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Blockchain: One Way to Accelerate Interoperability

Healthcare providers face two opposing constraints. They need to be able to share information about a person quickly, so they can provide the best treatment and avoid
errors. At the same time, they have to protect the person’s confidentiality and keep the information secure. Achieving both is a balance of find form and function in design. In my previous post on Blockchain technology I shared thoughts on the potential and possibilities. Here is my perspective on a path and some specific thoughts on how blockchain can be used to make healthcare safer, more accessible and secure.

A blockchain is  a set of records with many copies. Cryptographic signing guarantees the information’s integrity and authenticates each contributor’s identity. Cross-checking the copies prevents anyone from adding invalid data or deleting records. Only properly signed records get accepted into the system. Anyone trying to add a record needs to have the secret key. Anyone trying to remove records will create a copy of the blockchain that won’t match everyone else’s.

The best known blockchain application is Bitcoin, an online system of money and payments. People who don’t know each other can make payments without an intermediary like a financial institution. It’s only one of many ways blockchains can be used, though.

Health Records in Blockchain

Let’s consider a use case in healthcare. A provider would like to have access to as much information as possible about a patient’s medical and social history. The patient may have a relationship with multiple providers in multiple places across multiple states. A system for securely gathering all this information together needs to have these properties:

  • The information needs to be available only to authorized parties and safe from nefarious activity or unauthorized views.
  • Any authorized party should be able to add information.
  • All entries should be authenticated by their source, so forgery is impossible.
  • Unauthorized parties should NOT be able to alter or delete information.

Blockchain technology can provide all of these, but it requires a different approach from the commerce industry. For example, Bitcoin stores all of the information in the blockchain, but the information is purely abstract. It moves a quantity of bitcoins from one account to another. Everything on the blockchain is public, so it isn’t suitable for storing confidential information. Besides, storing everyone’s medical histories in a single document would present serious scaling problems.

Blockchain for Authorization

An approach which minimizes these problems is to use the blockchain only as a means of authorization, with the patient information securely stored elsewhere. The article “Blockchain For Health Data and Its Potential Use in Health IT and Health Care Related Research,” by Laure A. Linn and Martha B. Koo, describes how this could work.

For this purpose, the blockchain would be an index, not a database. Patients would be in control by designating who has permission to read and write information about them. Providers would be able to add data from a variety of sources, using open-source software and public APIs. Patients could set access permissions at a granular level. A patient receiving treatment for drug addiction, for example, might not want that information available to all healthcare providers.

Another use involves patients wearing devices to automatically update their records on a regular basis or when they have unusual readings.

Issues to Resolve

Preventing unauthorized access is vital, but the user is often the weakest link in online security. People aren’t good at remembering passwords that are hard to guess. Biometric authentication, such as an iris scan, could provide a better level of security for patients.

Some classes of users should have more access to data than others. A patient’s own caregiver should generally have unrestricted access, but a pharmacy needs only a limited set of data. Rules establishing access for user classes can be programmed into the system.

The data on the blockchain needs to be truly anonymous to the unauthorized viewer. Even if nothing is public but the patient’s identity, the timing of new entries in a person’s record could be a source of exploitable information. Patients should be identified only by keys that have no outside meaning. Even then, if a key’s association with a patient is discovered, it could be difficult to revoke or change. This concern needs further study. (On the other hand, Social Security numbers, which are overused and easy to discover, already pose a similar problem.)

For this approach to work, it has to be widely adopted. Competing implementations would fragment the available information. However, if everyone subscribes to the same blockchain implementation, it offers an inviting target to anyone looking to steal information. There have already been data breaches of traditional EHRs leaking information on millions of patients; defects in a universal system could allow the bulk theft of even larger numbers of records. The security level has to be extremely high.

It’s likely that rather than having one gigantic database for everyone, there will be competing databases used by different providers. A patient’s records might be scattered over several different databases. For the system to work well, they would need a high level of interoperability.

