There has been no shortage of commentary over the last many months concerning blockchain technologies, crypto, and digital assets. Starting as far back as 2017, I was engaging in varied discussions with industry colleagues regarding how blockchain might impact the world of healthcare and more specifically the world of medical coding and revenue cycle management. Back in 2017, and even more recently, I was not necessarily dismissive of blockchain as it related to healthcare but I was challenged to understand, like many, how it could be used to appropriate effectiveness in the HIM space. Reflecting back on this time I probably should have spent more time reading white papers on the topic and educating myself versus forming opinions based off of industry sources and other data inputs that were probably no more “in-the-know” than I was. I guess in some ways that’s how new technologies play out.
Gartner followers and tech aficionados may be familiar with the “Hype Cycle” model or the more well known “Technology Adoption Lifecycle” popularized by Geoffrey Moore. Whatever model you may look to, I would venture to say that we are in the very early innings, maybe even the first at bat, in the first inning, as it relates to the usage of blockchain in the healthcare ecosystem.
After dispelling some of my misconceptions about blockchain, crypto and the like, I’ve really dug in over the last many months to get educated to fully understand the impact of these technologies. I’ve looked at projects such as Ethereum, Solana, Cardano, and Chainlink to name a few.
At the 50,000 foot level what I can definitely say is that the implications for blockchain in healthcare, and specifically in HIM and revenue cycle disciplines is both exciting and I feel will be upon us much sooner than most realize. There are some characteristics of blockchain that will help us adopt these solutions with open arms in the healthcare space, here are a few observations on some characteristics that will be most exciting for this space.
#1 Importance of Consensus Mechanisms
In the HIM space there are a host of partners that collaborate together to ensure a patients care is properly accounted for and paid. These collaborators could include the physician group that is contracted to the hospital, the front-desk and registration personnel collecting data, the 3rd party that validates insurance information, the outsourced medical coding entity that assigns codes based off of the clinical documentation, the biller, the insurance entity, and the collections companies that seek out unpaid medical bills. It certainly takes a village. A challenge with this approach is that each of those partners has their own view into the data that is discreetly managed from the rest of the village participants. A significant appeal of blockchain for me when I look at this environment is the ability to maintain a central record of each patient’s encounter and related activities that is kept in sync for all participants. This consensus mechanism ability such as Proof of Stake in ETH2.0 or Proof of History in Solana could help provide a decentralized network ledger of all activities. Imagine a medical coding participant that would check out a patient’s record and then potentially suspend it because it needed further documentation to validate a particular procedure charge. In today’s world that action may or may not be captured. In a future-world, imagine that same resource taking the same action but this time that activity is logged and made a part of the distributed ledger for that patient’s encounter. Validating and ensuring HIM or RCM activities occurring relative to a patient’s visit could be extremely valuable to the “village” but also would be a built in mechanism for compliance validation.
For years, maybe decades, HIM organizations have struggled with the ability to properly interact and exchange important data with other organizations. In some ways this issue has been made worse by EMR companies seeking to handle every conceivable function required by a modern day healthcare operator. I suspect the thinking goes – “if we can provide all the capabilities within our suite of software why would X customer need to go anywhere else”. That’s a fine idea, but unfortunately it’s one that has already been tested in the hard reality of commercial ops and failed miserably. One need look no further than Oracle and Salesforce. Oracle decided many moons ago that not only could they provide their database software but they could also provide accounting, payroll functions, CRM, ERP, MRP and a host of other capabilities. That’s nice, but customers ended up realizing that they were creating every conceivable function in their enterprise linked back to one central software suite. I could spend days on this topic, but let’s say that organizations realized that it might be better to let the marketplace bring them capabilities that were specifically fit to their needs and could easily be integrated in with other solutions that they might enjoy. This created more reasonable enterprise dependencies and also created better cost structures. So organizations went from Oracle licensing them everything they could ever need for a large number that had to be put on the balance sheet to companies like Salesforce allowing them to license just a couple seats for their CRM suite (as example) that then could be made to play nice with their inventory software module from another vendor. This interoperability broke open incredible innovation but it is still elusive to modern day healthcare operators that have placed some very big bets with the Epic and Cerner’s of the world. A blockchain oriented healthcare enterprise will speed interoperability and actually pave the way for data exchange in a secure, decentralized fashion which will create fundamentally better cost structures and better capabilities in healthcare organizations.
Artificial intelligence can play a very large role in broader HIM space. How many functions exist today in the HIM world that could be programmed and better performed by a machine than a human? That’s not to say that human’s aren’t critically important to HIM… they are! The difference is that in the healthcare space we should be focused on ways to allow humans to tackle those tasks where they bring the most value and leave the more mundane / programmable tasks to machines. Blockchain and it’s adoption in healthcare will allow AI to increase in adoption within the healthcare market. Imagine having a medical coding operation that utilizes both machine capabilities (autonomous coding) and human experts. In a blockchain enabled world each coding event is captured with full audit trails so that compliance officers and healthcare executives can feel comfortable that their operations are being handled in the most efficient way but there is also appropriate infrastructure in place to allow for audibility and proper checks and balances.
On the QueueLogix side we have embarked on a very exciting project to take our flagship application, EventCare, and explore what is possible with customers whom are interested in further securing their HIM, coding and revenue cycle operations with blockchain modalities.
The world of blockchain is just getting started and the implications for healthcare are going to be incredible and most importantly are going to impact cost structures and patient satisfaction very positively.