We’ve been hearing a lot about exciting new opportunities to implement blockchain technology to address critical use cases in healthcare. One particular use case that has caught the attention of healthcare organizations seeking to improve workflow bottlenecks is prior authorization. Prior authorization is a process used to determine if a health insurer will cover a procedure, service, or medication.
The premise of prior authorization is to control costs of care while improving patient safety. For example, requiring prior authorization for an expensive medication creates an opportunity to identify a generic drug that may be just as effective, while also checking if the new drug will react adversely with other medications the patient is currently prescribed. However, despite its intentions, prior authorization has come under criticism from payers, providers, and patients. Payers and providers end up spending significant amounts of time working through the prior authorization process while patients end up waiting for what could potentially be a life-saving procedure while the process plays out. It is estimated that the effort spent on prior authorization costs the US healthcare system between $23-$31 billion annually.
One company stepping up to solve this allegedly important but practically flawed process is Canada-based startup Coral Health. The company creates blockchain-powered solutions that accelerate care delivery, automate multiparty administrative processes, and improve health outcomes by enabling secure, real-time, shared access to validated healthcare information. With a focus on enterprise applications, Coral Health is tackling this challenge of prior authorization as one of its first proofs of concept.
After connecting at the “Healthcare on the Blockchain” event earlier this year (coverage of Day 1, Day 2), Medgadget had a chance to catch up with Coral Health COO Philip Parker to learn more about the company and the broader opportunity of blockchain-based healthcare solutions. After reading the interview below, also check out Coral Health’s great library of blockchain content on the company’s Medium account.
Michael Batista, Medgadget: A couple months ago, we heard a lot about the potential for blockchain technology to impact healthcare at the “Healthcare on the Blockchain” event. Why do you think blockchain is uniquely positioned to disrupt healthcare?
Philip Parker: Blockchain technology comes at a really opportune time for healthcare. It wasn’t until the widespread adoption of electronic health record systems over the past few years that there was even the possibility of efficient data sharing in healthcare. While EHRs have made record sharing possible, sharing has remained laborious and it wasn’t until the FHIR API standards that the costs of data sharing fell to the point where organizations like Apple started talking seriously about giving patients access to their medical records.
The patient clearly makes the most sense as the center of the healthcare data equation because they have a full view into the services that they’ve received and the different providers they’ve visited.
The blockchain is the perfect fit for this new patient-controlled healthcare model because distributed databases provide a trusted, tamper-proof way for healthcare organizations to read and write to the same database instead of maintaining siloed views of a patient with limited visibility into the care the patient received outside of that specific facility. Another big idea we’re seeing is the concept of incentivizing the patient to share data. This is mostly driven by the fact that most funding for healthcare blockchain projects is ICO driven, but this movement towards direct patient compensation could go a long way towards overcoming patient apathy.
It’s worth mentioning that a lot of the issues in healthcare could be solved through the proper implementation of distributed databases and a blockchain isn’t always needed. While I believe in the benefits of a blockchain-based solution, one of the biggest impacts of the blockchain is openness to distributed databases that really hadn’t gotten much attention in the space before all the hype about blockchains.
Medgadget: Tell us a little about Coral Health’s approach to using blockchain technology.
Parker: The key to remember with blockchain solutions, and distributed databases in general, is that they are really network solutions. Without a network, a blockchain isn’t going to do much good. I believe that’s why we still see such limited implementation of blockchain use cases both within healthcare as well is in other industries as well.
While ideally we’d already have a large network to implement a blockchain-based solution, we weren’t blessed with one, so Coral Health’s approach has been to build a network by working with partners institutions to help their patients gain more secure and convenient access to their medical records. For example, our partnership with Principle Health Systems in Houston is to use the blockchain to send medical results to their patients with the help of our medical records app, instead of faxing the data. It’s important to note that this could certainly be done without the blockchain, as Apple is doing with Apple Health. The advantage of using the blockchain is that we can create a system where that data is not just sent to the patient but the patient is also motivated to unlock a lot of secondary value from their information.
By posting the data to the blockchain we create a single shared, immutable, and verified record of each patient that patients can then easily share with each of their providers. This allows providers to view the same information about a patient in real-time and eliminates the information gaps that have made coordinating care challenging for so long. In addition, because the data is trustworthy and patients can securely share access to it, Coral Health can create entirely new uses from that data. For example, patients can be incentivized to share access to their data with a smart contract that checks their eligibility for particular treatments or on an anonymized basis directly with a research institution studying a particular disease.
Medgadget: What kind of blockchain does Coral Health utilize or are you developing your own blockchain platform?
Parker: We’ve been using Ethereum to develop multiple proofs of concept, but we’ve been exploring other options and there is definitely no guarantee we will continue using it long term. Ethereum is very convenient to get things up and running quickly, but there are a few factors that don’t make it ideal going forward. While Plasma and Casper may improve upon scaling issues, there’s still no guarantee that either will deliver the performance benefits we need, especially not in the short term. In addition, healthcare is an industry where using permissioned blockchains can make a lot of sense because it lends itself to relatively small consortiums and there’s not the complete lack of trust that permeates many other blockchain applications.
We’ve been speaking to Hyperledger from the Linux foundation for a while now about Fabric and Sawtooth. We think that there’s a lot of potential in using one of those solutions and are actively looking into when it could make sense to move development over to Hyperledger.
