Difficult markets, data and healthcare
The traditional healthcare market is incredibly difficult for any newcomer to break into, and is especially tough for a novel technology. In the case of blockchain, many companies have come and gone over the year including some big players like GEM who found healthcare too tough and exited the market. Many start-ups also fall into the ‘technology looking for a problem’ trap and have not focused enough on the use case.
It should be easier for the big tech giants. They are on a mission to disrupt healthcare and they have the power, the customers and the data to crack it. Apple, Amazon and Google are betting on a future where they own consumer relationships and become the preferred one-stop shop for all life services, from financial to insurance to healthcare in a new healthcare ecosystem. This will feature medical grade consumer applications in diagnostics (using, for example – Apple Watch, Amazon Echo) and therapeutics; a ‘clicks and bricks’ delivery system for enhanced patient experience and convenience; and cloud computing and artificial intelligence focused on personalised precision health.
AI will certainly make it easier to design accurate, preventative health strategies personalised around everyone’s genetic makeup. In theory, scientists and doctors should have access to a vast resource of genomic sequencing data and health records – helping them discover cures and treatments for every type of disease. However, the reality is very different, with data locked in silos, often not even digitised, and only a small proportion of people have, so far, had their genomes sequenced.
Selling and sharing data
This situation is going to change – and quickly. There are many ongoing initiatives across the globe aiming to facilitate the storage and sharing of health data. Consumer DNA testing, for example, will become more pervasive as the cost of genetic testing comes down. However, private companies will be competing against each other and creating even more data silos while deriving large profits from that data by selling it to third parties, usually without sharing the earnings with the data donor. This could stifle research and innovation and prevent medicine and healthcare moving forward at the pace it should.
The public sector can address some of these issues and support more open data approaches and data philanthropy (where data can be donated for the public good). Matt Hancock, Secretary of State for Health & Social Care, recently announced the expansion of the 100,000 Genomes Project to see 1 million whole genomes sequenced by the NHS and UK Biobank in five years, with the ambition to have 5 million people agreeing to have their genomes sequenced in the next 5 years – to help UK citizens live longer and better as a result of the insights gained from the data.
While the opportunities for public health are significant in leveraging these vast datasets, there are increasing concerns that our health data could become increasingly vulnerable. Distributed ledger technologies like blockchain are one solution to store even the most sensitive DNA and healthcare data, without fear of it being stolen or misused in a cyber attack. Google’s Deep Mind is already deploying blockchains as an audit trail to provide better protection for users’ health data used in their AI engines and to bring more transparency to their infrastructure. Machine learning algorithms can be trained to create highly personalised user models to help quickly detect real-time threats and anomalies.
Blockchain and AI
So, while blockchain and AI together can provide a stronger shield against cyber attacks; blockchain can also provide an open, shared, decentralised data layer in which AI can digest large amounts of data and all stakeholders have access to this data. This decentralised system could give people full ownership of this data, reduce the monopolistic power of the tech giants, and allow citizens to share data with anyone on their terms to enhance their wellbeing and health – for example, nutritional and fitness advice, treatment plans, genealogy, disease predisposition, and lifestyle management.
Could a decentralised approach have a chance to succeed with legacy systems, cultural and organisational barriers so firmly entrenched in current healthcare systems? Will this make any dent to the plans for the tech giants to disrupt healthcare?
The publication of The Future of Healthcare- Our Vision for Digital Data and Technology in Health and Care is an inspired move for the UK, as it sets out the commitment to open standards, secure identity and interoperability, ensuring that systems talk to each other, that data can be shared, and that the right data gets to the right place at the right time.
The recent Healthcare Unblocked 2018 conference provided a balanced forum looking at the opportunities and challenges in a pragmatic way, grounded in realism, on the opportunities for transformational change mooted in the new technology vision for the NHS.
The merits of a ‘decentralised patient centric’ system in the NHS was the focus of some discussion. Eleonora Harwich, Director of Research and Head of Digital and Tech innovation at Reform reminded us that many things need to be addressed to make this feasible, including data quality, interoperability and standards. James Somauroo, Founding Partner of HS.Live was also pragmatic about blockchain being able to solve the current ills of the NHS and stressed, ‘it doesn’t matter that it’s blockchain, AI or any other technology – buyers don’t often care what’s under the hood and with blockchain, the conversation has been very tech-led. What matters first and foremost is that you solve a problem for a customer and benefit patients to create a sustainable business. Impact comes from scale.
Dr Navin Ramachandran from UCL and a member of the IOTA foundation added that legacy systems are an ongoing barrier but a looming bigger issue is continuing to allow increasing volumes of data to reside with the big commercial data providers.
