We need to explore blockchain as a new way to organise healthcare services.
The potential of blockchain and distributed ledger technology (DLT) in the healthcare domain has been recognised by several stakeholders around the world. Blockchain applications in the healthcare industry span from health data exchange and identity management to drug supply chain, from insurance to personalised medicine.1
The European healthcare ecosystems face difficult challenges, such as the aging population, multimorbidity, healthcare workforce shortages, and the rising burden of preventable noncommunicable diseases.2 Therefore, it is key to explore blockchain as a new way to organise healthcare services and as such develop more resilient, accessible and effective quality care to European citizens.
In this context, healthcare services can use blockchain-based tools to improve health outcomes, and are broadly recognised as an essential, not disruptive element to achieve sustainable healthcare systems that optimises nurses’ time in support of patient care needs.3
Health data often lies within technologies that are not interoperable today, thus hindering its wider use.4 More significantly, the use of people-centred health data is still under-developed across the EU.5 The data is often untraceable and fragmented across different locations and systems, with potential adverse impacts on diagnosis, treatment and follow-up in primary care and community care settings. Therefore, a continuity of care approach becomes crucial for healthcare ecosystems as updated citizens health records are lifesaving for citizens, based on informed decisions made by the healthcare professionals.
Healthcare services and blockchain: benefits for person-centred care
Rather than having one central administrator that acts as a gatekeeper to data, a network of clinicians needs to have access to synchronised citizens’ health records, visible to anyone with credentialled access, giving unprecedented benefits for person-centred care models in the EU.
Given the specific features of blockchain in establishing trust, accountability, traceability, and integrity of data,6one of the key applications envisioned is electronic health record management and exchange. Blockchain provides interesting solutions in health record management, as it introduces a decentralised mechanism for controlling and accessing data, while also introducing a timestamp to the data, as well as a robust audit trails mechanism.7
Compared to traditional databases in biomedical and healthcare applications, blockchain provides clear benefits, including more robust data provenance models (improving both ownership control and traceability of the origin of a specific data asset); increased robustness and availability (thanks to the high level of redundancy provided by the technology); and improved privacy and security (thanks to cryptographic algorithms).8
Blockchain can support the development of person-centred care models with specific focus on continuity of care, allowing nurses to process lifetime personal health data. Blockchain’s ability to secure citizens’ health data can give EU cross-border care a new dimension of deployment. These developments may reduce the workload of nurses’ frontline, thereby making primary and community care more accessible.9
The European Commission has published a recommendation10 on a European Electronic Health Record (EHR) exchange format that will facilitate citizens’ access to their health information electronically and securely across all EU Member States.
The creation of the International Association for Trusted Blockchain Applications (INATBA) provides an opportunity for stakeholders to focus on the health agenda and find practical blockchain solutions that are fit for purpose, supporting the frontline professionals and delivering better health outcomes for citizens throughout Europe. Blockchain represents an opportunity to make healthcare ecosystems more efficient, improving the quality and safety of planned and delivered care, and empowering citizens and patients to better manage their own health.
Added value for continuity of care
Blockchain has many unique characteristics, three of which make it particularly useful for continuity of care.11 These are:
- Full traceability of any information on the blockchain;
- The ability to ensure data has not been tampered with; and
- Increased security.
But the advantages of blockchain should go way beyond traceability and security. Blockchain should build trust and support frontline staff in planning nursing care across clinical pathways, making sure outcomes are recorded without being an administrative burden, so that the nurses’ workload can be reduced significantly, especially taking away the burdensome administrative tasks allocated and delegated to nurses. For continuity of care it is key that blockchain supports the holistic view of nursing care and serves as a single source of truth – meaning that all healthcare stakeholders can see the same information to which they have been granted access by the citizens and patients.
There are blockchain solutions which are now ready to be adopted in routine, real world scenarios; and most importantly, which are able to show a real return on investment, both in financial terms and in actual improvement in the existing workflow. Within this context, it is important that INATBA Healthcare Working Group explores the real needs in different health service provision scenarios, and of the environments and workflows in which healthcare professionals operates daily.
The true challenge is that the industry needs to meet with all relevant stakeholders to better understand the existing workflows and relevant shortcomings, to eventually co-create and co-design blockchain solutions in collaboration with the end users, to impact the way in which nursing care is provided in different real world scenarios.
The Research Data Alliance working group on blockchain in health data management12 recently provided a basic framework for designing distributed ledger technology solutions,13 that might help innovation and deployment when digitalising the healthcare sector.
Bringing innovation into practice
As a first step it is important to start developing the use case by identifying the problem or opportunity the end users are seeking to address through the solution and formulate clearly the expected outcomes, focusing – when possible – on tangible outcomes to be reached in the short or medium term.
Furthermore, it is important to establish benchmarks for future reference, by defining some key metrics to assess the results of the new blockchain-based system in comparison with existing systems and workflows. For this reason, it is of paramount importance to analyse in detail what is the current workflow for that specific operation and identify the relevant key performance indicator (KPI). This will serve as the ground truth for assessing the performance of the blockchain-based system, providing evidence of its efficacy or further guidance for improvement or redesign.
