Healthcare on the Blockchain Works, Just Not How You Think.
When first hearing about sensitive data going on the blockchain the pitch goes something like this,
“My company GenericHealthcareBlockchainName is going to take your most personal information and put it out in public where no one can ever delete it. Do not worry my friend your data is protected by the most modern encryption available today so it is safe.”
Yet in reality, it is so much more secure and intelligent than all that in practice. Properly done healthcare is a perfect candidate for blockchain tech to get involved and shake things up. It’s not about putting personal data on a public blockchain. The law in the USA and Europe won’t allow it, and frankly, it should not. Not surprisingly for those in the know, there are a bunch of ways for data to be secured with the blockchain without actually putting it there.
What data can be stored?
While the data itself should never be stored on the blockchain, the tech can still be used as a public record of events and verification without exposing any specifics about who or what happened.
How does this work in the real world with a company like Solve.Care? Using the app a patient makes an appointment request with proof of eligibility linked without exposing unnecessary personal information. The healthcare provider (doctor) receives the request. They can respond with availability or decline. Automatically, if they have no availability or the patient does not fit their network or other preset criteria, the Patient receives options and selects what provider they would like to see. At the time of the agreement, the patient consent and eligibility specifics can go automatically to the provider.
Are you with insurance or will your employer cover part of the cost? No problem, the appointment information and other relevant specifics can be sent to anyone that needs it using their care.wallet. This speeds up the process for payment and approval of care to nearly instantly. All this is done partially on-chain (public blockchain), which makes the whole process immutable. The public can only see that something happens, not by whom or what. If later the off-chain (private) information is changed or deleted, it is easy to verify and notify and update all involved.
What is happening behind the scenes?
One of the oldest examples of the public ledger is your local print newspaper. Once it’s printed, it is more or less permanent and immutable. Any changes have to be printed in new versions as a correction. Newspapers, specifically The New York Times, have been used to store and verify data since 1995. Blockchain on the healthcare takes it a step further. https://motherboard.vice.com/en_us/article/j5nzx4/what-was-the-first-blockchain
Imagine this. You are a spy, and you need to receive information from your contacts. To do it securely, it is agreed to check the local classifieds (public blockchain) every Tuesday for a freelance consultant listing. The information can’t just be published to the public since it would not be possible to remove it later if the passwords or contacts are compromised.
It must be posted to a place you can control. The listing includes an URL and to make sure it is hard to access you agree on decryption by removing any numbers found in the URL. Since this could be solved eventually (or indexed by Google), you also agree that there will be a password of “hereisyourpassword” to access once you get there.
After watching the paper for weeks, you see this:
“Need freelance consultant. Apply below
url: https:// s33olv1eca40reex4sa6mp99le.car. blog
After decrypting the message you are left with this URL: https://solvecareexsample.car.blog
Going to the website (private server), you find this post and type in the password.
It reveals this message:
“You need to wait longer, the time is not right.”
Using the hash provided in the newspaper post (public blockchain), you can see that the message has been unaltered since it was published.
Every time there is new information, a new post in the paper is added. Since you control where the final information is stored, you can program it to be available for only 7 days or forever. You can also allow for different passwords to see who accessed it or encrypted the URL (so only one person gets their own info). If needed, the information can be changed at any time. If someone is able to change the message on the server, you will know since even removing a period or adding a space radically changes the hash.
Specialists and Further Care
It is not just about booking appointments with a healthcare provider. We already have apps for that on the app store today without the blockchain. Using the same process as described before a physician can verify the need for specialized care at an appointment and share this with patient’s wallet. The patient confirms, and the consent is then exchanged between the two as well as the specialist. After syncing with the referral request and a schedule request is made where the two can agree on a time and place. Now there is proof for anyone who needs to know like insurance or employers. It is immutable that a specialist was requested, for what reason and whom it was requested by.
If while at an appointment there is a need for medication, it’s a quick step to make that happen. The current system of prescriptions is pretty ridiculous in the sense that the provider usually calls in the request and gives you a piece of paper with hard to read instructions.
With blockchain, a doctor can record the need for a prescription. This data is put on the private off-chain storage and the event is recorded on the public record. This allows your prescription to be shared in a way that only those in need have access to it (the patient, provider, insurance and the pharmacy). Each one is only receiving the information relevant to his part. If the doctor adds a prescription and includes notes such as the condition and the treatment plan, it can be seen by you and the DR. The pharmacy can only know the prescription requirements. Do you need a family member to go pick it up? No issue, share that prescription with their wallet. Once it’s picked up, everyone has proof that you now have it.
Claims for healthcare have always been a headache for both patient and provider. This is why many providers are happy to give steep “cash” discounts so that they do not have to deal with it. A member can create a claim using a care.card (app) and connect it to the care they received. After going through the guided process and submitting the complete claim, the insurer wallet receives it instantly. Bear in mind that today this one step of sending claims is often done over snail mail or fax. Even when done electronically there is usually a manual process since proof of cost and treatment have to be verified.
The claim can be reviewed quickly because the proof is readily available for those that are given access. In the current system, the payment process is done using checks in the mail or bank transfers. Using a system like solve.care and paying in care.coins is universal anywhere in the world and instant. No more lost or delayed payments like often happens with checks in the mail. In a blockchain solution, it can easily be automatic.
All the inefficiencies discussed above (and more) often fall into admin costs. The US healthcare system spends up to 30% on today. By moving these tasks to a more universal system, the costs can be greatly reduced. Doctors can have more time to spend with patients instead of with insurers. Insurers can reduce overhead well providing faster and more accurate service. A simple healthcare solution is a perfect reminder that blockchain tech can change the world while still preserving the advantages of traditional centralized systems.