Five Blockchain Use Cases for Healthcare Payers, Providers

Five Blockchain Use Cases for Healthcare Payers, Providers

This is a technology I am really excited about. The common wisdom and current case uses are an underpinning of cryptocurrencies, such as Bitcoin and Ethereum. While this is important, only secondary to the technology highlighted below and from the base article.

 

Blockchain may offer a solution to these issues by keeping all members of the community instantly updated on where a provider is allowed to practice, whether or not she is accepting new patients, and what new affiliations she has formed.

This is important, because of current mHealth initiatives, such as CMC Virtual Visit, requires you to physically be in North Carolina, though the system servers both Carolinas. That has to change.

Administrative tasks such as claims processing and underwriting may also benefit from a blockchain approach, since managed permissions make it easier for payers to assess the validity of a claim, manage pre-authorizations, and ensure that providers are meeting the criteria laid out in their value-based contracts.

“Smart contracts could automate these processes and decrease the time and resources needed to execute the terms and conditions [of value-based contracting],” the report says.  “And because smart contracts are decentralized and cannot be changed, all parties can be confident that terms will be consistently executed.”

Pages from CMC Mercy Wound Care 10062017_Redacted_Page_1I continue to get notice of bill payments, similar to an actual bill image to the left, despite my plan being straightforward, at least as I know about it. Possibility to save much headaches and time wasting.

Blockchain would nearly eliminate this as rules can be set; such as “only render services covered under Medicare” to a particular patient. This removes the doubts about all parties getting compensated.

 

Enhanced security and transparency may also drastically reduce the amount of fraud that slips through the defenses of public and private payers.  When entities must have current and authenticated identities before a transaction is approved, the ability to push suspect claims through the reimbursement process is diminished.

Payers with access to a patient’s complete medical record and all of the individual’s approved providers would be more able to identify suspect claims or payment requests that do not match the patient’s documented conditions or normal care habits, explains Deloitte.

Source: Five Blockchain Use Cases for Healthcare Payers, Providers

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Medical Data Overload

Medical Data Overload

Stream 04/07

Healthcare EMRs [personal]

I had the misfortune to sprain my wrist recently that required a medical facility visit. After lengthy waits and treatment, discharge papers (handout with no digital option) disclosed the usual suspects such as purpose of visit and treatment, meds given and prescribed, and follow up procedures. Here is where the follow-up gets hairy approaching fubar. At the left is the first page of an actual discharge paper given out by the Emergency Department. It touts their secure access to your health records and provides a way to contact your doctors and allied professionals. Near the bottom are follow-up instructions, who to see, address info, phone number, and timeframe. The mistake I made was depending on the forms in the service to set up an appointment for today. Their system did not work and when a call was made late Thursday about it, the staff was unapologetic and less than helpful about. This is but one example of how Electronic Medical Records (EMR) failed in real world applications, the kind that drives costs up and reduces outcomes. A copy of the record that I was given was sent to the specialists’ office, which they acknowledged; made its way to the digital equivalent of the circular filing cabinet, the “ignore” bin. An education about how EMR’s are not really what is needed for healthcare reform and cost containment sheds light on the subject. There is the concept of Electronic Health Records (EHR). EMR is a digital version of paper charts in the Doctor’s office, scanned for archival and supposedly sharing purposes among vetted parties. Right answer, wrong question. A move to EHR takes these digitized documents and facilitates sharing throughout the whole system by design. “The EHR represents the ability to easily share medical information among stakeholders and to have a patient’s information follow him or her through the various modalities of care engaged by that individual” (Peter Garrett & Joshua Seidman PhD, 2011, para. 6). This was five years ago little action taken on this. The facility certainly dropped the ball with the information passing with the patient suffering negative outcomes because someone did not think through a system promoted by “suits” who generally do not have a clue on what happens on the front lines of care. This leads us to the present. National Coordinator for Health IT Karen DeSalvo wants to move forward with public access of their own data with a measure of control that is anathema to the profitable business of “blocking” data. the Office of the National Coordinator (ONC) said its 2016 goals include continuing to “build the economic case for interoperability,” coordinate with industry stakeholders to increase enhance consumer access to data, and to discourage health information blocking (Hall, 2016, para. 8). There are many avenues to making dollars in the corporate world; I do not understand how blocking data allows happening beyond a potential lock-in similar to Windows lock in for personal computing back in the day.

BCBSNC Shakeup

A recent media report has the #2 person at Blue Cross Blue Shield of North Carolina (BCBSNC) has resigned leaving behind a mess of a computer system tied to mistaken billing of customers and other software issues.

name Alan Hughes
title Chief Operating Officer (COO)
compensation $1.77M (2014)

(John Murawski, 2016)

I was a customer of BCBSNC during my “interim” period prior to Medicare [long story] and based on most of my interactions with them on the phone and in person, no surprise of their flawed systems. Someone has to fall on their sword and there is usually a severance associated with this, which was not disclosed in the piece, but I do not think he will visit the poor side of Durham County anytime soon. When your background is the Chief Information Officer (CIO) and the information system does not work properly, it happens. The Department of Insurance has reported 11,162 customer calls as of April 1, including 2,346 complaints against the insurer. The agency’s investigation could result in fines against Blue Cross up to $1,000 per violation per day (John Murawski, 2016). That has to leave a mark, but it is election year in North Carolina, so “stay tuned”.

