The Doctor Can See You Now: Using Blockchain to Fix Provider Credentialing
The medical practitioner credentialing and enrollment process has much to gain from the utilization of the technology that underpins the Bitcoin market. The State of Illinois and Hashed Health have partnered to explore this.
The importance of medical provider credentialing and enrolment (that is, the processes by which healthcare facilities and insurers verify the training and education of medical practitioners, largely through primary research, prior to allowing such providers to bill for services) is, without question, paramount. With what seems like an ever-evolving landscape within the U.S. healthcare system – the most recent iteration including sharp focuses on value-based reimbursement and cost control – it is critical that the provider quality is traceable and transparent. Currently, the process is plagued with inefficiencies – after the physician is credentialed with a facility (which can take a number of months), insurers can take an incremental 90-120 days to complete the process[1]. Additionally, significant administrative burden is placed on the practitioner, thus limiting the time they can spend with patients and increasing hospital / practice working capital requirements. Presently, a central database of current, easily accessible provider data does not exist[2], which leads to duplicative work each time a credentialing process is initiated. The recruitment and onboarding of high quality practitioners is perhaps the most critical part of a hospital’s supply chain. With doctor shortages being prevalent in many medical specialties and annual turnover rates of 6.8%, meaningful opportunity exists to increase patient-facing time by improving the quality and accessibility of provider data through digitization.
Enter blockchain, an “open, distributed ledger that can record transactions between two parties efficiently and in a verifiable and permanent way”[4] . When applied to credentialing, all relevant documentation / inquiries would be placed into a ledger, which could then be accessed at any point in the future by a participating organization to which the practitioner grants access. Furthermore, the permanent nature of the ledger would limit the risk of post-entry fraudulent activity or tampering.
Earlier in 2017, the State of Illinois formed the Illinois Blockchain Initiative (“IBI”), a consortium of state and county agencies tasked with collaborating to explore innovations presented by distributed ledger technology[5]. Hashed Health, a venture-backed innovator that leads a consortium of companies focused on accelerating blockchain applicability within healthcare (and whose member companies include Accenture, Change Healthcare, and others), has recently partnered with IBI to launch a pilot to explore the utilization of blockchain to improve the credentialing process in Illinois. With increased scrutiny on cost at both the federal and state levels, the ultimate goal of the effort is to demonstrate an ability to effectively manage credentialing in this manner to other states, in an attempt to eventually reach national scale[6].
While development efforts and “prototyping” are crucial, should success come, widespread adoption will not be without its challenges. Given that credentialing and enrolment involve multiple parties (practitioners, healthcare facilities, and payors), IBI should ensure that representatives from each stakeholder group are involved in the iterations. Historically, these have been manual, archaic processes, and a transition to a more technologically innovative solution will require a shift of mindset, significant investment in training and education, and a robust system to ensure compliance going forward (as the incremental value of this solution will only be realized if the ledger is appropriately populated and maintained). The stakeholder equation is further complicated by the fact the insurance market is comprised of both governmental and commercial organizations. While it is helpful that the pilot is being championed by both public and private sector players, achieving buy-in on a federal level early on will be critical to spur widespread adoption given the significance of Medicare and Medicaid across the country. Additionally, blockchain technology’s relevance to hospital supply chain and operations extends beyond credentialing, and its applicability should thus be explored broadly. As an example, opportunity exists to build on the recent proliferation of electronic health records (“EHRs”) by enhancing effectiveness and driving down costs.
The introduction of blockchain to the healthcare industry has tremendous potential, and credentialing is a great place for IBI and Hashed Health to start. That said, some questions regarding roll-out and applicability are yet to be answered. Is it realistic to expect widespread adoption of a new, collaborative technological solution in an industry in which each player has generally been operating in isolation? And, as the applicability extends beyond this specific use case, will it be possible to convince regulatory bodies to allow for the storage of patient data in blockchain ledgers, given that patient-related information is held to a particularly high standard by regulations such as the Health Insurance Portability and Accountability Act (“HIPAA”)?
