Blockchain Technology for a Patient-Centred Clinical Pathway Feasibility Study

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"The NHS trails behind other industries in use of new and emerging technologies to transform business practice. It is agreed that digital technology holds the potential to transform the way patients engage with services and improve the efficiency and co-ordination of care and to assist people in managing their own health.The speed of adoption of digital technologies to transform care has been the focus of recent policy and discussion. The NHS England five year forward describes a digital vision to close gaps in care and quality, funding and efficiency and health and wellbeing. Lessons learned from NPfIT resulted in caution around centrally mandated solutions. The National Information Board PHC2020 describes practical steps in development of local digital roadmaps and the 2016 Wachter report calls for greater clinical leadership and interoperability as core goals of a digitised NHS.With a unique clinical-technical collaborative model we have developed and deployed integrated care pathways for specific populations that have been diffused nationally due to an approach of clinically driven solutions across networks, on a central platform that hosts the core clinical process without interfering with well-established local service delivery models. We believe this approach to digitised whole-care pathways across organisations supports social and clinical networks and provides opportunity for transformational change. This feasibility study will test whether a parallel system built using emerging blockchain technology, with a distributed ledger rather than centrally hosted information, could deliver greater cost efficiencies across the system, specifically around commissioning through capture of transactions at patient level and the ability to pull large volumes of data from populations for advanced analytics that are currently not available due to current practice of data warehousing within organisations. We plan to test the feasibility of blockchain technology by modelling patient flow and transactions on two systems in parallel; one using open source technology hosted on a shared central platform, and the same clinical process developed using blockchain, within a defined and well understood population. Cost-benefits can be analysed against current status, where patient level data is entered locally into a national database that informs commissioning through retrospective annual analysis of activity based on simple stratification of risk across the population linked to a tariff. Comparison will be modelled across two systems, one where real time data can be extracted from a web-based dynamic clinical process versus the potential for transactional analysis using distributed blockchain approach for the same clinical process.?"