EHR: History, hurdles and the promise of blockchain

 

Despite the widespread agreement that healthcare information technology has the potential to lead to safer, more efficient quality care, the implementation and adoption of Electronic Health Record Systems has faltered, both nationally and worldwide, not to mention the meaningful exchange of data, that will lead to better patient outcomes. The main obstacle has always been interoperability, something that blockchain technology offers a solution to. A distributed ledger also solves the need for intermediaries regarding access and validation, and the overhead for providers is minimal. However, it’s wise to first have a look at past attempts and identify the hurdles faced and what led to failure.

According to HIMSS definition, the Electronic Health Record (EHR) or Electronic Medical Record (EMR) “ has the ability to generate a complete record of a clinical patient encounter – as well as supporting other care-related activities directly or indirectly via interface – including evidence-based decision support, quality management, and outcomes reporting. ” [1]

Governments were the first to recognize the importance of interoperable, nationwide EHR and have been seeking to develop and implement such systems, with little success up to now. The NHS was the frontrunner in this effort, attempting to create a national EHR system, that would enable easy and secure data exchange, which in turn would lead to better outcomes and improve the quality of patient care.

In 2002, the National Health Service began one of the largest and most ambitious healthcare IT projects of the time, with the help of four companies, including US based company Computer Sciences Corporation (CSC). The NHS Connecting for Health (CFH) Agency, part of the Department of Health Informatics Directorate, adopted the responsibility of delivering the The National Programme for IT, an attempt to create a national electronic health record system by 2010, a project that would eliminate the challenges of interoperability. In April 2005, it began deployment of EHR systems in NHS Trusts. Unfortunately, the 4 year timeframe was idealistic for the time and the project was eventually shut down in 2013, mainly because it was taking too long and it was costing much more than anticipated. Furthermore, the companies involved projected an over optimistic roadmap, especially during the early stages of development. The NHS sued CSC and the company was forced to pay $97.5 million as compensation.[2]

Although the UK wasted 12.7 billion pounds, a number of NHS Trust had adopted Lorenzo patient record systems and many hospitals eventually acquired electronic patient record systems. In November 2013, NHS England launched a digital maturity assessment and index, something that has unfortunately been pretty low on the priorities of healthcare providers. Finally, a new framework to integrate patient data was published in 2014, commiting to make records digital and interoperable in real-time, by 2020(Personalised Health and Care 2020).

Certainly, more hospitals are using EHRs, but in most cases they’re not being used to their full capacity and surely, they haven’t caught up with the pace of advances in IT. Blockchain is the ideal construct, providing a universal set of tools for cryptographic assurance of data integrity, security, auditing, monitoring and excellent access management. Also, it offers the unique opportunity for advanced data privacy and ownership. The patient now has the ability to truly own his data and be responsible for access management, as well as contributing towards research in specific fields of medicine. As an acclaimed paper from the MIT Media Lab and Beth Israel Deaconess Medical Center accurately states, “EHRs were never designed to manage multi- institutional, lifetime medical records. Patients leave data scattered across various organizations as life events take them away from one provider’s data silo and into another.” In other words, although EHRs exist in many hospitals and GP practices, patient are still responsible for collecting and distributing their medical files manually.

William Hantzaras

Head of Product, LifeLine Blockchain Ltd

 

[1] http://www.himss.org/library/ehr

 

[2] Bowers, Simon, “Computer systems contractor CSC set to pay shareholders $97.5m,” The Guardian. September 17, 2013,

https://www.theguardian.com/society/2013/sep/18/csc-courts-sign-off-payment-shareholders