The Synaptic Health Alliance: A Look at how Blockchain Technology Could Improve Provider Data Quality 
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Sheppard Mullin Richter & Hampton LLP


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In 2018, five major healthcare companies – Humana, MultiPlan, Optum, Quest Diagnostics, and UnitedHealthcare – formed the Synaptic Health Alliance (the “Alliance”) to explore how blockchain technology could resolve current healthcare issues.

The Alliance launched its first pilot program in April 2018 to focus on specific ways that “blockchain technology can help ensure the most current information about healthcare providers is available in the provider directories maintained by health insurers.

”[1] Aetna and Ascension joined the Alliance in December 2018, thus adding additional resources and unique perspectives to the effort of streamlining provider data management.

[2]What is Blockchain?

As described in a March 1, 2018 article, “How Blockchain Can Impact Healthcare” authored by James Gatto, Esq. and posted on the Law of the Ledger: Legal Issues with Blockchain and Cryptocurrency Blog, a blockchain is, at its core, a distributed ledger for recording transaction data. In short, a blockchain can aptly be described as a simple list of transactions.

Traditional paper-based ledgers include consecutive pages in which each line records a transaction. When a ledger page is full, the process repeats on the next ledger page. In the case of a blockchain, each block is like a page. Transactions get verified and written into a block and when the block is full, a new block is created.

Unlike traditional paper-based ledgers, when a block is full, the system creates a hash value, which is just a random number generated by an algorithm based on the contents of the block. This hash value is then written as the first entry in the new block, thereby “chaining” together the blocks, hence the term “blockchain.

” If someone ever attempts to change an entry in a prior block, the hash value would no longer match what was written into the new block and that attempt would be deemed invalid.

In part, this is how blockchain creates unalterable records.Current Challenges Surrounding Provider Data ManagementHealth plans are required to actively maintain and update their provider directories to meet both federal and state regulatory requirements.

Provider directories include vital information for determining coverage for patients, including contact information for providers, information about plan participation for individual providers, and information regarding whether an individual provider is accepting new patients.

Approximately $2.1 billion is spent annually by insurers, doctors, and hospitals to maintain this provider data.[3]In addition to astronomical costs, current provider directories often contain inaccurate or outdated information.

The Centers for Medicare and Medicaid Services reviewed a pool of Medicare Advantage Organizations and found that “52.20% of the provider directory locations listed had at least one inaccuracy.

”[4] The inaccuracies included incorrect address information, errant phone numbers, and misidentification of a provider as presently accepting new patients, when the provider was not.[5]Inaccuracies in provider directories routinely result in issues with coverage for patients.

A survey conducted by the American Medical Association and LexisNexis® Risk Solutions found that 52% of physicians in the United States “say they encounter patients every month with health insurance coverage issues due to inaccurate directories of in-network physicians.

”[6]Blockchain as a Potential SolutionThe Alliance has assessed this current system as inefficient due to the duplicative efforts of health plans that “typically maintain their own provider data sets and rarely collaborate on the daunting task of provider data management.

”[7] The end result being redundant administrative expenses and silos of disconnected data.

[8]The Alliance considers blockchain to be a technology that could streamline the current process for maintaining accurate provider data. The Alliance “plans to build a permissioned blockchain that would let members view, input, validate, update and audit non-proprietary provider data within the network.


”[9] Specifically this blockchain solution could:

• Improve interoperability among stakeholders by creating “a synchronized, shared source of high-quality provider data” that would be stored via blockchain and begin to connect the currently separated data silos;
• Improve data integrity by creating a tamper-resistant, chronological record of each transaction which will “remain visible and unchanged, providing a real-time audit trail;” and
• Allow “participants to share some of the administrative burden and cost of data maintenance and reconciliation” thus reducing administrative costs for each member.
• [10]

Provider data is a foundational piece of the healthcare system that connects doctors to patients. This first pilot program by the Alliance could significantly improve current provider data management systems by utilizing blockchain technology as a uniform standard creating interoperability among stakeholders and improving accuracy of submitted data.


Sheppard Mullin Richter & Hampton LLP - Samuel Gilkeson and John M. Tilton

A report published in the International Journal of Health Geographics has medicine pegged to be the first industry completely revolutionised by the blockchain – but it won’t be easy.

After analyizing 40 papers from the PubMed journal, researchers noticed a continued and growing interest from the healthcare research and medical sector in developing blockchain solutions to streamline almost everything related to health.

Suggested use cases range from powering supply chains to securing medical data, but the report also highlights some fairly futuristic concepts. One radically forward-thinking concept, for instance, envisions using blockchain-enabled augmented reality technologies for “crisis mapping and recovery scenarios.

The paper attributes the blockchain with potential to breed smart drones powered by distributed peer-to-peer apps, built to provide relief in desperate situations. Autonomous vehicles delivering life-saving equipment such as defibrillators are some of the more futuristic applications developing faster than anticipated.

Emergency situations aside, the report asserts that Internet-of-Things (IoT) tech marks “foundation of the smart healthy cities and regions of today and tomorrow.” One EU-funded project, Guide2Wear, is building blockchain-powered wearable devices that would facilitate seamless traveling on public transport.