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Endnotes
1 Pam D’Apuzzo, “The Evolution of Credentialing and Provider Enrollment,” BeckersHospitalReview.com. September 10, 2015, https://www.beckershospitalreview.com/finance/the-evolution-of-credentialing-and-provider-enrollment.html, accessed November 2017.
2 David Chou and Bell Wellman, “Reinventing Physician Credentialing with Blockchain,” Health Standards Blog, June 20, 2017, http://healthstandards.com/blog/2017/06/20/credentialing-with-blockchain, accessed November 2017.
3 ”Physician Turnover Jumps as Retirement Regains Its Luster” 2013, Trustee, 66, 5, p. 4, Business Source Complete, EBSCOhost, accessed November 2017.
4 Marco Insanti and Karim R. Lakhani, “The Truth About Blockchain,” Harvard Business Review, January 2017, https://hbr.org/2017/01/the-truth-about-blockchain, accessed November 2017.
5 Illinois Department of Innovation and Technology, “Blockchain in Illinois,” https://www2.illinois.gov/sites/doit/Pages/BlockChainInitiative.aspx, accessed November 2017.
6 “Illinois Opens Healthcare Blockchain Development Partnership with Hashed Health,” Hashed Health press release (Chicago, IL / Nashville, TN, August 8, 2017).
Thanks for a great read! While the buzz around blockchain and healthcare is real, adoption has been slow. In addition to the challenges you raise (lack of buy-in and lack of infrastructure), this article by PwC highlights another challenge: the inability to audit the new technology (1). They mention the newness of blockchain, lack of technical expertise in the industry, and challenges with reconciling old control systems with this new decentralized technology as key audit limitations. With time, I believe that they’ll be able to overcome this, but to me the biggest barrier preventing adoption of blockchain technology throughout healthcare systems will be uncertainty about data ownership, privacy, and access. To your last point, there seems to be some doubt whether blockchain technology (pseudonymous via mathematical algorithms) is HIPAA compliant, and though a solution can likely be found, anything that endangers the privacy of patient health records is likely to slow down adoption greatly (2). All that said, one study I found reported that 76% of its respondents identified the adoption of blockchain technology as a key strategic initiative (3). For these reasons, I think addressing credentialing is a great way to start introducing blockchain into the healthcare system. It sits far enough from medical record access and patient confidentiality to placate blockchain skeptics, but would introduce tangible efficiencies across the networks that could spur adoption in additional areas.
1) http://usblogs.pwc.com/emerging-technology/the-blockchain-challenge/
2) https://iapp.org/news/a/blockchain-and-big-data-privacy-in-healthcare/
3) https://www.cognizant.com/whitepapers/healthcare-blockchains-curative-potential-for-healthcare-efficiency-and-quality-codex2995.pdf
Thank you, Mo, for the great paper – indeed, many are hopeful that Blockchain will finally accelerate the digitization of healthcare.
I agree with most of the points you raised, especially regarding the benefits that this will bring to the industry. On the flip side, I can also see many open points / disadvantages with adopting Blockchain for verification:
1) How can Blockchain address the issue of having different verification requirements for different institutions? (both locally, and later on globally)
2) What advantages does the decentralization of this data bring? Since reading the data will never be malicious (one can argue that physician certification should become public), aren’t the risks of a traditional centralized database limited to editing/removing the data? Are there solutions other than Blockchain for this problem?
3) What happens when a significant part of the network is down? Is there a minimum percentage of participating institutions that need to be ‘online’ for this to work?
4) Who owns the Blockchain clients? Which entity(ies) is(are) responsible for maintain the network data on its hard drives? How do the associated risks differ from those of using a traditional, centralized, online database?
Thanks for a fascinating read! It’s exciting that regulatory agencies are trying to be aggressive about adopting new technology. As I think about the core problem you identified in credentialing, I wonder if block chain is just the attractive new technology that helps create excitement about solving the underlying data sharing problem. I imagine that a secure database not built on block chain could potentially address many of the same problems. It could allow all the relevant players in the healthcare system to update and access information on credentials. One major advantage of block chain, as you pointed out, is that it’s distributed. One entity would not need to be responsible for maintaining the integrity of the system.