Metaverse and NFTs on the Healthcare Cloud

Metaverse and NFTs
on the Healthcare Cloud
December 8th, 2023
Eiji Sasahara, Ph.D., MBA
Partner - Healthcare Cloud Initiative, NPO
Representative, Cloud Security Alliance Japan Chapter
(A Member of European Connected Health Alliance)1

FYI.
3
・Cloud Security Alliance (CSA), “Blockchain/Distributed
Ledger Technology (DLT) Risk and Security Considerations”,
February 16, 2022.
(https://cloudsecurityalliance.org/artifacts/blockchain-dlt-risk-and-considerations/)
1. Introduction
2. Blockchain Technology Basics
3. Fabric Security and Risk Context
4. Fabric Solution Overview
5. Fabric Threat Assessment
6. Risk Assessment
7. Risk Mitigation
8. Fabric Reference Security Architecture
9. Conclusion
Source:CSA Blockchain/Distributed Ledger WG, “Blockchain/Distributed Ledger Technology (DLT) Risk and Security
Considerations”, February 16, 2022 (https://cloudsecurityalliance.org/artifacts/blockchain-dlt-risk-and-considerations/)

4
・Cloud Security Alliance (CSA), “The Use of Blockchain in
Healthcare”, July 15, 2021.
(https://cloudsecurityalliance.org/artifacts/the-use-of-blockchain-in-healthcare/)
1. Introduction
2. Blockchain
3. General
4. Research
5. Supply Chain
6. Financial
7. Facility and Energy Management
8. Patient Administration
9. Blockchain in Healthcare Cases
10.Discussion
11.References Source: CSA Health Information Management WG, “The Use of Blockchain in Healthcare”, August
10, 2021(https://cloudsecurityalliance.org/artifacts/the-use-of-blockchain-in-healthcare/)

AGENDA
• 1. What Is “Metaverse”?
• 2. Use Cases of Metaverse in Healthcare:
---Robot-Assisted Surgery (RAS) Systems---
• 3. What Is “Web3/NFTs”?
• 4. Use Cases of Web3/NFTs in Healthcare:
---Secure Health Information Exchange---
• 5. Conclusion/Q&A
5

1. What Is “Metaverse”? (1)
6
・ Gartner, “What Is a Metaverse? And Should You Be
Buying In?“, October 21, 2022
(https://www.gartner.com/en/articles/what-is-a-metaverse)
 Metaverse is a collective virtual shared space, created
by the convergence of virtually enhanced physical and
digital reality.
 It is an independent virtual economy, enabled by digital
currencies and non-fungible tokens (NFTs).
 As a combinatorial innovation, metaverses require
multiple technologies and trends to function.

7
 4 key Innovations Make Metaverse a Strategic
Technology Trend:
Description
Innovations
which is a new stack of technologies for the development of decentralized
web applications that enable users to control their own identity and data.
1: Web3
which can be defined as a three-tiered technology stack through which
users experience the intersection of the physical and digital worlds.
2: Spatial
computing
not only mirrors a unique individual, but is also a near-real-time
synchronized multi-presence, with the ability to be present in multiple
places at the same time in both digital and physical spaces.
3: Digital twin
of a person
(DToP)
a subset of DToP, is a dynamic virtual representation of a customer that
simulates and learns to emulate and anticipate behavior. Customers can
be individuals, personas, groups of people or machines.
4: Digital twin
of a customer
(DToC)
Source: Gartner, “What Is a Metaverse? And Should You Be Buying In?“, October 21, 2022

8
 Opportunities in a Metaverse:
(Now and in the Future)
Source: Gartner, “What Is a Metaverse? And Should You Be Buying In?“, October 21, 2022

2. Use Cases of Metaverse in Healthcare (1)
9
・apoQlar, Germany “Medical Metaverse Company, apoQlar,
Receives FDA 510(k) Clearance for its Mixed Reality Surgical
Planning Platform, VSI HoloMedicine” (December 5, 2022)
https://www.prnewswire.com/news-releases/medical-metaverse-company-apoqlar-receives-fda-510k-clearance-for-its-
mixed-reality-surgical-planning-platform-vsi-holomedicine-301690781.html
apoQlar:
• MedTech Startup Founded
in 2017 in Hamburg, Germany
• Unique Affordable Medical
Metaverse Technologies
Source: apoQlar, “Our Approach to Medical Mixed Reality”, (https://www.apoqlar.com/)