How can we redesign an entire public system to centre everything around the patient record, and where the value of data can be harnessed to help individuals as well as society? Ramachandran argued raw data should never be stored on the blockchain and requires a ‘hidden layer’ so very personal information (like genetic data) cannot be traced back to the individual. Tory Thorpe presented Accenture’s Identity Service Platform that uses biometrics to manage fingerprints, iris scans and other data for a secure decentralised digital identity.
Dr Manreet Nijjar, Co-Founder of Truu, a secure, verifiable digital identity for doctors, is also an NHS physician and knows full well the challenges of getting an innovation adopted in the ‘real world’ of the NHS, but cited the success of digital identity programmes in Canada and the Credit Unions in the USA as examples to look at.
Mohammad Tayeb, Co-Founder of Medicalchain said, ‘according to a recent study, medical errors are the third leading cause of death in the United States, and much of this relates to poor communication between doctors over patients’ needs. Medicalchain is using blockchain technology to facilitate the authenticity of medical records as well as the permissions of where they can and cannot be used. We believe that far more can be achieved if legislators pushed software vendors and hospitals/ clinics on the adoption of open standards. Many of the large software vendors out there are holding patient data ransom due to little or no open standards being used for data interoperability. In the UK alone, the NHS could save hundreds of millions each year if data was more widely accessible.
While opening up access to data through open standards and interoperability will unleash huge potential, how can AI and blockchain also work together to address heightened concerns over security, privacy and consent as well as the issue of GDPR stifling innovation? These are all issues that Hans Graux, a lawyer at Brussels based firm Timelex, says are major worries now with his current clients. He sums up, ‘there is an urgent need for a more coherent and more innovation-oriented approach among European data protection authorities to support scientific research in the health care industry. Otherwise, Europe risks missing out on important health care innovations, and these activities will simply move elsewhere.’
Humayan Sheikh, CEO of Fetch,ai, explained how his business is experimenting with autonomous ‘personal health agents’ to perform tasks such as delivering data or providing services, and are rewarded with a digital currency for their efforts — the ‘Fetch Token’. They make money on transactions and people earn money through the token, with value derived from knowledge (‘collective health intelligence’) and not data per se. People have ownership of their health agent, so NHS data would be part of their data vault for example. Fetch.ai solves the hacking problem (as there would be little incentive to hack one account) and it complies with GDPR too.
Broader consumer data
In addition to health data, we can harness wider consumer data too, with sensors increasingly embedded in all sorts of everyday objects, from connected cars to devices across the IoT. Consumer data will be generated exponentially by these devices, opening up yet more opportunities, but also constraints if data is stored in siloed, centralised databases.
Dmitry Kaminskiy, Co-Founder and Managing Partner of Deep Knowledge Ventures, invests in next generation artificial intelligence for drug discovery, biomarker development and ageing research. Insights can be gathered from DNA and other health, behavioural and consumer datasets with astonishing efficiency using AI- and all this can drive ‘smarter’ research and more personalised strategies to increase our ‘healthspan’, reduce healthcare costs for the NHS and share the benefits of longevity throughout society.
Ethical data use
Ethical use of data is a big issue. Natalie Pankova, COO of Project Shivom, is aiming to ‘democratise genomics’ and yield societal returns by creating the world’s largest platform for the secure storage and sharing of genomic data, and ensure data donors are not commercially exploited as has been the case with clinical trials companies, and particularly in the developing world. There is big money in clinical trials, but most data donors have not understood the value of their data – and a more ethical approach is needed.
This ethical approach to health was the key message of Heather Flannery, the newly appointed Health Circle Global Lead for ConsenSys Health, who also presented her vision for the ‘BiHG’ (Blockchain in Healthcare Global) initiative that is based on the IEEE standard.
The key message overall is that we need to experiment and learn in a way where incentives are aligned to deliver maximum value to the customer in an ethical way.
Blockchain on the rise
Over the past year, the number of use cases deploying blockchain has risen dramatically. Solve.Care who also presented at last year’s Healthcare Unblocked event, is a good example of how companies have identified more and more problems they can solve as more and more customers are using their platform. The Solve.Care platform is designed to simplify access to care, reduce administrative steps and burden, and simplify and speed up payments to healthcare providers. While its initial focus is on the coordination of care, Pradeep Goel, CEO, explained that the number of use cases deploying its technology to reduce friction in care has expanded to include transportation coordination, prescription management and even managing depression and loneliness. This goes way beyond medical records, consent management and micropayments most commonly cited as the obvious areas for blockchain and bodes well for the future.
Helen Disney, Founder of Unblocked, summarises: ‘Blockchain in healthcare is still a small – but nevertheless a fast growing segment of the nascent industry of blockchain being applied in sectors outside of financial services. It is encouraging to see so many companies building businesses that have both a commercial edge and a social goal of fixing many of the pains we experience in managing our own healthcare. The time is ripe to use distributed technologies to empower not just patients but also medical professionals, scientific researchers and healthcare providers all around the world.’
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