Improving Transitions of Care: Designing a Blockchain Application for Patient Identity Management

Authors

DOI:

https://doi.org/10.30953/bhty.v5.200

Keywords:

blockchain in healthcare, blockchain technology, decentralized identifiers, healthcare identity, interoperability, transition of care, verifiable credentials

Abstract

Background: The current healthcare ecosystem in the United States is plagued by inefficiencies in transitions of patient care between healthcare providers due in large part to a lack of interoperability among the many electronic medical record (EMR) systems that exist today. Both providers and patients experience significant frustration due to the negative effects of increased costs, unnecessary administrative burden, and duplication of services that occur because of data fragmentation in the system. Blockchain technology provides a solution to mitigate or eliminate these gaps by allowing for healthcare information exchange that is distributed, auditable, immutable, and respectful of patient autonomy. Our multidisciplinary team identified key tasks required for a transition of care to design and develop a blockchain application, MediLinker, that served as a patient-centric identity management system to address the issues of data fragmentation ultimately allowing for the delivery of high value care.

 

Methods: The MediLinker application was evaluated for its ability to accomplish various key tasks needed for a successful transition of patient care in an outpatient setting. Our team created twenty unique patient use cases covering a diversity of medical needs and social circumstances that were played out by participants who were asked to perform various tasks as they received case across a simulated healthcare ecosystem composed of four clinics, a research institution, and other ancillary public services. Tasks included, but were not limited to, clinic enrollment, verification of identity, medication reconciliation, sharing insurance and billing information, and updating demographic information. With this iteration of MediLinker, we specifically focused on the functionality of Guardianship and patient revocation of healthcare information. Additionally, throughout the simulation we surveyed participant perceptions regarding the use of MediLinker and blockchain technology to better ascertain comfortability and usability of the application.

 

Results: Quantitative evaluation of simulation results revealed that MediLinker was able to successfully accomplish all seven clinical scenarios tested across the twenty patient use cases. MediLinker successfully achieved its goal of patient-centered interoperability as participants transitioned their simulated healthcare data, including COVID-19 vaccination status and current medications, across the four clinic sites and research institution. In addition to completing all key tasks designated, all eligible participants were able to enroll with and subsequently revoke data access with our simulated research site. A high degree of data accuracy was noted with most errors occurring due to inaccurate data entry from user input. Our qualitative analysis of user perceptions indicated that comfortability and trust with blockchain technology, such as MediLinker, grew with increased education and exposure to such technology.

 

Conclusion: The ubiquitous problem of data fragmentation in our current healthcare ecosystem has placed considerable strain on providers and patients alike. Blockchain applications for health identity management, such as MediLinker, provide a viable solution to stem the inefficiencies that exist today. The interoperability that MediLinker provided across our simulated healthcare system has the potential to improve transitions of care by sharing key aspects of healthcare information in a timely, secure, and patent-centric fashion allowing for the delivery of consistent personalized high-value care. Blockchain technologies appear to face similar challenges to widespread adoption as other novel interventions, namely recognition, trust, and usability. Further development and scaling are required for such technology to realize its full potential in the real-world and transform the practice of modern healthcare.

Downloads

Download data is not yet available.

References

Gordon WJ, Catalini C. Blockchain technology for healthcare: Facilitating the transition to patient-driven interoperability. Comput Struct Biotechnol J. 2018;16:224–30. https://doi.org/10.1016/j.csbj.2018.06.003

Kessler C, Williams MC, Moustoukas JN, Pappas C. Transitions of care for the geriatric patient in the emergency department. Clin Geriatr Med. 2013;29(1):49–69. https://doi.org/10.1016/j.cger.2012.10.005

Congress of the United States. H.R. 34 – 114th Congress: 21st Century Cures Act. 2016. Available at https://www.congress.gov/bill/114th-congress/house-bill/34/

King BJ, Gilmore-Bykovskyi AL, Roiland RA, Polnaszek BE, Bowers BJ, Kind AJ. The consequences of poor communication during transitions from hospital to skilled nursing facility: A qualitative study. J Am Geriatr Soc. 2013;61(7):1095–102. https://doi.org/10.1111/jgs.12328

Nall RW, Herndon BB, Mramba LK, Vogel-Anderson K, Hagen MG. An interprofessional primary care-bBased transition of care clinic to reduce hospital readmission. Am J Med. 2020;133(6):e260–e8. https://doi.org/10.1016/j.amjmed.2019.10.040

U.S. Census Bureau. 65 and older population grows rapidly as baby boomers age 2020 [Internet]. [cited 2021 Dec 21]. Available from: https://www.census.gov/newsroom/press-releases/2020/65-older-population-grows.html.

Voigt P, Von dem Bussche A. The EU general data protection regulation (GDPR): A practical guide. Cham: Springer International Publishing; 2017.

