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The Blockchain Tsunami - Impact on Healthcare

Note: This might be a new topic for some;hence a brief introduction about Blockchain will help in understanding this breaking change. As such the length of the article is longer than usual.

Status Quo is a funny thing. If you get used to doing things a certain way, it becomes difficult to have a different perspective. And if you are doing it from birth, you assume that that's the only way.

Relying on central agencies as a trust agent is one such thing. When you make a financial transaction, you invariably rely on the bank to approve. When dealing with insurance, you rely on insurance companies. Making a purchase online, you would typically go to Amazon, Walmart or Target who have won your trust. When you buy a medicine, can you trust a street vendor?

Building trust with your consumers is not bad at all. The small caveat is that this comes with a price of one extra hop through these trust agents. It adds to the transaction time, adds to the overheads and hence adds to the cost. And even then it's not guaranteed of one hundred percent reliability. After all fraud is all too common even with strict policies and law, right?

Blockchain (BC) tries to address these concerns by eliminating the need of having a central trust agent. Being a part of the BC almost guarantees trust between transacting parties. It would be almost impossible to hack a transaction. Simply put, the mechanism relies on all individual members who are a part of the Blockchain network. Assume that you are a part of a BC of banks. You become a nodal agent immediately. You will have the entire ledger of all the people who are a part of the BC. You can only access the BC, with your Private key. When a transaction happens all the nodes of the BC are intimated. A voting happens and if 51% of the nodes agree about the authenticity of the transaction it's deemed as genuine and the transaction  is added immutably to the BC. This is exactly how Bitcoin works (arguably the most extensive implementation of Bitcoin that's in use). Of course, the actual implementation is lot more involved but you get the point.

Now think of the possibilities. BC needn't be just restricted to financial transactions. Smart contracts, goods purchase, voting system; you can have a BC for everything. If something is a part of a well known BC, you will make the transaction with almost 100% confidence without relying on any intermediary.

Which brings us to the crux of the discussion point. How would the Healthcare be impacted? As with other domains, BC can completely disrupt the current way of Healthcare. Let's take a couple of examples.

Blood bank and blood donation: From the time a blood is donated by a donor to the time of final consumption, a blood unit travels through multiple steps. There could be a high probability (especially in developing countries) that certain steps and guidelines are not followed. If the entire supply chain is fed into the block-chain; it will be impossible to bypass any process. Breaking a process will immediately trigger a BCalert and the final transaction will fail (which is the receiver receiving the blood). Pilferage is completely eliminated and any discrepancies are easily caught.

EHR/EMR: The second example is little more involved. Can the BC be extended to EMR/EHR? Currently we have some regulations in place (HIPPA, HL7) to ensure ownership and interoperability. But this is a gigantic mess in its current form. Records take days to be shared after verifying all prerequisites. The tussle between Payer and Provider takes days to resolve. With BC the entire process can easily be simplified. The ownership can be a part of the BC. In this case the Patient. In a system driven by BC, as long as the owner approves, the records are seamlessly shared. Pls. note that the standards and the compliance procedure would be very much there. The value comes in terms of ownership and sharing records to different parties almost instantly. There are some companies who have started work on this (including Kare4u).

BC is still in its infancy. It might be some time before this becomes mainstream. But when it does, it will change the way we do any transaction. This could by far be the most disruptive thing that we might see in our lifetime.