The Good, The Bad and the Ugly in CryptoHealth Solutions
According to ICO bench, almost 100(!) healthcare-related companies are either launching or planning to launch an ICO from now to summer 2018. From virtual TeleHealth services and self-sovereign electronic health records (EHRs), to fully-stacked patient engagement platforms, P2P payments and data-exchange markets, all of these solutions are trying to fix our healthcare system. And when taking into account blockchain solutions built for Artificial Intelligence (AI), big data, Virtual Reality (VR), software and finance, all plausibly useful in healthcare, there are probably more than 250 potential companies ready to disrupt the field.
The Good - our intentions
Even Crypto-enthusiasts understand that our Healthcare System is really, really, really broken
There are many problems with US healthcare system (not enough professionals, lack of access, fragmentation, inconsistent care, high cost) and we can sum them in this graph or in 6 words: we pay more and die younger.
So naturally many of us want to fix this and despite the myriad of solutions available (like here, here, here and here), the crypto community is convinced that blockchain technology will have a de-novo transformative impact on healthcare. That through its distributed databases; computational logic; peer-to-peer transmission; transparency with pseudonymity; and immutability of records we will change the way we do things.
The Bad - our planning
Most companies want to ‘boil the ocean’ and it simply won’t work
In the Israeli military I was taught OODA (observe-orient-decide-act) and after reading a few dozen crypto-health white papers and speaking to many of the authors, I decided to act and warn that our good intentions to fix healthcare are standing in our way to plan viable token economies.
In other words:
“Everyone, it’s too ambitious. It won’t work”.
For example, below is a “simple” traditional one-dimensional patient-provider EHR ecosystem. Already you can see how elaborate it is. Although theoretically it makes perfect sense, in practice it generates a level of friction and complexity that make EHRs often non-intuitive, expensive and disruptive (and not in a good way) to the point that nowadays:
“Primary care physicians spend more time working in the EHR than they spend in face-to-face time with patients in clinic visits”. (Family Medicine 2018)
Can you imagine how complicated this will become if we add revenue cycle, drug and supply chain, and medical device IoT data into the fray? Maybe not as complicated as the Health and Human Services (HHS) org chart, but still pretty complex. (I will write about the politics of eco-change in healthcare in a future post).
The Ugly - our pride
Be careful of presuppositions a.k.a ‘baked assumptions’
Many crypto-enthusiasts say to me: “Doctor, these hospital executives, they just don’t get it!”
Maybe.
But when I hear that I also recall the wise words of my staff sergeant saying:
“Do not assume your subordinates are lazy or your commanders are dumb!” (Sgt. Abergil, 1982)
In other words, the need for a pre-supposition-less stance (also known in phenomenology as bracketing or Epoché [pronounced epo-khē]) is not an exercise in humility or politeness, but rather a conscious effort to maintain the integrity of our intellectual framework. Without the ability to suspend our hypothesis and see things as they are many times we simply build a solution looking for a problem, or worse - build a solution for a non-problem. Let’s face it, not everything can, will or should be tokenized.
For example, do not assume EHR’s save money. They don’t.
Don’t pre-suppose that the health outcome of patients is linearly dependent on the quality of the care provided. Turns out this ‘baked assumption’ is wrong, especially in chronic diseases like diabetes, obesity, heart disease, chronic pain, addiction and mental health disorders. In these cases the patient’s behavior, the state of the community and environment (referred to as social determinants of health [SDoH]) and the public health policies are responsible for over 60% of the overall outcome.
Don’t assume patients will want their own health records. They might not.
Final thoughts - What to put in your white paper
A few recommendations:
- Try to solve one real problem well (like this one or this one).
- Make sure the solution you are building solves the problem you are addressing. I was surprised to find more than once that the solution (for example an identity token) did not fit the problem it was was designed to solve (let’s say cause a change in patients’ behavior).
3. Use correct token taxonomy. Active, passive, smart, fungible, non-fungible, transferable.
4. Be technical. Don’t be shy to explain what you are doing. Too many papers leave it for the reader to guess the protocols or the token structure.
5. Explain governance, speak to conflict resolution and how you plan to evolve. In detail.
6. When you are done writing your white paper reverse design it like this:
It helps. (Good examples for white papers are: here, here, and here).
If the flow doesn’t make sense, the scenarios are unreal or the persona you planned the solution for initially has changed, then stop. Redesign. Don’t let your ‘baked assumptions’ burn you!
Look out for my future posts: Pain, Pain Killers and Blockchain; What’s good for me may not be good for you and how to change it; How my first ‘blockchained’ visit to the doctor really went.
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