Cyberattacks occur worldwide almost every day, yet it is challenging to learn the type and target of an attack in real time. A vast amount of cyber intelligence goes untapped; even if it could benefit everyone, companies do not want to share sensitive information broadly. Doing so, they may expose themselves to legal or regulatory scrutiny. 

Companies certainly see the need and benefit of sharing real-time cyber intelligence if there was a way to share more information without revealing too much. Perhaps, we should look at creating a Blockchain-based cyber intelligence platform in conjunction with:

1. Zero-knowledge proof that separates data verification from the data itself. One party (the prover) can prove to another party (the verifier) the possession or existence of some information without revealing all the detailed information.
   
   
2. Multi-party computation on data sets can reveal how many companies have been impacted by a similar attack without revealing the company’ details. This method can allow multiple parties to make calculations using their combined data without revealing their input.
   
   
3. Homomorphic encryption allows users to perform computations on its encrypted data without first decrypting it, protects data, and lets users run queries on the data to gain insights.

This method may enable—privately and safely—shared, real-time attack metrics, which analytics can use to uncover trends in the attack’s location, type and sophistication. I would encourage further financial and technical studies of this method to ensure it’s effectiveness and efficiency. More people must collaborate to address this challenge.

Companies worldwide may be able to share real-time data about cyberattacks, while using a key to protect details. Sharing the keys can also become a path to commercialization, where attack details are transmitted via smart contracts with agreed-upon customers, government agencies, and regulators. 

Currently, no major player is utilizing Blockchain to share intelligence and trends around cyberattacks. They still use legacy, information sharing methods—often outdated or inaccurate—utilizing data exchange or Application Programming Interface (API). 

The establishment of this type of Blockchain could directly connect to a company’s cybersecurity defense infrastructure that can ingest relevant pieces of information flowing through the Blockchain—protecting the company from a new type of cyberattacks.

In cybersecurity, once you’re able to gather verifiable, accurate information about cyberattacks, it becomes extremely valuable to ingest that information into existing technologies deployed to protect the company. 

This method may crowdsource cyberattack defenses. Attacks seen in one part of the world on an individual computer could be transmitted almost in real time using Blockchain. This global communication could allow defensive measures to be set up in near real time. Global sharing can thwart the creation of new hacking groups, as their initial attacks will not succeed, and they will require more time to grow.

Exciting trends and new technologies are emerging to help address cybersecurity challenges, Blockchain being one of them. Several use cases come to my mind involving Blockchain and cybersecurity. For example, the above approach can also be utilized to safely share data with the third parties a company does business with; other combinations of Blockchain and Cryptography may provide unique use cases in cybersecurity.

The best solution may vary by person and organization. Instead, I encourage provoking conversation that, perhaps, inspires others to develop leading-edge solutions to solve cybersecurity issues that were once difficult and challenging years ago—well before the technological and innovative advances we are able to leverage today.

The post Thoughts on Cyber Intelligence and Blockchain appeared first on HealthTech Magazines.

Blockchain has been around since 1991, 17 years before it was first used in bitcoin. Since inception, it’s been touted as the solution for a myriad of business cases in a wide range of industries. The applications in healthcare were hyped as endless to the point it was almost mythical. Specifically, it could eliminate siloed medical data sets, facilitate faster medical claims processing, incentivize better clinical decision-making, provide patients with access to their own medical records, eliminate the middleman from provider legitimacy checks, standardize medical data, transparentize drug supply chain and my favorite – eliminate fraud. With all these possible applications, no wonder it appeared to be a panacea to the healthcare industry.

To gain the support needed to move forward, communicating the value of a blockchain solution must be presented in business terms. This means demonstrating the ROI with a specific use case that will solve a real problem for the organization.

Blockchain is defined as a distributed, decentralized transaction ledger owned, maintained and updated by each node. It’s a peer-to-peer system with no central authority that manages the transaction flow. The transactions themselves are added sequentially and immutably to the ledger by passing through a cryptographic tool in order to keep the transaction data a secret. This framework is what drives the passion of use for a multitude of solutions.

