Last week the Hospital of Taipei Medical University (TMUH) officially launched its blockchain. The purpose is to create smart health passports to share medical data between health organizations. Hence one of the first applications relates to hospital referrals. The project is quite comprehensive.
Taiwanese health system
The country has a legislated National Health Insurance (NHI) scheme, with 99% of the population enrolled. Funding comes from an obligatory insurance premium based on income levels, so the poor pay less. The average premium is $25 per month.
Hospitals and clinics are a mix of public and private organizations, though the majority are private companies. Patients pay a percentage of the fees, and there’s the option to opt out and have private insurance.
Compared to the UK system, Taiwanese patients have more choice. They can select which hospitals and doctors they wish to see, and they don’t have to wait for a general practitioner to act as a gatekeeper for referrals. Reportedly a Taiwanese citizen will visit a doctor on average 14 times per year.
TMUH blockchain benefits
TMUH identified two major issues it wanted to address using blockchain. The lack of gatekeepers in the Taiwanese system has drawbacks. If a patient wants to go to another clinic or doctor, they’d have to go to the hospital to apply for medical records. Often the hospital would email the records which might take days.
Hence, they addressed this referral process and data transfer by enabling that authorization and sharing to happen using blockchain. The patient authorizes using a mobile application, so the transfer is almost instant. Currently, they’re working with 100 clinics for referrals.
Secondly, there are currently no patient portals in Taiwan. Each hospital stores data so it’s siloed. And even though the health data belongs to the patient, there’s no way for them to access it. So they wanted to create a clear and easy way for patients to access their own data.
The hospital is high-tech with many functions automated and mobile. For example, check-in is automated using a mobile phone, and patient charts are updated by doctors and nurses using a mobile.
How it works
The technology partner is DTCO. They’ve created a “personal health record Operating System” or phrOS based on Enterprise Ethereum.
DTCO Jacob Lee commented: “Blockchain technology empowers the patient with unparalleled data privacy and security. But the autonomous data structure of phrOS not only empowers patients alone but also adds value to the healthcare industry, by reducing administrative costs, patient assistance and enabling patient authorized data sharing for improving transparency and accelerate the progress of human life sciences.”
The medical records are encrypted, and it’s possible to store them in various ways. Either using IPFS, private cloud, or data silos.
Every medical visit updates the medical records. But there are two elements to the data. There’s the hospital or medical treatment in the Electronic Medical Record (EMR). This is combined with health data from wearable devices or remote health home care (EHR) to provide a complete personal health record (PHR).
To register, a patient goes to a hospital running phrOS and opens an account. The hospital provides the patient with a printed private encryption key that requires the patient’s password to unlock it. They also receive a hospital card that contains the public key, just like a patient’s account. If the patient loses the private key, they have to go back to the hospital.
The patient can access their health data and authorize the sharing of data with other parties such as clinics, insurers, or pharmaceutical laboratories.
Dr Ray Jade Chen, Superintendent at TMUH, recently gave a presentation about the system. (poor quality recording)
TMU hospital is also partnering with private insurer Fubon Financial. If a patient has a procedure, at the moment they often have to pay for it themselves. And they can wait 1-3 months to be reimbursed by an insurer. By sharing the data using blockchain, it’s possible to reduce the time delay substantially.
The hospital is also partnering with TRPMA for drug development. The technology provider DTCO is building a data marketplace for clinical research.
In an emailed response DTCO elaborated: “the data transfer is from patients to pharmaceuticals/ research centers on the blockchain, anonymously. So, only if the patients want they would share their healthcare data in exchange for some rewards, helping with accelerating the development of new drugs in a transparent and compliant manner for the benefit of humanity.”