Medgadget: Coral Health’s website lists a number of potential use cases from durable lab records to clinical trial recruitment. Is there a strategy behind broadly tackling a number of different use cases as opposed to narrowly focusing in on one or two opportunities?
Parker: There were a number of uses cases that we saw as really promising, so we wanted to call attention to several of them because of the openness of so many different stakeholders to explore blockchain-based solutions. While we think all of those use cases have a lot of potential, we’re focused on just two uses right now.
We see the first step as improving patient access to their medical information. The patient is one of the most underutilized actors in healthcare. Once we’ve worked with our health system partners to improve patient access to their data we’re focusing on using that information to improve the cumbersome prior authorization process that costs providers alone over $30 billion each year in the US. We’re targeting that use case first because we’ve seen an openness on the part of payers to our proposed prior authorization solution and because it’s an area that doesn’t require a large number of patients to deliver compelling operational savings.
Clinical trials recruitment is another use case we mention on our website. We’ve designed a marketplace where researchers can post the information they need for upcoming studies and patients have the option to opt-in by sharing information either for anonymous retrospective studies or to participate in prospective clinical trials. Patients are able to securely share portions of their medical history to prove that they meet the study’s selection criteria and in return earn direct compensation from researchers. Because our marketplace is patient-permissioned, any type of research is possible. We think this could be a very valuable way for researchers to access the increasingly niche patient sub-populations that targeted therapies are focused on.
Medgadget: We’ve heard how organizations large and small see the blockchain as a daunting technology to implement. How would you respond to that concern?
Philip: Completely replacing an entire workflow with a blockchain-based solution would certainly look daunting at first. Implementing a small-scale pilot program, however, is a very limited commitment with a lot of upside.
My advice is for organizations to figure out what areas a blockchain-based solution would help and then engage in a pilot to explore what the potential benefits and feasibility of a larger scale deployment would be. It’s important to remember that a lot of these solutions are still being developed and it’s a great time to shape the ultimate design of the solutions rather than waiting on the sidelines and having to implement whatever solution eventually materializes.
Medgadget: Can you share an example of a specific programs Coral Health is preparing to launch this year?
Philip: Coral Health is working on a three-step process to automate prior authorization requests for our first partner, Principle Health Systems. First, we’re helping their patients can more convenient and secure access to their data. Next, we’re eliminating the data entry work that Principle Health is doing by pulling the applicable prior authorization form from the payer’s website and pre-filling the forms using the patient information from Principle Health’s EHR. Lastly, we’re working with payers to eliminate the need to fax information back and forth by programming smart contracts that contain all of the payer’s health plan information needed to assess a request and approve or deny prior authorization. These smart contracts will automatically access the applicable patient medical information and compare that information to the payer’s health plan, make a determination, and immediately relay the result back to Principle Health. With prior authorization information immediately available, providers and patients will be able to proceed with care instead of waiting for a response from a payer. In addition, this automated approach will free up the time and resources spent manually preparing and evaluating requests, leading to significant cost savings for both the providers and the payer.
Medgadget: What are some upcoming milestones Coral Health is looking forward to?
Parker: We’re in a really busy time at Coral. We’re planning to do a broad release of our medical record app and start our first pilot program in Q3 of this year so there’s a lot of prep work going into both those initiatives.
We recently completed the beta version of our medical records app. While we’re still actively building out additional functionality, we’ve finished our base architecture and anyone can now download the current version of the app, add medical records, securely encrypt those records, add a contact to the app, and securely send records. The big technological significance of this is that the data transmitted through the app is immediately encrypted, ensuring HIPAA and GDPR compliance, then stored in a decentralized fashion using a novel technology called IPFS (Interplanetary File System). This allows us to handle large files while still maintaining a distributed system by only storing the hash referents to the IPFS files on chain. This means you are getting both the security benefits of heavy encryption, and the democratized nature of multiple, and potentially unlimited, nodes hosting the files.
After we complete those initiatives we’re planning to kickoff pilots with some of our other partner institutions and then focus our attention to securing pilots with payers so we can test out the initial smart contracts we’ve been building that contain the medical policies for select procedures. That’s the first step in our path towards automating the prior authorization process.
Medgadget: Finally, what did you think about the “Healthcare on the Blockchain” event? Was there a specific discussion you found particularly compelling?
Parker: I really enjoyed the event! I’ve been going to a lot of general blockchain conferences like BTC Miami and Token Fest as well as healthcare-specific events like HIMSS so it was really great to finally attend a conference focused exclusively on blockchain applications in healthcare. The challenge I noticed was that while there was a lot of interest in blockchain applications, since so few organizations have implemented a blockchain solution, the audience was still struggling to see what use cases were a good fit for the technology.
That’s why I found the discussions centered around appropriate use cases for the blockchain in healthcare to be particularly interesting. I recall one exchange between Srinivas from Deloitte and an audience member where Srinivas explained that the blockchain is more an inter rather than intra organizational solution and the audience member countered by saying that they thought blockchain solutions were well suited even within an organization because in reality large health systems often operate as distinct fiefdoms. I think that was an excellent reminder of how difficult it is to apply hard and fast rules for when to use the blockchain.
Link: Coral Health…