This document provides an overview of distributed ledger technology applications in healthcare. It discusses using blockchain to improve value and outcomes in health research by more efficiently allocating research funds and facilitating data sharing between researchers. It proposes a system called Value Based Health Research that would standardize and analyze research administration data using blockchain to speed up the research process and better link research funding to health outcomes. The document also provides a top 10 list of blockchain events in healthcare in 2018.

1. DISTRIBUTED LEDGER TECH
APPLICATIONS - HEALTH
DLTA-H Report – Volume 1, Issue 12; 31 Dec 2018
(contact: info@sciencedistributed.com)
WELCOME
Welcome to the DLTA-H Report. This is the next phase of the weekly newsletter Blockchain Healthcare SITREP that ran
from Jul 2017 – Jul 2018 (archives here). The DLTA-H Report is news, events, commentary, and more relating to the
application of blockchain/DLT to improve value and outcomes in health and research.
~ Sean Manion, PhD - CEO Science Distributed
Value Based Health Research by Sean Manion
It is 2025 and the use of sonic weapons on and off the battlefield has led to a rapid increase in associated health related
issues resembling mild traumatic brain injury (TBI). The U.S. military sees parallels in this medical problem to the
rapid increase in blast-related TBI and other post-deployment issues in the early 2000s. The exposure of high numbers
of U.S. citizens to similar technology by U.S. law enforcement as part of standard crowd-control efforts has made the
issue even more widespread.
Congress allocates $1 Billion in funds to provide evidence-based solutions. You are trying to determine how to most
effectively allocate these funds for a rapid improvement in outcomes. Where do you begin?
How much is managed by the Department of Defense (DoD), Veterans Affairs (VA), Health & Human Services (HHS),
and others? How much is spent on intramural versus extramural research? How much money is managed through
Federal Acquisition Regulation (FAR) governed procurement (i.e. contracts) compared to non-FAR mechanisms (i.e.
grants, cooperative agreements, other transactions)? Should more money be given to academic or industry research?
How much focus should be on prevention, acute care, chronic treatment, rehabilitation, and other areas? How much
pre-clinical research needs to be done? Is it important to standardize pre-clinical models or try different models? Are the
current approaches to research administration effective or do we need a new approach(es)? What is the optimal risk
stratification profile for the research investment portfolio across the short, mid, and long term?
These aren’t new questions. They outline the challenges of health research administration across U.S. government
agencies managing hundreds of billions in research dollars every year. Administrators of efforts like the HHS Cancer
Moonshot that receive bolus doses of funding have very compressed time to make many of these decisions. In FY2007/08
Congress gave the DoD $300 million to focus on TBI and psych health research. This was a real challenge because of the
procurement rules in place. These limitations led to execution of those funds in a rapid scaling of known mechanisms. The
results were not optimal. I did some post-hoc analysis comparing the effectiveness of this approach to other DoD/VA
programs. The results were surprising. Sometimes the administratively easy solutions are not the most effective for
maximizing research impact and improving health outcomes.
There are dozens of competing, collaborating, and interlocking programs across federal agencies for TBI. Tracking down,
accessing, standardizing, and analyzing relevant administrative and research information was difficult. It took me months
to scratch the surface using data across multiple walled legacy systems. Aligning it with health outcomes data and
establishing attribution percentages for research impact was an uphill rock climb I didn’t get to finish. Doing this at the
scale of all federally funded research across the span of research impact (17yrs bench to bedside) seems next to impossible
given the much shorter budget cycles, leadership tenures, and attention spans involved.
How do we compress administrative analysis time by 10x or more? How do we facilitate data sharing at the operational
level? How do we standardize the admin data and provide trust in its provenance?
HHS has begun sprouting the seeds of a solution with the application of blockchain/distributed ledger technology and
machine learning applied to procurement data. The Accelerate Initiative, which recently received its authority to operate,
allows the peer-to-peer sharing, search, and structured analyses via “microservices” of procurement data across 20,000
HHS purchasing managers. What used to take months using only centralized legacy databases, now happens in seconds.
The impact is optimized government purchasing using real-time procurement history data, configured for specific contract
variables, at the fingertips of the buyers. This will speed purchasing, relieve healthcare providers and researchers of
administrative burden, and save millions of dollars.