The road to realized innovation is not going to be easy, for all great ideas will inevitably face major challenges, the paper posits. All blockchains must be resistant to ‘51 percent attacks’ and have robust security measures, especially considering the sensitive nature of data related to medical records and GPS.

Interoperability – communication between blockchains – is another major hurdle, especially for budding smart cities. The relationship between multiple blockchains must be seamless in order to reap the benefits provided by the technology.

The researchers emphasize that perhaps the most pressing existential problem facing blockchains might just be the European Union.

In May, the General Data Protection Regulation (GDPR) came into effect. It requires that all personal data must be deletable on demand, a difficult request for a distributed ledger using eternal immutability as a means of ensuring trust in sensitive data.

Considering it has been over a month since the enacting of the EUs new privacy guidelines and the sky hasn’t collapsed on blockchain startups across Europe, the working understanding is distributed ledgers could technically be exempt, as privacy and security are essential cornerstones to their marketability.

The full report is public and can be accessed here.

Discover more stories from TNW here: https://thenextweb.com/hardfork/2018/07/05/medicine-blockchain-imminent/

The healthcare industry sees a significant part of its operations dedicated to the management of medical and client information – personal patient data, patient incidents, records of treatments, lab results and consultant reports.

The handling of sensitive data comes with a number of challenges like security, accuracy, access, compliance with industry standards, and data protection, among others.

The administration of data processing can be cumbersome, and many current systems do not guarantee that all information regarding a patient’s medical history, across the providers who have given a medical service to the patient, is digitally stored.

This can make it difficult for both doctor and the patient under her care to have fast, easy access to the patient’s medical history.Up until now, a data solution that is robust, seamless, transparent and accessible to all parties in the ‘community’ is still elusive.

The healthcare industry has focused mainly on creating a centralised repository that has the capacity to hold and transmit patient data. A repository that is non-portable, non-standardised, and has limited access rights.

Blockchain technology could be the answer to some of the industry’s current challenges. Solutions could not only benefit the healthcare service provider but also the patient.

Demand for integrated healthcare services:  There is an ever-growing demand for integrated healthcare services that bring together different service providers to share information, and where the ultimate beneficiary is the patient.

This emphasises the need for an information technology platform that can eliminate dependency on manual intervention and which is transparent and accessible to all designated members.

Blockchain technology can offer to be the foundation for a new data model – a solution that works on Digital Ledger Technology (DLT) where data is not centralised but distributed, accessible to all members on the specific platform and where transactions need to be authenticated by all members.

A robust, fool-proof, secure infrastructure that chronologically records all transactions. These features have great implications for the future of the healthcare industry and the provision of integrated healthcare services. Data sharing: One of the most important aspects of a healthcare system is the way its data is shared across entities in the value chain.

Blockchain supports seamless information sharing that can eliminate duplication, errors and inconsistencies that arise from traditional, centralised data storage. The accuracy of medical and patient data, in this scenario, reaches new highs.

Solutions could not only benefit the healthcare service provider but also the patient

Member health management:  When patients with chronic conditions initiate treatment, they are exposed to a variety of services given by different health specialists, for example a fitness regime, nutrition recommendations, medication adjustments.

A care coordinator identifies the treatment methodology and wellness goals, and then creates a time-bound, milestone-based, health-appraisal plan for the patient to follow.

Some of these services can be supported by social apps that provide the patient with instructions, reinforcements and detailed reports from doctors and nurses. Patients can also obtain regular feedback and analytics using self-monitoring or home-care monitoring tools.

Patient data collected from different sources and different instances are inputted in the patient’s electronic health records database. With blockchain technology, this data can be decentralised and distributed to other entities in the healthcare ecosystem.

A care coordinator in charge of the health management of the patient has on-demand access to complete patient data and, at any given time, can use the aggregate data to monitor and improve the patient’s health.

Smart contracts: In simple terms, a smart contract is a coded software programme that integrates the conditions, legalities and provisions of a contract and automates actions accordingly. An electronic ‘contract’ enables the automation of the administrative tasks related to processing the patient’s benefits, specifying the payment terms and conditions.

The smart contracts application eliminates the need for intermediaries to manage and execute the member/patient contracts. This process decreases costs significantly and maximises performance, enabling accuracy, speed, and transparency.

These contracts can also define the type and quantity of data to be collected, as well as how that data can be used for the patient’s well-being. With this smart-contract file on a blockchain network, the provider does not need to call into the insurance company for every appointment or log in to a portal in order to validate the patient’s eligibility.

The eligibility can be determined and confirmed real-time via the smart contract. A patient-centric industry: The healthcare industry should always and at all times be patient-centric. The last thing that patients need when they are sick, especially when they are seriously or chronically ill, is the added stress of not being efficiently and duly served by those in charge of their well-being.

If blockchain can improve the quality and the levels of care given to patients, and the standards we are used to, then key stakeholders in the healthcare industry should seriously explore the possibilities that this new technology is being touted for.

 A technology that also promises significant cost savings and increased profit margins for business.

Nicholas Warren is a senior manager in the Financial Services Practice Group at Chetcuti Cauchi Advocates. E-mail: [email protected]
https://www.timesofmalta.com/articles/view/20180617/business-news/a-healthcare-blockchain-for-the-benefit-of-patients.681992