🌡️Introduction to the Healthcare of Today

Expectations of Healthcare Users

In today’s world, users expect an instantaneous and seamless flow of data. Many industries have adopted, or are beginning to adopt necessary technologies to guarantee their users’ expectation for instant information. Unfortunately, the healthcare industry has lagged behind. Legacy systems are burdensome, slow, often vulnerable and have little role for the patient.

Fragmented Health Services

Health data contained in legacy systems is siloed and difficult to share with others because of varying formats and standards. In short, the current healthcare data landscape is fragmented and ill-suited to the instantaneous needs of modern users. As a result of this, stakeholders are incentivised to keep their own records, and no single version of the truth exists.

Lack of Patient Centricity (passive user)

The relationship between healthcare professionals and patients has long been a paternalistic one. In recent times, however, there has been a significant shift of authority

Medicine is being democratised and patients are more empowered.

It is now considered reasonable to seek a second opinion and patients are expected to contribute to decisions made about their treatment choices. Even in single-payer system like the UK’s National Health Service (NHS), patients have the right to choose where and when they receive their care. Thus, with patient mobility comes the need for information mobility. In order to be provided with the best care patients not only can, but must have control over their own data.

Ill-informed Clinical Decision Making (data driven decision making risk of fatalities)

Clinicians rely upon investigations and tests to make informed decisions about a patient’s diagnosis and possible treatment plan. Traditionally, an investigation or test should only be requested and arranged if this is going to lead to a different possible diagnosis or alternative treatment plan. Unfortunately, even when the results of an investigation or test have returned, these are rarely shared widely with all of the health professionals involved in the patient’s care and are normally isolated, or siloed, at the institution which requested them originally. The patient’s quality of care suffers as a result of this. Other institutions are not aware of a patient’s complete history and in turn, this could lead to incorrect decision making, delays, and unnecessary costs for the patient or health institution. In the worst case, these medical errors can be fatal. Research at the American Johns Hopkins Hospital by Makary et al, 2016 concluded that medical errors are the third leading cause of death in the United States and that “most errors represent systemic problems, including poorly coordinated care.”

Security Risks to Patient Data

At present, electronic health records (EHR) are stored on centralised databases in which medical data remains largely nonportable. Centralization increases the security risk footprint, and requires trust in a single authority. Moreover, centralised databases cannot ensure security and data integrity, regardless of de-identification and controlled access requirements. Centralised health databases are legally a requirement and necessity in most countries worldwide and therefore require an added layer of technology to improve their portability and security. As cybercrime around the world is on the rise, healthcare systems are no exception as shown by recent high profile ransomware hacking. In fact, the healthcare industry has more data breaches than any other sector and medical records are being stolen and passed on.

“Your medical information is worth 10 times more than your credit card number on the black market.”

Data security is paramount due to the increased sensitivity of medical data. This was highlighted in early 2017 when a cyber attack struck healthcare institutions around the globe. This highlighted to the public the vulnerability of our healthcare systems to potential threats and a sober warning regarding the inadequacies of the current infrastructure. Many have tried to overcome this issue, and it is high on the agenda of governments and a source of frustration for both doctors and patients. A significant component of the challenge focuses on data security

Lack of Transparency

Increasing Costs

For patients and professionals, the present system is incredibly slow, inflexible and woefully opaque. These problems are equally visible throughout the claims process. When a patient needs services (from a provider such as a general practice, a pharmacy or nursing home), health plans are used to determine how much of the cost they will pay. In order to determine this cost, the health plan must validate services received from the provider against the agreement the patient and health plan have, and then share their findings with the provider. This only occurs if the provider is “in-network” with a health plan. For a provider to be considered in-network, a complex agreement needs to be negotiated which adds a significant expense to the provider’s administration costs. One part of these costs are Billing and Insurance Related (BIR) costs which include activities such as maintaining benefits databases and keeping records of services delivered. BIR costs are projected to reach $315 billion dollars by 2018 and take up to 3.8 hours for the average physician to navigate. On average, this whole process takes between one to two weeks if done electronically and takes three to five weeks by paper. Moreover, this process is rife with places for miscommunication and misunderstanding to occur. For care to actually take place, multiple people need to check multiple archaic agreements against multiple records. The result is an inefficient and opaque process that leaves stakeholders and, ultimately patients feeling confused and sceptical.

Insurance Fraud

Whether you have employer-sponsored health insurance or you purchase your own insurance policy, health care fraud inevitably translates into higher premiums and out-of-pocket expenses for consumers, as well as reduced benefits and coverage. For employers, this increases the cost of providing insurance benefits to employees, which then increases the overall cost of doing business. Moreover, the reality for many patients is that the increased expense as a result of fraud, could mean the difference between affording health insurance or not. Fraud by design dictates that false information be represented as fact. A common healthcare fraud involves perpetrators who take advantage of patients, by entering into their health record false diagnoses of conditions they do not have, or of exaggerating conditions they actually do have. This is done so that fraudulent insurance claims can be submitted for payment.

“The total cost of insurance fraud is estimated to be more than $40 billion per year.”

Unless this discovery is made early on, these false or exaggerated diagnoses become part of the patient’s documented medical history within the health insurer’s records if not in other databases as well.

Record Tampering

Medical records are to be considered not only as medical documents, but also as legal documents. To pass off a rewritten record as contemporaneous is a criminal offence and any retrospective changes have to be clearly marked, dated and signed, and the reason for such changes clearly documented. Altering existing medical records, removing records, or adding false records puts a healthcare professional at risk of medicolegal repercussions. Disclosure of authentic and original clinical notes is essential when a claim is brought up, and failure to do so can make a claim indefensible.

Telemedicine Market

Healthcare costs are on the rise around the globe as societies struggle to deal with ageing populations and the rising chronic disease burden. Current models of care delivery, particularly in places like the US and UK, are unsustainable. One trend combating increased costs has been the rise in digital health services. The value of the global digital health market was valued at $80 billion US dollars in 2015 and is expected to increase to over $200 billion by 2020 with a CAGR of 21%. Digital health solutions such as Telemedicine will be critical for driving efficiency and reducing costs. The scope of Telemedicine covers referrals, second opinions, education, follow-up care, monitoring, diagnostics and treatments across numerous specialities.

Examples include Telecardiology, Teleradiology, Telepathology, Telepsychiatry, Teledermatology and others. Clearly there is a large market, and benefits include:

• Improved quality of care

• More time for doctor-patient interactions

• Improved access to consultation

• Reduced costs

The market is currently dominated by North America and Europe though highest growth is expected in India, China, and Japan in the next few years. There are several challenges to full implementation:

Unfortunately, most modern Telehealth systems are not integrated with the core financial and clinical systems used by healthcare organisations. Data remains within the Telehealth application and requires manual entry later into health records. Digitisation promises much potential, but adding an additional silo without incorporating the information does not add value. In order to succeed, systems, devices, and data need to be seamlessly integrated. Privacy and security law issues must consider the management of data in non-traditional formats (for example, audio and/or video) and the sharing of data responsibilities encountered. To minimize the privacy/security risk of Telehealth encounters, providers require reliable methods for verifying and authenticating the identities of the patient and practitioners. Blockchain solutions are a great tool to overcome these issues.