Any blockchain carries the risk that one party might take control of enough copies to outvote everyone else and falsify the data. A weighted voting system, with known trusted participants carrying extra weight when verifying copies, could help to prevent this.

The paper “Decentralizing Privacy: Using Blockchain to Protect Personal Data,” by Guy Zyskind, Oz Nathan and Alex Pentland, discusses the blockchain for authentication at a more technical level than Linn and Koo. It’s worth study by anyone working on an implementation.

Issues for the Future

The HIPAA security and privacy rules place strong requirements on handling of protected health information (PHI). The rules allow some flexibility in implementation, but the Office of Civil Rights, which administers HIPAA compliance, will need to make a judgment on whether a blockchain approach complies before healthcare providers are confident about it. Government agencies are already looking into the possibilities and challenges.

Blockchain technology for healthcare is in the early stages of exploration. We won’t see any full-scale deployment for years, but prototypes and limited implementations may be available before long. The approach could streamline the sharing of healthcare information, allowing fewer mistakes and better treatment for everyone.

Those are my updates to my previous post on Blockchain. I’m asked frequently if I see a path forward, and while I do, it will take a catalyst to rally a collabortive effort towards this approach. Seeing more cooperation by organizations such as Careqaulity and CommonWell Health Alliance work together can potentially be a catalyst to influence some type of standard to accelerate us toward a future which must happen if person-centric care is to be realized.

Netsmart Celebrates Grace Murray Hopper – Grand Lady of Software

At Netsmart we like to make sure we keep the foundation of our industry fresh in our minds each and every day. What better way to keep our eyes on the future by seeing what has been established for us in the past?grace_hopper

As part of our effort to celebrate great innovators in health and computer sciences, we took the opportunity to name meeting rooms at our Kansas City headquarters after various industry visionaries. Included in this prestigious group is the one and only Navy Rear Admiral Grace Murray Hopper (1906-1992), a remarkable pioneer who not only contributed to the foundation of computing but also helped pave the way for women in technology. Let’s find out what earned her the nickname, “Amazing Grace.”

From a young girl who enjoyed taking apart clocks to a distinguished Yale alum to a Navy Rear Admiral, Hopper was destined to leave her mark in technology. She dedicated herself to public service and engineering, both male-dominated fields. She was fiercely dedicated to her work and her accomplishments proved she was more than capable for the job.

She was one of the first to foreshadow the impact computers would make in everyday life – certainly ahead of her time. Hopper was one of the first programmers of the Harvard Mark I computer and also helped develop the Mark II and III computers. She was also responsible for the first computer language compiler and the precursor to the COBOL programming language. If you’ve ever heard of the term “bug” in technology, you can thank Grace Murray Hopper and the single moth that caused her hardware trouble.

A brief description of Hopper’s accomplishments hangs on the wall of the room bearing her name. Perhaps she can inspire or create the spark needed to fuel creativity and ingenuity for the next industry pioneer? Who knows, maybe our next room could be named after one of our associates!

Ultimately, Navy Rear Admiral Grace Murray Hopper truly lived up to her nickname and was simply amazing. If it weren’t for the the invaluable contributions of individuals like her and all of our Netsmart associates, we wouldn’t be where we are today.

Stay tuned for more healthcare and IT pioneers that are featured across our campus.

Netsmart and HIMSS17: What to Expect

The HIMSS17 Conference and Exhibition is just around the corner! From February 19-23, join Netsmart and thousands of health and IT professionals from across the globe to learn about and advance the future of healthcare technology. We will be showcasing how Netsmart can help you take the right steps to integrate care across all healthcare communities. We’ll show you how we’re already connecting behavioral health and post-acute care to the rest of healthcare and the impact it has had to patient care.

Where to find Netsmart:

Find us at booth #967 where we will be revealing how we take steps to integrate care across communities with our electronic healthcare record (EHR) systems. We will have demonstrations available for you to see how we’re connecting behavioral health and post-acute care, including long-term care, home health and hospice to the rest of healthcare.

