The concise answer to the question posed in the title is: not exactly. Blockchain is certainly not a panacea or silver bullet that will magically address all interoperability woes. However, blockchains will provide opportunities to significantly move the needle in a positive way in terms of improving healthcare interoperability. Consider the Healthcare Blockchain Overview diagram below:
Blockchain is a new type of B2B middleware. By its nature, it sits between healthcare organizations in a B2B network. This is precisely where interoperability is required, so the success of blockchains in healthcare is critically dependent on healthcare organizations participating in blockchain networks achieving interoperability.
In healthcare, blockchains will not replace healthcare enterprise systems such as EHRs in the foreseeable future. Much if not most healthcare data will remain in healthcare enterprise systems where it lives today. There are very strong privacy, security, compliance, and performance reasons for why such healthcare data will not all be placed on blockchains.
In general, healthcare blockchains will contain minimal but sufficient information. Sufficient to support the intended use case(s), but otherwise minimal to minimize the list of concerns mentioned previously. See Healthcare Blockchain: What Goes On Chain Stays on Chain for further discussion on this. In cases where blockchains reference healthcare records stored off chain, metadata stored on chain can include pointers to the source systems containing this off chain data, as well as hashcodes which can be used to protect and verify the integrity of such data once retrieved, and of course interoperability metadata can also be included on the blockchain such as source data format, semantics, code sets, and version information. If we zoom in on the previous overview to take a closer look at interoperability there are two key aspects to it, each discussed below.
Interoperability for Healthcare Information Stored On the Blockchain
Blockchains are like a blank canvas. There is flexibility in terms of what healthcare information is stored on them, the semantics of this information, the code sets used, and formatting. For healthcare information that will be stored on the blockchain, in order to ensure that what is written can also be read and used by the rest of the blockchain network, it is necessary to enforce interoperability at the time the new information is appended to the blockchain. As healthcare enterprise systems write data to a healthcare B2B network blockchain, this information will be formatted by an Interoperability module in a way that is compliant with interoperability requirements of the blockchain.
In the previous diagram the “Blockchain Network Secure Link” shows how a source Healthcare Organization A can write information to a blockchain through an Interoperability module that formats the information to comply with interoperability requirements of the blockchain. On the receiving end, Healthcare Organization B can read healthcare information from the blockchain through its own Interoperability module serving the purpose of translating blockchain formatted information into formats digestible by the target enterprise systems of Healthcare Organization B.
A given healthcare organization may participate in multiple blockchain networks, for example, a healthcare provider may participate in blockchains for provider directories, provider credentialing, clearinghouses, clinical data sharing, public health, and many more types of blockchains. Each of these blockchains could have their own, different interoperability requirements. Part of the blockchain interoperability challenge for a given healthcare organization will be to ensure interoperability across the range of blockchains they participate in.
Interoperability in Healthcare Organization Direct Peer-to-Peer Interactions
This type of interoperability is required at the time one healthcare organization requests data directly (not through the blockchain) from another healthcare organization. As discussed earlier, blockchains could reference of chain data. In this case, the blockchain can be used for discovery of healthcare data across all of the healthcare organizations participating in a B2B healthcare blockchain network. In this case, the blockchain is serving the role of a decentralized record locator service.
In the previous diagram Healthcare Organization B searches metadata on the blockchain, discovers a patient record of interest, and initiates a direct peer-to-peer request to Healthcare Organization A to retrieve the source record. This request can be sent by Healthcare Organization B in an interoperable format with the help its Interoperability module. Similarly, Healthcare Organization A can receive this request via its Interoperability module which can then format this request as needed before it can be sent to internal healthcare enterprise systems within Healthcare Organization A to process the request and provide the requested data. Lastly, once the target patient record is found it may be sent back to Healthcare Organization B via the Interoperability modules to ensure that Healthcare Organization B can make sense of the record requested.
Harmonizing Identities to Support Interoperability
This is just a high-level discussion of blockchain interoperability in healthcare. Clearly, there is much more detail required to make interoperability work in practice. For example, data on the blockchain is going to reference identities of patients, providers, organizations, and other entities. In order for this data to be interoperable, each healthcare organization participating in the blockchain network will need to be able to make sense of identities used on the blockchain. However, each of these healthcare organizations today may have their own unique internal identifiers of these entities. This puts an additional burden on the Interoperability modules to bi-directionally translate between blockchain universal identities and internal identities used within each healthcare organization participating in the blockchain B2B network.
What other kinds of interoperability challenges are you seeing with the use of blockchains in healthcare? Welcome feedback and comments below. Intel Health and Life Sciences is actively working in these areas of innovation. Message me on LinkedIn if you would like to connect, discuss, and explore synergies and opportunities for collaboration.
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