by Mark Fabiano: Chief Executive Officer, Curatus
Thursday, May 30th 2019
As Shakespeare put it, “All that glitters is not gold.” I believe this message applies to blockchain in healthcare.
Blockchain technology, developed initially for cryptocurrency, is currently being considered as the technology solution for the pervasive problem of inaccurate provider data. Health plan leaders may want to be cautious about embracing blockchain as the solution to a complex problem.
Different Data Characteristics
This much-hyped technology is gaining momentum as the solution to a very complex problem. But before healthcare organizations get too far down the path with this nascent technology, we should caution leaders to consider where the new technology may have shortcomings in a healthcare context.
Blockchain was not envisioned nor designed with provider data governance and management in mind, so the transition could easily prove to be a costly rabbit hole. This is especially true given the vastly different data characteristics between the crypto-currency world and the world of healthcare provider information.
Blockchain's Glaring Problems
The healthcare industry proponents of blockchain consider the technology as a promising pathway to improved provider data accuracy and governance. It would allow authorized parties invited into the blockchain to make and then share updates to the extensive list of data elements associated with each contracted provider in a payer's network. In theory, this approach will create on-demand accurate provider data files to be shared by all participants of the blockchain.
There are several problems in this process that can still result in inaccurate data. To name a few: the lack of effective data curation; the need for enrichment and grading technology to be replicated at each entry point into the blockchain; and the serious lack of data processing speed that has plagued blockchain since its inception.
Blockchain was created as the integrity and inventory control platform for cryptocurrency, which has a finite number of virtual units with static characteristics. Blockchain fits that bill very effectively. Provider data, on the other hand, is neither finite in quantity nor static in nature. As such, blockchain's rigid structure could compound the already existing challenges with constantly changing provider data.
Provider Data Management in Flux
The reality is that provider datasets are detailed and constantly in flux. For example, new providers are continuously entering a payer's network, current provider profiles with dozens of data elements are changing all the time, and there are always a few providers leaving the network. In a blockchain structure, not just one — but now many — replicated and rigidly connected datasets may contain out-of-date provider information. Moreover, simply replicating and connecting a string of datasets doesn't magically increase the accuracy of the data being input.
I remain skeptical about whether blockchain can be effective in the way some in the healthcare industry have proposed to use it for improving provider data management. Giving even “authorized” access to create connected master records without common data validation, curation, and grading standards and technology will likely result in diminished rather than enhanced provider data accuracy. One erroneous update to a provider record creates a weak link, compromising the entire chain.
Value of Blockchain Data Limited
One of the key goals of health plans considering the blockchain approach is to create a clean and current member-facing online provider directory. Blockchain falls short of this goal.
Furthermore, there are other equally important uses of accurate provider data within a health plan that blockchain does not address. For example, quality, risk and encounter data must be submitted to CMS, NCQA and other state and federal regulators on a regular basis. The overall success and the serious financial implications of these data submission efforts hinges on complete and accurate provider data at the beginning of the process.
Even if the blockchain contained consistently accurate provider data, it still doesn't integrate the data with a plan's existing technology infrastructure without the costly and time-consuming process of building “integration bridges.” This limits the value and usefulness of blockchain data for operational areas beyond the provider directory.