Beyond telemedicine: The role of distributed technology in enabling health care without borders

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The inability to access appropriate care close to home has been a long-standing cause of health inequity in the United States and around the world, and the COVID-19 pandemic made the detrimental effects of this more apparent. A silver lining of the pandemic was the accelerated development and deployment of health technologies that enabled remote care delivery, allowing patients and providers to connect via a variety of telemedicine platforms and data tracking of vaccination status through electronic health records. Even as pandemic restrictions have eased, many patients prefer the convenience of meeting with their providers over Zoom instead of in the clinic. Similarly, several nonprofit and for-profit organizations are leveraging telemedicine to provide care in underserved regions worldwide. These are important advances, but they are not sufficient to solve entrenched global health system problems, especially when sharing health personnel and data across borders and jurisdictions. Innovative regulatory frameworks will be key to realizing the full adoption of a broad suite of potentially transformative health technologies.

Michael Dershem, MBA
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A key challenge in sharing health personnel resources more broadly and equitably is the lack of uniformity for provider credentialing, patient identification and data sharing among different countries and jurisdictions. This creates bureaucratic hurdles that prevent providers in one jurisdiction from providing care to patients in other jurisdictions, even when the technology for them to connect is readily available. Overcoming these hurdles requires new regulatory frameworks and mechanisms for cross-border data sharing that realize the full potential of telemedicine to overcome barriers to accessing care while protecting health data.

While this might appear straightforward in theory, in practice it requires the development and adoption of uniform standards across a health data landscape that is fractured, siloed and highly inefficient. Consequently, barrier-free data sharing is unlikely to occur for a long time. However, existing technologies are being deployed to streamline provider credentialing, patient identification and other aspects of care across borders.

Credentialing is essential for ensuring that providers have the requisite education, training, competency and licensing to deliver high-quality patient care in compliance with relevant regulations. Despite the importance of credentialing in protecting patient health, there is no singular credentialing paradigm. This means that a provider participating in multiple care or insurance networks needs to complete multiple credentialing applications, many of which require different information. Consequently, credentialing may take up to six months in a single jurisdiction. Moreover, most medical licenses are valid only within the jurisdiction in which they were issued, which is another significant barrier to cross-border care delivery. As a result, current credentialing processes contribute to the persistence of health inequities by limiting access to qualified care providers outside a patient’s jurisdiction, even in resource-constrained settings.

Distributed ledger technology (DLT), such as that used in blockchain, can be deployed to streamline cross-border credentialing. With this approach, health providers are given a digital identity stored on the blockchain that authenticates their qualifications and credentials, dynamically updated with permissible access for authorized users for the supported data. Rather than having to complete multiple credentialing processes, a provider would simply grant access to their credentialing data to each credentialing body. Obviating the need to complete numerous applications reduces the time, cost and risk of error associated with current credentialing processes. A provider in one jurisdiction could be rapidly credentialed in another simply by permitting the new organization to access the relative information. In this scenario, a patient needing specialist care unavailable in his or her community would have fewer barriers to receiving such care via telemedicine with a provider located anywhere in the world.

A DLT approach to personal health credentialing has already been deployed in Bermuda to address several fundamental problems in Bermuda’s health care sector. These include reducing the cost of care, enabling better allocation of resources within the medical commerce ecosystem, improving patient data interoperability, incorporating social determinants of health (SDOH) into patients’ medical records and enhancing cross-border care. The vertical integration of the distributed ledger system across care delivery, health data storage and sharing, and health care finance enables improved efficiency for patients, providers and payers. In addition to expanding the pool of available providers in Bermuda by eliminating credentialing barriers, this DLT system also supports secure messaging between patients and providers and enables blockchain-powered payments for medical care. Importantly, the system complies with global standards of decentralized identity and credentials, which should facilitate its adoption in other countries and regions working to overcome entrenched health inequities and inefficiencies. For example, a DLT approach to storing health data has also been deployed in India.

While there remains a long journey to a world in which moving health credentialing and data — much of which exists in readily shareable digital formats — will be as easy as transporting one’s physical possessions when moving from one location to another, DLT systems such as the one deployed in Bermuda are an important first step. Providers, payers and regulators must work together to go beyond telemedicine and enable truly borderless health care that protects and improves human health globally.

Michael “Dersh” Dershem, MBA, founder and CEO of Apierion, is a seasoned entrepreneur with over 20 years of experience in business development, capital sourcing and technology transfer. As a business development executive, he has assisted multiple ventures throughout their growth journeys and attracted millions of dollars of capital.