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Blockchain in Healthcare

I created this presentation for a client who wanted to understand how blockchain technology can be used in healthcare, particularly for eHR (electronic health record). They wanted a non-technical overview.

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Blockchain in Healthcare

  1. 1. See the future…. Blockchain and how it is being used in healthcare Susan Dart Commercial in Confidence  The Frame Group Pty Limited 2017
  2. 2. Overview Genesis of blockchain Blockchain is for real Blockchain is a general solution Blockchain use across many areas How does Blockchain work? Examples of existing blockchains How blockchain is being used in healthcare Examples of healthcare blockchain uses Benefits and challenges for healthcare Key companies to watch for healthcare Blockchain ecosystem 2
  3. 3. Non-technical definition of blockchain 3 Blockchain is an open-source technology that maintains data as a shared record distributed over many computers of people that do not know each other. Instead of having centralised access or a central authority, the entire network of combined computers is responsible for the integrity of the data and needs to approve changes made to that data (Philips Blockchain Lab) Trust machine: Manufactured trust through clever code
  4. 4. History is still to be written about Blockchain “Imagine a technology that could preserve our freedom to choose for ourselves and our families, to express these choices in the world, and to control our own destiny, no matter where we lived or were born. What new tools and new jobs could we create with those capabilities? What new business and services? How should we think about the opportunities?” (D.Tapscott) PHILOSOPHICAL Form independent communities free from corrupt societies Security for what underpins society Software applies the law! TECHNICAL Computer-science Distributed replicated databases Cryptography Decentralized 4
  5. 5. 5 At least 120,000 transactions per sec. for bitcoin requiring 450 thousand trillion solutions per sec 65% major banks will be using blockchains by 2019 Worldwide development network for United Nations is pursuing blockchain projects “I’m a big believer in the ability of blockchain technology to effect fundamental change in the infrastructure of the financial service industry” Bob Greifeld, CEO of NASDAQ There is a growing agreement among technology companies that blockchain is essential to the unlocking the potential of Internet of Things (IoT) “It’s hard not to be fascinated by something so transformative. This technology is being used in ways that have implications for central banking that span all the functions we have” Carolyn Wilkins, Deputy Governor of Bank of Canada We are paying close attention to..blockchain, recognizing this may represent the most significant development in many years in payments, clearing and settlement” Federal Reserve Governor Brainard IBM is working with 6000 clients on blockchain and IoT Microsoft has released a cloud- based blockchain-as-a-service platform Blockchain is creating a firestorm of interest
  6. 6. Blockchain is a general solution  Tamper-proof open-source database  Ownership of asset (art, music, land, fish, health record)  Blockchain transfers value  Anything of value (cryptocurrency, contract, title, EHR)  Secure (cryptography)  Public and private blockchains (peer-peer)  Consensus mechanism as to how to update the blockchain  Provenance (audit trail with time stamping) 6  Suits a supply-chain problem where there is no governance and ownership passes between each step in the transfer cycle  Suits keeping “global truth”
  7. 7. Blockchain is used in many areas  Cryptocurrency – blockchain contains the payment history of every bitcoin in circulation and proof of who owns what at any point in time; Bitcoin  Smart contracts - creating invoices or share certificates at end of transaction; Ethereum  Create your own blockchain – build your own platform for private networks; Multichain  Banking fintech 44 banks consortium - R3 CEV  Fishing supply chain - Provenance  Diamond trading - BlockGem  Art, Music and games – Ujo Music  Government – USA, UK, Australia  Land registry – Chicago  Healthcare – Estonia  Stock exchanges – ASX, NASDAQ  Tourism – Dubai’s Loyyal 7
  8. 8. 8 Australia’s role is standardisation of Blockchain Australia will lead the international development of standards governing blockchain The committee's work will focus on "technical solutions including protocols and interoperability" rather than legal obligations and regulatory matters, which Standards Australia said should instead be addressed by governments The committee - which will include 35 ISO members like the US, UK, Germany, Canada and Japan - will be tasked with creating a common language for "interoperability systems, privacy, security and terminology" The Australian Securities Exchange is looking at the technology as a replacement for its equities clearing and settlement system The federal Treasury and Data61 (CSIRO) are studying potential use cases Australia's biggest banks are part of an international consortium looking at using blockchain for bond trading
  9. 9. Blockchain – key concepts  It offers a way for people who don’t know each other to create a record of who owns what that will compel the assent of everyone concerned; it’s a way of making and preserving truths  Replicated ledger of value transactions across a distributed network  Value exchange protocol is the heart of the software and hardware  Validation via consensus that a transaction is valid  Block: a (provenance) list of time-stamped approved transactions with keys  Chain: blocks cryptographically connected in the distributed network  Miner: special computer that competes with other miners to be the first to approve a block and is rewarded (typically with bitcoins)  Digital ledger is shared and cannot be updated without validation from a majority of users (miners) 9