2.Use Cases of Metaverse in Healthcare (2)
10
“VSI HoloMedicine”
• Software Device that Brings
Crucial 3D to Surgical Planning,
Remote Consultation, Patient
Education and Medical Training
(U.S. FDA Clearance)
• Using Microsoft's HoloLens 2,
surgeons can transform flat CT,
Angio CT, MRI, CBCT, PET, and
SPECT sources into interactive
3D holograms
Source: Microsoft Azure Market Place, “VSI HoloMedicine®”,
(https://azuremarketplace.microsoft.com/en/marketplace/apps/apoqlargmbh.holomedicine_vsi_offer?tab=overview)

11
・ Rensselaer Polytechnic Institute,U.S.: Ge Wang et al.
“Development of metaverse for intelligent healthcare”,
(November 25th, 2022)
2022 Nov;4(11):922-929. doi: 10.1038/s42256-022-00549-6.
Epub 2022 Nov 15.
(https://doi.org/10.1038/s42256-022-00549-6)
 Metaverse Eco-system of MeTAI
(Medical Technology and AI)
a. Virtual comparative scanning
b. Raw data sharing
c. Augmented regulatory science
d. ‘Metaversed’ medical intervention
Source: Ge Wang et al. “Development of metaverse for intelligent healthcare”, November 25, 2022 (https://doi.org/10.1038/s42256-022-00549-6)

12
 Privacy:
Privacy and confidentiality are of critical importance for MeTAI.
Secure computation techniques, including blockchains, are
important tools in a zero-trust environment.
With federated learning as an initial step, many further
opportunities can be explored to preserve the integrity of patients’
data and utilize this information to advance clinical practice and
healthcare.
We advocate that the patients take control of their own data and
avatar(s), supported by the blockchain technology, so that their
own digital healthcare properties can be shared as they wish.

13
 Security:
In MeTAI, harassment can manifest as adversarial attacks on
algorithms, modifications to avatars and conventional human
misbehaviours.
Stabilize image reconstruction neural networks by synergizing
analytic modelling, compressed sensing, iterative refinement and
deep learning (ACID).
The trustworthiness of AI model explainability could be vulnerable
to subtle perturbations in the input.
The promise is that the quality of the evidence derived from MeTAI
will rapidly improve, and the resultant digital evidence, once
validated, will facilitate clinical translation of various innovations.

14
・ Leiden University Medical Center, The Netherlands:
Fijs W. B. van Leeuwen et al. “Where Robotic Surgery Meets
the Metaverse”, (December 14th, 2022) Cancers (Basel). 2022 Dec; 14(24): 6161.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9776294/
 Combination of two essential
innovations in the field of
minimally invasive robotic
surgery
• Augmented Reality (or
Mixed-Reality (MR)
visualizations),
• Artificial Intelligence
(includes Machine Learning) Source: Fijs W. B. van Leeuwen et al. “Where Robotic Surgery Meets the Metaverse”,
December 14, 2022.(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9776294/)

15
・ Inje University, Republic of Korea: Sikandar Ali et al.
“Metaverse in Healthcare Integrated with Explainable AI and
Blockchain: Enabling Immersiveness, Ensuring Trust, and
Providing Patient Data Security”, (January 4, 2023)
Sensors (Basel). 2023 Jan 4;23(2):565. doi: 10.3390/s23020565. (https://pubmed.ncbi.nlm.nih.gov/36679361/)
1. Introduction
2. Related Works
3. Metaverse Framework and
Building Block Technologies
3.1 Virtual Reality (VR)
3.2 Extended Reality (XR)
3.3 Augmented Reality (AR)
3.4 Internet of Things (IoT)
and Network
3.5 Edge/Cloud Computing
3.6 Artificial Intelligence (AI)
3.7 Digital Twin
3.8 Computer Vision
3.9 Blockchain
3.10 Avatar
4. The Proposed Architecture of Healthcare Metaverse Powered
by Explainable Artificial Intelligence (XAI) and Blockchain (BC)
4.1 Doctor’s Environment
4.2 Patient’s Environment
4.3 Metaverse Environment
5. Metaverse Healthcare Advantages and Challenges
5.1 Advantages of Metaverse in Healthcare
5.1.1. Health Monitoring
5.1.2. Consultation in an Immersive Environment
5.1.3. Surgeries in a Virtual Environment
5.2 Challenges of Metaverse in Healthcare
5.2.1. Application Development
5.2.2. Data Privacy and Security
5.2.3. Trusts
6. Conclusions