2. This approach can be applied to research and research administration in a system I call Value Based Health Research. It
will allow for rapid, objective strategic decision-making by senior officials tying previous research funding to health
outcomes. It will allow operational research program managers the ability to access and utilize federal research
administrative data that is most relevant to their mission requirement and constraints. At the tactical level it will speed up
administrative and regulatory processes, allow more rapid peer-to-peer data sharing among researchers while maintaining
individual research contribution tracking, and tie research impact to health outcomes in ways not previously feasible.
It won’t be easy. The technical challenges are small, but the human challenges are significant. Cross agency collaboration
is critical and requires senior level education, awareness, and sign-off. Modifying the Accelerate program’s successes to
more complex research admin data will take time, effort, and resources. Applications in the areas across the phases of
research will take multiple early pilots.
The impact of this will be huge. It will more rapidly and accurately advance treatment to improve health outcomes. It will
improve military readiness. It will spend taxpayer dollars more responsibly. It will save money. It will improve the quality
of life for many. It will save lives.
BLOCKCHAIN EVENTS – TOP TEN OF 2018
#10 - American Council for Technology - Industry Advisory Council (ACT-IAC) "Blockchain Forum" (DC) - A
great array of content across govt and industry. Many of the talks (including mine) are available on youtube.
#9 - NODE.Health "Digital Medicine Conference" (NYC) - Blockchain in Healthcare Global ("BiHG") - IEEE
ISTO hosted a Blockchain Bootcamp for Providers. It was the interaction with the broader health community at this event
that made it added value.
#8 - American University - Kogod School of Business "Blockchain Forum" (DC) - Brilliant kick-off to AU's new
Blockchain Hub. A wide range of content with some specific focus on health applications globally.
#7 - Blockchain in Healthcare East at University of DC - An in-depth dive into a variety of less explored blockchain
application areas including Military and Veterans health, protein folding, and blockchain readiness rating systems.
#6 - The Center for Business Innovation (TCBI) 2nd Annual Healthcare Blockchain Summit (Boston) - Where it all
started for me in 2017. 2018 did not disappoint. Brilliant speakers and great developments between sessions.
#5 - Blockchain and Health Science Research Symposium at Georgetown University - Co-host by Gilles Hilary, my
Science Distributed partners and I delivered a free, first of its kind day long training for students, researchers, faculty,
and admins along with science publishing and industry partners.
#4 Converge2Xcelerate (NYC) - Tory Cenaj and her Partners In Digital Health brought an amazing array of
innovative talks, debates, pitch contest, and more. Best part is that the whole thing was recorded and is available as a
podcast issue of Blockchain in Healthcare Today.
#3 Blockchain in Healthcare Global ("BiHG") - IEEE ISTO Free Webinar/Meetup events. This webinar series has
highlighted dozens of the top people and organizations throughout 2018. This always free forum goes in-depth with 2hr
interactive audience sessions with blockchain in healthcare practitioners and thought leaders across healthcare
applications with facilitation by the brilliant Heather Flannery of ConsenSys Health. Archives available, and continuing
top speed into 2019 (next up @SimplyVital Health on 11 Jan), you can sign up with one-time registration.
#2 Distributed Health, Nashville, TN. This was the 3rd annual DH event from BTC Media Group along with John
Bass and the team from Hashed Health. A tremendous array of speakers from industry, government, and academia.
Demos, hack-a-thons, code camps, big announcements, visionary thought leadership, and practical applications from
companies big and small all took the historic stage at the Nashville Symphony Center. This was the first big blockchain
and healthcare conference in 2016 and still leads the way. If you want to see the edge of innovation beautifully executed,
this is where to go.
#1 Blockchain in Healthcare Summit, MATTER/UIC, Chicago, IL. Held at MATTER in Chicago and designed by the
University of Illinois at Chicago Clinical Informatics Fellows, this was the perfect balance of big meeting focus and
small meeting quality content. It was one of the most provider/researcher focused meetings I attended in 2018, truly
getting the message outside of the blockchain bubble. From big picture to pilots, this had everything: academia and real-
world clinical application, representation by industry big and small, NGO broad vision in the beautiful MATTER facilities,
military and other federal focus (including my own talk on FITBIR applications), yet small enough with enough social time
to interact with most of the audience.