended to keep records accurate.
Blockchain approaches have the potential to reduce significantly the overhead associated with keeping provider information up-to-date, accurate and distributed to where it needs to be.
Example permissioned, private blockchain for provider registry
This blockchain interoperability diagram depicts a central organization hosting the consensus computing resource and providing overall governance for the registry. Given the nature of the approach, this could be a provincial or federal solution, as an emerging trend has pan-Canadian solutions for certain types of needs. The central organization’s compute resources would perform the computationally more intensive processes of hashing and encryption, while other participants would contribute transactions, validate blocks and consume the accurate and synchronized blockchain information as needed.
Colleges of Physicians and Surgeons would be able to update physician’s credentials and authorizations and have the data flow automatically to participating organizations. This would be open to other accreditation bodies as well, allowing clearer insight into other providers’ credentials. Hospitals could update physician information on their systems, creating transactions which flow into the central organization for block creation and distribution. Auditing and regulatory organizations would always have up-to-date records of the current status of all providers in the jurisdiction. Potentially, auditing and regulatory agencies would insert transactions with assertions that historical blocks are audited, approved or otherwise validated by external processes, improving the degree of reliability of the data.
The blockchain process would be low-overhead, easy to integrate to and provide an accurate and immutable record of the current status, contact information and accreditations of every provider along with their history. Just as with cold chain breaks, we are interested in exploring a proof-of-concept with interested parties and to become an enabler of this next generation approach.
The private, permissioned blockchain suitable for this example is the Hyperledger Fabric solution. IBM is a major contributor to the open source Hyperledger collaborative effort with the Linux Foundation. Our IBM Blockchain is a secure, hosted, private and permissioned blockchain deployment of Hyperledger Fabric suitable for large-scale and secure solutions
Different use cases for blockchain have different value propositions, but a common theme is that there are multiple participating organizations who have different needs and accountabilities. More important than the technology itself, is the relationship, incentives and governance model for the shared distributed ledger. The two use cases we have discussed so far: cold chain break management for vaccines, and provider registries, are just the tip of the blockchain iceberg. Subsequent blogs will look at further use cases and how blockchain supports and displaces other healthcare solutions such as Fast Health Interoperability Resources (FHIR).