How Blockchain Will Transform Practitioner Credentialing

By: Anthony D. Begando

Credentialing is a complex, costly, and time-consuming process mandated throughout the healthcare industry to ensure that a practitioner can competently deliver (and be compensated for) patient care within a specific clinical setting.  Today, the process largely consists of organizations independently collecting, verifying, and analyzing information pertaining to an individual’s background and experience.  These artifacts include education, employment, and clinical assignment histories, licensure and certification histories, on-going training, insurance coverages, and the like.  While several accreditation bodies define guidelines for performing this work, it is the ultimate responsibility of a healthcare organization to define and follow their own internal processes that are both compliant with those guidelines and their own specific needs.   Consequently, most healthcare organizations redundantly perform this work for each practitioner with whom they seek some form of professional relationship.  It is common for practitioners to maintain independent credentials data sets with 15-25+ organizations (e.g., hospitals and health systems, payers, networks) concurrently.

In healthcare delivery environments, practitioner recruitment, staff appointment, and insurer contract enrollment processes often take 4-6 months to complete– with credentialing and payer enrollment weighing heavily on the process timeline.  In hospitals alone, is estimated that for every day a physician’s employment or contracting is delayed, the organization forfeits $7,500 in net revenues.  Further, as healthcare moves rapidly into expanding delivery models such as telemedicine, direct-to-consumer, and outpatient specialty care, credentialing-oriented delays are direct impedances to growth for many firms.

The emergence of enterprise-level blockchain technology creates a unique opportunity to address the cost, complexity, and timeframe associated with this work.  The fundamental reason why healthcare organizations repetitively and redundantly perform the collection and verification of credentials information is that there lacks a trusted and reliable forum to request and receive verified credentials information.  Blockchain will change that.  Through the establishment of a network connecting practitioners, primary sources, and consumers of credentials information, a utility can be created which captures credentialing transactional data and, where authorized, makes that data available for consumption by all other future requestors of that same information.  Recognizing that this greatly simplifies an often complex process driven by artifact types stemming from thousands of sources of information, consider the following simple example:  A cardiologist is employed by a hospital for five years.  She was appointed to the medical staff and awarded privileges to practice a defined set of clinical procedures relevant to her practice area.  She resigned, in good standing, and moved to another hospital in another state.  For the remainder of her career, every delivery system, payer, network, practice group, and the like for which she seeks a professional relationship with will independently request verification of this employment episode, her privileges, and her standing upon termination—likely resulting in scores or even hundreds of redundant requests for this employment verification.

A blockchain-based utility would record and confirm, on the first requested verification, the provenance (source) of the information, the information contained within the verification itself, the result of the verification, and a formulaic key confirming that the information has never changed from its initial issuance.  For example, Anne Smith (a NAMSS accredited credentialing specialist) from XYZ Hospital (a Joint Commission accredited hospital) provided the employment verification and privilege delineations for Dr. Monica Ortiz to Bill Jones from Big Payer (working at an NCQA accredited firm) who confirmed the verification.  The utility blockchain records and confirms the source and reliability of that data eternally.  As such, every future request for that information would leverage the initial verification and have no need to repetitively request that data from XYZ Hospital ad infinitim.  Similar processes could be employed for both publically available sources (e.g., licenses, certifications, OIG sanctions) of information and private enterprises.  In time, the vast majority of historically verified transactions could be disseminated to requesting organizations and substantially reduce the level of costly repetitive reverification that pervades the industry today.

The future of blockchain in healthcare is immense.  This particular use case presents an ideal opportunity to solve a years-old problem that affects nearly all aspects of the industry.

Annotated Blockchain Terminology

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ALTCOIN – Short for “Bitcoin alternative,” this is a quick way to describe the various cryptocurrencies not named Bitcoin.

BITCOIN – Created in 2009, Bitcoin is a cryptocurrency that is peer-to-peer and thus requires no middleman or third party.

BLOCK – A record of permanent transactions that cannot be edited or altered; this record will end up being added to the ledger and is considered an integral component of the blockchain.