As with any new technology, major shifts don’t ever occur overnight, but it’s been a decade and we still haven’t experienced meaningful transformations in healthcare with tangible benefits. Blockchain has benefited other industries with improved supply chains and outdated methods in terms of accountability, traceability, and transparency. However, in healthcare, we’re still at the intersection of having a ‘hammer in search of a nail’. Even most recently, I’ve heard statements and seen whitepapers with such language as: the “potential” of blockchain, finding your use case for blockchain, and blockchain “could” be the answer. The decentralized framework to enable and support is sound; healthcare just needs to go beyond the state of concept studies and theoretical implementation ideas.

Most recently, in the pharmaceutical industry, blockchain has proven to optimize the complex process of chargebacks and adds value to the business with greater connectivity for suppliers and customers.  Another real, implemented solution set is with smart contracts in the insurance industry improving processing and automating claims related to flight delay insurance. Both of these proven solutions have 1 to 1 correlation to healthcare use cases, such as patient medical billing.

New ideas need open minds free from bias, stereotyping and subjective perception. The first thing that comes to most people’s minds when you say blockchain is cryptocurrency. Because bitcoin has been the most successful use case, the entire technology is perceived as negative. That’s a hard starting point and a tough one to overcome. Even if successful pilots or point-in-time solutions have been developed, because of the culture, it hasn’t moved out of the CTO seat to the Executive suite (CEO/COO) to support and fully implement throughout the business. If there’s not a level of trust in the technology, definition of the positive value it will bring, it will always remain with the technologist and be disregarded.

To gain the support needed to move forward, communicating the value of a blockchain solution must be presented in business terms. This means demonstrating the ROI with a specific use case that will solve a real problem for the organization. Capable of reducing or eliminating the costs associated with a current inefficient technology solution. Even better, targeting an area of high strategic relevance, where the blockchain solution can be transformative and increase market share. When you can deliver validated facts that align with organization’s interests, by extension the executive suite, then and only then will you gain the support and funding to fully implement and gain adoption. 

Acquiring and keeping funded is always a concern and challenge for any technology solution in healthcare. As blockchain continues to move at a glacial pace, new and ‘so-called’ more glamorous solutions are on the rise with ML and AI. Reminiscence to the same hope and hype of blockchain, the solution offers tangible benefits. They have already begun proving their value in healthcare and funding has started to flow into those technologies. If you haven’t previously secured budget dollars for current blockchain solutions or haven’t proven the return on investment, it will be harder to capture additional capital or ongoing operational finances to keep moving blockchain into the future. 

Lastly, there are currently no concrete or direct U.S. laws regulating blockchain technology in healthcare.  Because healthcare is such a complex industry with various influential stakeholders and an enormous amount of regulation, it makes the value proposition of blockchain much more unsettling. History shows us that without standards or benchmarks, especially in technology, it’s the wild west. No standards equate to no confidence and without benchmarks, there’s no real performance measurement. Again, since blockchain hasn’t gained momentum and if the government is quiet about blockchain, less healthcare organizations are inclined to keep advancing any possible related solutions.

Considering all the obstacles and challenges, blockchain technology may not be the savior healthcare was expecting. We need to recognize and express it’s not the panacea that will solve all your business needs. However, just because it may not be necessary to use in all of healthcare, it can still be a single point solution which provides high value. This could be the catalyst for other healthcare-related enablement’s, but it’s ultimately engagement that will shape blockchains’ future for healthcare.

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Since its introduction a little over a decade ago, there has been a mix of pessimism and measured enthusiasm about the prospects of the blockchain technology in the enterprise. Some business leaders continue to dismiss the blockchain, a decentralized time-stamped ledger of transactions that are written and cryptographically secured on a peer to peer network, as a passing fad, while an increasing number advocate for its enterprise adoption.

According to Deloitte’s 2020 Global Blockchain Survey, many business leaders list blockchain as a top-five strategic priority and increasingly commit resources to it. A growing majority of global enterprises (55%, up from 53% in 2019, and 43% in 2018), now view blockchain as an enterprise priority. Despite this uptick in commitment to the technology, 54% of leaders also feel that the technology is overhyped. This is not unusual, and perhaps signifies the cautious optimism that many leaders have developed around this technology.

