Talking Blockchain

Please forgive the style of this piece — it is taken from a talk I gave at GIANT Health Event in November 2017.

Clinicians today are incredibly fortunate to be practicing in an era where antibiotics, cancer therapies and advanced diagnostics are available. We have decoded the human genome. We have robots helping us operate with increasing precision. People are living far longer now than they ever did before.

But with all this complexity, we have also created some rather large problems for ourselves. Rather than tasting urine to diagnose diabetes, we now send blood tests to a lab. Instead of merely tapping on the chest or knee, we order CT scans and MRIs. And where we may have prepared a remedy ourselves in the past, we now prescribe medications that are collected at a pharmacy. We rely on many others to help us deliver care. And because we have learned so much, it is impossible to know it all. So we have specialists. In everything.

Of course that is only a part of the picture making the practice of medicine a challenge today. Globalisation means we move around more. Consumerism means we shop around more. And all of this leads to an increasingly fragmented system — where information is widely distributed, communication channels are broken and patients are disempowered.

The finance of healthcare is also complicated. And expensive.

Whether payment is through tax revenue or insurance models, the flow of money in healthcare is big business. Between 4 and 18% of GDP depending where you look.

The healthcare ecosystem is very complex.

If we extend this ecosystem to include pharmaceutical companies, research institutes, medical device manufacturers and all the players along the supply chain it becomes apparent just how intricate it really is.

You may say complexity isn’t necessarily an issue. I agree it doesn’t need to be. So where is the problem?

The crux of it is that it comes down to trust.

· Patients trust that their medical records are kept confidential and secure yet millions of records are compromised yearly:

· Doctors trust that the information they have in front of them is true yet a John Hopkins University School of Medicine study suggests: Medical Errors Now Third Leading Cause of Death in the U.S.A.

· Health Insurance Companies trust that clients and providers are honest but medical fraud cost the US Economy $272 billion in 2012. Health records are worth 10X what credit card information is worth on the dark web.

· Nurses trust that the drugs they administer are not fake but counterfeit medication is a $200 billion business.

I originally planned to go into great depth about the mechanics of blockchains. But in the vain hope you would stay awake I decided that I should probably tell you more about the fundamental philosophy that the technology represents.

Before I do that, I would like to make a point about the current blockchain landscape.

Not everything called blockchain is a blockchain as it was originally described. This is a fluid, evolving field and terminology is messy.

Not everything needs a blockchain. If the word database can be substituted and the product still makes sense, a blockchain probably isn’t required.

About $3 billion has been raised by ICO funding. I believe that more than 80% of these endeavours will fail. I don’t say this because I don’t have faith in the technology. What I do think, however, is that there are some fundamental benefits that blockchains can bring if we concentrate on the underlying principles. So we need to understand their value.

– and that is as a ledger implemented as a replicated state-change machine.

…..or as a communications channel implemented as a peer-to-peer database not requiring an intermediary for consensus which allows multiple entities with diverse economic interests to collaborate where it is natural tocheat or seek advantage…(courtesy of Dr Bryant Joseph Gilot MD CM DPhil MSc).

Whilst easy to brush over, I would suggest that perhaps THE most important word in the description above is COLLABORATE. It seems everybody wants to build their own blockchain. I believe they are missing the point.

Given the complex ecosystem in healthcare depicted earlier, I would say this is nothing short of revolutionary.

What this means that when presented with information, we are able to SELF VERIFY the Author and Content of a Record, the state before and after each Record and whether the record is complete with no omissions or additions.

None of the above is possible in the current system without a myriad of checks and balances and the use of third parties.

With Bitcoin we are able, for the first time, to transfer a digital FINANCIAL ASSET peer-to-peer, without a third party intermediary, across borders, in a censorship resistant network, without permission from a central authority.

And if we extrapolate, we are now able to:

· Share INFORMATION ASSETS peer-to-peer while retaining CUSTODY and NEAR COMPLETE AUTONOMY of the ASSET.

· PROVIDE ACCESS CONTROL by employing cryptographic challenges and proofs AND…

· Through the use of DIGITAL IMMUTABILITY we can now offer

· TIME STAMPING and TRANSPARENT AUDITABILITY.

So what does this mean practically?

It means:

· Patients are now able to have custody of their own medical records.

· They are able to provide time and content limited access to the person of their choice.

· A doctor reviewing a record can be assured of its author and content.

· Researchers and big pharma can now mine big data and make new discoveries because the owners of the records can be certain their privacy can be secured and can be incentivised to share.

· Data streamed from wearable technology can be added to records and stored with confidence.

· Insurance providers can underwrite policies in the knowledge that the data provided has not been falsified.

· Nurses can medicate patients knowing the provenance of the drugs.

· Doctors can issue digital asset prescriptions and pharmacists can be secure that the physician is appropriately licensed.

Sounds great. What next?

There is already much work that has started but of course this is not going to happen overnight. Blockchain is in its infancy and there are many challenges ahead.

· It is an immature field with much to learn.

· Trust in the technology itself needs to be earned.

· There will be regulatory hurdles about information sharing, financial reporting and around the laws governing smart contracts.

· We will need a common set of standards for how blockchains should be written

· There are scalability issues potentially limiting widespread adoption

· A significant cultural shift from competition to cooperation is required. Because you can’t play on the blockchain by yourself….

In spite of this, however, I believe we are witnessing the birth of a new paradigm in business transactions and trust. We have an opportunity to collaborate in a positive sum game and build a healthcare system that works for all parties.

I am very fortunate to be involved with Medicalchain. We are collaborating with numerous partners and look forward to a time when patients, doctors, pharmacies, research institutes and insurance companies interact on our platform to bring you healthcare 3.0. Join us on our journey.

If you walk away from this talk with only one message I would like it to be this:

We can revolutionise healthcare but we will need to build it together.