Use case: blockchain improves planning of primary and community care
Optimising clinical pathways through blockchain and artificial intelligence (AI) are great opportunities for the nursing profession to process and to store nurses’ activities and actions, as well as monitoring the data that continuously feed into the nursing care process, and as such better plan daily activities.
A European society where a growing number of people live with comorbidities and non-communicable diseases in need of more complex nursing care interventions in community care settings, as the duration of hospital visits is forced to become shorter and shorter, and in need of more tailored care to address the unmet needs, can benefit from blockchain tools for community care.
The use case scenario supports the design of tailored continuity of care pathways, enabling a bidirectional flow of data between patients and authorised care actors, making data accessible across community care based healthcare networks, and allowing credentialed users to securely add, with the citizens’ consent, to the nodes of information needed to make the continuity of care operational and effective.
In the case of chronic patients’ management, some interesting initiatives have been launched, combining DLT with novel medical IoT devices (IoMT) to facilitate patient remote management, self-management, and continuous monitoring. Surely the adoption of IoMT can help improve the quality of care and reduce the occurrence of severe events which might otherwise lead to hospitalisation, while at the same time reducing unnecessary visits to emergency rooms.
Furthermore, the data coming from these devices need to respond to basic quality and safety criteria, which DLTs can help achieve by providing elements for proving data provenance and integrity, as well as – and not less importantly – the authenticity and identity of the IoMT device itself.
The current systems of data entry by frontline nurses, who are now spending more valuable time in increased administration and data collection rather than caring for patients, is a real barrier to address the unmet needs. This adds further responsibilities that distract frontline nurses away from the patient’s bedside.
Blockchain technology has great potential to boost continuity of care without being disruptive. Healthcare, especially now we are going through the COVID-19 pandemic, is in itself already disruptive enough!
Blockchain can be a valuable support for the already overwhelmed healthcare sector frontline staff, and particularly for the nurses who co-ordinate continuity of care 24 hours a day, seven days a week, 365 days a year. It is therefore key that blockchain solutions enhance the interaction between the citizen or patient and the healthcare provider, ensuring access to more accurate, complete, and trustworthy health data, thus positively impacting the delivery of more people-centred and personalised healthcare.
Blockchain solutions should have a positive and measurable impact on the nurses’ workloads with a quantifiable rebalancing of tasks from administrative support towards care delivery. In consideration of the pertinent role that nurses play in primary and community care, it is crucial to ensure that frontline nurses can independently deliver high quality and safe care by developing (throughout the EU) advanced capabilities in managing the chain of care.
- Frost & Sullivan Report: Blockchain Technology in Global Healthcare, 2017–2025 – Healthcare Industry Assesses Blockchain Potential to Optimize Healthcare Workflows and Improve Outcome-based Care Delivery Models, June 2017, p.34.
- Communication on Digital Transformation of Health and Care in the Digital Single Market
- eHealth Action Plan 2012-2020
- eHealth Interoperability Framework Study
- Communication on Digital Transformation of Health and Care in the Digital Single Market
- Ribitzky, R., Clair, J. S., Houlding, D. I., McFarlane, C. T., Ahier, B., Gould, M., … & Clauson, K. A. (2018). Pragmatic, Interdisciplinary Perspectives on Blockchain and Distributed Ledger Technology: Paving the Future for Healthcare. Blockchain in Healthcare Today.
- Halamka, J. D., & Ekblaw, A. (2017). The potential for blockchain to transform electronic health records. Harvard Business Review, 3.
- Kuo, T. T., Kim, H. E., & Ohno-Machado, L. (2017). Blockchain distributed ledger technologies for biomedical and health care applications. Journal of the American Medical Informatics Association, 24(6), 1211-1220.
- European Social Pillar
- European Commission (2018) Communication from the Commission to the European Parliament, The Council, The European Economic, and Social Committee and The Committee of the Regions on enabling the digital transformation of health and care in the Digital Single Market; empowering citizens and building a healthier society. European Commission, Brussels. (Online) Available from: https://ec.europa.eu/digital-single-market/en/news/communication-enabling-digital-transformation-healthand-care-digital-single-market-empowering
- World Economic Forum, 2019, Building Value with Blockchain Technology: How to Evaluate Blockchain’s Benefits. White paper (p.9).
- The full RDA WG is available here: https://www.rd-alliance.org/system/files/documents/Blockchain%20adoption%20evaluation%20framework_0.pdf
Danny van Roijen
Digital Health Director, COCIR
Co-chair Health WG, INATBA
Mirko De Malde
Italian Ambassador, Blockchain In Healthcare Today journal
Co-chair, Health WG INATBA
Executive Director, INATBA
Professor Dr Paul De Raeve, RN, MSc, MStat, PhD
General Secretary, European Federation of Nurses Associations
Member of Healthcare Working Group, International Association for Trusted Blockchain Applications (INATBA)
This article is from issue 14 of Health Europa. Click here to get your free subscription today.