Newsletter Spring 2019 - John Kucharczyk, Can Blockchain and Artificial Intelligence Transform the Management of Healthcare?

Can Blockchainand Artificial Intelligence Transform the Management of Healthcare? 

John Kucharczyk, PhD, Executive VP, HealthGraph Inc 

Co-authors: Chris Duncan, Subbu Jois, Robert Stebbins, MD, HealthGraph Inc 

In a 2018 survey, more than half of executives believe blockchain will be a disruptive force in healthcare [1].i 

Blockchain is a form of Distributed Ledger Technology (DLT) that was initially developed to enable a secure way to transfer electronic currency (Bitcoin) between users [2].iiBlockchainprovides amethod to record and maintain a permanent tamper-proof log of transactional events and data.A blockchain database is maintained by a network of users and secured through cryptography. New information added to the database is parceled in blocks, which are linked to a chain of previously created blocks. Each block has a unique ID (a hash) that ensures the integrity of the data stored on the blockchain. 

Blockchain recordsare maintained across decentralized and distributed computers linked in a peer-to-peer network comprised of individual users. Each of the computers (nodes)in the decentralized network maintains a copy of the block, and all copies are updated and validated simultaneously. Cryptography (via hash codes) is used to secure the authentication of the transaction source, and authorized changes can be made in seconds. 

Unlike traditional databases, blockchain-distributed ledgers have no central data store.A consensus mechanism lowers the risk of fraud by requiringthat any change in a ledger must be agreed upon by a specified number of nodes, and once accepted, updates each transaction in the ledger. Proof of workin blockchain is a form of electronic mining thatprovides validation that the transaction is legitimate and secured by the cryptographic hashes that ensure its authenticity. Proof of stake determines which node gets to update the blockchain and prevents tampering with the underlying blockchain mechanism. On the basis of these primary and secondary blockchain attributes, it is theoretically almost impossible to alter or delete a transaction event that has been recorded and entered into a blockchain. 

While the largest commercial use of blockchain technologyhas to date been to create secure and efficient networks for financial transactions, blockchainapplicationshave proliferated across a broad range of industries, including healthcare [3].iiiIn the next section of this article, we describe how blockchain has already impactedseveral key areas of the healthcare industry, includingelectronic health records(EHRs) and personal health records (PHRs).The final section of the article briefly describes how a digital health start-up, HealthGraph Inc., is developing a novel next-generation blockchain-like technology, which can be merged with Artificial Intelligence (AI) algorithms to create an intelligent, versatile, and secure platform for personalized healthcare analytics. 

Interoperability of Electronic Health Records (EHRs) 

EHRs present problems for healthcare providers and payers because of different data formats, structured and unstructured inputs, incomplete records, and the requirement to comply with Health Insurance Portability and Accountability Act (HIPPA) regulations. These EHR features complicate risk stratification and clinical decision support [4].iv 

One advantage of blockchain EHRs is that healthcare userspatients and physicians–themselves control the blockchain technology. A second advantage is that health data from previous transactions are organized according to a single standard so that all users have reliable access to the same accurate, up-to-date information. Blockchain-based EHRs enable users to collaborate with confidence because the EHRs are based on a consistentdatabase that establishes their security and interoperability [5].v 

Interest in blockchain EHR platforms is also growing because healthcare organizations are searching for secure strategies for managing big data [6].viBy decentralizing ownership of key data setswhile increasing authorized sharing protocols, blockchain EHRs help create an interoperable, big data system that prioritizes accuracy and shared-decision making. 

EHRs are now well positioned to facilitate the flow of big clinical data to healthcare research and delivery organizations. As application developers further integrate patient home monitoring data into EHRs, clinicians are able to access multiple types of patient-generated clinical data to better inform patient care.Adding biometric data to the medical record and empowering patients with easy access and control of their data also improve understanding of personalized patient-centric medical information, which is further described in the next section. 

Personal Health Records (PHRs) 

PHRs are clinical databanks managed and maintained by patients.PHR records contain many of the same data as hospital medical records, including medical history, diagnostic test results, and clinician documentation. A key challenge for PHRs is sharing data securely. Notably, with blockchain-based PHRs, health records are controlled entirely by the individual patient. Patients can selectively releasehealth data needed by their providers while keeping the rest of their profiles private and secure.  

As healthcare delivery organizationsshift focus from implementation of EHRs to optimization of PHRs, patient data interoperability issues become increasingly visible. PHRs are now accessible via personal computers and mobile devices over the internet. Blockchain platforms can collect health data in a secure and automated manner, which allow patients to more easily aggregate their records from different sources and share whatever they want with their physicians. Blockchain PHRs are thus well positioned to facilitate interoperability among data contributors. 

Standards are being developed to ensure that patients can connect their personal electronic devices to health care providers and payersthroughautomated application programming interfaces. PHRs are expanding from collecting and organizing clinical data to providing patientswith streamlined record portability, analytics derived from patient-generated medical data, and access to cost information.  

Advances in internet-connected consumer devices have allowed patients to collect clinically relevant data using electronic sensors found on virtual assistants, smartphones, and wearable devices, such as smart watchesproduced by Samsung, Apple, and Fitbit. Amazon produces health software using a virtual assistant product (Alexa) to collect symptom descriptions and enhance patient engagement and education.  

