Alex Lightman

How much time do U.S. primary care physicians spend face-to-face with each patient? On average, between 13 and 20 minutes. How much time is spent updating Electronic Medical Records (EMRs) for a primary care appointment? On average, about 20 minutes. How much time will it take the patient to obtain a copy of results from the visit? While many physicians can deliver copies of medical records soon after request, HIPAA (the Health Insurance Portability and Accountability Act) gives providers 30 days to address inquiries, with an optional 30-day extension. Time devoted to EMRs is edging out the time spent treating patients. And for the patient, getting access to EMRs takes exponentially more time than the actual appointment. Most healthcare providers use EMRs. But with at least 350 EMR solutions available, the likelihood of a primary care physician and a dentist (two providers most people will visit during the year) sharing the same EMR software is slim, making it challenging for the dentist to know if the patient has a medical condition to consider before dental treatment. The responsibility of informing the dentist about recent healthcare issues becomes the patient’s burden. For older consumers, most of whom have two or more conditions requiring treatment by specialists, the number of unique EMRs becomes difficult to manage, increasing the risk of poor treatment due to incomplete information. Joe Biden’s recent op-ed in Fortune raised a rallying cry for improving EMR accessibility. His involvement with the White House Cancer Moonshot, the American Economic Recovery and Reinvestment Act of 2009 and the Veterans Affairs Department has included initiatives and funding to make comprehensive patient medical records available. But Biden acknowledges more can be done – and needs to be done to improve access for patients. Interest in a blockchain-enabled solution for managing EMRs has been heating up in the past two years, with thought-leaders at Harvard and MIT recognizing the need for change and citing (and exploring) blockchain’s power to transform the current system. Information professionals and consumers are having conversations about using blockchain elements – distributed ledgers, tokens, and ‘key’ devices – to better manage EMRs. How Blockchain Technology Eliminates EMR Data Silos The roadblocks preventing EMRs from working more effectively for patients and providers centre in three areas that can be addressed by blockchain-based solutions: Roadblock #1: Ownership Although patients own their medical records, the current bureaucratic system makes it almost impossible to control and manage access. With blockchain-based technology, access would be owned by the patient who could grant permission to access with a ‘key’ that would decrypt sensitive information including patient name and identification. Smart contracts on a blockchain would provide checks and audits of EMR accuracy and completeness. Roadblock #2: Security The move to digital medical records was made, in part, to enable physicians to proactively identify patients needing preventative care. But the absence of controlled access resulted in almost 15 million patient records being hacked in 2017. Using blockchain technology, patient data associated with appointments, x-rays, test results, procedures and prescriptions could be available at a moment’s notice and would eliminate unauthorized access or data manipulation. Roadblock #3: Interoperability Biden cited the lack of interoperability – the ability of different software applications to communicate and exchange data across physicians, labs, hospitals and pharmacies — as a leading challenge to EMR effectiveness. With a patient ‘key,’ providers would have access to EMRs. Importantly, patients would be able to review all EMRs from a single system, saving time and any associated costs that may be charged to get copies of records. Roadblock #4: Complying with HIPAA Requirements HIPAA regulations limit the direct use of blockchain to store protected health information (PHI) because the blockchain ledger verification process relies on mathematically-derived pseudonyms, prohibited by HIPAA’s Privacy Rule. In addition, a system allowing direct posting of patient information to the blockchain would require each provider to maintain a private database with the complete medical records of all patients – data storage and ease of access would quickly become large problems. MedChain is an example of a Blockchain company that offers a creative solution that acts as an intermediary between the providers’ HIPAA-compliant database and the blockchain network, delivering the benefits of blockchain while maintaining the HIPAA Privacy Rule. Refocusing Healthcare Data Management Patients are being advised to ‘keep track’ of their medical records as ‘key to protecting’ their health. The current EMR system is mired in bureaucracy, meaning patients face the burden of obtaining copies of all medical records and making them available to each of their healthcare providers. Efforts to improve the efficiency of healthcare data management have also been undermined by ransomware attacks, cyber breaches, IT staff shortages, and a slew of software providers (with no clear market leader) encouraging healthcare systems to switch vendors, making interoperability difficult. The time needed to maintain EMRs is slowing patient care as physicians spend more time entering data than treating patients. The extra workload and associated reduction in productivity are undermining physicians’ commitment to healthcare, causing some to reduce hours or leave the profession.

Blockchain Beach

Alex Lightman

Stories By Alex Lightman

Opinion

Blockchain Solutions to Electronic Medical Records Issues

Opinion

Mining Industry Overview and Challenges