Dr. John Halamka
Blockchain in healthcare Q&A with Dr. John Halamka
February 06, 2019
by Gus Iversen, Editor in Chief
Dr. John Halamka, already a well-known figure in the world of health IT, has become one of the more visible champions of blockchain technology in healthcare, as well as one of its most optimistic advocates.
Last year, in addition to his roles as CIO of Beth Israel Deaconess Medical Center and dean of technology at Harvard Medical School, Dr. Halamka took the reins as editor-in-chief of Blockchain in Healthcare Today, a new peer-review journal dedicated to building a body of research for digital ledger technology.
HCB News: Are you currently involved in any blockchain research you can tell us about?
Dr. John Halamka: In early 2018, blockchain was at the inflated expectations peak of the Gartner Hype Curve. By the end of 2018 it migrated past the trough of disillusionment to the plateau of productivity for selected use cases. BIDMC has committed to three areas of inquiry:
a. Data integrity – how can you prove that a medical record was not changed, deleted, or amended? When an encounter is complete, create a “hash” or one-way mathematical digest of the record and write that hash into the blockchain. If anyone has questions about the completeness or integrity of a record, it can be provided by comparing the “hash” today with the historical hash recorded the blockchain.
b. Provider Credentialing – today there are over 1,000 insurance companies in the U.S. Clinicians must submit credentialing data to each insurance company from which they seek payment. It’s a huge administrative burden. A number of collaborators are building a blockchain-based credentialing tool so that data can be submitted one time to a trusted ledger and then all payers can pull data from that ledger, reducing cost and burden.
c. Consent – The U.S. has 50 states with 50 different privacy and consent policies. We believe that recording consents on the blockchain instead of in each EHR will enable transfers of patient data while respecting patient preference via querying a public ledger before each exchange. This work is part of the MedRec project. See: https://medrec.media.mit.edu
HCB News: As blockchain applications emerge in healthcare, how will providers interact with them? Is there a level of training that will be required or will it be behind the scenes?
JH: Blockchain is an infrastructure component. The tools provided by blockchain developers are hard to use and require more steps than an average human can navigate. Uses of blockchain in healthcare need to be invisible to the user. The ideal application hides the complexity while still enabling the benefits of a public ledger.
HCB News: What are some of the tools for blockchain in healthcare that already exist, and what do they bring to the table?
JH: Companies such as Simply Vital Health, Embleema and Optima Curis, (I advise all of them) have created applications on top of blockchain to address data sharing challenges without adding complexity. Simply Vital Health’s tools are open source, encouraging developers throughout the world to leverage their easy-to-use care coordination tools based on blockchain.
HCB News: Do you feel there are major misconceptions about blockchain and what it could mean for healthcare? If so, what are some of the biggest myths?
JH: Blockchain can be slow, cumbersome, potentially expensive (energy costs), unscalable and limited to small amounts of data. It will not replace existing databases, solve interoperability problems, provide a solution to identity management challenges (i.e., who is the patient), be useful for analytics or replace existing architectures. It’s an adjunct to what we already do, providing some utility for use cases requiring trust.
HCB News: Looking ahead to the next 5 or 10 years, how can you imagine blockchain changing healthcare? Where is the biggest potential?
JH: As mentioned before, the most likely use of blockchain will be for helping solve problems associated with the trustworthiness of data. Since blockchain is not operated by government or a corporation, the trustworthiness of information recorded on the chain transcends politics and policy. I really believe that consent management using distributed public ledger technologies has real potential.
Last year, in addition to his roles as CIO of Beth Israel Deaconess Medical Center and dean of technology at Harvard Medical School, Dr. Halamka took the reins as editor-in-chief of Blockchain in Healthcare Today, a new peer-review journal dedicated to building a body of research for digital ledger technology.
HCB News: Are you currently involved in any blockchain research you can tell us about?
Dr. John Halamka: In early 2018, blockchain was at the inflated expectations peak of the Gartner Hype Curve. By the end of 2018 it migrated past the trough of disillusionment to the plateau of productivity for selected use cases. BIDMC has committed to three areas of inquiry:
a. Data integrity – how can you prove that a medical record was not changed, deleted, or amended? When an encounter is complete, create a “hash” or one-way mathematical digest of the record and write that hash into the blockchain. If anyone has questions about the completeness or integrity of a record, it can be provided by comparing the “hash” today with the historical hash recorded the blockchain.
b. Provider Credentialing – today there are over 1,000 insurance companies in the U.S. Clinicians must submit credentialing data to each insurance company from which they seek payment. It’s a huge administrative burden. A number of collaborators are building a blockchain-based credentialing tool so that data can be submitted one time to a trusted ledger and then all payers can pull data from that ledger, reducing cost and burden.
c. Consent – The U.S. has 50 states with 50 different privacy and consent policies. We believe that recording consents on the blockchain instead of in each EHR will enable transfers of patient data while respecting patient preference via querying a public ledger before each exchange. This work is part of the MedRec project. See: https://medrec.media.mit.edu
HCB News: As blockchain applications emerge in healthcare, how will providers interact with them? Is there a level of training that will be required or will it be behind the scenes?
JH: Blockchain is an infrastructure component. The tools provided by blockchain developers are hard to use and require more steps than an average human can navigate. Uses of blockchain in healthcare need to be invisible to the user. The ideal application hides the complexity while still enabling the benefits of a public ledger.
HCB News: What are some of the tools for blockchain in healthcare that already exist, and what do they bring to the table?
JH: Companies such as Simply Vital Health, Embleema and Optima Curis, (I advise all of them) have created applications on top of blockchain to address data sharing challenges without adding complexity. Simply Vital Health’s tools are open source, encouraging developers throughout the world to leverage their easy-to-use care coordination tools based on blockchain.
HCB News: Do you feel there are major misconceptions about blockchain and what it could mean for healthcare? If so, what are some of the biggest myths?
JH: Blockchain can be slow, cumbersome, potentially expensive (energy costs), unscalable and limited to small amounts of data. It will not replace existing databases, solve interoperability problems, provide a solution to identity management challenges (i.e., who is the patient), be useful for analytics or replace existing architectures. It’s an adjunct to what we already do, providing some utility for use cases requiring trust.
HCB News: Looking ahead to the next 5 or 10 years, how can you imagine blockchain changing healthcare? Where is the biggest potential?
JH: As mentioned before, the most likely use of blockchain will be for helping solve problems associated with the trustworthiness of data. Since blockchain is not operated by government or a corporation, the trustworthiness of information recorded on the chain transcends politics and policy. I really believe that consent management using distributed public ledger technologies has real potential.