Blockchain

Tina Woods

The Future Of Health – In Blockchain We Trust?

A revolution in trust and how we work together

Trust is the foundation for business. Maintaining trust and corporate reputation is expensive, time-consuming, and often very inefficient. Blockchain technology has been hailed as a solution to protect trust, and could be a revolution in the way everyone —businesses, governments, organizations and individuals—work together.

Blockchain provides a simple, secure way to establish trust for virtually any kind of transaction, helping simplify the movement of money, products or virtually any other asset around the world. Blockchain also prevents any single company or centralized intermediary from having the power to manipulate transactions and the assets involved.

In the context of a trust economy, blockchain can be viewed as a ‘digital public ledger’ that could be used to record everything of importance using advanced cryptography and distributed programming to create a secure, transparent, immutable repository of truth. In this system, the individual—not a third party—determines what digital information is recorded in a blockchain, and how that information will be used.

As a repository of valuable data, blockchain can provide individual users with secure control over their digital identities. It can also potentially offer businesses an effective way to break down information silos and lower data management costs.

Imagine a place where individuals could safely store and manage all their assets including their driving licenses, passports, insurance policies, bank accounts, tax filings, property deeds, voting records and medical records (with full breakdown of medical, pharmaceutical and fitness regimens, and medical device or wearables usage data). Will there be day when we can have our own life management platform with our data and assets stored in one place that we share with organisations on our own terms? Almost like our own personal ‘life bank’?

There are some countries that are already using blockchain, like in Estonia, the first country in the world where citizens carry smart cards through which they can access over 1,000 online government services including viewing their health records. The Estonian eHealth records service comprises two parts. The first is a traditional database containing actual records that can accessed through a national eID card by licenced healthcare professionals, such as doctors and pharmacists, as well as citizens themselves. Every time a record is accessed or altered, the activity is logged in the blockchain, and a “keyless signature” is returned and stored next to the record. These signatures serve as an electronic timestamp which proves when changes were made, while the blockchain independently verifies who made them. The system is fully transparent- so any patient can log in and see exactly who has been viewing their records – and can even restrict access to groups of users – and any criminal or improper use of files is immediately detectable.

In other countries, like the US, where there is no national digital citizen initiative in place, there has been an explosion of blockchain-based businesses in health focused primarily around medical record and data management and supply chain tracking.

A recent Forbes article quoted IBM that about 16% of payers and providers are ready to adopt, implement and commercialise blockchain in the US. IBM along with Accenture, Hashed Health and Kaiser Permanente currently take part in the Hyperledger Healthcare Working Group to ensure steady evolution of blockchain platforms.

But there are also a number of exciting start-ups emerging, like Patientory, a blockchain-powered health information exchange on a mission to make healthcare secure by storing and managing health information in real time, with electronic medical record (EMR) interoperability and enhanced cybersecurity protocols.

BlockRx provides a blockchain-based platform that provides security, verification, distribution and decentralization across the pharmaceutical supply chain, helping pharmaceutical companies protect both their brand and patients by minimising the risk of counterfeit drugs entering the supply chain.

Another US based company, Gem, develops blockchain applications for healthcare and supply chain management. Their “Gem Healthcare Network” will add security via permissioned blockchains in which patients control access and a shared ledger system where every new change is recorded. Gem has partnered with Philips to explore how blockchain can support a “patient centric approach to healthcare” and with the Center for Disease Control (CDC) to help manage population health and disaster response operations.

Hearthy has big plans, particularly in South America. Professor Shafi Ahmed, Co-founder, says that their decentralised, open system is geared to improve health care access to everyone around the world, and equalise care regardless of income. Patients have direct access and control of their personal health records, and receive tokens or cash back on premiums when they share their data with healthcare providers and researchers (for example, in clinical trials). The system leverages its telemedicine expertise and bolts on to existing legacy systems, facilitating adoption.

These companies address the critical pain points around health data sharing and bring greater transparency and trust to the health ecosystem by supporting secure integration of care information across a range of stakeholders while protecting patients’ identity and giving insights on population health. They also allow people to decide who sees their medical records – and to know exactly who’s accessed the record, and how they may have changed the data.

