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and potentially result in fewer prior authorization requests because health care providers will have the coverage information they need when making treatment decisions. Technology adoption by all involved stakeholders, including health care providers, health plans, and their trading partners/vendors, is key to achieving widespread industry utilization of standard electronic prior authorization processes.
We agree to:
■ Encourage health care providers, health systems, health plans, and pharmacy existing national standard transactions for electronic prior authorization (i.e., National Council for Prescription Drug Programs [NCPDP] ePA transactions and X12 278)
■ Advocate for adoption of national standards for the electronic exchange of clinical documents (i.e., electronic attachment standards) to reduce administrative burdens associated with prior authorization
■ Advocate that health care provider and health plan trading partners, such as intermediaries, clearinghouses, and EHR and practice management system vendors, develop and deploy software and processes that facilitate prior authorization automation using standard electronic transactions
■ Encourage the communication of up-to-date prior authorization and step therapy requirements, coverage criteria and restrictions, drug tiers, relative costs, and covered alternatives (1) to EHR, pharmacy system, and other vendors
to promote the accessibility of this information to health care providers at the point-of-care via integration into ordering and dispensing technology interfaces;
and (2) via websites easily accessible to contracted health care providers
The above consensus statement from the AMA, American Hospital Association, Blue Cross Blue Shield, America’s Health Insurance Plans, and the Medical Group Management Association
has lofty goals. Transparency of the preauthorization process in Delaware can be brokered using blockchain technology on the DHIN. Electronic submissions
of preauthorization requests and necessary clinical documents could also be brokered on the DHIN to facilitate monitoring of timely turnaround by the insurers. Getting the clinical information to the DHIN could be done directly through an EMR as a PDF document
(if the EMR has that capability). Alternatively, a third-party health IT as a PDF document, at your request.
Preauthorization is just one use of the blockchain in medicine. A larger and the blockchain to house the health data of Delawareans from diverse medical records from every EMR. In 20 years, we would have a database on all Delawareans that could revolutionize population health science.
A similar but less ambitious idea would be to integrate the diverse medical records at a single hospital. Typically there are separate EMRs for the cancer center, outpatients, inpatients, and
the emergency department. There are patient safety concerns. A pulmonologist decides to do a bronchoscopy on a patient. The oncologist orders a CT- guided lung biopsy. Neither doctor is aware of the other’s action because they are on separate EMRs. A cardiologist days before the lung biopsy is ordered
by the oncologist. Neither doctor is aware of the other’s action because they are on separate EMRs. These are true
stories. Fortunately, neither patient was harmed. The only EMR that is global is EPIC. I believe that their slogan is, “one patient, one chart.” EPIC costs so much that typically only hospitals the size
of the Mayo Clinic, Geisinger, and the Cleveland Clinic can afford it. EPIC is not a panacea. It is hard for one software company to do everything well. The blockchain would allow physicians to keep the programs they like and display the data so that it can be shared.
An additional use of the blockchain technology would be for credentialing. If the credentialing data and the DHIN, it could reduce the time it takes to get doctors credentialed. This would ease a paperwork burden that wastes doctors’ time.
The uses of the blockchain in health care are multiple, varied, and limited only by our imagination.
CONTRIBUTING AUTHOR
■ ANDREW DAHLKE, MD is a Neuroradiologist working in Lewes, Delaware and currently serves as President-Elect of the Medical Society of Delaware.
REFERENCES
1. Wattenhoffer, R. The Science of the Blockchain, Inverted Forest Publishing, First Edition 2016.
2. American Medical Association. 2017 AMA Prior Authorization Physician Survey. www. ama-assn.org/sites/default/files/media- browser/public/arc/prior-auth-2017.pdf.
3. Consensus Statement on Improving the Prior Authorization Process. https://www. ama-assn.org/sites/default/.../prior- authorization-consensus-statement.pdf.
4. American Medical Association. Addressing Prior Authorization Issues. https://www.ama- assn.org/practice-management/addressing- prior-authorization-issues.
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