Enterprise blockchain pilot projects and production implementations continue to emerge globally, with the most common use cases falling into these categories:

Digital Identity Management:  Blockchain can be leveraged to address several challenges around identity management, including the effort to shift more of the control or ownership of identity data from identity providers to the individual owners of the identity. There are also ongoing projects to use blockchain to solve the problem of Provider Data Management in Healthcare.

Supply Chain Management: Blockchain can be used for real-time/multi-party tracking of goods, with an immutable audit trail. This has found application in Logistics and Retail (e.g., for product recalls) and in Pharmaceuticals (e.g., for drug traceability).

Financials: The Finance industry has been a leader in exploring the enterprise use of blockchain, and active pilot use cases include FX settlement in Banking. The Healthcare industry has also been exploring the use of blockchain to facilitate Revenue Cycle management.

Clinical Research/EHR Interoperability: Lifesciences and Healthcare also have interesting uses cases of blockchain, including managing patient consent in clinical trials, and tackling the longstanding problem of Electronic Health Records interoperability.

Despite the growing number of enterprise blockchain initiatives, a lot of obstacles remain in the path of enterprises seeking to adopt blockchain technologies. These include fundamental confusion around the nature of the technology. Many enterprises also struggle to identify viable business use-cases for the technology and to determine where blockchain offers better value than existing technologies. The lack of requisite technical skills has also made the exploration of the technology difficult. In addition, regulatory and technology standards that are required for the wide adoption of any technology are still evolving in the case of blockchain.

A Proven Path Forward

One proven approach to addressing the blockchain adoption challenges listed above is the use of a blockchain consortium to accelerate enterprise adoption. This is in some ways reflective of the success of other industry consortia in the evolution of nascent technologies (for example, the World Wide Web Consortium – W3C). A consortium membership allows an enterprise to leverage the collective technical skillsets of the consortium, as well as make for the distribution of the costs and risks associated with the development of the technology. It also facilitates the development of standards, key infrastructure and use cases, and partnerships for the purpose of the technology. It could also provide access to market intelligence. Blockchain consortia are private/permissioned and require membership to participate. This helps to mitigate some of the concerns around privacy and security associated with participating in public blockchains. Their focus defines the activities of blockchain consortia.

Business-focused blockchain consortia comprise of business entities with similar, complementary, or even competing business interests. This type of consortium is focused on developing blockchain use cases and standards for the adoption of the technology, and creating a partner ecosystem. Examples include the Synaptic Health Alliance, formed by some Healthcare Industry leaders to “explore the use of blockchain technology in tackling the challenge of accurate and efficient provider data management and sharing.” Another example is the IBM Food Trust, which connects “participants across the food supply through a permissioned, permanent, and shared record of food system data.”

Technology-focused blockchain consortia are focused on developing core blockchain technologies and related standards. The best-known example of this is Hyperledger, a global collaboration, “focused on developing a suite of stable frameworks, tools, and libraries for enterprise-grade blockchain deployments.”

Hybrid blockchain consortia, on the other hand, works to both develop the core technology as well as the business applications and uses cases for blockchain. An example is R3, founded in 2016 by several of the world’s leading banks. R3, now consisting of 300 participating global enterprises, has evolved into an enterprise software firm.

Today, there are dozens of global consortia, with participation by many of the leading global companies. Any organization wishing to explore the blockchain should consider whether joining a consortium would be beneficial to its efforts, as opposed to trying to go it alone in the beginning. They can start by identifying the blockchain consortia in their industry and assessing them based on the four success criteria described below to determine if joining a group could accelerate their learnings and adoption of blockchain technologies. An organization can also consider forming a new consortium in partnership with other enterprises.

The success and effectiveness of a consortium depend on a few key factors:

Governance: Having a well-defined and well-structured governance model is key to the success of any consortium. This helps define the role and participation of members, many of whom might be competitors.

Membership: The entities constituting the consortium defines what it can accomplish and how seriously it is taken by industry and regulatory authorities. Having key industry stalwarts in a consortium could grant it a lot of credibility and legitimacy out the gate.

Leadership: The leadership of the consortium can help set and drive its mission and vision and keep the organization on track. Leading consortia members often contribute significant intellectual property and technical capability to the consortium. Having reputable organizations in leadership roles on the consortium improves its chances of success.