  10. 10. How does blockchain work at its simplest level? 10
  11. 11. Examples of existing blockchain projects  Colu – colored bitcoin for local currencies (Barbados, Israel)  Everledger – protect luxury goods by adding attributes for an item’s proof of identity  Onename – stores personal information in order to do away with passwords  CoinSpark – acts as a notary  – Chicago property transfer  Guardtime - Estonia health 11  Bitcoin, Altcoin – cryptocurrency  Colu – colored bitcoin for local currencies (Barbados, Israel)  Ethereum, Symbiont – smart contracts that execute themselves automatically  Sixchain - derivatives  Factom land registry for Honduras, Greece (only 7% of land mapped)  NASDAQ recording trades in privately held companies
  12. 12. Blockchain transaction dashboard – Ethereum example 12
  13. 13. Blockchain transaction dashboard – Bitcoin example 13
  14. 14. Bitcoins in circulation as of 4 September 2017 14
  15. 15. Blockchain in healthcare - expectations  Disrupt the complex and frustrating healthcare system in a positive way, mostly revolving around simplifying the management and transfer of health records and information  “Busting down the silos in healthcare could be the beginning stages of a healthcare revolution” CIO at Humana, Chris Kay  Data needs to flow between primary health care providers, specialists and holistic medicine practitioners for each patient  Data security is a big driver in the push to adopt blockchain  90% of companies have had a data breach!  Often, more than 300 people touch a single medical claim (USA)  Industry recognises it is spending on new technology but not making the care any better  Solving the master patient identifier problem  Global healthcare interoperability  Protected ecosystem  Blockchain has at least started the conversation to improve this! 15
  16. 16. 16 Typical usage expected of blockchain in healthcare For clinicians, blockchains can support universal identifiers for any data entered into an EHR, which is then available to other authorized providers and care team members Patients can monitor their own health information, approving, denying or sharing changes to their data, ensuring a higher level of privacy and engagement Researchers will benefit from better data integrity and reliability, creating a ‘platform of trust’ for data sharing Payers will have better data reconciliation, fewer errors and frauds, reduced administrative and claim processing costs, and the potential to reach underserved markets Healthcare providers can send encrypted personalise medical recommendations to patient using their own digital identifier (key)
  17. 17. DNA wallets 17 An Israeli startup named DNA.Bits is planning to store genetic and medical data which is secured via the blockchain and accessed using private keys This could allow healthcare providers to securely share – and possibly monetize – patient data, helping pharmaceutical companies to tailor drugs more efficiently This will form a “DNA wallet”
  18. 18. Healthcare payments  In a similar style to Factom and HealthNautica, BitHealth is looking to store and secure medical records using the blockchain  This system also facilitates Bitcoin payments, giving patients additional options for how they pay their healthcare insurers  Insurers who offer this method will likely have a competitive advantage over their peers 18
  19. 19. 19 Block Verify is looking to use blockchain in the fight against counterfeit drugs In a similar way to M-Pedigree technologies (African social enterprise), it features panels on drug packages that can be peeled or scratched off to reveal a unique verification tag This is then cross referenced with the blockchain to ensure that the pharmaceutical product is legitimate Counterfeit medicines often contain the wrong quantity of active pharmaceutical ingredients, which can result in illness or death. The system from mPedigree assigns a code that is revealed by scratching off a coating on the drugs’ packaging. This code can be text messaged by the consumer or medical professional to a free SMS (short message service) number to verify the authenticity of the drug If the drug packaging contains a counterfeit code, the consumer will receive a message alerting them that the pack may be a fake, as well as a phone number to report the incident “Pharmaceutical safety regulators in Ghana and Nigeria are working to ensure that the concerns of users are promptly addressed Anti-counterfeit drugs and blockchain
  20. 20. Number crunching and blockchain  Stanford University used to rely on expensive super computers to simulate protein folding as it happens incredibly fast  This method was costly with a single point of failure  Using blockchain, they can instead use a decentralized network of over 170,000 computers to produce 40,000 teraflops of computing power  This could make its way into the analytical space by utilizing a broad base of data for predictive analytics 20