A number of interesting organisations and start-ups presented new thinking at a recent event held in London, Healthcare Unblocked. Helen Disney, CEO of Unblocked, who organised the event, summarised:, “Blockchain in healthcare is still in its infancy but the unique properties of this technology have the power to transform the interaction between patients and systems to empower consumers through better sharing of medical data. It also has the potential to cut through swathes of administration and paperwork for the benefit of professionals, freeing them up to spend more time and money on patient care“.

What were the key highlights?

Navin Ramachandran gave an interesting perspective on the work he is doing via the IOTA Foundation which is aiming to create a ‘Ledger of Things’ to help accelerate the ‘Economy of Things’ or ‘Machine Economy’.

Pradeep Goel, CEO of Solve.Care, presented his view that blockchain could solve a huge problem with fraud that currently exists within the insurance system. With the challenges of interoperability as they are, his business is founded on the notion that events should be placed on the blockchain and not data per se, and has plans to use CareCoin to replace third party administration.

Imogen Bunyard at Qadre and Raja Sharif at Farma Trust offered interesting views on how blockchain can help prevent counterfeiting in the pharma supply chain, and build trust in the system.

Robomed Network is a start-up focussed on “value-based care” using its own smart contract system that pays on achievement of outcome for the patients- drawing on clinical guidelines to equalise care and remove inefficiencies between countries.

Iryo is a global participatory health ecosystem that rewards patients with tokens (that can be monetised) for sharing data. Only fully encrypted data is stored, and the system can only be accessed with a “key” belonging to the patient- giving them full control over access.

Zenome, is a decentralized market of genomic data and services to promote personalised medicine but with citizens in control of their genomic data – this represents a complete departure from the business model established with 23andme, that leverages the value of personal data to drive its revenue.

These start-ups all point to the tremendous potential of blockchain technology to empower patients by giving them control and ownership of their own data, including monetizing this data on their own terms.

But the “human” side of blockchain still needs to be addressed to really get people to trust these new token systems. And this is where the convergence of blockchain, virtual reality and artificial intelligence creates powerful new ways to ‘humanise the blockchain’.

How? Mark Stephen Meadows, CEO of Silicon Valley based firm Botanic Technologies , explains the thinking behind conversational interfaces that ‘understand, respond, take action and build trust at scale using trusted multimodal bots’. Knowing what people think is valuable, and the more private, the more valuable. Voice contains far more personal, private, and valuable data than text, which is why voice assistants, like Alexa and Google Home, are creating such excitement and is one of the reasons bots hold such promise.

Bots allow a conversation with an enormous richness of data, and the more we listen to bots, the more knowledge we gain. Meadows says, “Bots engender a greater sense of trust with people and research shows that 85% of patients would prefer to interact with a conversational interface than a doctor”.

End user data is the most valuable resource on the planet, and in Meadows calculation, “our data that we currently share for free to Google and Facebook is worth about $300/month. Blockchain technology allows this data to be owned by citizens rather than given way for free, and could also help remunerate the user and redistribute the value of personal data more widely in society.”

Mark argues that to grow a fair data economy we need an open source approach where a broad range of companies (and not just the tech giants) can access the data and intellectual property needed to build AI systems and bots. User privacy needs to be built into this ecosystem and those users willing to exchange their personal data with AI platforms should be rewarded for doing so. This is behind Botanic’s plans to license its Intellectual Property to a not-for-profit Foundation known as ‘Seed Vault Ltd.’, which is seeking to build an open AI ecosystem where access to AI is open to everyone and users can own tokens as a reward mechanism and token of utility within the system.

Could ‘bots on blockchain’ really be more trusted than doctors? Could blockchain hold the key to a whole new trusted and more equitable economy in health? These are important questions at a time when citizens and businesses are increasingly cognisant of the value of data and citizen rights with General Data Protection Regulations (GDPR) coming into force in May 2018- and with increasing anxieties over the power of the tech giants.

Only the future will tell. But leading Silicon Valley technology investor Andreessen Horowitz is right now investing more in blockchain than any other technology, so that gives a clue to its potential.

Tina Woods is founder of Collider Health, a health innovation catalyst that works with organisations to think and do differently and transform health with meaningful impact. She also heads up the Future Health Collective, a cross-industry, interdisciplinary group to foster collaboration and radical innovation in areas of unmet need in health and social care.