Berwick DM, Nolan TW, Whittington J. The triple aim: Care, health, and cost. Health Affairs (Project Hope). 2008;27(3): 759–69. https://doi.org/10.1377/hlthaff.27.3.759

Gupta R, Moriates C. Swimming upstream: Creating a culture of high-value care. Acad Med. 2017;92(5):598–601. https://doi.org/10.1097/ACM.0000000000001485

Johnson P, Alvin M, Ziegelstein R. Transitioning to a high value health care model: Academic accountability. Acad Med. 2017;93:1. https://doi.org/10.1097/ACM.0000000000002045

Dzau VJ, McClellan MB, McGinnis JM, et al. Vital directions for health and health care: Priorities from a National Academy of Medicine Initiative. JAMA. 2017;317(14):1461–70. https://doi.org/10.1001/jama.2017.1964

Kuo TT, Kim HE, Ohno-Machado L. Blockchain distributed ledger technologies for biomedical and health care applications. J Am Med Inform Assoc. 2017;24(6):1211–20. https://doi.org/10.1093/jamia/ocx068

Christ MJ, Tri RNP, Chandra W, Gunawan W, editors. Exploring blockchain in healthcare industry. 2019 International Conference on ICT for Smart Society (ICISS); 2019; 19–20 November 2019.

Khurshid A, Holan C, Cowley C, et al. Designing and testing a blockchain application for patient identity management in healthcare. JAMIA Open. 2021. https://doi.org/10.1093/jamiaopen/ooaa073

Bouras MA, Lu Q, Zhang F, Wan Y, Zhang T, Ning H. Distributed ledger technology for eHealth identity privacy: State of the art and future perspective. Sensors (Basel). 2020;20(2):483. https://doi.org/10.3390/s20020483

Harrell DT, Usman M, Hanson L, et al. Technical design and development of a self-sovereign identity management platform for patient-centric healthcare using blockchain technology. BHTY. 2022. 7(1); in press.

Meingast M, Roosta T, Sastry S. Security and privacy issues with health care information technology. Conf Proc IEEE Eng Med Biol Soc. 2006;2006:5453–8. https://doi.org/10.1109/IEMBS.2006.260060

Ozavci G, Bucknall T, Woodward-Kron R, et al. A systematic review of older patients’ experiences and perceptions of communication about managing medication across transitions of care. Res Soc Admin Pharm. 2021;17(2):273–91. https://doi.org/10.1016/j.sapharm.2020.03.023

Burton LC, Anderson GF, Kues IW. Using electronic health records to help coordinate care. Milbank Q. 2004;82(3):457–81, table of contents. https://doi.org/10.1111/j.0887-378X.2004.00318.x

Rustad EC, Furnes B, Cronfalk BS, Dysvik E. Older patients’ experiences during care transition. Patient Prefer Adherence. 2016;10:769–79. https://doi.org/10.2147/PPA.S97570

Hughes F, Morrow MJ. Blockchain and health care. Policy Pol Nurs Pract. 2019;20(1):4–7. https://doi.org/10.1177/1527154419833570

Zhuang Y, Sheets L, Shae Z, Tsai JJP, Shyu CR. Applying blockchain technology for health information exchange and persistent monitoring for clinical trials. Ann Symp Proc AMIA Symp. 2018;2018:1167–75.

Raghavendra M. Can blockchain technologies help tackle the opioid epidemic: A narrative review. Pain Med. 2019;20(10):1884–9. https://doi.org/10.1093/pm/pny315

Durneva P, Cousins K, Chen M. The current state of research, challenges, and future research directions of blockchain technology in patient care: Systematic review. J Med Internet Res. 2020;22(7):e18619. https://doi.org/10.2196/18619

Dubovitskaya A, Baig F, Xu Z, et al. ACTION-EHR: Patient-centric blockchain-based electronic health record data management for cancer care. J Med Internet Res. 2020;22(8):e13598. https://doi.org/10.2196/13598

Griggs KN, Ossipova O, Kohlios CP, Baccarini AN, Howson EA, Hayajneh T. Healthcare blockchain system using smart contracts for secure automated remote patient monitoring. J Med Syst. 2018;42(7):130. https://doi.org/10.1007/s10916-018-0982-x

Hawlitschek F, Notheisen B, Teubner T. A 2020 perspective on “The limits of trust-free systems: A literature review on blockchain technology and trust in the sharing economy”. Electron Commer Rec Appl. 2020;40(C):3. https://doi.org/10.1016/j.elerap.2020.100935

Esmaeilzadeh P, Mirzaei T. The potential of blockchain technology for health information exchange: Experimental study from patients’ perspectives. J Med Internet Res. 2019;21(6):e14184. https://doi.org/10.2196/14184

Published

2022-03-14

How to Cite

Abdul-Moheeth, M., Usman, M., Harrell, D. T., & Khurshid, A. (2022). Improving Transitions of Care: Designing a Blockchain Application for Patient Identity Management. Blockchain in Healthcare Today, 5(S1). https://doi.org/10.30953/bhty.v5.200