If You Build it Will They Come? Patients, Providers and Blockchains in Health Technology Assessment

It is an open question as to whether blockchains can become an integral part of health care management in the US. On the one hand, there are the advocates of blockchains who see them as empowering patients to capture property rights to their medical records in a secure, encrypted, and portable form. On the other hand, there are blockchain critics that see the opportunities offered in health care as little different from those offered in other industries, viewing a blockchain structure as one that may reduce administrative and transaction costs, with little thought given to the potential of blockchain platforms to support a range of health technology assessment activities. While previous commentaries have pointed to this potential, the obstacles offered by the absence of clearly defined property rights and the absence of a market for DNA profiles have not been explored. The case put forward here is that any expectation that a blockchain as a ‘one-stop-shop’ for the interrogation of personal health records alone is unlikely to succeed. Apart from property rights effectively blocking this business model the blockchain vendor should consider targeted value added activities. At best, only a subset of records has the possibility of being transferred, with ongoing concerns regarding their quality and scope. This does not mean that the blockchain software model should be rejected. Far from it. The blockchain as a health technology assessment platform has the potential to support added value activities which not only improve the process of care and reduce costs and improve efficiencies, but also provide an ideal framework for property rights assignment. This opens the door to incentives and the monetization of value added health data by patients and providers, capturing rents that are at the moment expropriated by third parties. Critical issues are not only property rights and creation of a market place, but the ability to link and incentivize patients and their providers to support active blockchains to generate value added.