Don’t miss your chance to talk with industry experts about your organizations biggest interoperability challenges and learn how we can help you get connected to the rest of the healthcare ecosystem. Click here to schedule a demo at our booth.

Stop by our booth not only to rest your feet, charge your mobile devices, and learn more about Netsmart, but you can also enter to win a Fitbit Alta!

Breakout showcases and sessions:

Netsmart will be featured in the Interoperability Showcase which follows a fictional patient through the care continuum across various communities. You’ll see how HIT companies are working together to ensure information flows seamlessly across all care settings to ensure the best outcome for the patient You won’t want to miss it! #EmpowerHIT

Exhibit and Interoperability Showcase Hours at Exhibit Hall (Booth #967) and Interoperability Showcase (Booth #9000):

  • Monday 2/20 10:00 am – 6:00 pm
  • Tuesday 2/21 9:30 am – 6:00 pm
  • Wednesday 2/22 9:30 am – 4:00 pm

Our partners at InterSystems are hosting a presentation about unstructured data with Netsmart’s Senior Vice-President of Innovations, Matthew Arnheiter and Mental Health Center of Denver’s Vice President and Chief Information Officer Wes Williams, Ph.D. from 1:00 pm – 3:00 pm on Monday, 2/20 at the InterSystem booth #1561.

Connect and share:

We want to hear from you! Throughout the week, tag us in your favorite HIMSS17 moments with us on Twitter (@NetsmartTech) or Facebook (/Netsmart). Make sure to include #HIMSS17 and #NTST in your posts!

More than just an EHR, Netsmart is committed to connecting all aspects of healthcare with a central focus of serving the whole person. We’re honored to be a leader in the industry and we are excited to show you what lies ahead for health technology! See you soon!

Who is Netsmart?
Netsmart is the largest technology provider connecting behavioral health and post-acute care with all of healthcare. Netsmart is passionate about integrating care across all aspects of a community. As a leader in healthcare, we know that healthcare doesn’t always happen in a traditional clinical setting so we’re committed to working alongside our clients to innovate the most effective and intuitive technology possible.

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Will You Be My Volunteer?

Valentine’s Day is much more than chocolate, flowers and giant, stuffed teddy bears. It’s a day where we can share our love with not only loved ones, but also with those in our community. If you’re looking to make your Valentine’s Day (or any day) extra special this year, here are four ways to spread the love:

  1. Spend time with loved ones: Instead of paying for an expensive meal, invite those who might not have a place to spend Valentine’s Day over for a home-cooked meal. Sharing your home with others is a special way to show love and kindness.
  2. Treat others: Do something that brings an extra-special feeling to someone’s day. Spend the evening delivering home cooked meals or desserts to those in need with a local food organization.
  3. Get crafty: Take time to create special homemade valentines for senior living centers or hospices around your home. Be sure to include the caregivers!
  4. Donate items (and your time): Spend time collecting items like food, clothes, and household goods to donate to shelters in need. Find local organizations who need volunteers all year or create a fundraiser for an organization you hold close to you heart.

Spreading love shouldn’t happen just one day out of the year. There are many programs and organizations across the country that could use your help in many ways every single day. Want to help or not sure where to start? A simple web search of volunteering in your area is a great way to find the right opportunity for you. All it takes is a little bit of time to truly spread the love!

Happy Valentine’s Day!

Q1 syncWEEK Recap

Every quarter Netsmart hosts a syncWEEK to gather leadership from across the company to discuss Netsmart’s state of the state and plan for the future. The first syncWEEK of 2017 wrapped up last week and we were so excited to review where we’ve come from and where we’re going through different educational sessions and networking opportunities. Netsmart is committed to continually improving the way we work and deliver the best solutions to our clients, and syncWEEKs are a great forum to brainstorm with each other, share best practices and recognize our associates’ accomplishments. Here is some of the feedback our associates shared with us.
Hear from our Netsmart associates who attended:  

“Being empowered to share our passion for behavioral health in conjunction with technology is a characteristic that is unique to Netsmart, and we execute that passion, naturally.” – Michael Hulgan Jr., Solutions Consultant 


