In our last blog, we discussed the interest expressed by the U.S. Department of Veterans Administration (VA), in the use of Blockchain Technology (BCT) and Distributive Ledger Technology (DLT) for healthcare records of military service personnel, past and present. We noted that the VA is embarking on a decade long conversion of their current EHR to a commercial product. The cost? Around $15 billion USD. Though the VA has expressed interest, they have not incorporated any BCT/DLT into the new platform under development by CERNER®.
A published Request for Information (RFI) (link below) indicates that the VA is looking at blockchain beyond the EHR. The VA seems to be looking at “if” and “how” blockchain can bring more efficiency to its acquisition process, that is, how blockchain solutions can be used in “routine government contract procedures, and in particular, contract closeouts.”
Blockchain Technology has been a hot topic in federal circles of late with a myriad of agencies examining how they can leverage DLT to verify their operations.
The VA is not totally convinced this is possible however, as everyone else, it is fascinated by the potential. The same can be said of the Office of National Coordinator for Health Information Technology (ONC). In 2016, the ONC held a blockchain challenge for papers on how DLT could address the interoperability, scalability and security of EHRs.
Part of the problem, that most enterprises are experiencing, is what I would refer to as the bridge or middleware between the blockchain and legacy systems. Today, the industry is trying to use APIs (Application Program Interface) or FHIR (Fast Healthcare Interoperability Resource) to connect information from one system to another, when and where it is needed. There are major issues with both; however, we’ll save that conversation for another day.
The question is, how can we implement DLT through the APIs or FHIR, to communicate faster, better or cheaper? There are still issues that remain unanswered, and questions beyond that of cryptographic signatures, tokenization, processing (mining or equivalent), and distribution.
Regardless, one clear opportunity for a DLT EHR, for example, can be in those applications where there is little “trust.” Because of laws, regulation and systems set in place both by ONC and HIPAA, the U.S. system works. There is a secure and reliable authentication of connected sources to the healthcare technology infrastructure when a U.S. government certified EHR is in use. However; international use of the EHR concept is in a quite different place with few common standards, and no single certification entity to validate these applications or ensure data integrity. This presents a clear opportunity for using a blockchain-based EHR, for those patients/consumers who want a copy of their records out of uncertain institutional control, or desire that their healthcare records be accessible across international borders, even if it is not connected directly to the “national” healthcare infrastructure. This presents a tremendous advantage for those who travel (Medical Tourism) or who are traveling for a specific procedure to be performed in another country, i.e., cosmetic surgery, cancer treatments or treatment of other situations that cannot be accommodated in their home country due to limitations or even cost.
We know one thing is certain, the Blockchain and Distributive Ledger Technology has the potential of ensuring security, privacy, and data authenticity of EHRs, Clinical Trials, IoT connected wellness devices, Genomic profiles, etc., to a scale we have only recently begun to imagine.
-Noel J. Guillama, President