A cutting-edge technology could greatly enhance the peer-review process, according to one proponent. The blockchain technology most commonly associated with cryptocurrency like bitcoin could revolutionize how hospitals review and credential physicians, he says.

Few healthcare professionals are likely to have experience with blockchain, but the concept is not as daunting as it might seem at first, says J. Mark Waxman, JD, partner with the Foley & Lardner law firm in Boston.

Blockchains are essentially a type of database, Waxman explains. Each user can verify and update the file before making it accessible to the next user.

In this way, “blocks” of peer review information can be linked together in a “chain” with encryption that provides enhanced security. Users can also link to prior blocks of information.

Unlike more typical databases, blockchain can grant users access to all of the data or certain chains — restricting access to those who need to verify some parts of the chain, for instance, but who should not have access to other information.

Several health systems are considering blockchain for peer review, but none has implemented it so far, Waxman says.

“I think it makes all the sense in the world if you have a way of keeping track of a physician over the course of a career through this one resource that can be accessed by a lot of different people, in a limited way,” Waxman says. “It would save a lot of time because you go to so many different places over the course of your career from medical school to residency, to jobs here and there. The notion of having one record that can be updated and accessed by the appropriate parties should be appealing.”

Blockchain has the potential to greatly reduce the time and effort required for credentialing, he says.

“If you have everything you ever did before in one place that was current and attested to by the participants, that’s good for the doctors and patients because the doctors get credentialed quickly,” Waxman says. “It’s good for the employer that doesn’t have to pay for all that redundant work.”

Waiting for First Big Step

Unfamiliarity with blockchain is the initial hurdle, followed by fears that it would mean completely overhauling existing peer review systems, Waxman says. Implementation of blockchain for peer review would require a large hospital or health system committing to the idea and spending a couple of years educating stakeholders about it before going live, he says.

“The physician remains at the center of the process, initiating the process and allowing the blockchain to be used. Some of them will welcome the idea of a system that simplifies something they have to do over and over, while others may say electronic records turned out not to be what we all hoped they would in terms of improving efficiency and economy, and so they won’t feel like trying this,” Waxman says. “Once you get physicians on board, then it will depend on the willingness of others to participate. The educational process throughout a health system will probably be the way the whole thing really gets started.”

Waxman suggests that interested healthcare leaders explore organizations such as the Blockchain Alliance, a coalition of companies and other organizations interested in ensuring the security of blockchain systems.

(The alliance website is at: https://blockchainalliance.org/.)

“The first thing is to realize you’re not alone in finding this an intriguing concept. You can look at who else might be interested in your area and then go to leaders in your own system to explore how you might take this step,” Waxman says. “This can help the physicians and the hospital or health system reduce the manual labor and costs required for reconciling all this credentialing data for plan participation. That has to be attractive to everyone involved.”

Waxman has published a proposed agreement for a blockchain credentialing process. It is available online at: https://bit.ly/2VpJUAR.

SOURCE

• J. Mark Waxman, JD, Partner, Foley & Lardner, Boston. Phone: (617) 342-4055. Email: mwaxman@foley.com.