Blockchain was publicized as a solution that could revolutionize the way companies manage data and identity by increasing transparency and trust in a wide range of industries.
But what does it mean for health care and management? To answer this question, HealthTech magazine convened a group of thought leaders at the intersection of blockchain and health IT.
Our round table consisted of Jason Goldwater, senior director of the CedarBridge Group health technology consultancy firm; Tim Mackey, associate professor at the University of California, San Diego School of Medicine; Maria Palombini, Director of Development of Emerging Communities and Initiatives, Global Business Strategy and Intelligence, for the IEEE Standards Association; and Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center and editor-in-chief of Blockchain in Healthcare Today.
We talked with them about the basics of blockchain, misconceptions about the solution, cases of industry use and more.
HEALTHTECH: How do you describe the blockchain to colleagues less tech savvy?
GOLDWATER : I often describe blockchain as a modern accounting system for data minus accountants. It is based on a general accounting system that gathers information from numerous sources and updates the data when new elements are continuously being introduced.
Data is owned by everyone in the chain and no one has control on everything. It is an immutable and robust way to collect and store hundreds of thousands of data items.
MACKEY: I ask them to think about data that are related, like their digital health records, but they come from multiple sources that are not connected. Would not it be nice if everyone could access this data and agree that it was accurate and reliable ? what blockchain can do
PALOMBINI: I say: "Imagine if you had a digital safe that contains every element of your personal health profile. You can decide when, where, how, what and who do you want to share with, keeping your privacy, then use that data to get better health service Would it be interesting for you? "
HA LAMKA: I am a vegan, so I really hate to use this example, but: Imagine having a cow and making a hash of canned meat. I think you agree that it's really hard to turn hashish into a cow – is a one-way transformation . Blockchain is a decentralized public book that anyone can read and warrant the integrity of data using cryptographic one-way transformations that are unique but consistent.
Transformations are linked, each one dependent on the last one. We can prove that the data have not been modified showing that the transformed data today corresponds to the transformation made in the past.
If any part of the chain is altered, the transformations will no longer match.
HEALTHTECH: What will be The biggest impact of the blockchain on the health sector?
GOLDWATER : There will be three major impacts on the sector.
One is data of superior quality on patient care. Blockchain allows you to collect information from multiple sources – IoT devices, smartphone apps, patient portals – and send it to health care providers, who can monitor quality of care on a longitudinal basis. Suppliers will know what interventions are needed, while patients will have more control over their data.
help stimulates greater participation in patient performance performance measures, which will improve quality measurement.
The third advantage is the simplification of payments. The use of the blockchain to document several clinical meetings for each patient helps payers understand what services have been provided, allowing for easier distribution and coordination of payments.
MACKEY: Blockchain will unlock data silos of individual patient health information and give consumers ownership of their digital health identity. This, in turn, could help to inform the analysis of big data health, revolutionizing the way we conduct surveillance for risk and protective factors associated with diseases.
The potential benefits for public health are immense .
PALOMBINI: Precision medicine is based on two fundamental principles: data and science. Blockchain has the ability to move precision medicine from a common practice test concept to addressing the key challenges that surround not only the collection of patient information, but also the sharing and use needed in the art of precision medicine.
If patient-centered identity becomes a reality on the blockchain, health professionals would have a clear longitudinal view of each patient ; prognosis, treatment prevention and prevention guides would be based on validated and verified characteristics related to the patient's profile.
Blockchain would allow these data to be collected and shared in a way that protects patient privacy and keeps them as central partners in the process.
HALAMKA: Since it is a public ledger that you write and never erase, it is a perfect control track. We can use it to ensure that medical records are not altered, to ensure that clinical trials have been performed without fraud and to record consent preferences using a blockchain function called smart contracts.
The main advantage is to create trust : The information is publicly registered and can not be changed. This will benefit all ecosystem stakeholders who want to ensure data integrity.
Standard database technology can not provide that level of security. It's a perfect application for blockchain.
HEALTHTECH: What are the biggest misunderstandings that people have?