Ransomware

UPDATED: Symantec said, “The 2007 and 2010 fixes referenced in the article were not contributing factors in this event” (Ann C Nickels, 2016). Further comment will not emanate from MedStar concurrent to the advice of IT, cybersecurity and law enforcement experts.

This topic will not go away. The hackers that penetrated MedStar Health in the Maryland/DC region came in through a 9 year exploit named JBoss, an application server courtesy of Red Hat Inc. (Tami Abdollah, 2016). As night turns into day, the hospital chain denies this. It must be stated that part of the mission of hackers is to expose weak spots where found. This time, it is the Samas or “samsam” vector specifically for JBoss middleware and other Java based servers. More details can be found here and here. When an IT person in charge of security ignore application threats from the writers of such software and the government on at least 2 other occasions, that would fit the definition of maleficence. MedStar is in deep doo doo, but admitting it would bring more of the wrong kind of attention in a competitive marketplace. Never mind these breaches are not specific to this chain.

Bibliography

Ann C Nickels. (2016, April 6). MedStar Response to Incorrect Media Reports. MedStar Health. Retrieved from http://www.medstarhealth.org/mhs/2016/04/06/medstar-response-incorrect-media-reports/

Susan D Hall. (2016, April 7). Karen DeSalvo: Tech can improve patients’ access to health data. Retrieved April 7, 2016, from http://www.fiercehealthit.com/story/karen-desalvo-tech-can-improve-patients-acesss-health-data/2016-04-07

John Murawski. (2016, April 5). Blue Cross executive resigns amid technology fiasco | News & Observer. The News and Observer. Raleigh, NC. Retrieved from http://www.newsobserver.com/news/business/article70020192.html

Peter Garrett, & Joshua Seidman PhD. (2011, January 4). EMR vs EHR – What is the Difference? Retrieved from https://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr-difference/

Tami Abdollah. (2016, April 5). Hackers broke into hospitals despite software flaw warnings. AP The Big Story. Washington DC. Retrieved from http://bigstory.ap.org/article/86401c5c2f7e43b79d7decb04a0022b4/hackers-broke-hospitals-despite-software-flaw-warnings

 

Technology and Healthcare, an Intersection

I need to make known that I am not a huge fan of obvious advertorial content, in other words, sponsored content (“Tablets could ease healthcare workflows,” n.d.). Since the concept is not going away and is part of the fuel that drives the “free” as in cost web, my preference for it to be labeled as such. This linked story meets that requirement.

Having said this, I found this article to be fascinating as well as a “duh” moment for me is why is this not widespread. Whenever technology is introduced in a collaborative way to any field not friendly to it, there is lag, blowback, disdain, et cetera. I consider myself having a practical understanding of technology, albeit on a limited income. It has made my lifestyle for the better part of the last two decades and enabled my graduate studies and ePortfolio, linked elsewhere on this blog. Since tablets, slates, two-in-one devices are the modern Personal Digital Assistant (PDA), they can carry much more usefulness and information that can be hardened, accessible, monitored, and placed in the hands of medical professionals to remove some of the more mundane aspects of their jobs while letting the focus is patient care and medical decision-making (“Our Solutions — Greenway Medical Technologies,” n.d.). As a health consumer, the ability to communicate with the healthcare team in matters that are near real-time or quickly via e-mail is a shrewd operating state that allows for better diagnosis. It also allows less time going over the same thing at each doctor visit, thus saving the patient time and money, while maximizing the practitioner’s time by getting to the point of the visit. The article is one vendor’s vision to educate its market on their product and service offerings for this field. I am not actively in the field, so one can only guess how effective their pitch is, but it is a market too large to ignore, and will become more important over time as health care transitions to a single-payer model. IMHO, it is not if it will happen but when. The only reason it hasn’t happened to this point is partisan politics. Economics and demographics will force this shift among us, if not civil disobedience.

The barriers to deployment are less technical and more choice-based. The secure Electronic Health Records (EHR) marketplace is available, albeit not at an initial reasonable cost or an “open” system. One of the companies mentioned in the article just so happens to support an Auburn man on the PGA Tour, so the company can’t be all bad and headquartered near my old stomping grounds in Carrollton, GA [~85 mi from where I grew up and about the same distance from my undergraduate education]. The Hippocratic Oath that medical doctors historically swear by has tenets that cover topics like this:

  • To hold him who taught me this art equally dear to me as my parents…
  • I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them.
  • In purity and according to divine law will I carry out my life and my art…
  • Into whatever homes I go, I will enter them for the benefit of the sick…

The list continues (North, 2002).

Anything that enables a particular Greek historical admonishment, and can be interpreted in modern software and digital transmissions is a good thing in the end. A local hospital group, the “Purple” team, is running ads based on the ability to telemedicine your doctor with Skype™ style technology from anywhere or anytime. A utopia based vision, for sure, but one that can and must happen in order for health outcomes to match the rest of the developed world.

http://techpageone.dell.com/technology/tablets-could-ease-health-care-workflows/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+techpageone+%28Tech+Page+One%29&utm_content=Netvibes#.VDcckxYqTVF

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