16
 Building block technologies of the metaverse
• Blockchain:
 NFT, Smart Contract, DeFi
• Artificial Intelligence:
 Machine Learning,
Deep Learning, etc.
• Networking:
 IoT, 5G, SDN
• Interactivity:
 VR, AR, XR, BCI, MR
• Digital Twin:
 3D Simulation,
3D Modeling, Avatars
Source: Sikandar Ali et al. “Metaverse in Healthcare Integrated with
Explainable AI and Blockchain: Enabling Immersiveness, Ensuring Trust,
and Providing Patient Data Security”, January 4, 2023
(https://pubmed.ncbi.nlm.nih.gov/36679361/)

17
 Architecture of the Healthcare Metaverse
Source: Sikandar Ali et al. “Metaverse in Healthcare Integrated with Explainable AI and Blockchain: Enabling Immersiveness, Ensuring Trust, and
Providing Patient Data Security”, January 4, 2023 (https://pubmed.ncbi.nlm.nih.gov/36679361/)
Distributed
Blockchain
Patient’s
Environment
Doctor’s
Environment
Explainable
AI(XAI)
Model
Metaverse
Environment

18
 Metaverse Healthcare Advantages and Challenges
Source: Sikandar Ali et al. “Metaverse in Healthcare Integrated with Explainable AI and Blockchain: Enabling Immersiveness, Ensuring Trust, and
Providing Patient Data Security”, January 4, 2023 (https://pubmed.ncbi.nlm.nih.gov/36679361/)

3. What Is “Web3/NFTs”? (1)
19
・ Gartner, “What Is a Web3?“, February 15, 2022
(https://www.gartner.com/en/articles/what-is-web3)
 Web3 is a new stack of technologies for the
development of decentralized web applications that
enable users to control their own identity and data.
 These technologies include blockchain as a trust
verification mechanism, privacy-preserving and
interoperability protocols, decentralized infrastructure
and application platforms, decentralized identity, and
support for applications like decentralized finance.
 These will eventually realize the vision of a decentralized
web.

20
 “Metaverse” and “Web3” :
Metaverse denotes an
evolving vision of a
digitally native world in
which we will spend our
time working, socializing
and engaging in all types
of activities.
Web3 provides
decentralized protocols
and a technology stack
that can be used to build
parts of a metaverse and
the new communities and
economies that it will
enable.

21
 Web3 Enabling protocols and technologies:
 Privacy-preserving, trustworthy off-chain computing integrated with on-chain
smart contracts
 Cross-chain interoperability that enables assets to move easily across isolated
blockchains
 Middleware abstraction layers that make it easier for developers to implement
portable applications
 Scalability solutions that remove the computing burden from primary base-
level (Layer 1) blockchains, such as Ethereum and Bitcoin
 Distributed, persistent and secure storage systems for off-chain data linked to
blockchains
 Other technologies, such as privacy-preserving protocols like zero-knowledge
proofs, that protect confidential information, and artificial intelligence (AI)
models that can infuse NFTs with intelligence

22
・ National Institute of Standards and Technology
(NIST), “IR 8472 (Initial Public Draft)
Non-Fungible Token Security“, August 31, 2023
(https://csrc.nist.gov/pubs/ir/8472/ipd)
 NFT Definition:
A non-fungible token (NFT) is an owned, transferable, and
indivisible data record that is a digital representation of a
physical or virtual linked asset. The data record is created
and managed by a smart contract on a blockchain.

