Decentralized Network: How Does It Work?

In a previous blog, we discussed a new approach to interoperability that doesn’t require data to be requested, aggregated, and validated each time it’s used or shared. Unlike a traditional network design, a decentralized network enables healthcare permissioned stakeholders to access continuously refreshed, always current data in real time, allowing them to communicate, transact, and collaborate with any other network participant.

In this blog, we discuss how a decentralized network enables more effective collaboration, drives innovation, and improves the healthcare experience.

How does a decentralized network work?

An excellent example of how a decentralized network works is the real-time claim adjudication process. This workflow includes:

• A provider submits claims directly to a network payer from their home base instead of through their traditional clearinghouse pathway.
• The network’s real-time adjudication (RTA) solution automatically examines each claim’s details against the payer’s RTA criteria.
• If the claim is “clean” and deemed processable by the payer for RTA, the claim will be automatically directed to the payer’s designated RTA endpoint.
• If the claim is not processable by the payer for RTA, it will automatically be directed to the payer’s traditional clearinghouse endpoint.

The ability for stakeholders to transact directly with each other simplifies the business of healthcare, modernizing how it operates and ultimately, lowers the cost of administering healthcare.

How do data security and immutability work on a decentralized network?

On a decentralized network, participants always have control over who can access their data and how that data can be accessed. This is made possible through services that manage and unlock access to permissioned data based on the use case.

When participants join the network, they must register their clinical or administrative data associated with members, patients, and practitioners. Each is given a person ID, a unique network identifier. When the network detects other organizations who share data for the same person ID, data-sharing authorization policies are automatically evaluated to determine if access to data is permissible. Where authorization is approved, data is shared directly and securely between network participants. The network itself does not see or store the data that is shared between participants.

The authorized transactions between network participants are trackable, auditable, and immutable. This effectively lowers issues of distrust, friction, and data hoarding between payers and providers.

How does a decentralized network improve the patient experience?

The administration of healthcare—those revenue cycle processes like coverage verification, prior authorization, and collections—are highly complex and often involve inefficient, manual, error-prone workflows that can impede a patient’s ability to receive timely care or to know how much it will cost. A decentralized network provides an entirely new way to administer those processes by:

• Leveraging FHIR for standardizing data
• Allowing real-time, permissioned access to accurate data for all healthcare stakeholders
• Enabling processes that used to take days or weeks to be completed within seconds or minutes
• Eliminating time-consuming, manual, error-prone workflows
• Giving providers the information they need when and where they need it to provide high-quality patient care

Instead of continuing to add fixes on top of a broken system, healthcare needs to create a new, better system—a system built with a new kind of interoperability. Learn more here