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Patient Directed Health Data Exchange on The Blockchain

Posted on September 7, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve long been friends with Dr. Tom Giannulli who most of you will probably have known as the CMO of Kareo. I first met Dr. Tom back when he created what I would call the first iPad optimized EHR interface back when Dr. Tom was at Epocrates and before they sold that EHR to Kareo. Needless to say, Dr. Tom is the kind of guy that likes to sit on the cutting edge of technology and how it applies to healthcare. So, it was no surprise to me when he came to me with his patient directed health data exchange called PatientDirected.io which is built on the blockchain.

While a lot of people talk about blockchain and theories about how blockchain could help healthcare, a lot of what people were doing was just talk. What I like about Dr. Tom and PatientDirected.io is that they just put out a video demo of a patient chart being requested from Kareo by the patient and then the patient sending that chart to Epic. Check it out to see what I mean:

Many of you that watch this demo might be asking. How is this on the blockchain? That’s one of the things that many people don’t understand about blockchain. If it’s done right, you won’t know anything about the blockchain. However, the blockchain can do things like creating smart contracts with providers which can create trusted connections. The blockchain is distributed, so your data isn’t stored on a central server that’s owned and controlled by PatientDirected.io. Basically, blockchain has a number of benefits, but it’s the “Intel Inside” and so it’s not something you should see as an end user, but it could provide some great benefits.

I also like that PatientDirected.io isn’t trying to reinvent the wheel. They’re using trusted third party applications like Verato to handle their master patient index and for verifying patients identity. There’s a lot more to explore when it comes to identity management, but it’s smart to work with companies that are doing this all across healthcare.

I was also impressed with the detailed sharing permissions that were available in PatientDirected.io. At first glance, a part of me wonders if it’s too complex for most patients. However, as long as the options are there, the interface can adapt to allow for specific patient preferences when it comes to data sharing. Of course, it’s nice that all of the sharing of this data will be tracked on the blockchain.

The key to all of this working for me is the integration with the EHR vendor. It looks like it’s using Direct to handle the messaging to the EHR vendor and back. This is good because I believe all certified EHR (which is pretty much all of them) have direct messaging built in. Some have integrated it better than others, but they all have this capability. My big concern with it though is whether what’s being shared by EHR vendors using Direct is enough data. And will that data that gets sent from one EHR to another appear in a format that’s useful to the receiving physician? If it’s not, then it doesn’t solve much of anything. Plus, I wonder what happens when a doctor gets a record request and doesn’t respond. This is especially true for EHR vendors who haven’t integrated Direct into the core EHR workflow. Will this take a culture change to not leave patients waiting for records that will never come?

As you could imagine, PatientDirected.io has an ICO offering on StartEngine.com. Looks like it just got started, but there’s an opportunity to buy their tokens if you’re interested and believe they’re on to something special.

I think there is a space for a patient directed health information exchange assuming we can make the exchange of information between disparate providers very simple. There are still some challenges for patients when it comes to getting access to their health information, but the law is clear that patients should have access to their health information. Now we just need the user interfaces to be as simple as clicking a button like is demonstrated in the video above and we’ll see much more patient directed health information exchange.

Let Vendors Lead The Way? Are You Nuts?

Posted on August 13, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Every now and then, a vendor pops up and explains how the next-gen EHR should work. It’s easy to ask yourself why anyone should listen, given that you’re the one dishing out the care. But bear with me. I’ve got a theory working here.

First of all, let’s start with a basic assumption, that EHRs aren’t going to stay in their current form much longer. We’re seeing them grow to encompass virtually every form of medical data and just about every transaction, and nobody’s sure where this crazy process is going to end.

Who’s going to be our guide to this world? Vendors. Yup, the people who want to sell you stuff. I will go out on a limb and suggest that at this point in the health data revolution, they’re in a better position to predict the future.