GOLDWATER : There is the fear that health service providers will become inundated with information and will never be in step with their patients, they do not realize that there are controls on what data is sent and which requires a commitment between a supplier and a patient.
MACKEY: The biggest misunderstanding is that the blockchain is bitcoin . It is difficult to distinguish between what is happening in the wild, wild west of the first coin offerings against the integration of business approaches with business blockchains.
PALOMBINI: There is a lot of hype that blockchain can solve every problem in the industry and will eliminate and xist technologies. Blockchain will not do any of those things.
At the IEEE Standards Association, we work with blockchain technologists and other stakeholders across the health ecosystem to lead consensus on technical standards that will enable the blockchain to interoperate with existing technology platforms.
In addressing the problem of the sector you want to solve, it is better to first define the use case and then decide if the blockchain is the right solution, not the other way around.
HALAMKA: People mistakenly think that it is a database, an analysis tool, a fast / scalable platform, an interoperability solution, an easy-to-use platform or that will replace electronic medical records. How many transactions at Beth Israel Deaconess do we do in our EHR? 12,000 . What is the total throughput of the blockchain today? Seven transactions per second.
Remember, the blockchain is a ledger of data integrity . It is not a database. Anyone who believes he does not understand blockchain.
HEALTHTECH: What are the strongest obstacles to adoption?
GOLDWATER : There are still a large number of providers and payers who do not understand this technology or how to apply it, and there are a large number of companies that build blockchains for use in the healthcare sector without any structure for evaluate functionality or applicability.
need to develop a set of metrics and use cases to assess whether certain blockchain solutions meet a minimum level of functionality to enhance the health enterprise.
MACKEY : Some of the biggest obstacles are familiar: privacy and policy . HIPAA and GDPR come to mind first, but more specifically the PHI with respect to consumer health information and privacy laws and regulations that affect sharing and deidentification. These factors put the healthcare industry in a single risk sector.
And do not forget that home health policy is a political minefield; the flow and uncertainty of politics make it difficult to develop solutions that fit incentives and health payments.
PALOMBINI: The biggest barrier is not technology or interoperability, its processes and protocols. The most important question we are facing is: how do we incentivize the parties who have benefited from "owners" of patient health data to renounce ownership of such data?
HALAMKA: Blockchain is not an interoperability, a telemedicine or identity management solution. The use cases for blockchain must be carefully specified so they make sense.
Blockchain is at the height of the hype curve right now. If we are not careful, it will become a meme for overpromising and underdelivery in health care.
HEALTHTECH: Will blockchain in health go mainstream? If so, when?
GOLDWATER : We are still a few years away. The problem is not really technical, it is a business and cultural .
] It is possible to develop a range of solutions, but it will be necessary to determine their applicability, effectiveness and ability to adapt to multiple providers and healthcare systems, as well as to patients and payers. For now, we have I still need to explain what this technology is, how it can be used and what the implications are.
MACKEY : In some healthcare verticals, the adoption of blockchain will happen fairly quickly For example, in the clinical trial space there are clear advantages that pharmaceutical companies and the FDA are already advancing, as better recruitment of patients, consent of participants to trials using smart contracts and ensuring the validity of clinical trial data and protocols.
In other verticals, such as the supply chain, it will be slower due to concerns about data privacy, the cost of compliance and the conflicting interests of several business partners, such as logistics service providers and manufacturers.
PALOMBINI: I do not think we will ever have 100% compliance in the health sector. Even now, some doctors do not have websites and some patients do not send emails
However, in the next two or four years, I imagine an increase in discussions
on the results of concept tests and pilot projects, as well as results of partial implementations on public blockchain projects coming out of consortia and work groups.
HALAMKA: In the coming years I think it will be widely used for audit trails management of clinical trial and tracing consensus . Practitioners can expect the blockchain to be an invisible technology implemented behind the scenes that provides greater security and information verification because practices increasingly depend on the use of digitized information.
Blockchain for health care is at the start of its life cycle, but has potential standardizes the secure exchange of data in a less onerous manner than previous approaches.
