As noted in a previous blog-post, Healthcare Information Exchanges (HIE) need to be patient-driven and patient-mediated. For this to happen, the HIEs must become far more interoperable. Unfortunately, achieving such interoperability brings with it additional challenges, including (but not limited to) areas of security, privacy, rewards/incentives, scalability, and governance.

The Patient Matching Problem

Given patient privacy concerns, the US Congress currently prohibits federal agencies from developing such patient identifiers. As a result, medical providers employ software designed to match patient records with demographic information (such as name, sex, and date of birth). Nonetheless, a 2017 survey by the American Hospital Association revealed that 45 percent of large hospitals still find it challenging to identify patients across information systems accurately. This is especially true for the millions of twins residing in the US.

The US Government Accountability Office just released a new report this week specifically focused on patient matching concerns. Although these issues are indeed challenging, blockchain technology may serve to resolve this issue. As John Halamka, Chief Information Officer at Beth Israel Deaconess Medical Center in Boston notes:



“There are 26 different electronic medical records systems used in the city of Boston, each with its own language for representing and sharing data. Critical information is often scattered across multiple facilities, and sometimes it isn’t accessible when it is needed most—a situation that plays out every day around the U.S., costing money and sometimes even lives. However, it’s also a problem that looks tailor-made for a blockchain to solve”

Locating health-care records, both history and transactions specific to a patient from various HIEs is an expensive and complicated process. With the advent of blockchain technology, creating and locating a universal master patient ID number has become far more feasible. A master patient ID number could help locators help establish full details about the patient in question.

How The Current System Operates

At present, patient identification systems like the Master Patient Index (MPI) and Enterprise Patient Master Index (EPMI) have been created to manage patient identities with HIEs. Despite extensive efforts to develop such systems, ample evidence suggests duplicated patient records often exist along with incomplete or wrong medical data. It’s estimated that about 10 out of 17 errors in medical errors being patient-misidentification related errors. Such mistakes not only burden healthcare institutions, but they also add to patient suffering due to treatment delays. Additionally, such instances of ‘incorrect information’ would also lead to denied insurance reimbursement claims.



Moreover, the same patient’s identity can vary from one healthcare institution to another. For instance, the format how a name is registered could vary by institution – like First Name, Last Name, Middle Initial; Given Name, Last Name; First Name, Middle Name, Last Name; etc. From a global point of view, the format of date of birth changes with the location, and so do nation-specific identification numbers like the Social Security Number in the United States or the AaDHAR Number in India. Without a unified patient identification system that is functional, patient identity systems may remain inefficient unless the patient sticks to one such system throughout.

A study funded by Deloitte stated that:



“In fact, identities are currently existing cryptographically on the blockchain. Each cryptographic address is mathematical with a unique private key that is used to easily verify the ownership of an address or an identity yet does not reveal any personal information relating to the individual. The decentralized and auditable characteristics of Blockchain can help enforce standardized verifiable identities for patients via a universal patient index registry shareable across all healthcare facilitates within a nation and beyond. In case of lost or stolen keys, new addresses are also trivial to generate and re-assign to patients.”

Edward Bukstel illustrates how a blockchain-based patient master ID might work below:



“One of the fundamental requirements for blockchain adoption is the use of a Unique Patient Identifier or large prime numbers. Imagine Cerner or Epic modifying their respective systems to hold a “representation” of this patient identifier. When you go to the ambulatory MRI center, for a diagnostic procedure, there is NO interface with Cerner or Epic, the result simply gets shot out into the internet using blockchain as it’s a carrier. The prescription filled at CVS is also written to the blockchain with your personal identifier and so is another prescription filled at Walgreens. The blockchains flying around the internet are checked constantly for errors, Some of the error checking will incorporate a notation that the drug prescribed at CVS has an adverse interaction with the drug prescribed at Walgreens. Messages from your Facebook profile regarding health conditions will also be found in your blockchain. The auto-correcting nature of the blockchain should ensure a correct record is always available upon request, anywhere in the world.

As you can see, blockchain technology appears ready-made to facilitate something akin to a master patient id number.

Unparalleled Blockchain Security

XTRABYTES, an emerging blockchain development platform, is set to release details about a new Proof-of-Signature (PoSign) consensus method. The latter is configured in such a way as to make 51% attacks impossible to carry out. Indeed, the XTRABYTES team believes their PoSign technology will fully change industry expectations about medical data silos and blockchain security concerns.



They also believe that their new PoSign technology will improve chances to transform healthcare. Expect to hear more about XTRABYTES after its technology solutions become known to the healthcare industry.

