There is much talk of how Blockchain will revolutionize healthcare. This hype must be tempered by the fact that healthcare already has a trust factor built-in, or patients would not take pills prescribed by doctors, or let providers stick needles in their bodies. It is often said that “Riches are in Niches,” and this is the case for blockchain and areas that are tangential to the direct care of the patient.As referenced in the 2015 ONC Interoperability Roadmap, Social Determinants of Health (SDoH) will need to be connected to the patients’ health status. Physicians currently monitor carboxyhemoglobin as an indicator of a patient’s level of smoking. As part of a smoking cessation program, a smart contract on the clinical Blockchain could identify normal blood carboxyhemoglobin (COhb) as reported by a clinical reference lab from the Laboratory Analyzer Blockchain and execute a request to increase an incentive benefit controlled by a “private / permissioned” USDA Clinical Blockchain. The clinical Blockchain will track the specific “chain of custody” from iStat Analyzer (Accriva, Radiometer, etc…) to the patient test results report, which triggers the smart contract with the USDA to distribute an incentive. Both the physician and the patient are notified of the disbursement. Similar use cases could be implemented for patients with diabetes, and obesity, helping people live healthy lives.

1. Blockchain: SDoH and Rare Disease Use Cases
Funding, Intellectual Property, and Opportunities
Healthcare Blockchain Summit
Washington, DC
March 21, 2017

2. Blockchain: SDoH / Rare Disease Panel
After an accident in 2014, I did
not know or could not
remember all of the different
HCPs, doctors, an groups that I
spoke with about my health
status.
I still do not know.
Can a blockchain ledger help?

3. Clinical Systems 25 Years Ago and Today

4. Incentives
• Satoshi Paid Miners
• We may have to pay patients.

5. Blockchain: SDoH / Rare Disease Panel
• Edward Bukstel
• Shereese Maynard, MS/MBA
• Joe Guagliardo
• Nina Kilbride

6. Internet of Things
Telemedicine
AI / Machine Learning
Sharing Culture Driving Innovation –
Open Data Initiatives
DLT won't replace healthcare infrastructure
(in the near future)
Joe Guagliardo
Technology and Blockchain Practice
@ joeg_techchain
Why the time is right …

7. Why now?
Interoperability – Data and Technology
What is consensus on the private or
semi-private blockchain?
Unstructured Data v Structured Data
(“Smart” Data) Ownership
“Smaller”, discrete problem, but
what's the business model?
Other Legal, Regulatory, Ethical
Challenges

8. Financial Inclusion Analogy
Verified Transparency – Access to “Rare” Data
Storage Medium v New Class of “Assets”
(rewards)
Population Health
The Social Impact

9. • Transaction costs would
be reduced, attributable
to disintermediation, as
well as near-real time
processing. This is a
lean strategy- making
system more efficient.
What keeps us up at night? Opportunity for Blockchain
Given low transaction
volumes, this reduces
business case for central
systems or new edge
networks for participating
provider organizations
Cost Per
Transaction

10. Population Health Data
What keeps us up at night? Blockchain Opportunities
• Limited access to
data
• Available data not
actionable
• Distributed, wide
access to patient
longitudinal health
data across the
distributed ledger

11. Interoperability and Waste
What keeps us up at night? Blockchain Opportunities
• Interoperability is a study in
futility, especially if cross-
state HIEs are allowed,
because records are not
compatible across systems
• Inconsistent permissions
inhibit the health
organizations and
exchanges from accessing
the right patient data at the
right time.
• Shared data would enable
near real time updates
across network to all
parties.
• Smart contracts create a
consistent, rule-based
method for accessing
patient data that is
permissioned to authorized
health organizations

12. A blockchain-enabled health information
exchange could be the answer to unlocking
true interoperability. Blockchain-based
systems have the potential to drastically
reduce costs, eliminate friction and
associated waste, and reduce the costs of
current intermediaries. These ideas support a
more patient-centered system structure.