Distributed: Health 2018: Learnings from Nashville’s Blockchain Conference
by Damon L. Davis ( @damonldavis), former Director, Health Data Initiative, Chief Technology Officer’s Office, U.S. Department of Health & Human Services
Before this week I was only vaguely familiar with blockchain technology. I mean, very few of us haven’t heard of cryptocurrencies like Bitcoin, right? Rumors I heard stated the technology has enormous potential to disrupt the healthcare industry, but I didn’t really know enough to understand how? Sure, I get the benefits of storing and accessing data in electronic health records (EHR) for health information exchange (HIE), but healthcare is so much larger than EHRs. There have to be more use cases than that, right? When I got the opportunity to learn more at the Distributed Health blockchain conference in Nashville, TN, I decided to dip my toe in the blockchain waters. The event, now in its third year, was co-hosted by BTC and Hashed Health and held at the beautiful Schermerhorn Symphony Center. I went expecting to expand my minimal knowledge on some high-level benefits of blockchain like:
- Greater transparency
- Enhanced security
- Improved traceability
- Increased efficiency and speed
- Reduced costs
By the end of the conference, my mind wasn’t just expanded, it was blown!
As a neophyte in the space, I started at square one with the “HIMSS Healthcare Blockchain 101” session. The panel of experts, David Houlding of Microsoft, Jason O’Meara of Quest Diagnostics and Jay Sales of VSP Global talked about, among other things, the basics of culture change in your organization to allow blockchain to be considered. A point that stuck with me is the need to divorce the blockchain conversation from it’s most commonly associated topic, cryptocurrencies (oops, I opened with that!). They’ve have had a mercurial performance and public opinion has similarly waxed and waned for and against them. The suggestion was for an internal culture shift to occur, the focus must be on blockchain as an emerging technology that’s redefining the value chain across myriad industries, not just financials. They underscored that there is massive potential for positive disruption in every health vertical.
Diving in a little deeper, the “Building Provider Credentialing Exchange” session gave me the first “aha!” moment with a great set of use cases. I had never considered that all of my physicians and nurses have separate credentials for every hospital and practice they serve, every insurance company they bill, and in many instances multi-state licensure where the pattern repeats itself (a doctor in Washington, D.C. might also practice in Maryland and/or Virginia). I learned a provider can have over 20+ credentials to serve in the medical profession which is a lot of individual identities to manage annually. Anthony Begando, CEO of Professional Credentials Exchange (ProCredX), pointed out blockchain’s distributed ledger power as an opportunity to have practitioner credentials updated with cascading effects across a network and infrastructure accessible to the healthcare system’s many participants.
QubeChain CEO and co-founder C. Rees Morgan II, one of Microsoft’s first software engineers and a veteran of secure software implementation with the CIA, told the audience their blockchain solution is typically implemented in mature organizations at large scale and is highly secure. He’s brought his expertise from the intelligence field to the commercial blockchain space with the highest level of security. Among the stated features of blockchain is the ability to maintain in perpetuity, reference, and build on the original data historically entered in the system. The data are stored on multiple nodes in the network even though some data elements may be very old, inaccurate and therefore, arguably, of no further use. This component of blockchain functionality is called “immutability” meaning the data can never be deleted. Morgan left the symphony hall stage with one final pitch for why his company is doing great things with the technology, “we’ve figured out how to delete data from a blockchain.”
Of course, as a newbie in an emerging technological area, I was wide-eyed and enthused for every conversation and presentation. I had an interesting convo with Dr. Brenda Lemus, Senior Associate Dean at Meharry Medical College who has spent her career developing drugs. We listened attentively at the front of the symphony hall because, like myself, she’s learning about the technology too. When I asked what her interest was, Dr. Lemus shared that the FDA is looking for the most accurate, timely information about pharmaceutical drugs at every point in the supply chain. I hadn’t contemplated that use case for blockchain, it’s capability to track specific drug lots and introduce new distribution controls.
