How blockchain could improve quality reporting

The hype around blockchain had reached new heights at HIMSS18 in Las Vegas, much of it centered on how an immutable, decentralized ledger of transactions and exchanges could be used to solve issues around interoperability and data sharing. Jason Goldwater, MA, MPA, senior director of the CedarBridge Group suggested it could streamline another headache for healthcare professionals: quality reporting.

Goldwater said blockchain may not solve all of healthcare’s problems, as other HIMSS sessions may have claimed, but he does believe it has the potential to “revolutionize outcome measurement” both in how measures are gathered and how they’re reported. Having worked on quality measurement at both CMS and the National Quality Forum, he’s seen it evolve from abstracting data from paper charts to reporting through electronic health records (EHRs). The transition to value-based care, he argued, can’t rely on process-focused measures or siloed data. That’s where blockchain comes in.

“Then quality is not something that’s measured at one point in time, quality is measured dynamically over time,” Goldwater said. “You’re making sure the patient is consistently receiving quality care and blockchain has the ability to capture information from such a wide variety of sources that the patient can send to the doctor, that it then takes out the two reasons why we haven’t done this yet,” which he said were provider burden and security concerns.

By taking measurement at the time of the outcome, then giving patients the ability to send it to other providers, Goldwater said it not only makes sharing the data easier but can more easily identify what measures matter.

Blockchain’s digital signature capability—allowing each user to sign and verify transactions without tampering with other data on the blockchain—could also make it easier for patients to report their own outcomes. Those patient-reported outcomes could increase focus on patient’s experience, incorporate a more honest patient perspective into measures with more comprehensive information, all while taking some of the pressure off physicians to handle reporting. Goldwater emphasized there could be even greater possibilities if data collected from devices like an Apple Watch is shared via blockchain.

“If you collect that data and you send that day’s data to your provider, which can have your medication adherence, your resting heart rate, current heart rate, the variability, how much you slept, how much you exercised, what you’ve eaten—think about what the doctor can do with that information in terms of providing quality. Think about how a quality measure can be used over time as a result of that,” Goldwater said.

The technology isn’t perfect, Goldwater said. For instance, processing for a public, decentralized blockchain most useful for quality reporting can be slowed down as more transactions are entered into the ledger. A data breach also isn’t impossible, though less likely than with current systems. Blockchain won’t “save the planet,” he joked, but it has use cases like quality measurement where it could be a major step forward.

“It could really change how we develop measures, populate measures and use measures in a way that will change the quality dynamic permanently and increase quality and decrease cost of care and really give power back to patients, he said.