Teleradiology platforms: the business case for blockchain

Teleradiology is ripe for blockchain. Healthcare image diagnosis is based on trust; It could be based on truth. Let’s explore how.

Teleradiology or remote radiology service is the future of radiology. Information technology has been the genesis of radiology and nuclear medicine. Night-hawk services have changed the future of work for radiology. All but vascular and interventional radiology is protected from outsourcing. As radiology outsourcing moves to low-wage countries revisiting the fee-per-report reimbursement scheme is in order. How can the in-house radiologist compete? Blockchain technology can assist with improving the truth of CT, MRI, and conventional radiographs.

Blockchain technology can assist with improving the truth of CT, MRI, and conventional radiographs. Blockchain technology gives radiologists and their patients’ truth.

Why are use cases so scarce?

Are you trying to apply blockchain to healthcare? Having trouble finding concrete use cases? There’s a simple reason for that.

Are you protecting trade secrets or using innovation as a strategic advantage? Non-Disclosure Agreements are why you’re unable to find specific use cases for a named company.

Ever had a great idea, only to realize that someone else created the product, service or designed the interaction first? I think we all have experienced this at one time or another. Something almost comical happens the more you’re engaged in a field. You’re unable to talk about the best ideas. Verbal agreements lead to confidentiality agreements which eventually result in non-disclosure agreements.

At some point, you grow your understanding of a topic from information to knowledge to strategy. It’s at the strategy level where it gets dangerous. Why? You have the knowledge and the ability to execute. Few leaders will reach out to an expert they don’t think can deliver or whose ideas can’t be realized. Frequently, leaders, championing innovation efforts are frustrated with the lack of specific or contextual examples with innovation. Recently this frustration is the difficulty in finding use cases applying blockchain in healthcare. It’s not all grim; there is an up-side. Here are two examples.

  1. A builder is building a new custom house; however, they are not able to talk about the design. If you were considering the development of a custom garage for your boat or plane, the goods news is their knowledge will transfer.
  2. A doctor designed a patient care program for a specific patient, and they are unable to discuss it the name or specific situation of the patient. However, that knowledge and the theme will be useful if you’re designing a new patient experience.

Almost all knowledge is transferable. Don’t get hung up on the specifics – partner with a leader that is trustable and has a track record. If they are engaged at the edge creating strategies for sustainable competitive advantage, board members will be quick to ensure their IP is protected. The organization won’t want those competitive ideas discussed outside a small circle of individuals. That same profession courtesy will be extended when exploring new models for profitability with your organization.

Teleradiology for clinical applications

Radiology is the science of high-energy radiation for the diagnosis and treatment of disease. Teleradiology extends this definition into the transmission of radiological patient images, for example, x-rays, CT scans, and MRIs.

Diagnostic imaging modalities, the way a disease or illness is diagnosed by a doctor vary based on clinical need. I’ll briefly explain the seven of the major types of modalities used today.

  1. Projection (plain) radiography (X-ray): is produced by transmitting x-rays through a patient. Film has been replaced by computed radiography (CR) and more recently by digital radiography (DR). Examples of plain radiographs include various types of arthritis and pneumonia, bone tumors (especially benign bone tumors), fractures, and congenital skeletal anomalies.
  2. Fluoroscopy and angiography: generated with a fluorescent screen, an image intensifier tube is connected to a closed-circuit television system. This type of special X-ray image is used to help identify abnormalities such as tumors, cysts, and inflammations.
  3. Computed tomography (CT scan): CT scans use X-rays combined with computing algorithms to create an image of the body. Often used for urgent or emergent conditions including cerebral hemorrhage, pulmonary embolism (clots in the arteries of the lungs), aortic dissection (tearing of the aortic wall), and obstructing kidney stones.
  4. Ultrasound (echo): is used to visualize soft tissues structures in the body. Medical ultrasonography uses ultrasound in real-time. This imaging technology is useful when observing changes over time. For example, heart valves and major vessels or monitoring changes in carotid arteries that may be a warning sign of an impending stroke.
  5. Magnetic resonance imaging (MRI): use powerful magnetic fields. Align atomic nuclei with body tissues. Among all the imaging modalities, MRI scans give the best soft tissue contrast. MRIs help doctors to determine if tissues are health. They can be issued to identify brain tumors, traumatic brain injury, developmental anomalies, multiple sclerosis, stroke, dementia, infection, and the causes headaches.
  6. Nuclear medicine: uses radiopharmaceuticals administered into a patient. Positron emission tomography (PET) scans or single-photon emission computed tomography (SPECT) can be used to improve diagnostic accuracy. Nuclear medicine imaging is used to evaluate specific conditions relating to the heart, lungs, thyroid, liver, brain, gallbladder, and bones.
  7. Interventional radiology (IR or VIR): vascular and interventional radiology are minimally invasive to the patient. Whether for diagnosis (angiography, looking at blood vessels and organs) or treatment (angioplasty, to widen obstructed arteries or veins) IR is used to identify the disease. Several uses for IR exist including the diagnosis or treatment of vascular disease, renal artery stenosis, and gastrostomy tube placements.

Teleradiology’s business case

Teleradiology is the transmission of radiographic images from one location to another for sharing studies with other radiologists and physicians. The benefits of teleradiology mirror the benefits of telehealth. A doctor who needs the results of a scan can transmit that image to the west coast or overseas to ensure a timely reading.

The primary benefit of blockchain technologies, when applied to teleradiology, is truth, not trust by offering an integrity check on patient images. Yesterday, a physician had to trust the image was accurate and unaltered diagnosis – but they had no proof. Today, a physician has truth – immutable evidence that the image they are reading is unchanged.

