F092 How can blockchain bring back autonomy to the physician-patient relationship? (Leah Houston, HPEC)
Leah Houston is an Emergency Physician who has been following blockchain development since 2012. When a hospital she used to work for stole her identity for fraud billing, she decided to design a blockchain-based solution that would prevent such abuses from happening to any doctor in the future.
Leah Houston.
HPEC restores agency and autonomy to the physician-patient relationship with self-sovereign (physician-owned and controlled) digital identities and verifiable credentials.
The key point is that the solution is returning autonomy to physicians and eliminates third party interference from the doctor-patient relationship.
The solution empowers doctors, makes their credentialing easier and simplifies transitions from one hospital to the next one if one wishes to switch jobs.
The issue with physician credentialing in the USA
At the moment, the credentialing process is still done manually and takes months to complete. As Leah Houston experienced herself, it is also vulnerable to exploitation. "Unfortunately, I had an experience where a hospital I worked for was using my professional identity after I left the institution. They used my professional number for billing, and I only learned about that when the federal government contacted me about my practice of medicine without a license — I was no longer licensed in that state. As you can imagine, that created a huge problem for me. Eventually, I was able to resolve that problem, and I reached a settlement agreement with the hospital for identity theft," describes Leah Houston. This was not only an example of identity theft, but also insurance fraud, and an event that tainted dr. Houston's professional brand. That experience made her realize that digital identity solutions that she had learned about back in 2015 could be applied to healthcare.
Credentialing is a known problem, and companies like ProCredEx are already trying to solve it with the use of blockchain and collaboration with involved parties. The difference with HPEC is that the latter is putting the control directly into the practicing doctor's hands, which creates true decentralization.
What else is currently out there in terms of blockchain implementations in healthcare?
There is a vibrant development of blockchain in healthcare projects. More visible projects include Solve.Care, MedicalChain, Nebula Genomics and others. US Human and Health Services started using blockchain for COVID-19 tracking. Leah Houston is most optimistic about the use of blockchain for the supply chain management. In healthcare, that could contribute to detecting and identifying counterfeit medications, as well as contamination. "I also think in general; we're going to start learning more about precision medicine and personalized health. I think that we're going to have a rapid understanding of rapid acceleration in the understanding of our epigenetics as human beings, and which DNA sequences are being turned on and off in the known in common chronic health conditions like diabetes and heart disease that are killing a lot of people, and also rare genetic diseases, chronic conditions," mentions Houston.
Returning trust and eliminating surveillance without consent
Digitization of healthcare was supposed to bring transparency, help patients get easier access to their medical records, and ease data transfer from one hospital to another if patients switched providers. Instead, digitization caused an interoperability nightmare, put a bureaucratic burden on physicians. The initial aim was to gather patient data smartly to accelerate medical and scientific progress with the use of that data. Instead, due to the lack of initial privacy regulation, digitization caused a lot of patient data exploitation. "We are now a part of an extreme healthcare surveillance model. The doctor-patient relationship is no longer private. You, as a patient, are being monitored. Doctors are being monitored. They're watching what I'm prescribing to you. They're watching whether you're filling a prescription or whether you're getting that MRI. They're looking at how long it's taking you to do those things. They're looking at how long it's taking me to tell you the results. All this started 1996 with HIPAA, which gave electronic health records, permission to share protected health information. It had guidelines about privacy and data sharing, but it essentially created an implied consent. As soon as you fill out this one form before you hit your doctor's office, you give permission for your healthcare data sharing. In my opinion, it is my job as a doctor to restore privacy to the relationships that I have with my patients and that is what my company aims to do," says Leah Houston.
Dirty data issues in healthcare
On top of that, a lot of data is not even accurate. Leah Houston came across many inaccuracies after practicing across the US and multiple different hospitals by close to 10 or 15 different hospitals. "I walked into a room in the emergency department and I saw that somebody had got an amputation below their right leg. When I looked at the patient, I saw he had a left leg amputation. And I can't delete that, and Ii I look back that information is on every single record for the past three years, even though it's wrong. Patients have duplicative diagnoses; for example, hypertension, high blood pressure and HDL are all the same thing. Or patients have a depression diagnosis, just because some doctor prescribed them antidepressants they never actually took. Now they have depression written under their diagnosis on the EHR for the rest of their life. All of these are problems that any physician acknowledges is real."
Leah Houston believes the introduction of blockchain-based solutions and restored doctor-patient trust will improve the accuracy of the data because doctors would be much more careful about the notes they are writing and sharing with their colleagues.
HPEC, which is in very early developments, currently has 50,000 followers across social media, a new Facebook group with over 1200 doctors, and an email list with a little over 4000 people, most of them are physicians. There are around 1.1 million physicians in the US.
“Insurance is not insurance”
If one thing is true about dr. Houston is that she is passionate about fixing the injustice that exists in the US healthcare system plagued with intermediaries. Her passion drives her towards disrupting the system, even if it might go against existing players such as insurance companies. “Insurance companies are denying payment to doctors because they are out of a their network, and they are also making their networks narrower. Why is it that a patient can’t choose the doctor that they want to go to for their surgery? Why is it that we see an increase in surprise bills and an increase in prior authorizations and denial of payments for services? This is not insurance. I personally don’t care if the current systems like us or don’t like us and want to work with us or not because in my opinion, after talking to thousands of physicians, we are really done with insurance companies. I think that basic care should be paid for out of pocket. I think people who are in need should be part of networks that will be getting aid from their local governments and communities. I don’t think that the current insurance in its current form is very valuable to either doctors or patients.”
Tune in for the full discussion where you will be able to hear how credentialing works in the US, what are the powerful forces that are hurting healthcare, and why doctors and patients should regain control over their communication and treatment choices.
Listen also in iTunes or Stitcher.
Some questions addressed:
How does an ER doctor get interested in blockchain?
If I'm not mistaken, among the first issues you aim to solve is medical credentialing because you yourself had a negative personal experience when you lost control over your credentials at a hospital you used to work in?
Why does credentialing take several months to complete?
Blockchain development in healthcare is happening fast in the US, at least compared to other countries. Can you name examples of solutions you are optimistic about most, leaving HPEC aside for a minute?
In a recent column, you wrote that doctors need no middlemen between them and their patients, and blockchain has an ability to make that our new reality. "What kind of decentralization does HPEC bring?
The US healthcare system is extremely fragmented and in that sense decentralized — health maintenance organization (HMO) at least partially control patient care, Pharmacy Benefits Managers (PBMs) control the drug prices — you recently quotes a case where a dose of Tylenol cost 87$ in a hospital when the price of a whole bottle with 50 pills in the pharmacy costs 14$. Insurance companies decide which patient needs pre-authorization before being covered for a prescribed drug, can deny coverage of treatment and payment to providers. Wouldn't a little more consolidation and centralization aid the broken US healthcare system?
How you push the middlemen and misaligned incentives out without their consent? How does you solution integrate with existing healthcare stakeholders?
How many doctors are already a part of HPEC? What are at the moment the biggest challenges you face?
Misaligned incentives and the impact of COVID on them due to lost revenue …?
"When a physician is employed, or if they take insurance, they are forced to share their patients' protected health information with insurance companies and health systems. Those systems then do data analytics on that information in order to find ways to deny services to patients while denying payments to physicians. This is why we have seen an increase in unpaid services, surprise bills, and prior authorizations. This is wrong. Physicians have an ethical obligation to protect the privacy of their patient's information, and insurance companies should be obligated to pay for covered services." Isn't this more a political than a technological problem?