  21. 21. 21 Benefits of blockchain with Electronic Health Records (eHRs) Blockchain technology can connect information on disparate networks to a common infrastructure in order to create an integrated solution for existing health IT interoperability It allows providers, patients and payers to share a single version of the truth about a patient’s healthcare information Multiple providers, at multiple sites, could access an uncorrupted, secure and universal patient record, avoiding redundant tests, procedures or prescriptions Payers with the right permissions could have access to relevant information in order to process claims rapidly and with more precision Patients would have transparency into the entire continuum of care Blockchain would not be centralizing health information in healthcare exchanges, but instead, decentralizing the system in a securely and interoperable manner Blockchain logs every single event on the EHR (documents, prescriptions, patient interactions, payment requests)
  22. 22. GemHealth  Gem, a company providing enterprise blockchain solutions, recently launched Gem Health, a network for developing applications and shared infrastructure for healthcare. Gem Health hopes to connect users of wellness apps, EMRs, patient ID software and more on the same network.  “This technology allows participants to move data in real-time, without the need for reconciliation, because each participant is connecting to the same network, working on shared information, and collaborating peer-to- peer  —  all without exposing these channels to theft, forgery and malice," according to Gem  "Because the integrity of this history can be proved with mathematics, everyone can trust that it is secure and true”  "Disconnected parties — within an organization or across an entire industry — can now securely converge on the same information, allowing for the development of an entirely new class of applications that will unlock wasted resources." 22
  23. 23. GemOS example of EHR blockchain 23
  24. 24. GemHealth Medical Management on blockchain 24
  25. 25. Estonia who’s e-health solution is built on blockchain 25  In 2007, Estonia placed all their citizen’s health records online  Guardtime partnership with Estonian eHealth Foundation for $1m  Enables real-time visibility into the state of patient records  Goal was to have forensic- quality audit trail on patient records  Citizens have a chip- embedded ID card (digital identifier) that gives them access to over 1000 government services via one website  Estonia is considered most digitally advanced societies in the world  Everything can be done on-line (except marriage and divorce)  Medical records have sensitive information  Estonia recognises that cloud-based systems can be breached  Blockchain proves the integrity of the record and everything that has happened to it over time  Impossible to alter patient’s information without it being noticed  Government can react to incidents immediately
  26. 26. MedRec – EHR example  MedRec gives patients a comprehensive, immutable log and easy access to their medical information across providers and treatment sites  Leveraging blockchain properties, MedRec manages authentication, confidentiality, accountability and data sharing—crucial considerations when handling sensitive information  MedRec integrates with providers' existing, local data storage solutions, facilitating interoperability  It incentivizes medical stakeholders (researchers, public health authorities) to participate in the network as blockchain “miners”  This provides them with access to anonymized data as mining rewards, in return for sustaining and securing the network  MedRec thus enables the emergence of data economics, supplying big data to empower researchers while engaging patients and providers in the choice to release metadata 26
  27. 27. Medical researchers and blockchain  Users share their health data while maintaining control of it  Users can authorise and track the use of personal data  Research institutions can prove full user consent  Regulators have an independent record to conduct effective audits  Health app developers can populate data inside “containers” which can be used to share with research institutions  The user has complete control over all data transfers and can decide how much data is released to a research institution 27
  28. 28. The Ledger makes it possible for you to get credit for learning that happens anywhere, even when you’re just doing the things you love You can earn Edublocks from a formal institution, like a school or your workplace When choosing a subject to study in the future, you may wish to choose the subject whose students are earning the most income You can also use the Ledger to find investors in your education. You can offer investors a percentage of your future income in exchange for free learning hours Education vision using blockchain: Edublock Each Edublock represents one hour of learning in a particular subject. But you can also earn them from individuals or informal groups, like a community center or an app Your ledger account tracks everything you’ve ever learned in units called Edublocks Your profile displays all the Edublocks you’ve earned. Employers can use this information to offer you a job or a gig that matches your skills The Ledger keeps track of all of the income your skills generate, and uses that data to provide feedback on your courses
  29. 29. Benefits of healthcare in adopting blockchain  Security and privacy of records  One source of truth  Adoption by health entity enables evolution across the industry to a similar level of technology  Less fraud and counterfeit  True provenance of research clinical data  Reduced costs and complexity  Supply chain management  A shared ledger with smart contracts  Reduced risk and increased trust  Patients could own their own records, sharing them seamlessly and securely  Generate new insights about population health  Stop the selling of medical records by cybercriminals 29