23
 NFT Properties
1. Owned: NFTs designate ownership by recording a blockchain address.
2. Transferable: Owners and designated approved entities can transfer the
ownership of NFTs to other addresses.
3. Indivisible: NFTs cannot be subdivided (although the ownership may be
fractionalized).
4. Linked: NFTs have references to the asset that they represent.
5. Recorded: NFTs are smart contract data records stored on a blockchain.
6. Provenance: NFTs have their chain of ownership recorded.
7. Permanence: NFTs are normally indestructible (although some are designed to
be burned).
8. Immutable: The asset that an NFT represents cannot be modified.
9. Unique: Each NFT represents a unique asset.
10.Authentic: Each NFT asset is what the NFT claims it to be (e.g., artwork from a
particular artist).
11.Authorized: Each NFT asset has been authorized by an owner to be sold as an
NFT.

4.Use Cases of Web3/NFTs in Healthcare(1)
24
・ Peking University, China: Yan Zhuang et al. “Self-Sovereign
Identity Empowered Non-Fungible Patient Tokenization for
Health Information Exchange Using Blockchain Technology”,
(March 15th, 2023) Comput Biol Med. 2023 May;157:106778. doi: 10.1016/j.compbiomed.2023.106778.
Source: Yan Zhuang et al. “Self-sovereign identity empowered non-fungible patient tokenization for health
information exchange using blockchain technology” March 15, 2023. (https://pubmed.ncbi.nlm.nih.gov/36934533/)
Archive
Node
Full
Node
Light
Node

25
 Modules contained in the architecture for the use of NFT
for HIE authentication
1. Creation Module
2. Linkage Module
3. Authentication Module
4. Exchange Module

26
 NFT containing patients’ blockchain account address
 NFT containing hospital blockchain accounts

27
・Technical University of Munich, Germany: Sebastian Sitaru
et al. “Nonfungible tokens (NFTs) in dermatology and health
care: A guide for health care professionals”
(December 20th, 2022)
JEADV Clin Pract. 2023;2:32–37. (https://onlinelibrary.wiley.com/doi/full/10.1002/jvc2.95)
(a) NFT can represent a physical object like a car or a house.
They have at a minimum a class and an owner associated
with them but can include other information.
(b) NFTs are not interchangeable, unlike fungible tokens like
Ethereum currency.
(c) NFTs and fungible tokens can be transferred between
participants using the same mechanisms.

28
What are NFTs?
Source: Sebastian Sitaru et al. “Nonfungible tokens (NFTs) in dermatology and health care: A guide for health care
professionals”, December 20, 2022. (https://onlinelibrary.wiley.com/doi/full/10.1002/jvc2.95)

29
Possible application of NFTs in dermatology using the
example of clinical images
1. Minting: Photographer creates
the two clinical image NFTs
2. Ownership: Owner of the NFTs
is the patient XYZ
3. Viewing: Patient must give
permission to the healthcare
provider
4. Permission enforcement by
blockchain
Source: Sebastian Sitaru et al. “Nonfungible tokens (NFTs) in dermatology and health care: A guide for health care
professionals”, December 20, 2022. (https://onlinelibrary.wiley.com/doi/full/10.1002/jvc2.95)

30
・Tufts University Medical Center, U.S.: Antonio Yaghy et al.
“The potential use of non-fungible tokens (NFTs) in
healthcare and medical research”
PLOS Digit Health 2023 Jul 27;2(7):e0000312. doi: 10.1371/journal.pdig.0000312. eCollection 2023 Jul..
 Opportunities:
• Blockchain architecture is ideal for ensuring security and privacy while
granting individuals jurisdiction over their own information, making it a
unique solution to the current limitations of existing health information
systems.
• NFTs can be used to give patients the option to monetize their health
data and provide valuable data to researchers.
• Wearable technology companies can also give their customers the option
to monetize their data while providing data necessary to improve their
products.

31
・Risks Regarding Web3/NFTs
 Risks:
• NFTs have raised concerns regarding their carbon footprint, as the
technology is dependent on computational-heavy tasks that
validate transactions on the blockchain.
• NFTs hold certain monetary value and are listed online, and these
can attract unethical players that will try to steal those assets from
less technologically savvy people.
• NFTs can contain patient health information, and they may need to
be regulated in terms of storage on the blockchain and exchange
on marketplaces to ensure compliance with HIPAA and similar
regulatory entities abroad.

5. Conclusion／Q&A
32
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