This document presents an overview of the Blockchain for Patient Engagement Solutions. The presentation highlights various data streams generated along the patient journey. Also, discusses current solutions and their concerns such as security, accessibility and control. Finally, presents potential Semi or full Blockchain models to improve and create new patient engagement solutions. This disclaimer informs readers know that the views, thoughts, and opinions expressed in the presentation belong solely to the author, and not to the author’s employer, organization, committee or other group or individual.

1. Blockchain in Life Sciences for
Patient Engagement
Jayanthi Repalli, PhD
Feb 20, 2017
This presentation explores Blockchain’s potential role in
patient engagement solutions, and discusses how it might
improve existing solutions and patient outcomes.

2. © All rights reserved
What is patient engagement?
2
While the definitions for patient engagement differ, they all converge to the purpose – that active patient
engagement improves patients outcomes.
Our patients want more than medicine.
They want to know that their medicines
have been developed with their needs in
mind, and that we are willing to share
health and disease information that can
help them and their doctors make the
best decisions.
-Pfizer
https://www.pfizer.com/files/investors/financial_reports/annual_repo
rts/2015/patient-engagement.htm
Patient engagement is providers and
patients working together to improve
health.
-HIMSS
http://www.himss.org/library/patient-engagement-toolkit
Patient engagement is about
personalized medicine. Patients actively
working with their healthcare providers to
set goals, stay healthy, manage
conditions and follow plans to maintain
their own health and wellness.
-Vigyanix
https://www.pfizer.com/files/investors/financial_reports/annual_repo
rts/2015/patient-engagement.htm
Patient engagement is used to describe
everything from patient portals to social
media strategies, from tracking vitals with
wearables to patients actively
participating in their own health and
wellness.
-Healthcare IT News
http://www.healthcareitnews.com/news/what-does-patient-
engagement-really-mean
Patient engagement is a broader
concept that combines patient activation
with interventions designed to increase
activation and promote positive patient
behavior, such as obtaining preventive
care or exercising regularly.
-Health Policy Briefs
http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=86

3. © All rights reserved
What’s in it
for
everyone?
• Better informed and connected
• Responsible and decision maker
• Improved disease management
• Effective adverse effects
management
• Increased satisfaction
• Personalized medicine
• Preventive medicine
• Real time patient monitoring
• Better outcomes
Providers
Pharma
Patients
3
Each party of healthcare ecosystem has tangible and strategic benefits from improved patient
engagement.
Why is it important?
• Better value proposition
• Increased negotiation power with payers
• Improved patient compliance
• Better outcomes
• New relevant products and services

4. © All rights reserved
Trends impacting patient engagement
4
• Mobile devices usage such as tablets and smart
phones have grown 4X in the last 5 years.
• Wearable technologies have evolved and able to
offer insights in real time.
• The computing power has grown exponentially, which
enable gathering and analyzing big data.
• An aging population is growing and requiring new
healthcare and home care models, which span
beyond four walls of provider facilities including
supporting services and insurance models.
• Analytics capabilities have advanced significantly –
able to perform predictive and prescriptive analytics
focused around patients.
• Patients want access to their health data on demand.
Patient expectations and new technology trends such as wearables, analytics and IoT are driving new
business models and patient centered engagement solutions.
The wearable technology market is expected to
reach to $51.6B by 2022 with CAGR of 15.51%.
http://www.marketsandmarkets.com/PressReleases/wearable-electronics.asp
$173B
Global healthcare IoT market is expected to grow at
CAGR of 38%, to $173B by 2020.
https://vigyanix.com/blog/iot-and-patient-engagement-how-iot-is-defining-three-es-of-
engagement-infographic/
94%
American social media users are willing to share
their health data to help doctors improve care.
https://nam.edu/wp-content/uploads/2015/06/VSRT-PatientDataSharing.pdf
$51.6B
$29.5 B
Advanced analytics market is expected to reach to
$29.5B in 2019 with CAGR of 33.2%.
http://www.marketsandmarkets.com/PressReleases/advanced-analytics.asp

