Welcome to my view and thoughts on the world of Blockchain. This is part 1 of a 3-part series I will be composing. The journey you are about to embark on is meant to begin conversations, spawn new ideas, and more importantly, think about the patient population. My name is Mario Toruno and I am a healthcare technologist and visionary, and I have served in multiple healthcare technology leadership roles. For the past 14 years, I have helped drive healthcare technology transformation and strategy for better patient outcomes. During my time I have helped clients integrate systems, implement emerging technologies, and most importantly, make a positive impact for our patient population. Welcome to my thoughts on Blockchain and how this technology will change transactions in healthcare for good. I hope you enjoy the journey.
In 2008 Satoshi would come out with a paper — one could almost say a dissertation — describing a new system. This new concept of decentralization created what we know today as Blockchain and it would become the framework for this now famous cryptocurrency called Bitcoin. I have argued in the past that while cryptocurrency holds an incredible value for unstable economies and countries under distress as a viable bartering system, for stable economies that present no need for the extra bartering system, they should take advantage of the power behind cryptocurrency, blockchain. Before moving on, let us discuss what blockchain is, this is an attempt to level set our readers before moving forward.
Blockchain is a transactional system that keeps track of transactions in a ledger. This can be regarded much like your accountant does if you own a business or can even go further into the everyday use of the ever-so-aged check book, which I have not seen since the early 2000s. I am sure by now you are asking yourself, a ledger and accountant, so what makes this different? There are a few differences to keep track of when one thinks of blockchain. The first is verification and the second is validation. If we think about verification and validation, one will immediately think about a signature of sorts, maybe when signing the lease on an apartment or buying a home. When one signs the lease, you are not only validating the contract, but you are also verifying the contract existing between 2 parties via your signature. Now let us look at your signature. This also holds the most important part of a contract, the validation of the contract itself. Without your signature, a valid transaction does not exist. Of course, this is due to your signature holding the most weight throughout the process mentioned above.
Let us now begin to explore how this will change the healthcare industry. It is important to understand that while the examples here revolve around healthcare, blockchain can translate into many industries as long as a transaction exists.
In the above section we explored a high-level blockchain scenario, if you could even call it that. So, what does this have to do with healthcare? If one thinks about healthcare as a receiver you think about the forever dreadful waiting periods, terrible food maybe, or even receiving meds in a scheduled period from a nurse. If you are on the providing end of the spectrum, you would relate to the endless signatures needed to move on to a next step, the systems being used to track, dispense, and even at times administer care.
Let us now ponder this question: what is the common ground between these two perspectives? Transactions, transactions, transactions, no matter whether the person is a receiver of healthcare or being part of the medical staff providing the care, every step almost has an inherent transaction. This is where the power of blockchain should be leveraged. We should begin to create systems that handle the signatures via smart contracts. If we could replace signatures within the healthcare system, we could gain better efficiencies due to less waiting times. As a patient begins to move through the healthcare system, the interdependencies of a signature will no longer exist with the replacements of using smart contracts.
Let us now dig a little deeper on what the true implications of a smart contract and how it will revolutionize healthcare. Like any organization, much of the transactions are driven by culture, rules, regulations, and laws. This can’t be any truer in the healthcare arena, as many know already. The other factor, which was not talked about, was people. Many times, people need to do actions on documentation in order for the next steps to occur. This is where the power of the smart contract comes into play. It can, and I predict that it will, take the place of the manual transactions that are dependent on people in order to move forward. Smart contracts will become the automation needed in order to optimize the healthcare workflow from multiple points. This could take the place of the signature needed during a drug administration, radiology order, or even in the most extreme cases in the emergency room workflows.
In the above discussion we reviewed points from the provider perspective. Now let us review this concept from an administration perspective. Throughout the point of care there are many points that the administrative side has to keep track of, from billing and coding to the records management and release. Many of these actions, from giving a patient their records, to billing, go through many checks. We now recognize that those checks are, of course, transactions! Once again, as we discovered in the above, the smart contract will be, and I predict, one of the many silver bullets throughout the digital transformation and upgrades to the healthcare systems and its inherent workflows. The administration parts of the healthcare systems, whether this is a large hospital system or small to medium size clinic, will become the immediate benefactors of blockchain and its smart contracts capabilities.
In this first part of the series, we reviewed one aspect of how blockchain will make a difference, and furthermore impact the healthcare system. Can this picture I describe in the above truly work. If one thinks of supply chain management, the answer would be yes. So, the question we now must ask ourselves is how? How can we make this picture of moving a patient through a system as seamless, or as close to seamless, as water flowing down a river? Although I have introduced the smart contract capability, it would be naïve to think it would not be difficult to implement. But, it would not be impossible.
In Part 2 of our Journey I will introduce how blockchain will change the patient experience, and more importantly, provide the provenance of data. As healthcare is becoming patient centric, patients are now able to gain access to their medical record data easier.
So how will blockchain play into this, and where does the provenance of data come into play? In the next part of our journey we will begin this discovery together.
Follow my thoughts on how technology will change the world and part 2 of this series.