Can Occupational Therapy and Healthcare Be Decentralized?

Many occupational therapy practitioners as well as clients and patients have their frustrations with the healthcare system in America.

“It’s too expensive.”

“It does not cover anything/everything.”

“It has poor services for mental health.”

“It is overly privatized.”

And so on.

Many hope for it to be like other countries and universal.” Is this the answer? Or is a system that is more decentralized better?

One thing is for sure – there is a lot of money moving through the healthcare system. Money goes into insurance premiums, HSA/FSAs, educational programs for various professions, e.g., OT programs, equipment, and supplies (think PPE during the pandemic), and for the labor force from the start of care to discharge. Then there are the things that go on behind the scenes that involve a lot of money that we all take for granted: billing, EMR systems, software, databases, servers, data collection, research and researchers, and so on.

The hospital I work for recently switched from an outdated EMR system to a nerfed version of EPIC. It was a disaster. Employees hate using it. Productivity has actually slowed down. Errors are made. People are frustrated. But is it an issue of the adoption of newer technology (upgrading) and having to learn new software? Or is the software just not good enough and tailored to our productivity?

We are living through dramatic innovations and changes brought about by the invention of Bitcoin by Satoshi and its whitepaper publication in 2008. I am still impressed by how anyone can easily send money with crypto overseas without having to ask for permission, worry about delays, or high service fees (depending on the crypto you use of course) like they do through traditional financial systems.

Imagine having to send a lot of money to family in another country the ‘traditional way’. How would you go about doing it? You may be thinking, that’s fine, I can use Paypal or Venmo. But now think about sending a lot of money. Would you be worried about it now?How much will the fees be? Will it get denied due to the high dollar amount? How will currency exchange work out? How long will it take Will it even get there? That is one problem with centralized services in finance.

Crypto solves all of these problems and more. And the same can be said with healthcare.

With Web 3.0, and the pandemic putting a halt to things being open, supply chain issues, and a strain on our healthcare system, I wonder if technologies such as the Blockchain, Smart Contracts, and NFTs have a place in healthcare.

While this may seem very abstract and far out, I think it is only a matter of time before healthcare adopts this technology or co-exists with it.

Our healthcare seems to be stuck in an old system and way of operating that is not working. We have to wait for a referral that seems to take forever. Insurance is this big black box that no one really understands. Why are we paying this or that when it probably does not even cost that much in reality? How can we cut down on costs and improve services in accordance with the triple/quadruple aim and meet future healthcare metrics? Clearly, things don’t seem to be working as we are facing inflation, poor health with Americans becoming obese and overweight, etc.

Occupational therapy is no stranger to assistive technology.

I believe we (as a profession) have to think bigger and be open-thinkers for ways to use crypto/blockchain/Web 3.0/Meta and leverage its power to not only improve the way occupational therapists work, but to improve patient outcomes, bring health and wellness to our communities, and set an example and high bar to reinvent what occupational therapy set out to do in the beginning.

Again and again we as consumers face the consequences and fallout from an old system that does not work well. Healthcare records are hacked and our private information is leaked. We have to ask for medical records or billing for something simple like our visits to submit to our HSA. Medications are expensive. To do something as simple as scheduling or canceling an appointment requires a lot of time on the phone with someone. It’s a pain in the behind, a waste of time, and should be automated.

Imagine a system that more efficiently (and accurately) approves referrals with AI, the Web, and less of a middleman as a bottleneck. After all, with research and enough data points, shouldn’t there be a pattern to having me referred for a routine ultrasound or for a woman to have a routine breast exam for cancer? Why should we have to wait 1+ business days for this to go through? And have to follow up ourselves or have someone call us when it can be automated somehow securely?

Why can’t our medical bills be more transparent, understandable, and most of all – have different payment options instead of one lump sum bill? I don’t know about you, but I don’t have thousands of dollars that is liquid waiting around to pay an unexpected hospital bill. And that’s the other problem with “old money”. Unless you have it in cash, it is not really liquid. It takes time, verification, and is often only operating during business hours. We have the Internet now. Thankfully bank transfers can now occur ‘instantly’, but inter-bank/external bank transfers require the dreaded couple cent verifications.

Yes many would argue that crypto is volatile, but there are solutions to this. For example, you can ensure the value of your money by storing it in stablecoins like USDT or USDC. If you are hoping to take a riskier position, you can trade it for more speculative coins such as DOGE or SHIBA (not financial advice). Wouldn’t it be cool if there was a coin or solution for paying hospital bills or insurance? The debit card is one interesting application of this idea that I think many of you should pay attention to.

What if money can be staked or earn interest to make your money go farther? How about a credit score that exists in the crypto world outside of the traditional credit bureaus? What if you can pay your doctor or therapist directly (and cut down on costs)? The same could apply for supplies and equipment such as DME. Wouldn’t it be cool if there was a virtual exchange for DME (like Facebook Marketplace, without the Facebook Marketplace) to buy and sell it so that it does not end up in the landfill? Wouldn’t it be neat to pay for your occupational therapy program or your ongoing licensing with crypto?

How about rewarding research and publications with crypto? The journal article system is very expensive, outdated (it’s literally PDF downloads), and not effective for innovation and information sharing. As we have seen with COVID-19 and information sharing online such as via Twitter, it can exponentially help us to develop a vaccine. If we were relying on traditional journal article publications to communicate information, we would probably not even be close to having the first vaccine being developed, let alone human trials being completed with where we are at today. Check this paper/project out: A Framework Proposal for Blockchain-Based Scientific Publishing Using Shared Governance

There are a lot of other smarter people than me. This is definitely the case in occupational therapy as well. If you are reading this, you have the potential to invent something or improve on something that can drastically improve our lives for the better. We can use and leverage technologies such as crypto and the Internet to benefit society in so many ways that we have not realized.

It just hasn’t been invented yet or is not mainstream yet.

Don’t get me wrong, I think there is nothing wrong with regulation. As CZ of Binance says, we need regulation because as a society, we are not ready for it yet or there will probably be anarchy. Along the same chord, healthcare has been overly privatized, but it can benefit in many ways with regulation from decentralization. Why should a private company store (and probably sell) our personal health records? Or process our billing? Or package our insurance policies? Why is the price of medical services so expensive? Do you believe that occupational therapists deserve to be millionaires? Doctors are paid a lot for what they do. Are OTs underpaid? If you work for a boss or a company, you probably would think so.

Can decentralization help with this by cutting out staffing agencies, insurance, management, etc.? I am of course not anti-insurance. Insurance could (and probably will) one day operate on the blockchain or Web 3.0. As content creators such as musicians and artists struggled during the pandemic, NFTs help to support their creativity, craft, and community. While healthcare has been impacted by the pandemic, it was not affected as much and continues to operate. However, ask your patient or client what they think though. How many Yelp star reviews would they give the American healthcare system? Probably not many.

I get it. The healthcare system is complex and there is no one solution to “fix” it. But we should try and test, trial, and research in a micro-scale. How can we leverage computing power (exchanges, smart contracts, crypto miners, software programmers, data points, and occupational therapists) to better improve our lives? After all, almost everyone has a smartphone these days and knows how to use it. If solutions are user-friendly, secure, tested, and easy to adopt, we can all benefit from this as well in many ways we wish we can with our current broken healthcare system.