BLOCKCHAIN – A distributed and decentralized ledger of transactions that everyone can view but that no single entity controls – one simple example is that of a shared spreadsheet where multiple persons can add data to subsequent cells but cannot edit what has already been added; the most common blockchain that people refer to is the Bitcoin blockchain.

CONSENSUS – The situation that occurs when several nodes all have the same blocks within their locally-validated blockchain.

CRYPTOCURRENCY – A medium of exchange that relies of encryption to verify the transfer of value, the evidence of which is added to the blockchain.

CRYPTOGRAPHIC HASH – A “digital fingerprint,” created by a complex mathematical algorithm, which makes input data virtually impossible to reverse engineer in a nefarious manner.

CRYPTOGRAPHIC HASH – A “digital fingerprint,” created by a complex mathematical algorithm, which makes input data virtually impossible to reverse engineer in a nefarious manner.

CRYPTOGRAPHY – The study of secure communication techniques that prevent the interception of data being communicated by unintended recipients.

CRYPTONYM – A primary public identifier; the keyed hash of a minimum attribute set for an identity.

DECENTRALIZED AUTONOMOUS ORGANIZATION (DAO) – An organization that is run based upon the rules which are set within specific “smart contracts”.

DISTRIBUTED LEDGER – A shared database that has multiple witnesses, virtually eliminating both fraud and double spending; a blockchain is a type of distributed ledger.

ETHER – The token of the Ethereum blockchain, Ether is mined in a manner similar to that of Bitcoin.

ETHEREUM – A decentralized blockchain network that runs “smart contracts:” applications that run exactly as programmed and which are based on a triggering event.

FIAT CURRENCY – Money which is deemed legal tender by a government and which can be used to settle a transaction (ex. USD, EUR, JPY).

GENESIS BLOCK – The first block in a blockchain.

HASH RATE – The measuring unit of the processing power of the Bitcoin network.

HIERARCHICAL DETERMINISTIC WALLET – A system of deriving keys from a single starting point (also referred to as a seed); this system allows a user to perform a wallet backup or restore a wallet without needing additional information.

INITIAL COIN OFFERING (ICO) – A popular (albeit unregulated) method of fundraising within the cryptocurrency world that avoids the need for a company to raise traditional venture capital.

MERKLE TREE – A binary tree of cryptographic hashes.

MINING – The method by which transactions are ultimately added to the blockchain; this process involves adding transactions together in one “block” and then solving a complex mathematical puzzle.

MULTI-SIG – A situation where more than one key is required in order to authorize a given transaction.

NODE – Typically a reference to a computer, this is what a member of the blockchain computer network is called.

ORACLE – A data feed that can be leveraged to import external data onto the blockchain.

PRACTICAL BYZANTINE FAULT TOLERANCE (PBFT) – An algorithm that is relied upon in order to establish consensus within a blockchain system.

PRIVATE KEY – A string of letters and numbers that allow you to send cryptocurrency to others.

PROOF OF STAKE (POS) – An alternate system to Proof of Work; the PoS system states that the more cryptocurrency possessed by a given miner, the more mining power he has.

PROOF OF WORK (POW) – A system that requires miners prove that they have utilized significant computing power to perform the validation of a given block; PoW makes it extremely difficult to alter any aspect of the blockchain, as doing so would require the re-mining of all subsequent blocks.

PUBLIC KEY – This is also a string of letters and numbers, but it is derived from your unique Private Key.

SATOSHI (UNIT) – Contrary to popular belief, Bitcoins can be broken up into smaller units; Satoshis are a one hundred millionth of a Bitcoin (.00000001 BTC).

SATOSHI NAKAMOTO – The official “creator of Bitcoin;” to date, nobody knows exactly who this person (or group of people) actually is.

SECURE ENCLAVE – A cryptographic co-processor, commonly seen within Apple devices, that enhances the security of a device even if the other processor is compromised in any way.

SECURE HASH ALGORITHIM-256 (SHA256) – A type of cryptographic hash function commonly used within blockchains.