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Patient engagement solutions
5
Portals
Apps
Wearables
Emails
Texting
Web interactive programs
Patient engagement solutions provide personalized insights to patients on a variety of media – portals,
apps, emails, and wearables – through synthesizing and analyzing data from a variety of sources by
using advanced analytics.
Providers
Public domain
Payers
Pharmaceuticals
Pharmacies
Patients
Big Data
&
Analytics
Storage
&
Process
Data sources and various parties Patient engagement tools and platforms
Academia
Sources: http://www.mtbeurope.info/content/ft1501001.htm, http://catalyst.nejm.org/patient-engagement-technology-tools-gain-support/

6. © All rights reserved
Patient journey and data streams
6
Patient feels discomfort and
notices some symptoms; and
searches online for relevant
information.
Patient searches online and talks
with friends, family and decides
what treatment to take based on life
style and goals.
Patient starts on treatment and
ongoing changes are tracked with
doctors office visits and also mobile
devices such as wearables, apps, etc.
Patient visits a doctor. Doctor collects
symptoms and other information and
creates a health record.
Doctor diagnoses the disease
using lab results, historical
information, and symptoms and
recommends potential treatment
options.• Advocacy groups and patient
communities
• Social media
• Research data
• Claims data
• Environmental
data
• Public Health
data
• Pathology and
laboratory test
results
• Genetic and
genomic data
• Electronic medical record
• Electronic health record
Providers/patients submit
claims to payers such as
insurance, Medicaid etc.
• Mobile and tele health data
• Automated sensors and smart devices
• Digital pills
1 2 3
456
Many types of data are generated throughout the patient journey and is utilized by all parties across
healthcare ecosystem. All these data streams are commonly collected, stored, and processed using
traditional database or cloud storage systems.
• Advocacy groups and patient
communities
• Social media
• Research data
• Public health data
Note: Text in grey color indicates data streams at each step of patient journey. They are not exhaustive. Source: http://www.mtbeurope.info/content/ft1501001.htm
Providers
Public
domain
Payers
Pharma Pharmacies
Patients
Academic
Storage & Process
Big Data & Analytics

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Drawbacks of existing solutions
7
Existing patient engagement solutions employ the state of the art database and cloud technologies,
processes and tools. However, security, data integrity, intermediation, and accessibility are still concerns.
Security
Cyber security is one of the primary concern, which could arise
from many avenues such as data breach, unauthorized
access, device hacking, etc.
Authorization and Access
Most of the solutions use cloud infrastructure for which tracking
of authentication, users accessibility, and data locations is still
a challenge. Unauthorized data access into the data stream is
a growing concern.
Analytics
Automatic analytics is not typically part of the solutions. Data
streams are not synthesized or streamlined to generate patient
focused insights, which requires additional effort from providers
and users.
Big Data or Right Data
The data generated by IoT devices is exponentially
proliferating, but, big data is often underutilized, misutilized,
and is not correlated to the patient focused solutions.
Interoperability and Integrity
Current solutions let the data streams collect and store in
cloud, however, they do not ensure interoperability and data
integrity across wide variety of IoT devices. The streams may
not have similar structures and are not readily usable for
further analytics without additional processing efforts.
Mobile apps
While mobile apps are tremendously increasing, the quality,
accuracy, and relevancy is yet to be improved, and so as the
data from these apps. Also, the most of the apps are not well
designed for clinical applications.
Controls and Intermediation
User doesn’t have a direct control over one’s own data. One
needs to depend on this intermediary or service provider of
storage systems for any of activities such as access, analytics,
storage, data breach protocols, etc.
Sources: https://www.healthit.gov/sites/default/files/11-74-ablockchainforhealthcare.pdf
https://www.healthit.gov/sites/default/files/6-42-use_of_blockchain_to_develop_proms.pdf

