Saving lives Block by Block

Our interview with Dr. Alex Antoniou, Co-founder of BlockMedx, is out (iTunes, Google Play, and Stitcher)! Alex is the Chief Medical Officer and Director of Strategy at BlockMedx, a blockchain startup that is building:

“A secure, compliant, end-to-end e-prescribing solution for transmitting controlled drug prescriptions, creating a new incentive economy between physicians, pharmacists, patients, insurances and authorities in order to combat the opioid crisis, improve health outcomes, and save lives.”

How did you go from medical training in Baltimore into the world of digital tokens and blockchain startups?

When I started my clinical training back in 2008, most hospitals didn’t have Electronic Medical Records. If patients want to see their X-ray results, they need to go the hospital to see their imaging results. I started to use my spare time to learn coding and, more importantly, exposed myself to health informatics through a fellowship. With those technical skillsets, I was able to create a workflow where patients can securely send their imaging copies electronically, instead of storing them on a disk.

After gaining more data analytic skills at the Johns Hopkins Carey Business School where I learned Natural Language Processing (NLP) and Machine Learning, I joined McKinsey as a healthcare consultant. I traveled around the country to help clients solve complex problems. During this process, I learned inefficiency with which the stakeholders operate within the system. This inefficiency extended beyond hospitals into insurance plans and other stakeholders.

Then I started to look at how blockchain can be used for hospital Revenue Cycle Management and health insurance models. I was fascinated by idea of using blockchain to solve the healthcare conundrums.

Michael Brunner and I put our heads together since we’re both healthcare providers trying to prevent opioid abuse. We discussed how blockchain tech can solve the issue in our existing prescription drug system. There was a focus on the lack of utilization and scalability of healthcare data. We agree that blockchain could be used as a solution to not only treating the opioid epidemic, but also preventing it. So we created a pitch deck for BlockMedx, which is now a startup based in Austin, Texas.

Does your focus on the opioid epidemic originate from personal or professional experience?

The economic and social costs of this epidemic are staggering. $75 billion a year, 30 billion a year being direct healthcare cost.The mortality rate of opioid epidemic has been increasing by more than a decade.

More than half of 65,000 opioid addiction related deaths can be attributed to drugs prescribed by doctors. If nothing is done to stop this crisis, more than half a million will die in the next decade.

We’re squarely focused on this application or use case because Michael and I are both practitioners who have witnessed the social impact of this epidemic.

An incentivized economy is about network effect. BlockMedx uses MDX tokens to facilitate and incentive stakeholder behaviors within the ecosystem. How do you convince healthcare institutions & practitioners to accept MDX tokens?

It’s important that our healthcare system can change patient behaviors without creating administrative burden and prohibitive cost. BlockMedx is based on a public blockchain with smart contracts that automate the payment processes between payers and providers, thereby encouraging patients to adopt health improving behavior.

Patients are rewarded with MDX tokens which can be used to pay for telehealth visits, in person visits, or redeem pharmacy rebates, without having to incurring expense by going through a 3rd party payment system.

Although literature shows that this mechanism can change patient behaviors, it hasn’t been applied in the real world until now. We’re connecting doctors, pharmacies, regulators, patients by putting them all on the same network. Therefore, there‘s a strong incentive to make sure their interest are aligned by using the tokens and smart contract technologies.

In terms of frictions, we foresee the volatility of cryptocurrencies to be an issue that could drive traditional institutions away from the platform. To combat the volatility, we proposed to create a wallet for providers which converts fiat to MDX every time a transaction happens at the market rate, as opposed to buying all the MDX tokens all at once.

The public blockchain will record the transactions when a smart contract is executed- it does not require trust. This would reduce the friction created by needing a intermediary to verify the validity of a fiat-based transaction. Therefore, this would help patient engagement and improve medication adherence for a $300 billion market.

What is the learning process for users? Is there a web app or portal to access BlockMedx?

The simple answer: users will not see the blockchain- it will happen only the background. Patients will use a streamlined mobile app with a wallet which is easy to use. They won’t have to memorize the private key of the wall every time they access it.

How do patients securely manage & control their data in big data age? What technologies is BlockMedx going to use to secure the data?

Health Insurance Portability and Accountability Act (HIPAA) places requirements on the specific data elements that can be used to identify a patient in healthcare data. Some technologies have been developed to securely transfer data (in this case prescriptions) from doctors to patients. That includes a second layer solution on identity management, which is a hot topic in not healthcare but also blockchain. Under the current legacy system, patients have access to their medical records, but don’t have control over it.

Meanwhile, hospitals and doctors rely on the existing EMR solutions to store their version of the healthcare data which is not accessible to patients. The idea to put all healthcare data on blockchain as a single source of truth for both doctors and patients would be revolutionary. This would reduce administrative burden eventually. However we’re not there yet.

We’ll meet HIPAA requirements while developing a decentralized identity management system to protect the user identify issue for doctors as an extra layer of security. BlockMedx allows identity management across institutions to take place right away so that doctors can start prescribing.

A decentralized identity management solution on the blockchain gives us interoperability. Once the identity is confirmed on one chain, it can be applied across all other chains.

What are the data sources for BlockMedx? Public, private or mixed?

We have access to medical school data from the University of Texas in Austin, in addition to some other data sources such as state level prescription drug monitoring database, which has all prescriptions in the past 2 years with only 3 day delay.

We’re also looking into federal government data sources made available by CMS. Alternatively, it is possible to buy claims data from private data vendors such as IBM for 80 million patients in the U.S. .

Looking ahead, what are some of the biggest challenges BlockMedx will be facing?

Scalability and transaction cost. BlockMedx is looking to expand its footprint outside U.S. to the healthcare systems around the world. This means it will need to process millions of healthcare records on the blockchain. Engineers are using Sharding and other solutions to solve scalability issues. The idea is to batch the transactions on a local node before sending to the blockchain, in order to lower cost.

Looking ahead on our road map: we have established partnership with a major blockchain protocol to take advantage of their security features. More the come but the announcement will come soon! (Editor note: Shortly after the interview, Wanchain announced partnership with BlockMedx as one of its incubator projects)

How to get into this space as a newcomer?

You can start as an intern or contractor for a company, or start a company yourself. Currently at BlockMedx, we have writers, engineers, business development opportunities for folks who are new to the space. There are many more opportunities out there. The ratio of blockchain engineer job postings to candidates is a stagger 80:1.

Here in Austin, we have a strong blockchain community where we support each other regardless of the products we are building. We all want the community to be successful.

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Hosted by: Dang Du, Yidu Wang
Show Notes Writer: Yidu Wang

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