  30. 30. Challenges for blockchain in healthcare  Privacy models – blockchain is open source, transparent  Need to access pieces of health data (different representations for different purposes)  Education  Skills and having enough software developers  Scaleability  IP development – patents pending  Different protocols and reward systems  Remembering your password (private key)  Office of the National Coordinator for Health IT (challenges) 30
  31. 31. Office of the National Coordinator (ONC) for Health IT competition principles Competition for application of the Blockchain technology must be applied to address a healthcare workflow and ecosystem from the start as it is introduced to this emerging digital industry  Validated transactions through consensus: The current work in Health Information Exchanges (HIEs) relies on a mutually agreed on submission process and exchange of information based on accepted standards and content to facilitate continuity of patient care between organizations. Blockchain simplifies and enhances this capability  Provenance: Many actors touch information that is aggregated through the chain of patient care; call centers, administrative clerks, nurses, physicians, billing clerks and so on, each of whom can contribute to the documentation of what happens to a patient on their journey through the system. In a paper-based system, the provenance of information, while not always accurate, had less chance of lapses than the electronic system. As an area critical to establish accountability and trust, provenance in healthcare is ripe for a solution like Blockchain-applied appropriately  Immutability: All actions are recorded - so correcting an error has the action and actors documented in the transaction. In the paper system, an error in documentation should be corrected with the author’s information and time and date. Blockchain tracks these actions as attributable to actor and reflect both initial documented action as well as correction  Finality: There is one place to determine the ownership of an asset (in this case, the author of information in documentation of care) and the completion of a transaction 31
  32. 32. Result of blockchain competition at ONC 70 submissions and 15 winners – some examples 32 Smart health profile: tie a smart profile to a patient so that Medicaid (Medicare) patients can easily re-enrol and re-qualify for health services (means tested) Processing claims: put claims data on private blockchain accessible to organisations that exchange the data and have it updated in real-time MedRec: secure, store and exchange EHR PGHD (patient generated health data): blockchain becomes the storage for health readings from patients’ mobile devices such as Fitbit, Jawbone and Apple Watch
  33. 33. 33 Companies to watch for healthcare blockchain solutions Factom, Medvault, Tierion, Health Nautica, MedRec, Blockchain Health Co, Apple - EHR PokitDok – APIs for blockchains Hashed Health consortium – collaborative working solutions (policy guidance) Hyperledger Healthcare Working Group Philips Blockchain Lab Office of the National Coordinator of Health IT (USA) - innovation GemHealth: information exchange between patients, healthcare providers, payers Hexoskin smart shirt – PGHD, wearable body biometrics Healthbank – privately owned HER Guardtime – Estonia DNA.Bits – genetic data BitHealth – payments using bitcoins BlockVerify – fight counterfeit drugs Stanford Uni – distributed supercomputer simulations
  34. 34. Blockchain ecosystem – digital economies, Internet of Things “The expected proliferation of hundreds of billions more (devices) is at the threshold of a transformation sweeping across the electronics industry and many others. Yet, the dream of a smart, safe and efficient future is threatened by subscription fees, ubiquitous advertising and intrusive surveillance. Our study shows that a low-cost, private-by-design “democracy of devices” will emerge that will enable new digital economies and create new value while offering consumers and enterprises fundamentally better products and user experiences.” IBM’s report titled “Device Democracy” 34
  35. 35. Blockchain ecosystem – democratic internet  US Commodity Futures Trading Commissioner J. Christopher Giancarlo believes, “if allowed to thrive, blockchain may finally give regulators transparency”  DAO: Decentralised Autonomous Organisations … virtual companies investment club  Libertarians dream of a world where more and more state regulations are replaced with private contracts between individuals which blockchain makes self-enforcing (The Economist)  “Privacy is the foundation of free societies…We believe that the economy works best when it works for everyone, and this new platform is an engine of inclusion” (Tapscott) 35
  36. 36. Conclusion  Blockchain is playing a major role in the evolving digital economy  Health data is officially a new asset class (2011 World Economic Forum)  “My data, my choice, my healthbank” is possible with blockchain  Healthcare projects using blockchain are underway  Estonia is a prime example of a digital economy managing its citizens via a digital healthcare solution using blockchain  To healthcare professionals: It’s time to become familiar with blockchain and how it can improve your industry  How many data breaches of medical databases will happen before the industry switches to blockchain technology? The Frame Group thanks Mark Klose for his support in progressing this project. 36
  37. 37. The Frame Group Pty Limited 1300 252 789 Sydney | Canberra | Melbourne | Brisbane 37