Does this add value? You tell me. Let’s assume you’re a patient. When your doctor made a diagnosis on your image would it matter, to know with near 100 percent certainty, that the image was unaltered? It would matter to me. Let’s assume you can choose two providers to read your image. The first provider ensures the image is unaltered and the second claims to have high security, but they off no such guarantees. Which provider would you go to? This is the business care for teleradiology – a business case for truth over the trust.

As a recent study found that one out of twenty or 12 million U.S. adults annually are misdiagnosed. Most patients won’t gamble on their health when the circumstances are serious enough to warrant a scan.

Immutable patient images

We can expand the business case of teleradiology into image transmission. Using blockchain technology, patient image immutability ensures that a provider can validate that the image diagnosis is unchanged. Providers can validate that the latest copy or the “right” image version was received.

This proof can be incorporated into the image display view for clinicians. For example, an image would have three statuses:

  1. Confirmed: A green check mark would appear if the image were validated and unaltered
  2. Untrusted: A red “X” indicates the image had been manipulated, and
  3. Unknown: A gray question mark could be used if there was a connection problem).

If the clinician was so inclined, they could select “image validation” and view the patient image transaction ID, hash, date received, date stored, and the date transmitted as proof the image was unchanged.

Blockchain technology can create proof of the receipt and transmission of Digital Imaging and Communications in Medicine (DICOM) data. DICOM is a standard for handling, storing, printing, and transmitting information in medical imaging.

A few myths debunked

Are patient records stored on the blockchain? No, the blockchain provides a check of the patient image (a hash similar to a checksum function) to ensure the record hasn’t been tampered with. The patient image and data do not live in the blockchain.

Is the blockchain able to handle these large record sizes? A common misconception is that these patient images will be transferred to a blockchain. This isn’t how it works. The patient image would be transferred to your existing image repository, only the check or hash will reside on the blockchain, not the image.

Do blockchain projects in healthcare require significant changes to core technology? No. The imaging workflow is not changed. To implement, simply add a new workflow that records the data source in a digital ledger. A basic check can then be used to validate the data source is unchanged.

Doesn’t blockchain data need to be encrypted? Nope. Remember the patient image is not stored on a blockchain, only the hash. Unless you hold the private and private key, you’re unable to make use of the data. You’d use the same standard security protocols for transferring data.

Is additional infrastructure required to bolt on blockchain for encryption? The short answer is no. Often healthcare leaders who start to research blockchain incorrectly feel data needs to be encrypted. The data that is being transmitted to the blockchain isn’t subject to HIPAA; it’s not protected health information. Remember, no part of the image is being transmitted to the blockchain.

MIT does have an active project exploring a peer-to-peer network that allows users to share their data with cryptographic privacy guarantees. This would be useful when the patient learns their relative position in the group but learns nothing about other members “diagnosis.” However, this community-based approach for data analytics is less applicable in our teleradiology example.

The path to implementation

Are you thinking about applying blockchain technology for teleradiology? There are many methods to exploit the benefits of blockchain technologies. Blockchain’s characteristics of distributed, public, time-stamped, and persistent establish proof; giving providers immutable proof that sensitive data has not been altered. When it comes to your health, would you rather have trust or truth that your patient images haven’t been changed?

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Peter is a technology executive with 19 years of experience, dedicated to driving innovation, digital transformation, leadership, and data in business. He helps organizations connect strategy to execution to maximize company performance. He has been recognized for Digital Innovation by CIO 100, MIT Sloan, Computerworld, and the Project Management Institute. As Managing Director at OROCA Innovations, Peter leads the CXO advisory services practice, driving digital strategies. Peter was honored as an MIT Sloan CIO Leadership Award Finalist in 2015 and is a regular contributor to CIO.com on innovation. Peter has led businesses through complex changes, including the adoption of data-first approaches for portfolio management, lean six sigma for operational excellence, departmental transformations, process improvements, maximizing team performance, designing new IT operating models, digitizing platforms, leading large-scale mission-critical technology deployments, product management, agile methodologies, and building high-performance teams. As Chief Information Officer, Peter was responsible for Connecticut’s Health Insurance Exchange’s (HIX) industry-leading digital platform transforming consumerism and retail oriented services for the health insurance industry. Peter championed the Connecticut marketplace digital implementation with a transformational cloud-based SaaS platform and mobile application recognized as a 2014 PMI Project of the Year Award finalist, CIO 100, and awards for best digital services, API, and platform. He also received a lifetime achievement award for leadership and digital transformation, honored as a 2016 Computerworld Premier 100 IT Leader. Peter is the author of Learning Intelligence: Expand Thinking. Absorb Alternative. Unlock Possibilities (2017), which Marshall Goldsmith, author of the New York Times No. 1 bestseller Triggers, calls "a must-read for any leader wanting to compete in the innovation-powered landscape of today." Peter also authored The Power of Blockchain for Healthcare: How Blockchain Will Ignite The Future of Healthcare (2017), the first book to explore the vast opportunities for blockchain to transform the patient experience. Peter has a B.S. in C.I.S from Bentley University and an MBA from Quinnipiac University, where he graduated Summa Cum Laude. He earned his PMP® in 2001 and is a certified Six Sigma Master Black Belt, Masters in Business Relationship Management (MBRM) and Certified Scrum Master. As a Commercial Rated Aviation Pilot and Master Scuba Diver, Peter understands first hand, how to anticipate change and lead boldly.