Academic and private sector experts discussed transforming healthcare information architectures using distributed ledgers in the “Applying Blockchain to Medical Records” session. One premise is the use of application programming interface (API) management and a suite of technologies will allow health care to connect its disparate data like never before. Amanda Stranhaus from the University of Michigan moderated Nathan Cannon Chief Technology Officer at Parallon Business Performance Group, Aman Quadri Chief Strategy Officer at Amchart and Dana Zhang in Computer Science at Vanderbilt University. They had an interesting debate over whether there will be a shift from institution-based medical records to person-centered medical records based on Stranhaus’s hypothesis that as hospital systems and health provider data systems continue to hacked, data held inside of institutions may be seen as a liability. The question is will those entities want to shift the data ownership, and that liability, to the individual enabled by blockchain. The counter-argument from Cannon was the monetization of the data by those institutions is in conflict with that paradigm shift. The panel suggested the health systems will continue allowing patients to interact with and manage their data as held by the institution but that blockchain could support patient control over their data. Near the end the topic shifted and someone pointed out with desperation in their voice that neither the entire electronic health record (hundreds of pages in paper form and therefore a lot of digital information) nor personal health information (PHI) should be placed in the blockchain. As if on cue the panel underscored the point in a united chorus of voices, “please don’t do that!”
The federal government, notoriously slow to implement new technologies, was well represented by Jose Arrieta, Associate Deputy Assistant Secretary for Acquisition for the U.S. Department of Health and Human Services (HHS). Arrieta inspired the crowd with his tale of his team’s hard work on two-week human-centered design sessions to build out a blockchain system for government acquisitions. He said they didn’t take down nor take away any of the multiple existing software systems. Their goal is to allow blockchain to support those systems, pushing data to the users about vendors, contracts and prices the government has historically paid for goods and services. They’re very close to testing the system in order to obtain an authority to operate (ATO). Once an ATO is issued and the system is live, Arrieta’s team will have the first implementation of blockchain in the federal government.
Richie Etwaru, Founder & CEO of Hu-Manity gave a rousing talk on what blockchain is, what it isn’t, and where we are in the development of the technology. He likened our current spot on the timeline to where we once were with AOL chat in the early days of the internet, and we all know how far we’ve come since then. Etwaru encouraged everyone to avoid trying to understand the nerdy nitty-gritty of how blockchain functions in favor of thinking big picture about the paradigm shifts it can enable. “If you’re in a company and someone is pitching you right now that says I took the thing that you had and I put it on a blockchain… say thank you and walk away. But if someone comes to you and says we’ve created something that could not have existed before this ability [blockchain] to have agreement, at scale, between unusual participants in a network… invite them to stay.”
In “The Other Option: Patient Owned Data” George Matthew, Chief Medical Officer for DXC Technology adeptly moderated a passionate panel featuring Heather Flannery of Consensys, James Hazel from Research Fellow at Vanderbilt University, Somchai Rice, co-founder Chief Science Officer for MedBlox, Matt Sinderbrand of BetterPath, Richie Etwaru of Hu-Manity. Right off the bat Sinderbrand railed sarcastically but with conviction against the title of the panel, proclaiming patient owned data isn’t the ‘other’ option, it’s the ‘only’ option, and many of his co-panelists agreed. Their discussion points covered “patient self-sovereignty”, Flannery, having many challenging steps that must be overcome to allow patient owned data to be both ethical and scalable. Patients owning their data empowers them to be active in their own healthcare the group agreed that the onslaught of health information requires improved education directed at health care consumers in order to empower everyone. The argument was the value comes from showing a health consumer what they can do with their data that will benefit themselves. The group advocated a vision of an individual’s data as personal property from which they should directly accrue benefits and can sue an entity for their data’s misuse. When Etwaru’s expressed a need to get away from thinking about legal frameworks to focusing on market dynamics and removing data brokers, the panel appeared to unanimously agree.
The conference held a Code Camp on Wednesday with Ethereum using FitBit data. It sounded so cool, but I couldn’t stay and I would have been out of my depth. I just got out of the baby pool at this conference, I’m not ready to swim with a whale in the open ocean.
There was a consensus across Distributed Health that the level of thought and creativity about distributed ledger technologies for healthcare is maturing. I caught up with Dr. Tom Savel, Director, Informatics Innovation Unit, Center for Surveillance, Epidemiology, and Laboratory Services (CSELS) at the CDC. Chatting in the sponsor demo booth area where he admitted he also aspires to implement blockchain at the Atlanta, GA based branch of HHS. I shared that I’m new to the space but that I had learned a ton so far. His reply was, “I’ve been in tech for many years, and this [blockchain] is one of the coolest things I’ve seen.” Blockchain appears to be at the heart of a new wave of healthcare technology innovation, and I’m really excited to learn more. Thanks Distributed Health, I’ll be back for sure!
I want to thank George Mathew of DXC Technology for the opportunity to attend Distributed Health 2018.