SMART CONTRACTS – Digitally self-executing contracts that run on the Ethereum blockchain; a simple example is an “if this, then that (IFTTT)” contract.

VALIDATING NODE – A node which verifies a given transaction and then adds the transaction to the blockchain.

WALLET – Software which is used to store the private keys that you need in order to access & spend cryptocurrencies.

ZERO-KNOWLEDGE SUCCINCT NON-INTERACTIVE ARGUMENTS OF KNOWLEDGE (ZK SNARKS) – A form of cryptography that is used to verify the correctness of a computation without needing to execute the computation.

Hashed Health CEO to speak at South by Southwest

Several members of the Hashed Health team will be traveling to Austin for South by Southwest, which has a two day series on Blockchain technology this year — spanning from March 14 to March 15.

Among those speaking is Hashed Health CEO John Bass.

As part of a panel for the Startup and Tech Sector portion of Austin’s South by Southwest Event, Bass will be speaking on Blockchain and the Crisis in Healthcare. The panel plans to address how blockchain solutions can unpack current care gaps in the healthcare delivery model of today.

The event will take place on March 14 at the JW Marriott Salon E (110 E 2nd St Austin, TX) from 12:30pm – 1:30pm.

Other speakers on the panel include Beth Breeden of Lipscomb University, Dominique Hurley of healthverity, and Aaron Symanski of Change Healthcare. More information on the panel can be found at: https://schedule.sxsw.com/2018/events/PP75277.

Hashed Health to attend HiMSS’18

From March 5 to March 9, the Hashed Health team will be traveling to Las Vegas for HIMSS’18, an annual conference and exhibition that brings together 40,000+ health IT vendors, entrepreneurs, clinicians, and other professionals in the field.

This year the conference will take place at the Venetian-Palazzo Sands Expo Center. Several of the events, including the six HIMSS18 education sessions, will be livestreamed through the facebook page for the event:  https://www.facebook.com/HIMSSpage/.

Notably, Corey Todaro, the Chief Product Officer and Director of Hashed Labs, will be speaking on Tuesday, March 6. The panel will be located at Hall G Booth 11955ET from 9:30am – 10:30am and is entitled “Blockchain reset – seeing through the hype and starting down the path.”

Other speakers on the panel include David Houlding of Intel Health & Life Sciences, Emily Vaughn of Change Healthcare, Mike Jacobs of Optum, and Ted Tanner of PokitDok.

Use cases to be discussed include drug supply chains and provider credentialing processes. The objective of the educational panel is to help audience members identify practical use cases, address questions of interoperability, and ideate on questions of privacy, compliance, and deployment.

Mr. Todaro will also be speaking Wednesday, March 7 from 11:30am to 12:30pm at Palazzo K of the Venetian Convention Center with Brian Behlendorf, Executive Director of HyperLedger for a session entitled “Blockchain 101 for Healthcare”.

Keynote speakers for the overall event include Founder and CEO at Zipline Keller Rinaudo, Vice admiral Raquel C Bono of the Defense Health Agency, Secretary of Veterans Affairs David Shulkin, Technical Advisor and Former Executive Chairman at Alphabet Inc. Eric Schmidt, and Magic Johnson.

Those attending the event are encouraged to stop by the Hashed Health exhibition booths: Booth 9,900-51, 9.900-52, and 9.900-53. For those following along remotely, check for updates at: https://chat.hashedhealth.com.

The Rocketchat channel is part of Hashed Health’s Collective initiative. Collective is our medium to connect the different players in the healthcare blockchain arena via various means including RocketChat channels, podcasts, global meetups, conferences, webinars, content development, and other community events.

Hashed Health team attends ETHDenver

Our hacker team of Zhenting Zhou and Deon Summers attended ETHDenver from Friday, February 16 to Sunday, February 18.

Held at the Sports Castle on 1000 N Broadway, Denver, CO, the Ethereum Hackathon brought together coders and entrepreneurs to develop Blockchain solutions for various use cases. The event had approximately 1,500 attendees and was livestreamed through Facebook. More information can be found at https://ethdenver.com/.