Early adopters of first generation PHRs experienced poor integration with hospital data because records that could be accessed were oftenincomplete. These challenges are being addressedby improved integration with EHRs.One widely accepted standard for PHRs and EHRs, Fast Healthcare Interoperability Resources, uses web-based programming protocols to connect health care organizations to the internet. Patients now havethe ability to connect third-party applications to EHRs via application programming interfaces. The ability to seamlessly integrate clinical data into PHRs has led one PHR to be adopted by more than 130 major health systems in less than one year. 

In addition, software programming tools, such as Apple HealthKitand Google Fit, are driving developers to build patient-centric health-related applications. With a blockchain foundation in place, these systems can share data securely. However, whether the various technological advances ultimately improve patient outcomes, lower costs, and improve quality remain important unanswered questions.  

Claims Processing and Secure Contracts 

Smart contracts allow agreements to be verified via blockchain. Parties signed under a smart contract agree to be self-managed by computers that represent the interests of the users. Blockchain-structured smart contractssimplify complex, data-intensiveprocesses, such as value-based healthcare contracts, and potentially save companies money.Since smart contracts are decentralized and cannot be changed, all parties can be confident that terms will be consistently executed. For example, insurance claims can be securely processed in a blockchain system by providing a common record that allows transparent validation of the underlying claim. 

Smart contracts make it easier for payers to identify and connect to providers who meet criteria for value-based care arrangements, which can take a long time to draft and execute manually.Smart contracts can automate these processes and decrease the resources needed to execute terms and conditions.   

DrugSupply Management  

Improving supply chain management with more accurate tracking techniques is a high priority for many healthcare organizations. A Pistoia Alliance survey reported in 2017 that sixty-eight percent of pharma and life science executives said that blockchain could improve medication supply chain management. 

A decentralized asset management system like blockchain ensures that transactions between supply chain partners are secure and transparent and produce a tamper-proof audit trail for products. Blockchain also providesa mechanism to reduce waste and fraud whenproviders order consumable supplies.Abuse-prone medications, such as opiates,are alsolikely better controlledwith a blockchain-based supply chain. 

Detection and Prevention ofFraud 

Healthcare fraud costs $80 billion annually.Blockchain’s ability to create validated identities and accurately record tamper-proof transactions has already made it popular in the financial industry. In healthcare, fraud can be reduced if payers have access to a patient’s complete medical record and are therefore better able to identify suspicious claims or payment requests. Smart contracts canalso verify the validity of providers submitting claims and proactively monitor patterns of billing that could indicate fraud.  

Implementing an industry-wide blockchain-based fraud detection systemwill, however, require collaboration between multiple stakeholders along the healthcare continuum.Payers, for example, will needunrestricted access to both patient data and provider information that meet HIPPA requirements, which could present privacy concerns. Additionally, all stakeholders will need to adopt standardized blockchain technologies to facilitate development of a fully operationaldata exchange capability. 

How Artificial Intelligence (AI) May Impact Healthcare Delivery [7]vii 

AI can provide advantages over traditional clinical decisionmaking because learning algorithms can evolve to become more precise and accurate, allowing greater insightsinto diagnostics, care processes, treatment variability, and patient outcomes. At the 2018 World Medical Innovation Forumon AI, leading medical researchers highlightedthe areas of the healthcare industry area most likely to be impacted by AI: 

Clinical decision-making:AI has been shown to favorably impact clinical decision making, which often requires intensive analysis of highly complex datasetsand where patient outcomes often vary with the skill and experience of the individual clinician. In the longterm, AI is anticipated to continue to play a significant role in clinical decision support, risk scoring, and overall patient care. 

Next-generation radiology and pathology tools:Over 80 percent of the data stored in a typical EHR consists of radiology or pathology results. AI mayenable the next generation of radiology tools to replace the need for tissue samplesand target treatments more appropriately.AI algorithms may also deliver more accurate digital pathologyresults and help unlock prognostic data embedded in pathology images to better inform patient treatment decisions.  

Improving EHRs and PHRs:AI already uses voice recognition tools to automate routine EHRentries, including clinical documentation. Natural language processing tools, including video recording of patient-physician meetings,are also being used increasingly.Virtual assistants with embedded intelligence can be utilized at the bedside by clinicians for orderentry.AI may also help to process routine medication refills and result notifications.  

Wearable health care monitors:Patients now have access to wearable devices with sensors that can collect valuable data about their health.These data can be supplemented with patient-provided information from home monitoring devices, such as self-images taken from smartphones.Of note, the quality of cell phone cameras is increasing every year. Images that are viable for analysis by AI algorithmscan already be produced with cell phone cameras. 

A Next-Generation Blockchain /AI Technology 

Blockchain was the first-generation computing environment with DLT to validate decentralized transactions. A digital health start-up, HealthGraph, Inc., based in NYC,is developing a next-generation decentralized network DLTthatintegrates withmachine learning and existing data systems to create an intelligent, HIPPA-compliant, secure platform for personalized healthcare delivery and analytics. HealthGraph’sproprietary technology platform consists of a complete end-to-end blockchain-like DLT system with mobile applications,web-based portals, and analytical tools,allowing for the creation of robust systems that can support large volumes of data, analytic platforms, and machine learning. The technology is particularly applicable to a healthcare information system in which real time services are provided to patients, providers, and payers with low costs and increased interoperability and security  

HealthGraph’s patient-centric information platform is advanced over current blockchain systems because of enhanced performance, speed, and securityin the collection, distributed storage, analysis,and transfer of personalized information resources between patients, physicians, and insurers. HealthGraph anticipates that its technology platformmay fundamentally change the management of healthcare, making it more efficient and reliable.