Funding: Any viable consortia need a good source of funding for its activities. Having members that are financially committed to the mission of the consortium is critical to its success.

Blockchain is likely to become a strategic imperative in the coming years, and enterprise leaders are best served to position their organizations to learn and explore its potential benefit. Joining a consortium could be the easiest way for many organizations to achieve that goal.

The post Accelerating Your Enterprise Blockchain Adoption appeared first on HealthTech Magazines.

We live in an era of incredibly mature electronic health systems and decision support. While some technologies, such as block-chain and artificial intelligence have yet to show their full potential, the rest of real-time clinical decision support is a very mature field. In this context, why is it still so to present real-time cost and coverage information at the time of diagnostic test selection? Instead, it seems that we are locked into the clunky, archaic Advanced Beneficiary Notice of NonCoverage, otherwise known as the “ABN”.

Maybe other organizations have come up with an elegant solution that works for physicians and their patients. In most traditional health systems (those who do not have a health insurance arm), the workflows involved seem oriented to meet regulatory requirements of CMS and the Registration and Scheduling staff. More recently, CMS have pushed health systems to publish their standard prices on line. Both tools are important, and yet do not meet the needs of physicians and patients at the point of care.

Why can’t a physician and a patient know, at the time of consultation, if a test is covered, and what the patient will have to pay?

The current limitations I have observed in the current state ABN workflow is that the alert pops up with a form only at the time of signing the order. It typically contains minimal pricing information and no recommendations about alternative studies or diagnoses.

In an ideal world, in-line decision support for physicians regarding non-covered services would contain the following:

1. The ability to match against the patient’s problem list to look for proper diagnoses already charted on the patient.
2. A list of “common indications” that are typically covered, as well as the ability to add in free text.
3. Where appropriate, alternative procedures that would be covered, given the patient’s diagnoses.
4. The ability to do minimum frequency checks against a future, planned date, rather than the date the study is being ordered.
5. The ability to do minimum frequency checks against related studies that exist in records that are available through the Health Information Exchange (a tall order, I’ll admit!).
6. In-line display of estimated cash pricing.
7. The ability to customize to include additional alternatives, such as clinical trials.
8. Two-step decision making and processing such that the finalized decision is passed to other members of the care team to complete the process, including financial counseling, if appropriate.

Appropriate Use Criteria and Pharmacy Benefit engines are probably getting to be the closest in terms of a usable reference to assist physicians and patients steward their healthcare resources, although not incorporating my entire wish list. An ideal solution would allow incorporation of the Choosing Wisely campaign as well. Although Choosing Wisely specifically steps clear of coverage determinations, it overlaps considerably with how physicians recommend for and against diagnostic tests.

Certainly, the infrastructure for real-time eligibility and preauthorization exists. Standardized vocabularies such as SNOMED and LOINC should make interoperability a breeze. The use of FHIR APIs are in place in most large health systems, to facilitate secure data flow.

We often look for big, innovative disruptions to save us from ourselves in healthcare. Here is a classic “last mile” problem waiting to be solved. Why can’t a physician and a patient know, at the time of consultation, if a test is covered, and what the patient will have to pay? Let’s hope there are a few innovators out there considering how to build that mousetrap. I’d sign up!

The post Advanced Beneficiary Notifications – the Final Frontier appeared first on HealthTech Magazines.

When I joined Providence St. Joseph Health, one of the country’s largest health systems, I understood health care to be a sector ripe for innovation. My expertise is not on the clinical side, so I have left that to others. My focus has been on a topic that is decidedly less flashy, but no less critical: revenue cycle management.

While it may not make headlines, innovation in revenue cycle management is imperative for the type of transformation that health care needs. In 2018, revenue cycle inefficiencies were responsible for more than $500 billion in U.S. healthcare costs, primarily due to an overreliance on manual, outmoded processes built on physical correspondence, legacy data systems, and employees who spend hours calling insurers on the status of claims. Compounding the impact of these inefficiencies, health care providers today are confronted with headwinds that threaten to worsen their revenue cycle yields on multiple fronts: rapid growth in patient liability at a rate of up to five times that of overall reimbursement, payers challenging and denying a significant number of claims (with 20 – 25% of claims rejected, up from 10 – 15% just 3 years ago), and an increasingly complex environment of regulatory reform and new payment models that will exacerbate these challenges for health systems. Given the crucial importance of a health system’s revenue yield to its ability to re-invest in the health of its community, addressing these frictions in the revenue cycle must be a top priority.