“syncWEEK is always a great time of connecting and recharging.  I loved the format that included the product training sessions with client guest speakers as well as the Leadership Innovations session with Leta.  Many thanks to everyone who contributed to make it such a success.” – Corrie Barron, Solutions Team Lead

“syncWEEK could be renamed ‘Information Input Week.’ I love meeting all of my new teammates.  The pieces are coming together and I am excited for our clients and for my future with Netsmart!” – Maureen Wainwright, Client Alignment Executive, Sales – Homecare

“The energy was palpable! Confirming the importance of all team members by exploring Netsmart’s financial and product growth. I especially enjoyed the hands-on presentations for team members to feel new features and the importance to the users. Hearing the passion of the agencies reminded us that our work has heart and higher causes touching many. The week helped me as a new associate in the journey towards my success.” – Nancy Fella, Product Strategist – Engineering Research & Development

“Four days well spent! Monday overviews really helped to set the tone and let us know where we were at and what needed to be the focus moving forward. The communication workshop was wonderful and I feel better equipped to have different kinds of conversations. I am very grateful for a company that invests its time and resources in their people.”  Jenny Houston Sayler, Solutions Marketing Specialist, Marketing – Homecare


“It was so good to meet our new associates from our recent HealthMedX acquisition. I had the opportunity to learn more about the post-acute market this week. Although there are differences, the more we talked, it was evident that our goals and challenges were very similar.” – Tracey Roxby, Client Alignment Strategist

Thank you for taking time to join us during this syncWEEK! We’re looking forward to a great year of success in 2017 and it’s the hard work and dedication of all our associates that makes it happen!

Invitation to Integrating Care: Moving Beyond Interoperability to True Collaboration

Netsmart’s VP and GM AJ Peterson invites you to dive in to his recent blog series entitled, “Integrating Care: Moving Beyond Interoperability to True Collaboration.” Focusing on the importance on the care coordination for patients with coinciding mental and physical health conditions, AJ elaborates on the adoption of technology in integrated health and how interoperability is essential to executing successful care plans.

Read the entire series here:

Part I

Part II

Part III

Part IV

Integrating Care: Moving Beyond Interoperability to True Collaboration, Part IV


We’re nearing our destination! In this blog series over the past several weeks we’ve identified the importance of integration and collaboration as expressed through the impacts of severe mental illness (SMI). We’ve seen the practical use of applications like referral process automation. We’ve examined how standards-based transaction and data elements can provide visibility across systems into a patient’s well-being. In short, we have facilitated communication and the collection of massive amounts of powerful information about individuals and entire populations. So, what’s still lacking? Two words – expansion and context.

Let me explain.

The thing we need to expand is our very definition of integration. We can define integration by the ability to share information between organizations and across entire systems but that doesn’t ensure that the information is consumed or even that the data is helpful. A more helpful definition of integration consists of not only of having the ability to share information, it requires that the data is received and disseminated within clinical workflows that have been optimized to make the delivery of holistic care seamless.

Likewise, the data that’s being shared within a given clinician’s daily workflow has to have context. It’s not enough to know that a patient is experiencing co-morbid conditions. We must take a broader view. We have to ask, what social determinants of health are causing or at least impacting the co-morbid conditions the patient is living with? Social determinants can range from housing to family support. It’s only when we feed the physical, mental and social data into an easily consumable clinical workflow that we begin to fully realize the benefits of integration and true collaboration.

A given patient may interact with a vast range of services including education, justice, social service and more. Care providers and modalities must be assembled in the following forms: patient-centered team care, population-based care, measurement-based care, evidence-based care and accountable care.

Moving beyond interoperability to true collaboration is an audacious goal but the reasons to pursue this goal are compelling, the applications are numerous, and the technology and systems are available. If we collectively work to define integration is its fullest terms and to contextualize the data produced, we will have created a holistic care delivery system that produces far more positive outcomes and reduced costs.