How India Can Reimagine Its Entire Healthcare System With Blockchain

Many people have heard about the blockchain in the context of cryptocurrency. But there’s much more to blockchain than that. It is a public ledger that’s secure and immutable and that’s exactly what Indian healthcare needs.

The Indian Healthcare Ecosystem 

There are six key stakeholders in the healthcare ecosystem:

1. Patient
2. Provider
3. Payer
4. Pharma
5. Medical technology
6. Government and healthcare regulators

These stakeholders interact with each other through a complex network of interdependent and data-intensive workflows to generate meaningful health information. Over the years, a provider-centred care delivery model which uses the current framework of existing technologies has resulted in a lack of trust and transparency in the healthcare ecosystem. This, along with issues surrounding patient data privacy, security, and the fear of losing the competitive advantage by sharing data with another provider in the healthcare ecosystem, has aggravated the data-related challenges. However, as the healthcare industry now transitions to a more patient-driven care delivery model by introducing preventive healthcare and forming a close-knit ecosystem of patient-payer-provider, it is highly imperative to decentralise this model using trust-enabling technology. With its unique selling proposition of data security, blockchain is positioned as one of the key emerging technologies that can help in establishing a trust-based healthcare ecosystem by keeping the patient at the centre of all data generation and exchange. It has the potential to redesign some of the key processes of the healthcare industry by making them secure, transparent and efficient through accountable participation by all the key stakeholders.

Permissioned Healthcare Blockchain

Imagine a network on healthcare institutes where they don’t own a patient’s personal data. The data all belongs in a blockchain network. The patients are identified via their hash ID which will be their unique identifier. The hashing allows the ID to be unique and secures the privacy of the user. 

How permissioned healthcare blockchain helps

• The blockchain can aid in the creation of a patient information sharing marketplace. This way, it will be possible to actually incentivize information sharing between the different institutes to prevent any kind of information blocking. 
• Since the blockchain is Immutable and traceable, patients can easily send records to anyone without the fear of data corruption or tampering.
• The patient can be incentivized for good behaviour via a reward mechanism. Like, they can get tokens for following a care plan or for staying healthy. They can be rewarded by tokens for giving their data for clinical trials and research.

Other major problems in healthcare which blockchain can solve:

• Counterfeit drug prevention and detection: Blockchain can be used to introduce anti-tampering capabilities in the manufacturing phase to ensure pharmaceuticals are genuine.
• Clinical trial results: Blockchain can provide accountability and transparency to the clinical trial reporting process by curating all trials associated with a published study.
• Internet of Things: Patient-generated health and device data from IoT- enabled medical equipment has enormous promise, especially if interconnected with health records accessed by providers and patients.

Stakeholder interaction using blockchain

Let us take a scenario of hospitalization lifecycle of a patient where blockchain can transform some of the current processes to enhance the patient experience.

Patient admission

Current ecosystem

• Manual capture of admission record, duplication of episode ID
• No details of the previous admission at hand to assess if re-admission
• No visibility of clinical service and bed availability

Blockchain-enabled ecosystem

• Real-time online updates of admission process details for timely preparedness and reference
• Easy availability of the previous admission at the same or other care provider supports clinical decision

Clinical documentation

Current ecosystem

• Verbal, manual capture of patient’s clinical record
• Duplicate capture of previous medical, family and other history 

Blockchain-enabled ecosystem

• Electronic and real-time capture of clinical details
• Quick access and retrieval of patient’s past medical history for clinical decision support

Clinical diagnosis

Current ecosystem

• Manual and time-consuming process to arrive at diagnosis due to lack of access to clinical symptomatology, investigations ordered and their results in one place

Blockchain-enabled ecosystem

• Quick and accurate clinical diagnosis due to real-time and electronic availability of required patient clinical details and results

Medication and treatment

Current ecosystem

• Manual ordering and indenting of medicines 
• No visibility into medicines prescribed by other treating clinician can impact patient safety

Blockchain-enabled ecosystem

• Electronic, on-time medication order and dispensation 
• Medication dosage tracking and monitoring
• Real-time visibility of other medicines being prescribed ensures patient safety

Monitoring

Current ecosystem

• Physical patient monitoring is captured on flowsheets and other manual clinical documents
• Lack of real-time validation by treating physician

Blockchain-enabled ecosystem

• Allows real-time and remote monitoring of the patient by care provider due to the integration of medical devices to EHR

Discharge

Current ecosystem

• Lack of real-time online information on patient condition leads to a lengthy and time-consuming process as multiple approvals are needed from various departments in the hospital

Blockchain-enabled ecosystem

• Real-time, remote monitoring of patient’s condition by all key stakeholder departments in the hospital leads to a faster discharge process

Health insurance claim

Current ecosystem

• Coordination with a third party for preauthorization and necessary approvals 
• Manual and time-consuming claim verification by the third party

Blockchain enabled ecosystem

• Automated transmission of patient billing details
• Workload at third party lessens due to ease of online, real-time claim verification
• Alert on the previous history of claims to detect fraud

Payment

Current ecosystem

• Slow and manual reimbursement process 
• Physical copy payment receipt and its storage

Blockchain-enabled ecosystem

• Timely claim verification and payment and compliance with regulatory body mandates
• Integrated insurance payouts via digital transactions

Conclusion

Potential of blockchain for Indian healthcare industry highly depends on the acceptance of the new technology within the healthcare ecosystem in order to create technical infrastructure. Though there are certain concerns and speculations regarding Blockchain’s integration with current healthcare systems and its cultural adoption. The technology is still popular in the healthcare sector. It has taken the healthcare industry by storm over the past year and many solutions are being developed to adopt it. With so many potential use cases and possibilities, blockchain is sure to disrupt the healthcare landscape for good. Also see: https://youtu.be/4ZAvPhef05I