In a simpler time, revenue cycle management was a straightforward process that could be left to the individual talents of billers capable of eking a margin from the billing cycle. As health systems have scaled and payment methodologies have increased in complexity, however, more and more providers are searching for ways to standardize processes, automate workflows, and unlock economies of scale.

Providence St. Joseph Health is turning to technology, commonly used in banking, to transform its revenue cycle. In addition to our pursuit of continuous improvement in core legacy revenue functions and patient-facing activities, we’re building a hub for insights and innovations that will serve as a common base for the entire revenue cycle. To this end, we recently acquired Lumedic, a next-generation blockchain-based revenue cycle platform. With our new partner, we are advancing shared ledger technology, smart contracts, and machine learning for an efficient, secure, and trusted end-to-end platform. Moreover, we are identifying opportunities to drive efficiencies and modernize our revenue cycle – for instance, by streamlining the underlying business processes unique to referrals and prior authorizations. While these prior authorizations typically require manual, time-consuming processes where hospital employees track down information on a payer’s website and hope that it is up to date, blockchain-enabled technology can update a decentralized ledger in real time rather than individually validating or updating files or data systems.

As health systems have scaled and payment methodologies have increased in complexity, however, more and more providers are searching for ways to standardize processes, automate workflows, and unlock economies of scale.

A blockchain-enabled approach also has the added benefit of enhanced security, given that it leverages modern cryptography, public-key infrastructure (PKI), decentralization and consensus protocols that render it resistant to hacking. Many people ask: Why go to the trouble of making dramatic changes to the revenue cycle process when we might do just as well by merely improving on the current model? In our view, while incremental improvements through increased standardization and automation can be beneficial in the short-term, these efforts do not make the fundamental changes necessary for transformation. Approaching a process differently can work. Uber, for example, didn’t just fix the taxi dispatcher model. Instead, it changed the model, using a systematic approach to applying rules for the user experience. It took the inefficiencies of dispatching out of the system, increased ease-of-use and transparency, ultimately resulting in a better, more hassle-free ride.

I realize this may sound futuristic. However, if you’re not convinced about blockchain, consider that a whole country is adopting it for medical care. Estonia uses blockchain technology to control their health records and facilitate the proper use of the records by the medical community. The system is touted for providing a collaborative ecosystem and a single immutable data source for health care professionals and patients.

As we see it at Providence St. Joseph Health, there is a strong case for building out a blockchain platform and applying it to the revenue cycle. There is a multitude of benefits beyond the uses we are currently working on, but, for now, our focus is on unlocking the efficiencies that blockchain technology enables. Imagine a world that runs by standardized, enforced rules instead of passing paper back and forth. Imagine an innovative network that will facilitate seamless sharing of trusted information and collaboration on integrated business processes, reducing inefficiencies in the health care system, and improving the patient experience. Our investments in blockchain technology aim to help make our vision of a frictionless revenue cycle a reality.

The post Attaining Frictionless Revenue Cycle Management appeared first on HealthTech Magazines.

At the nexus of Healthcare and Technology emerges solutions aimed to improve patient outcomes and satisfaction, while making the jobs of clinicians safer and more effective. The primary driver of these solutions is to address industry-specific challenges faced by these populations. One such solution at the convergence of Health and Tech that is beginning to show signs of maturity is Telehealth—the remote delivery of healthcare services over an audio and visual telecommunications platform.

We are experiencing an exciting time for Health Tech, as a whole. We are seeing climbing rates of adoption of digital health tools among consumers, including wearables and Telehealth applications. New players are emerging in the healthcare industry leveraging technology to bring new delivery models to consumers. State and Federal legislators are discussing ways to reduce barriers to Health Tech innovation, while encouraging industry leaders and new players to look toward solutions like Telehealth, as the new norm.

