Early in my career as CFO for a multi-billion dollar hospital system, I learned the term “highest and best use” from Mardian Blair, a remarkably astute CEO who applied that concept to the deployment of scarce resources in pursuit of greater value. I found later that he had appropriated this term from real estate valuation. Its full definition is the “reasonable, probable, and legal use of vacant land or an improved property, which is physically possible, appropriately supported, financially feasible, and that results in the highest value.”

Today, I am appropriating that phrase to describe the potential for blockchain to solve massive problems in healthcare and health information that, until now, have remained unsolved. I believe that the blockchain we are building to solve those problems is the “highest and best use” for blockchain in healthcare.

Underwhelming prognostications

Although much has been prognosticated about the seemingly mystical potential of blockchain to be transformative, until recently I maintained a healthy skepticism toward the use of blockchain in healthcare. I read many potential use cases for blockchain in healthcare that left me asking, “Is that it?” Those proposed solutions to well-worn problems in healthcare left me feeling underwhelmed.

Over time, I became more intrigued as we explored blockchain’s new solution space. We discovered concepts such as public permissionless usage, distributed autonomy, self-sovereignty, and immutability. Eventually, those concepts began resonating with my background and training in computer science.

My oldest son, a trained philosopher, helped me further unpack the rich meaning of the concepts. We began to see how these blockchain elements have vast potential to converge and provide solutions to important, unsolved healthcare problems. To fully envision this convergence, we had to “think different.”*

In fact, I have spent my entire career thinking differently about healthcare problems — particularly about health information problems. For more than thirty years, I’ve been a pioneer in and proponent of the notion that patients need to be at the center of the health information universe. This conviction propelled me to develop one of the earliest personal health records for drkoop.com and AOL.

That project’s failure, along with the failure of most subsequent personal health record initiatives, did not deter my conviction that putting the patient at the center of the health information universe will usher in a remarkable transformation in healthcare. I look forward to unpacking the possibilities in future posts.

Blockchain’s potential to transform healthcare

As we continued exploring the blockchain solution space, it became obvious that blockchain is ideally suited to putting the patient at the center of the health information universe. Consider three trends in healthcare today that, as they coalesce, have the potential to result in transformational change: patient engagement, health information silos, and blockchain.

Engaging patients in managing their own health is universally recognized as a chronic need. Massive investments in electronic health records over the past decade have only broadened the separation between silos storing patient health information. Such investments have failed to break down barriers and facilitate ready exchange of health information among siloed enterprises that store and control access to that information. In contrast, Blockchain employs the new solution space of public permissionless usage, distributed autonomy, self-sovereignty, and immutability to solve these previously insurmountable problems, empowering patients to manage their own health via access to and control over their own health information.

Putting patients at the center of the health information universe is foundational to unleashing new opportunities for engaging patients in the management of their health. Putting patients at the center of the healthcare information universe is the quickest and most effective way to break down barriers between silos currently housing patients health information. Blockchain is uniquely suited to put patients at the center of the health information universe.

A self-sovereign, immutable, universal health index is the blockchain formulation that puts patients at the center of the health information universe. It creates the foundation for a host of patient engagement applications. It opens up vast stores of health information currently housed in silos, making that information accessible and useful when and where it is most needed — without tearing down those silos.

Self-sovereign control of personal health information

A significant aspect of the current health information exchange problem is the glaring lack of access and control that patients have over their own personal health information. Whereas doctors, hospitals, and insurers have punctuated interest in patients and their health, only patients themselves have an enduring, lifelong interest in control of and ready access to their own health information.

Blockchain finally makes possible self-sovereign control by patients over their own health information — how it is used and accessed, and by whom. Through crowdsourcing, Kalibrate Blockchain is developing a decentralized Universal Patient Index to patient health information that will facilitate smooth, effective, patient-controlled exchange of health information across the electronic data silos that securely store this information.

Universal application and access

Not only will the Universal Patient Index give patients control over their personal health information, but it also will give them the ability to provide revocable access to that information to healthcare providers and insurers everywhere who need that health information for critical decision-making. With patients at the center of the health information universe, there will be no contracts to sign, no programs to code, and no implementations to perform by providers and insurers.

In reality, all health information is distributed, with parts and pieces existing in various places, and no centralized point of access. This limits and restricts effective healthcare decision-making. There is a very real need for a comprehensive point of access and control to ensure that healthcare providers are making truly informed decisions in the best interests of individual patients needing treatment and care. The Universal Patient Index puts patients in charge of granting access to their health information — a freedom and level of control that has been lacking to this point in healthcare.

Immutable index to personal healthcare record

Specifically, the Universal Patient Index provides an index to a patient’s medical records that are stored in various healthcare provider Master Patient Indexes (MPI’s). The index itself is an encrypted medical record log — an immutable blockchain index to where each patient’s private health information is being stored, who is currently storing it, what format it is stored in, and who has been given permission by the patient to use and hold that private health information.

Importantly, these index log entries do not themselves include any private health information. The actual private health information still resides at the third party doctor’s office, hospital, or other health record information sources and silos. Not even the corresponding patient identity, which is linked to indexed private health information, is stored on the index. Rather, patients are the sovereign holders of master keys that correlate their indexed private health information. Without a master key, private health information indexed on the Universal Patient Index is encrypted and undiscoverable.

Transformational development in health information access

Not only is this development transformational, but it is also profound in terms of health information storage, access, and exchange. Our developers serve functions similar to historical mapmakers who provided information to explorers in search of new sources of value. Information is the foundation for innovation in healthcare. The Universal Patient Index provides healthcare innovators with the information they need to innovate and provide top-notch treatment.

Rarely does a technology emerge that solves significant problems such as patient engagement and siloed health information as profoundly as blockchain does. Kalibrate Blockchain’s Universal Patient Index promises to mark an inflection point in healthcare, which is why I believe that it will prove to be the “highest and best use” for blockchain in healthcare. As a pioneer in regulatory compliance, Kalibrate Blockchain is also committed to meeting the highest standards required by the SEC with regard to ICO’s.

Ultimately, Kalibrate Blockchain is developing a transformative solution to the health information access and exchange problem. That solution is “physically possible, appropriately supported, financially feasible” and “results in the highest value” — assuredly, the highest and best use for blockchain in healthcare. That is big news.

*”Think different” was Apple, Inc’s 1997 advertising campaign, purportedly in response to IBM’s “Think” slogan.