[Malta Blockchain Summit 2018] — Applying Blockchain to face the challenges in Healthcare

For the last couple of years, there has been a huge buzz around the technology called “Blockchain”. Many people compare such hype to the famous Dotcom Bubble happened in the late 90’s — the irrational run-up of speculative investments on Internet-related stocks from 1995 to 2000 following the genesis of the World Wide Web alongside with the Commercialisation of the Internet. The resulting overinvestment formed a bubble and led to the Dotcom Crash, leading the collapse of companies with a multi-million valuations. Now we hear the same about the projects and the whole sphere around cryptocurrency, binding this with a technology that brought us it — Blockchain (Distributed Ledger Technology, further DLT). 
The history is cyclical, so if we look back to what people are comparing Blockchain tech, we will see that Dotcom Crash brought not only the disappearance of companies but an acceleration to the technological development and the place for companies applying the Internet to bring the real value and changing the world we live in. As I hope the same would be applied to Blockchain tech and the value it can bring to a variety of industries — as an example to Healthcare.

November 2, 2018, Malta Blockchain Summit gathered around 8500 participants as well as a Technology Pitch with hundreds of investors. Malta Blockchain Summit is one of the largest events devoted to blockchain innovation. Among hundreds of booths, pitches, and talks regarding crypto, for the first time, such a big blockchain event hosted an all-day roundtable and panel discussion session about the DLT application in Healthcare. I was invited to give a talk on the experience of designing the architecture for data management, analytics, validation, and storage powered by Blockchain and AI at Longenesis. In the next blog posts, I will tell more about Longenesis project both from the technical and ecosystem vision perspective, but here I would like to briefly summarise the day-long roundtable on DLT application in Healthcare.

Main reason to organize the session was not only to gather people from around the globe — stakeholders, academics and industry representatives but also to show that Blockchain means much more than application in FinTech and mining coins — it is about bringing the changes to the classical way of how we treat the data, giving the hidden value of it to the stakeholders.

Delegates of the roundtable session on DLT application in Healthcare

14 delegates gathered in the Executive Boardroom of Malta on Friday morning, starting with the Quickfire presentations of their projects and experience that would like to share with other participants.

An impressive part of delegates was represented by the University of Malta and Maltese governmental institutions (Ministry of Healthcare). It is amazing how Malta is tackling the emerging technology on the governmental level, by introducing tech-friendly legislation for Gaming, AI and Blockchain companies, to the level of interest among the researchers, clinics, and industry.

One of the initiatives that were presented was the project from Maltese BioBank willing to launch a project that would organize cohorts from approx. 1% of Maltese population engaged in sharing their genome + other health data for 10 years. In parallel with that, it is proposed to do the data harvesting from all the Maltese newborns, forming the BioBank with a national-level dataset used for accelerating the healthcare ecosystem on Malta.

“Blockchain is already added to the “Malta Digital Strategy” for the next 5 years so our intention today is to understand the DLT from an industry-specific perspective and to show the value proposition to healthcare industry stakeholders.” 
— Dr. Hugo Muscat, Consultant at Ministry of Healthcare of Malta.

Biobank representatives from the University of Malta are now working with the government on the regulatory process, at this moment having data on 
10 000 cancer cases in the scope of EU Biobank initiative, and are planning to launch the project very soon. Such an initiative should be well treated and taken as an example of tech integration for other countries.

One of the most inspirational speakers for me was Dr. Alex Cahana from CryptoOracle where he did a due diligence of approx. 200 Whitepapers of Blockchain Healthcare projects. He made a brilliant parallel with the lesson learned from the Military Duty (apart from his work experience in the medical sphere) describing the architecture of decentralized systems:

“You're not as good on your own as together in the team.”
- Dr. Alex Cahana

It seemed clear, that the companies should stop putting the word “Blockchain” as a flagman in the first place. It is not about the name of technology, it is about the problems we are about to solve. Read more about this on CoinTelegraph: https://cointelegraph.com/news/report-companies-dropping-the-term-blockchain-due-to-hype-around-technology

What value can be brought to the stakeholders? Patients may benefit from giving detailed trends and defining the risk factors for the state of health and also giving the control over their own data and providing a transparent way to ensure the level of trust of how the data is being used. From another side, clinics may benefit from an ability to have aggregated and validated sets of data and conduct a more effective patient management, having a traceable audit of receiving consents from patients for using the data.


Trends and challenges

Below is the short summary of the trends and challenges of applying Blockchain systems (may not only relate to Blockchain-based systems) gathered from the Delegates of the roundtable.

