The promise of the transformative impacts of blockchain technology is so regularly touted by evangelists that we have unfortunately become immune to it. One of the gaps from my perspective is the level at which evangelists are having this discourse; it is at a the thirty-thousand-foot level and way over most people’s head.
The purpose of this piece will be to try and reverse this trend by tying blockchain to a very specific example of what it could offer in one of the key sectors of the US economy: Healthcare. I will look to walk you through a blockchain implementation from start to finish.
Let’s dive right in!
Healthcare — The Elephant in the US Economy!
The US spent $3.5 trillion dollars on healthcare in 2017 which worked out to $10k per person. Nothing new? Keep in mind that this is one of the highest amounts in the world for healthcare expenditure and the average spend per person does not capture the skewed spend towards the wealthy. This piece is not a critique or review of the system but there can be no doubt that this is a system that is ripe the for implementation of new technology to improve the delivery of patient care and to reduce the cost incurred by patients. The good news is that the best minds are working on this problem right now and any extra improvements from new technology is always welcome I would imagine…
Focused Healthcare Use Case
The use case that I would initially focus on for blockchain to make that impact is the one of Controlled Substances in a Patient Care setting. These substances are, in essence, really powerful medicines that need to be closely monitored and tracked within a hospital. This is a restrictive area in itself and is well suited to the definitive source of truth that comes from a ledger of transactions. So let’s set a clear system scope here with proposed benefits as any organization would, embarking on a new initiative:
System Scope: To ensure only authorized staff access the Controlled Substances of the hospital and the movement of those substances is recorded at every step of the way that can be public or private. The use of blockchain technology to closely monitor the movement, consumption and use of those substances in compliance with US laws. Some of the benefits of this will be:
- Supply Chain Visibility: See where all Controlled Substance stock is at all times. A longer term target could be to get those substances added to the blockchain by the manufacturer once created so doctor / patient could see country of origin etc.
- Patient Safety: Medical practitioners could flag a patient who requires that specific treatment and the technology would implement it with specific system restrictions.
- Accuracy of Patient Billing: Patients only get billed for what was actually consumed. Transactions that they can clearly see for themselves on their own device.
- Leakage / Loss of Stock: See where all Controlled Substance stock is at all times. This includes batch information as well as expiry dates in the case of any recalls.
- Patient Privacy: The use of blockchain nodes and wallet for identity obscures the sensitive public data from being distributed.
A business case would most likely need to be created to tangibly identify both the hard and soft dollar savings associated with this implementation. It is safe to say that the close monitoring of powerful medicines in a hospital is of benefit for both the health of patients and the organization itself. The next question naturally becomes how would they go about implementing it?
Getting it Done
I would propose a high level methodology to get us on our way:
#1 Resource It: In the healthcare setting, there is a tendency to first get a project charter then do a significant project plan spanning 1000s of discrete tasks. Before you know it, you are six months in with nothing tangible to show. As this is a targeted initiative, a small team of 5 to 7 dedicated people is probably the best place to start. You will need two or three capable developers, a project manager, a business analyst, and two front line staff to ensure that you are getting input from the front lines.
#2 Build It: With powerful platforms like Algorand being built out that are highly scalable, you have great resources at your fingertips. Dive in and set yourself daily targets to get your system up and running. There should be a mix of short, medium and long term goals. If you do not have a prototype within 4 to 6 months then you do not have the right people on the project or you are not giving it enough focus.
#3 Test It: This is without a doubt one of the most important phases. It is where you hone the product to make sure it meets the business need. In fact, it is recommended to do a testing cycle with end users after about a month of building then more development then more testing. Rinse and repeat until complete. The theories made during design can be idealistic and there is nothing like a real life testing cycle to get you the feedback that you need. It is generally best to rotate in a new tester in each cycle so that you are making the system as usable as possible for the average staff member.
#4 Deploy It: The deployment phase is generally easier the better your testing has been. It is the absolute definitive litmus test. I think you should start small (one controlled substance room in a large facility) and give it an extended support period. Documentation is also really key at this point to both educate users but also ensure that you are compliance with all required standards.
#5 Perfect It: The first wave of ‘Go Live’ is the perfect point to gather your lessons learned and product feedback. The next step is to incorporate it and make your product enterprise quality that is can be used across your facility / organization / US / the world!
It goes without saying that underpinning this approach should be the standard project governance and change management efforts associated with any organization change. The approach discussed here is more akin to Agile methodology but this does not mean a Waterfall or other approach is not valid. The approach I chose illustrates how to get something moving quickly.
There seems to be a general view that US healthcare is on a trajectory that it cannot be changed from. It is unfixable and will only get more expensive for its patients. This is the Thomas Maltus view of the world that I think should be challenged. The best way to take this on is to target some small and impactful projects with new transformative technology then build out from there. This article was an attempt at just that.
Blockchain technology offers the ability to cut costs and render the health care system more efficient by eliminating the need for third parties to establish trust between medical practitioners and patients.
To illustrate, the medical practitioner prescribes medicine which the patient immediately sees on their own device and can verify himself. After verification the medication is shipped to the patient and automatically billed to his account. This all seems pretty straightforward but it is something we are a long way from today. We need to start using technology to get us to this point and bring more transparency to the healthcare system. In the longer term we can strive to get towards the following end state:
A Note About HIPAA
To a healthcare professional reading this at first glance, they may well call out HIPAA! What about HIPAA?! Any US technology solution operating in the healthcare space needs to meet their compliance requirements of that country and blockchain technology should be no different. For example, if you set up a patient as a node or wallet in the Algorand system they would have an ID of 3b21951f72565deeed2fd75dce18fbaf which does not contain anything unique to recognize or identify that patient. The implications are that there should not be any initial HIPAA impact of using it at first glance and actually offers improved privacy then is available today. You would need a mapping table in your backend system to map 3b21951f72565deeed2fd75dce18fbaf to the actual user in question for the billing system. This other system would fall under HIPAA compliance but that is naturally a separate activity.
If this article has triggered a thought of an potential use case for your company / industry that you would be interested in pursuing then please reach out!