Blockchain in Healthcare

1. Blockchain
in Healthcare
May 15th, 2019
Quæfacta
Lea Dias, CEO & Co-founder
David Andrianavalontsalama, CPO & Co-founder

3. !3
France Australia
Average Length Of Stay (Acute Care) 5.7 days 4.2 days
Hospital admissions/year 12.7 M (2017) 11 M (2016/2017)
Hospital discharge rate/100 000 inhabitants 18,783 17,760
Doctors consultations per capita 6.1 7.7
Total nurses/1000 inhabitants 10.5 11.6
Number of CT scans in hospital/1000 inhabitants 124 13
Number of CT scans ambulatory/1000 inhabitants 81 114
Number of MRI exams in hospitals/1000 inhabitants 48.7 1.9
Number of MRI exams ambulatory/1000 inhabitants 65 43
Medical devices: Data production x times a day xxx xxx
Average number of medications prescribed on discharge xxx xxx
Average number of procedures in hospital xxx xxx

4. !4
Patient

5. !5
Case study
Patient :
• Mr J Doe
• 57yo male, morbidly obese, smoker
• PMHx: hypertension, hypercholesterolaemia, NIDDM
• Presents: Stroke like symptoms, dizziness,
confusion, weakness in limbs, speech difficulty, facial
drooping

6. !6
1. Examinations 2. Diagnosis 3. Emergency
treatment with
medications
4. Procedure 5. Treatment
team may
include:
6. Medications
post stroke
Ischaemic stroke
J Doe
Intravenous injection
of tissue
plasminogen
activator (tPA)
Angioplasty and
carotid artery stent
• Doctor trained in
brain conditions
(neurologist)
• Rehabilitation
doctor (physiatrist)
• Nurse
• Dietitian
• Physical therapist
• Occupational
therapist
• Recreational
therapist
• Speech
pathologist
• Social worker
• Case manager
• Psychologist or
psychiatrist
High blood pressure
medication
Blood thinners
Anti - coagulants
Diuretics
Cholesterol medication
Anti-fibrillation drug
Diabetic medication
Antidepressants
Physical examination
Blood tests
CT scan
MRI scan
Carotid ultrasound
Cerebral angiogram
Echocardiogram

7. Fragmentation and gaps in the transfer of information between hospital care and community care
Patient
Hospital
Providers
Hospital HealthcareCommunity Healthcare
Outpatient
clinicsGP Clinic /
Community Health
Home Health
Pharmacy
Wearable
devices
Laboratory
Rehabilitation
Screening
& diagnosis
Ambulatory
care
!7

8. 1. Observable gaps in the transfer of
information
2. Lack of interoperability — Many
devices and practitioners interact and
do not share the full data
3. Procedures that should be implemented
are not, or not followed, or incomplete
!8

9. Medicines information, inpatient records, admission and discharge
information are often missing or poorly communicated by health
professionals within hospitals and to community health providers.
This may lead to:
‣ hospital readmissions;
‣ adverse drugs events;
‣ compromised patient care;
‣ serious or fatal outcomes.
!9
Consequences of siloed and missing information

10. !10
Patient
Role of blockchain Securely sharing
information
Interoperability
Traceability
Accountability
Fraud detection
Incentives
Data privacy
Analytics & AI

11. Multi-vendor + smart contracts
Vendor A
Vendor B
Vendor C
Auditing
system
hash
data
data
data
hash
hash
The data and
results are accurate
certification!
command
+ hash
data
Anchoring system using blockchain + smart contracts
!11
Interoperability

12. Patient
Hospital
Providers
Hospital HealthcareCommunity Healthcare
Outpatient
clinicsGP Clinic /
Community Health
Home Health
Pharmacy
Wearable
devices
Laboratory
Rehabilitation
Screening
& diagnosis
Ambulatory
care
!12
Securely sharing
information

13. !13
Pharma Pharma
Pharma /
Med device
Product
Development
Innovation
Active
Pharmaceutical
Ingredient
Manufacturing
Secondary
Manufacturing
ERP ERP ERP
Logistics Logistics
Distribution Supplier
ERP ERP
Logistics Pharmacist Customer
Wholesaler
Reseller
(Pharmacist
dispenses Rx
2D scan - WF1)
Patient
ERP
ERP
PIS
Smart device
Direct
to patient
Retail
Pharmacy
(Pharmacist
dispenses Rx
2D scan - WF1)
Hospital
Pharmacy
(Pharmacist
dispenses Rx
2D scan - WF1)
Supply chain logistics workflowTraceability

14. !14
TR TR TR
TR
TR
TR
TR
TR
TR
TR
TR
TR
Acquiring traces

15. !15
Traceability content: Who? What? Where? When? Why?
Traceability actor: Any known user + key
Acquisition tools
Anchoring: Any known blockchain
Metrics: How many traces per device? How often? How long?
What a trace holds

16. !16
How we acquire a trace
Tool suite:
• API
• Mobile & desktop apps
• Dashboards

17. !17
TR TR TR
TR-1 TR-2 TR-3

18. !18
TR TR TR
TR-1 TR-2 TR-3
TR
TR-4smart contract

19. !19
TR
TR-XXX = 2000 lines

20. !20
TR
TR-XXX = 2000 lines
smart contract
TR TR-XXX-1
TR TR-XXX-2
TR TR-XXX-2000
TR TR-XXX-3
…

21. !21
Chain reconstitution
Whole chain
Partial view #1
etc.data
analysis

22. !22
Chain anchoring
Whole chain
Partial view #1
etc.
+ supervisor
validation
+ supervisor
validation
smart
contract
smart
contract
TR
TR-x
TR
TR-y

23. !23
Trace composition
Supply chain model
Diversity of actors
Incremental level of trust
What a chain holds

24. Data
Lake
!24
TR
TR
TR
BLOCKCHAINS Analysis
TR-SPEC TR-SPEC
Trace
reports Traceability
chains
Traces
validated
data
Data
retrieval
Analytics
dashboard
BUSINESS RULES
event
anchoring

25. + 1 level
of trust
Data
Lake
!25
TR
BLOCKCHAINS Analysis
+ supervisor
validation
BUSINESS RULES
TR
TR-SPEC TR-SPEC

26. !26
Analytics & AI
Weighting the trust
Feedback loops
Pattern matching from theoretical chains
Statistical inference from actual chains

27. !27
Fraud detection
Pharma companies
• Detection of counterfeit medications.
Governments/healthcare
• Detection of opioid/medication misuse, abuse and theft;
• Detection of inappropriate use of medications (including high cost
medication).
Insurance companies
• false claims/information by patients and providers to receive
payable benefits.

28. !28
Incentives
• Insurance companies may incentivise patient’s (data) for good
behaviour via a reward mechanism.
e.g. tokens for following a care plan or staying healthy.
• Pharma companies/medical institutions may incentivise patients
who provide data for research and clinical trials.

29. !29
4,567 steps
2 coins
cash in

30. Quæfacta
!30
We do:
• Blockchain traceability solutions in
healthcare
• AI, data acquisition and analytics
https://quaefacta.com
contact@quaefacta.com
Thank you!
May 15th, 2019