From a technological viability standpoint, we are more capable of delivering Telehealth effectively in multiple healthcare settings than ever before. I serve as Chief Information Officer for Consulate Health Care, a national leading provider of senior healthcare services. Our talented team of Health Tech pros and vendor partners are currently implementing Telehealth in a controlled test group of our Skilled Nursing Facilities.

Telehealth platform integration with legacy e-health record systems and single application sign-on capabilities helps to streamline utilization by cutting down on the amount of time it takes for clinicians to become familiar with new technology platforms.

We are seeing the industry’s most advanced wireless internet networks provide seamless, two-way interaction through high-resolution cameras and crisp, clear VOIP communication. We are integrating our Telehealth platforms with electronic patient recordkeeping systems to send and receive information quickly and securely, while allowing Telehealth clinicians to monitor the status of patients in real-time. In other words, the technology needed for effective Telehealth platforms already exists.

While technological capability is an essential element to industry-wide adoption, it is not the only element. The healthcare industry at large has a significant amount of work to do as it relates to policy making, security, education and talent development, as well as overall trust and adoption among patients and clinicians.

These barriers are similar to circumstances occurring in other emerging technology trends, such as Future Mobility or Blockchain—where the technology fueling these trends already meets or exceeds the needs of the consumer, but overall adoption remains moderate at best due to a lack of governance and policy, infrastructure, security and overall consumer trust.

Healthcare providers looking to offer Telehealth solutions to their patients must treat training and development with the same regard as tech implementation. At Consulate, we view this as a culture-changing initiative to meet and exceed the needs of our patients, while improving the employee experience and work-life balance of our clinicians and physician partners.

Let’s face it—in today’s healthcare environment, clinicians are busy—making tech implementation and culture-change challenging, at any scale. This reality constitutes the “make it easy” approach essential to successful team implementation. Telehealth platform integration with legacy e-health record systems and single application sign-on capabilities helps to streamline utilization by cutting down on the amount of time it takes for clinicians to become familiar with new technology platforms.

Another barrier to address is onsite and remote physician team integration. While Telehealth physicians engage patients remotely through an audio/visual platform, at its core, the technology introduces new groups of physicians to existing clinician teams. Onsite care teams and Telehealth clinicians have to learn how to effectively trust each other and work together to leverage the platform’s full capacity.

While it is up to the individual clinician to be adaptive and open-minded when it comes to learning, and actually using new patient care technology platforms, it is the responsibility of provider organizations to ensure their care teams have the knowledge, resources, infrastructure and accountability measures in place to ensure platforms like Telehealth are utilized to their fullest capacity.

Part of training and education is helping onsite and remote clinicians, as well as ancillary staff understand the evolving administration and payer management ecosystem. On April 5, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a rule that updated the Medicare Advantage program by allowing plans to include “additional telehealth benefits” as part of Medicare basic benefits starting in 2020. The plan requires that providers comply with applicable licensing requirements and laws for the state in which the patient is located and receiving care. This is important for care teams to know and comfortably communicate to support staff and consumers, as Telehealth become a more widely-adopted resource.

As we have seen in the past, integration and culture-change initiatives will converge to promote Telehealth as a trusted resource among care teams, over time. This trust will extend to the patient community, as care teams demonstrate familiarity and ease of access. Additionally, increased accessibility to physician-led care helps to ensure quality outcomes and patient satisfaction—helping consumers become more comfortable and accepting, or trusting, of Telehealth. Consulate’s Skilled Nursing Facilities with Telehealth offerings are already showing decreases in un-necessary patient readmissions to hospitals and emergency rooms visits due to extended access to physician-led care.

As trust builds between onsite practitioners and remote physicians, care teams will have more resources to treat patients, helping to cover patient care needs over long periods of time and shift changes—aiding to offset physician burnout through a balanced, team-oriented approach to quality care.

As the technology continues to develop and converge with consumer electronic mobile devices, future applications of Telehealth show signs of increased scalability and utilization among patients and clinicians—bringing its value to more hospitals, long term care and skilled nursing facilities, as well as assisted living and home care environments. Tech integration working in congruence with team implementation will bring Telehealth into more health care delivery models faster, helping more patients and communities benefit from its power.

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