Sure, that probably sounds obnoxious. While vendors may employ reputable, well-intended physicians, the vast majority of those physicians don’t provide care themselves anymore. They’re rusty. And unless they’re in charge of the company they serve, their recommendations may be overruled by people who have never touched a patient.

On the flip side, though, vendor teams have the time and money to explore emerging technologies, not just the hip stuff but the ones that will almost certainly be part of medical practice in the future. The reality is that few practicing physicians have time to keep up with their progress. Heck, I spend all day researching these things, and I’m going nuts trying to figure out which tech has gone from a nifty idea to a practical one.

Given that vendors have the research in hand, it may actually make sense to let them drive the car for a while. Honestly, they’re doing a decent job of riding the waves.

In fact, it seems to me that the current generation of health data management systems are coming closer to where they should be.  For example, far more of what I’d call “enhanced EHR” systems include care management tools, integrating support for virtual visits and modules that help practices pull together MIPS data. As always, they aren’t perfect – for example, few ambulatory EHRs are flexible enough to add new functions easily — but they’re getting better.

I guess what I’m saying is that even if you have no intention of investing in a given product, you might want to see where developers’ ideas are headed. Health data platforms are at an especially fluid stage right now, tossing blockchain, big data analytics, AI and genomic data together and creating new things. Let’s give developers a bit of slack and see what they can do to tame these beasts.

Blockchain and Tokens

Posted on March 20, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ll admit that I’m still trying to really understand blockchain and tokens. I can see elements of potential, but I think everyone would agree that we’re still very early in the development of blockchain and tokens. I’ll avoid comparison to the early internet days, but no doubt there’s a lot to be learned from those comparisons.

A VC blogger I read who invests in the blockchain space shared this really great presentation on cryptotokens and a look at the various players in a blockchain community. If you’re trying to understand blockchain and tokens in particular, read the following presentation in full screen mode and you’ll have a better understanding of it.

No doubt this cryptotoken presentation was skewed towards how regulators should approach regulating the space. However, it helped me understand some of the ways tokens are used in blockchain. Do I understand it fully? Not yet, but this is getting me closer.

What’s not clear to me is how much we will really need to know to benefit from blockchain. It seems to me like the answer is not much. When I use Amazon I don’t need to know what database they use or what programming language their website uses. The same is true for a laptop. I don’t really need to know the details of how an Intel processor works, but I do like to see the Intel Inside sticker on the outside and some of the specs.

I have a feeling blockchain will evolve to be something similar. A few very technical people will need to know more about the details and they’ll build the infrastructure. However, most people will just use a service and not know any of the technical details. However, if blockchain is successful, then people will want to choose a service that’s built on blockchain because of some of the characteristics that make it better than one centralized system. We’re certainly not there yet in healthcare.

A Circular Chat On Healthcare Interoperability

Posted on September 6, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

About a week ago, a press release on health data interoperability came into my inbox. I read it over and shook my head. Then I pinged a health tech buddy for some help. This guy has seen it all, and I felt pretty confident that he would know whether there was any real news there.

And this is how our chat went.

—-

“So you got another interoperability pitch from one of those groups. Is this the one that Cerner kicked off to spite Epic?” he asked me.

“No, this is the one that Epic and its buddies kicked off to spite Cerner,” I told him. “You know, health data exchange that can work for anyone that gets involved.”

“Do you mean a set of technical specs? Maybe that one that everyone seems to think is the next big hope for application-based data sharing? The one ONC seems to like.” he observed. “Or at least it did during the DeSalvo administration.”

“No, I mean the group working on a common technical approach to sharing health data securely,” I said. “You know, the one that lets doctors send data straight to another provider without digging into an EMR.”

“You mean that technology that supports underground currency trading? That one seems a little bit too raw to support health data trading,” he said.

“Maybe so. But I was talking about data-sharing standards adopted by an industry group trying to get everyone together under one roof,” I said. “It’s led by vendors but it claims to be serving the entire health IT world. Like a charity, though not very much.”