The seven winning teams included Elkrem, Cache, Feel Good, Solidity, Keysplit, Canteen, and Blockstreet.

Elkrem, an ethereum development board, looks to revolutionize the hardware aspect of blockchain. Cache is a cyberpunk cryptocurrency trading game based on the classic Drugwars played on TI graphing calculators using ERC20 and ERC721. Feel Good is an end to end traceable and accountable blood donation system to avoid transmission of contaminated blood. The solidity gas profiler aims to assess where transaction fees were spent within the context of a smart contract. Keysplit is a way to recover a lost private key through safeguarding it with a designated “guardian.” Canteen is a realization to decentralize the concept of kubernetes and streamline the number of applications for companies and start ups. Lastly, the Blockstreet boys came up with an end to end decentralized development platform with a tutorial system.

Zhen and Deon worked on two separate projects and expressed their enthusiasm for having participated.

In particular, Zhen worked on a project to kick start scientific research funding with ethereum. More information on the project can be found at: https://medium.com/@kyletut/proposing-the-forecasted-elastic-allocation-token-6ebe7d43778a. The GRANT submission can be found at: https://devpost.com/software/grant#updates.

Deon, who teamed with some developers of the TrueBit project, explained his favorite winning project as the solidity gas profiler.

His team focused on solving a problem that the Aragon team introduced: verifiable Off-chain Tabulation of Carbon-vote signaling.

“Current voting on the ethereum network is either done by locking up tokens, or creating snapshots (such as MiniMe tokens from the Giveth team). We created a way to vote and reach consensus where each vote is weighted by the number of tokens in a voter’s wallet. A voter can vote yes/no to a proposal, and if anytime in the future he sends or receives tokens, the voting balance is updated at that time”, explained Deon.

Some of the team’s favorite presentations included Joshua Hannan, William Dias, and Jessica Marshall’s Introduction to Smart Contract and DApp Security and David Knott’s Introduction to Vyper.

The Hannan, Dias, and Marshall team went through a number of ethereum “hacks” and ways to prevent them (some problems taken from https://ethernaut.zeppelin.solutions/). Through emphasizing the need to keep smart contracts as secure as possible, this talk stood apart as necessary for the ecosystem.

David Knott introduced Vyper as an Ethereum programming language that poses an alternative to Solidity (the most popular one currently). David went through examples, gave information about the inspiration behind Vyper, and outlined their goal of making it an easily readable and secure language for the ethereum ecosystem.

To pose questions for the Hashed Health participants at ETHDenver and continue the conversation, visit https://chat.hashedhealth.com.

 

February Meet Up – Nashville

On February 15, Hashed Health & BTC Media collaborated with the support of the Nashville Technology Council to host another Hashed Collective Event: The Nashville Blockchain Meetup.

The event was hosted at the Nashville Technology Council (500 Interstate Blvd) and livestreamed via Hashed Health’s facebook page. There were approximately 80 in attendance. The crowd was compromised of blockchain enthusiasts, entrepreneurs from a variety of fields including healthcare, and developers.

The presentation, delivered by Anastasia Mavridou and Abhishek Dubey of the Vanderbilt University School of Engineering Institute for Software Integrated Systems, covered Secure-by-Design Smart Contracts and Blockchains for Time-Sensitive Community Applications.

Abhishek Dubey started off the presentation by explaining the role of consortium/private blockchains and comparing them with public chains.

Some of the community applications he discussed outside of healthcare applications included green energy linking between houses.

Anastasia then took the stage to discuss threats posed by software vulnerabilities in smart contracts with a focus on contracts that integrate with our community applications.

Questions from the crowd included several technical questions and a short discussion about pending legislation HB1507. The bill can be found at: http://www.capitol.tn.gov/Bills/110/Bill/HB1507.pdf.

Followers from Hashed Health’s Rocketchat channel also tuned in via chat.hashedhealth.com.