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Blockchain solutions for patient engagement
8
Blockchain solves some of the pressing challenges and makes health data available to all parties in real
time and improves patient engagement.
Decentralized data offers no single point of failure
Cryptography keys and digital signatures ensure security
Information is ubiquitous, transparent to all parties in the network
Transactions are irreversible once verified or accepted
Transactions are verified in near real time
Peer-to-peer network, eliminates intermediaries
Traditional solutions
Blockchain solutions
Patient goes to a
lab and gets some
tests performed
Results get distributed to
everyone (doctors, patients
etc.) in the Blockchain (based
on preferences)
Historical results are
automatically populated and
available for the review
Patient goes to a lab and gets
some tests performed
Day 1 Doctors get test results, but
doesn’t have access to
historical data in real time as
they are distributed in
different systems
Doctor manages to obtain and
analyze data from different
systems; and gets in touch
with patient and share the data
Day4Day2
Day1
Day2
Day2
• Patients have access to the lab results, historical data, and necessary
insights, which help them in having meaningful discussions with doctors.
• 82.7% of patients (who had received an HbA1c or abnormal Pap)
expressed that availability of lab results helped them to prepare the
communication and increased access with providers.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919031/
Lab test results use case

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Semi or fully private Blockchains
9
Semi- and fully-private Blockchains address concerns in privacy and access control of public Blockchains.
• Closed access: Nodes are private and only accessible to the participants
of the network, which ensure compliance and security.
• Control and Access: Patient controls access and permissions to
authorized users and designators in real time. Also, partial accesses could
be granted (e.g., access to a provider to a particular portion of health
record in a particular time frame).
• Custom consensus engine: As opposed to public chains, rules can be
customized by participators for the participants.
• Transparency: patient would be able to monitor the flow of all data and its
usability – data acquisition, storage, processing, queries, and analysis.
• Better Treatment Outcomes: Patient would be able to create a
collaboration community of providers, advocates, family, and friends to
keep them informed, receive better ideas, and manage disease
effectively.
• Decentralized system: Decentralized data storage will prevent an
adversary from posing threat to data or corrupt the network. Even if the
adversary breaches network, the publicly shared indices and hash points
and all the information would be encrypted, which ensures security.
Security:
• Public Blockchains lack data privacy and present security
concerns for healthcare applications.
Scalability:
• Limitations on block size and transactions present scalability
issues.
Large Size Data:
• Replicating data across all nodes is not feasible for healthcare
applications; storing everyone’s data across all nodes may present
enormous storage issues.
Access:
• Permission less networks concept will present additional
unauthorized access or unintended usage of the data.
Limitations of public Blockchain Advantages of semi or fully private Blockchain

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Blockchain
• Consists a complete
indexed history, patient’s
unique identifier, and an
encrypted link to health
record.
• Each record is time
stamped.
• All patient records
(historical) are together
and stay with the patient.
• Patient has control over
the permissions on whom
to share with.
Example of a private Blockchain model for patient data management
10
A private Blockchain consists the parties of user’s choice, and a data lake that stores all the relevant data
– time stamped and permanently. The metadata enables analytics and patient focused insights.
Data lake
• Stores different types of health
data (e.g., images and lab
reports).
• Consists structured and
unstructured data
• Information is encrypted and
digitally signed.
Healthcare
players
Adds any medical record (e.g.,
prescription, pathology report) to
patient’s block chain, who has a
unique identifier and notifies
patient.
Patient
Adds medical data to blockchain
with digital signatures from IoT
devices (e.g., mobile apps,
wearables).
Index
• An index is generated for each
health record or data stream.
• Each index contains metadata
about the health record, fields,
unique identifier and link to
original data record location.
Analytics
• Metadata is readily
available for queries.
• Data could be mined for
patient focused insights.
• Structured and
unstructured data
analytics could be
summoned.
• AI and machine learning
could be employed.
Source: https://www.healthit.gov/sites/default/files/11-74-ablockchainforhealthcare.pdf

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Closing remarks
• Patient engagement services play key role in enabling new business capabilities for life
sciences.
• Patient relevant data is dispersed, tremendous, and overwhelming.
• Many organizations looking for solutions for effective data management and insights
generation.
• Private blockchain could enable some of the essential capabilities including controlled
access, real time data availability, security, and patient focused insights.
• This new technology enables seamless data integration without compromising security
and confidentiality, which can readily provide data for predicative modeling and insight
generation, which will improve patient engagement and outcomes.
• Though the full potential yet to be determined and proved, it opens an avenue for a new
set of creative solutions.
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Thank You!
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the author appropriately when used.