“Oh, I get it. You must be talking about the industry group that throws that humungous trade show each year.” he told me. “A friend wore through two pairs of wingtips on the trade show floor last year. And he hardly left his booth!”

“Actually, I was talking about a different industry group. You know, one that a few top vendors have created to promote their approach to interoperability.” I said. “Big footprint. Big hopes. Big claims about the future.”

“Oh yeah. You’re talking about that group Epic created to steal a move from Cerner.” he said.

“Um, sure. That must have been it,” I told him. “I’m sure that’s what I meant.”

—-

OK, I made most of this up. You’ve got me. But it is a pretty accurate representation of how most conversations go when I try to figure out who has a chance of actually making interoperability happen. (Of course, I added some snark for laughs, but not much, believe it or not.)

Does this exchange sound familiar to anyone else?

And if it does, is it any wonder we don’t have interoperability in healthcare?

Could Blockchain Tech Tackle Health Data Security Problems?

Posted on March 25, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

While you might not own any them, you’ve probably heard of bitcoins, a floating currency backed by no government entity. You may also be aware that these coins are backed by blockchain technology, a decentralized system in which all participants track everyone’s holdings on their own individual systems. In this world, buyers and sellers can exchange bitcoins untraceably, making bitcoins perfect for criminal use.

In fact, some readers may have first heard about bitcoins when a Hollywood, CA hospital recently had all its data assets frozen by malware hackers, who demanded a ransom of $3.4 million in bitcoins before the hospital could have its data back. (The hospital ended up talking the ransomware attackers down to paying $17K, and when it paid that sum, IT leaders got back control.)

What’s intriguing, however, is that blockchain technology may also be a solution for some of healthcare’s most vexing health data security problems. That, at least, is the view of Peter Nichol, a veteran healthcare business and technology executive consultant. As he sees it, “blockchain addresses the legitimate previous concerns of security, scalability and privacy of electronic medical records.”

In his essay posted on LinkedIn Nichol describes a way in which the blockchain can be used in healthcare data management:

  1. Patient: The patient is provided a code (private key or hash) and an address that provides the codes to unlock their patient data.  While the patient data is not stored in the blockchain, the blockchain provides the authentication or required hashes (multi-signatures, also referred to as multi-sigs) to be used to enable access to the data (identification and authentication).
  2. Provider: Contributors to patient’s medical records (e.g. providers) are provided a separate universal signature (codes or hashes or multi-sigs). These hashes when combined with the patient’s hash establishes the required authentication to unlock the patient’s data.
  3. Profile: Then the patient defines in their profile, the access rules required to unlock their medical record.
  4. Access: If the patient defines 2-of-2 codes, then two separate computer machines (the hashes) would have to be compromised to gain unauthorized access to the data. (In this case, establishing unauthorized privileged access becomes very difficult when the machines types differ, operating systems differ and are hosted with different providers.)

As Nichol rightly notes, blockchain strategies offer some big advantages over existing security, particularly given that keys are distributed and that multiple computers but need to be compromised for attackers to gain access to illicit data.

Nichols’ essay also notes that blockchain technology can be used to provide patients with more sophisticated levels of privacy control over their personal health information. As he points out, the patient can use their own blockchain signature, combined with, say, that of a hospital to provide more secure access when seeking treatment. Meanwhile, when they want to limit access to the data it’s easy to do so.

And voila, health data maintenance problems are solved, he suggests. “This model lifts the costly burden of maintaining a patient’s medical histories away from the hospitals,” he argues. “Eventually cost savings will make it full cycle back to the patient receiving care.”

What’s even more interesting is that Nichols is clearly not just a voice in the wilderness. For example, Philips Healthcare recently made an early foray into blockchain technology, partnering with blockchain-based record-keeping startup Tierion.

Ultimately, whether Nichols is entirely on target or not, it seems clear that health IT players have much to gain by exploring use of blockchain technology in some form. In fact, I predict that 2016 will be a breakout year for this type of application.