  • Keeping permissions:
    one of the most popular value proposition for the Blockchain-based systems is an ability to store the permissions — a consent of the user/data owner/patient to give/grant access to the health data for a certain entity (e.g. clinic, doctor, Pharma etc.). Blockchain can give us an opportunity for a traceable audit, meaning that it is possible to “look back” and state at what time, for which data units, whom and for what purposes patient/data owner granted/refused the access, providing a step forward to regulation of the health data management.
  • GDPR compliance:
    Blockchain startups often use the term “data is being stored on Blockchain” which gives a stereotype of using the Blockchain as an actual Data storage system, which is not true due to the architectural specificity of the tech (it is much more convenient, faster and secure to use traditional data storages for that). Platforms use the combination of the data storage and blockchain database for storing the transactions, often consisting of the timestamps, hashes and meta-data. Due to the enormous buzz around the Data protection regulation (GDPR), people start to get confused how the “immutable can suddenly become mutable” if the person/patient initiates the data deletion from the system. Without any changes to the transactions (“immutable stays immutable”) Still Blockchain enables the systems to be regulatory compliant by designing the specific transactions for removing the data from the platform, giving a patient rights to see the whole history of data usage (in addition to that showing the purpose and time of use). Since the transactions store the hashes of the public key (basically the address of the wallet) you may anonymise that, so this is not leading straight to a person showing his name, surname and other personal data without receiving his consent on that.
Link to the course on GDPR by Uni of Groningen, NL 
(kudos to Alexander Zhebrak for sharing this link with me): https://www.rug.nl/rechten/news/archief/2017/university-of-groningen-offers-online-course-about-the-eu-general-data-protection-regulation?lang=en
  • Identity provision:
    one of the challenges addressed during the roundtable was an ability to identify the user in the platform in order to grant certain functionality based on his professional background/role on the platform. Such functionality would give an opportunity to identify whether the health provider is certified to work with certain type of data, identify research specialists or clinicians by storing their professional certificates using Blockchain.
  • Security:
    one of the values often proposed by the Blockchain startups is that Distributed Ledger Technology provides security for the system and data stored on it. Frankly speaking, this is not quite correct, since technology gives an ability to make the operations with data immutable (this also can be corrupted if the system is not well protected), but this has nothing to do with the risk (e.g. data leak) on one of the system's OSI levels (e.g. cloud-based data storage or network layer vulnerabilities etc.). The system should be protected not only with an immutable audit to store the operations such as patient's consents, data upload, deletion etc., but it should be addressed as a complex problem on a variety of levels. So the challenge to face is how can we ensure a security of the system on multiple layers to provide a level of trust to the patients, clinics as well as to other stakeholders.
  • Changing the classical term “donor”:
    this issue differs from the above-mentioned since it is not a technical level challenge, however it is as important as the previous ones. This challenge was brought to the participants of the roundtable by the representatives of the University of Malta and the Malta Biobank. People willing to share their biological material/data are traditionally called “donors”, but is it a right way to treat people committed to bring value to research and industry development? Would changing the term to something different such as “participant”, “research partner” etc. would help to accelerate the relationship development and more proactive involvement of people into such ecosystems?
  • What is the role of the government in the decentralised healthcare ecosystem? 
    When we speak about the decentralised ecosystems, we often think of avoiding the governmental institutions as a symbol of the “centralised management”. It may work in some of the cases, but what is the right way to go when we speak about healthcare? In most of the countries healthcare policy is being proposed, formed and executed by governmental institutions, including state hospitals, so avoiding such important stakeholder does not sound correctly and wise, also in the scope of the technology adoption on a national level. The question of the role of the stakeholders still sounds opened to me (I will leave this as an open question here...), but it is inevitable that the roles should be adapted in a way to give the transparency to the processes happening in the ecosystem, driving the development of the healthcare industry and preventive healthcare methodologies on the level of a certain patient/group of patients. As the result, such synergy may bring us more prosperity and effectiveness in healthcare process management.
  • Growing role of patients:
    A new paradigm is coming into view for healthcare, highly tech-driven, yet at the same time better suited to the individualised needs of each patient. It is clear that healthcare transforms to be patient-centric [2]. One of the challenges to be addressed while developing the systems, is building long-lasting relationships between patients, doctors and Pharma and using this to transform the patients involvement to the pro-active model by sharing various data points to be correlated with an aim to open “a black box” (a black box describes the classical way of diagnostics — doctor can examine the patient state of health inside the clinical facility, but what happens to the patient when he leaves the building? How this data can be applied for driving the preventive healthcare and bringing additional value for diagnostics and search for health trends among the group of patients for a healthcare provider?).
  • Bringing value and meaning with the data to the patient:
    as touched above, having the information about the patient state of health from variety of aspects, while the patient is outside the clinical facility, would help the health specialists “open the black box” and make diagnostics based on the “more detailed picture”. Nevertheless, this is not the only component of the success potion. We learned how to harvest the data to get more about the patient vital signs, emotional, activity data etc. (we will learn how to get even more data in the nearest future), but what happens if we just give all the harvested data straight to the health specialist or a patient? This might be the same as to throw someone in the ocean or leave in the middle of the downtown in a rush hour — there is so much noise that is would be quite a complex task to understand and choose the data points that matters. It is important not just to show the harvested data, but to understand what data, at what point of time and in what form of communication needs to be shown to the patient/health specialist.
  • Providing incentive to patients and clinicians:
    if you go to Healthcare Blockchain startups pitches, you will often hear that their value proposition is the following: “we will make the patient healthier”. The same goes for doctors: “doctors would benefit from this solution”. The thing is — no patient will become healthier by just uploading his data to the platform and seeing that in a visualised form. This might be a long-term aim (see the Maltese BioBank initiative above), but the clear pains and both short- and long-term benefits should be set for the stakeholders entering the platform. If we take the doctor, his incentives and specificity of profession may be at least partially defined with these points: effective management of patients, compliance (not to get into trouble because of the new system), getting compensated for their job, and in general — to be a successful professional. So, if you are about to pitch your project, do consider the above-mentioned and define a clear, reachable value proposition when targeting the stakeholders.

So, what’s next?
It does not end on the one-day-long Roundtable. The delegates plan is to make a strong community, including industry professionals to drive the value of the technology to the healthcare industry and its stakeholders. If you are interested in joining us, PM me for more details. :)


References

[1]: “What is the dot-com bubble?”, Quora. Available: https://www.quora.com/What-was-the-dot-com-bubble

[2]:Imagining a Doctor who is always in”, by Kaveh Safavi, Senior Managing Director, Health Industry, Accenture. Oct 16, 2017. Available: https://www.accenture.com/us-en/blogs/blogs-imagining-doctor-who-is-always-in