Three Recent Events to Make Us Consider Blockchain for Healthcare Data Management
Hao Sen Andrew Fang, SingHealth Polyclinics, SingHealth, Singapore; SingHealth Duke-NUS, Singapore, email@example.com
As an observer of current affairs with a keen interest in blockchain, it has already been a very eventful start to the year. For one, the Bitcoin price made new all-time highs, surpassing US$40,000 and triggering significant media buzz. Yet amid all the hype of Bitcoin and cryptocurrency prices, I found three major news events to be particularly relevant and instructive for the blockchain healthcare community, especially with regard to data management. In this blog, I wish to share my brief thoughts on these recent events.
As results from the recent U.S. presidential election were announced, there were already numerous legal challenges to the results citing voter fraud. The Wall Street Journal also reported an appeal made to Georgia’s top election official to re-calculate the state’s results.1 Dispute over electoral results is not unprecedented, and it reveals the possibility of data manipulation while more importantly underscoring the need for better transparency in data provenance.
In the healthcare context, it is also not hard to imagine a central authority altering health data for its own benefit—such as to report glowing health statistics. In fact, corruption in health systems is real and there are anti-corruption efforts being undertaken by the global health community to address them.2 Even in scenarios where there is no malicious intent, the current lack of transparency in which most health data are collected, analyzed, and reported has raised questions and doubts. We had already witnessed this first-hand in the early days of the COVID-19 pandemic when erratic numbers coming out of Wuhan evoked public doubt and distrust.3 These scenarios only highlight the importance of data immutability and, more broadly, data transparency in the modern age.
Currently, health data privacy is protected by law such as the Healthcare Insurance Portability and Accountability Act (HIPAA), General Data Protection Regulation (GDPR) and Personal Data Protection Act (PDPA) depending on jurisdiction. While it is reassuring to know there are such laws in place, the Whatsapp move demonstrates how the protections still fall short. It is not hard to imagine a commercially driven healthcare organization selling patient data (even if it is de-identified) for profit, without explicit knowledge of its patients. To address this, there are growing calls to rethink the current approach of data privacy protection to that of data ownership, including lawmakers.6 In this proposed model, healthcare organizations may license the use of patient data and patients earn a dividend from the use of their data. Such a model could eliminate concerns of data privacy as any use of the data would need patients’ explicit consent. In addition, such a model would also offer a more equitable relationship for patients and healthcare organizations with regard to the value generated from the data.
Amid a Reddit driven rally of certain company stocks including GameStop and AMC, consumer investment platform Robinhood abruptly suspended trading of those stocks.7 This unilateral decision enraged retail investors who later went on to file a class action suit against the platform. This exposed the weakness of centralization, where users are at the mercy of a single monopoly platform.
In healthcare, one major area of centralization is in data management. Especially for healthcare organizations that store and access their data on the cloud, it is very likely that they would utilize one among a handful of services such as Amazon Web Services and Microsoft Azure. What happens if these services suddenly decide to block its services? Subscribing to an additional provider is possible, but it would be prohibitively costly for most. This highlights the need for a system that is not under the control of a single party or small consortium. We need a decentralized data management system which cannot be turned off on a whim.
While these events may seem disparate and unrelated to healthcare—one from politics, one from legal and another from finance—I believe they hold key lessons for the healthcare industry which could easily face similar challenges as presented above. These events demonstrate certain shortcomings and potential weaknesses of existing data services and information systems, which can also be applicable to healthcare. These shortcomings call for systems built on data transparency, ownership and decentralization—properties that are inherent to blockchain technology. Given these recent events and the lessons they bring, blockchain should be strongly considered as a solution to enable a paradigm shift in data management, especially for the healthcare industry.
Acknowledgements: The author would like to thank his family and work organization, SingHealth Polyclinics, for their support.
Should Emerging Technology be a Part of Medical School Curriculum?
Cole Holan,1 Cody Cowley, 1 Jeremiah Alexander1
1Dell Medical School at the University of Texas, Austin, Texas
When we applied to medical schools there were specific aspects of a program that we wanted. We needed a school that embraced change and encouraged students to seek opportunities outside of the curriculum that allows innovation in medicine to occur.
Modern medical education consists of 1.5 to 2 years of pre-clinical education in a classroom and 2 to 2.5 years of clinical rotations. Currently, only three schools have moved to 1-year pre-clinical, which opens up an extra year of time during medical school. One article suggested that to prepare students for the rapidly changing healthcare environment, undergraduate medical education programs should have the freedom to implement curricula allowing students to individualize their study plan based on their career path and competencies.1
In the traditional model of medical education, we must determine if we are training doctors to conform to a broken model or to become the solution through innovation and creativity? If the goal is to teach medical students to change the current platform, it is wise to expose students to opportunities to innovate and rethink aspects of healthcare. Medical students need the ability to contribute and work within teams that are innovating. Faculty at our institution have been tremendously helpful in introducing us to some of these innovative technologies.
During our first year in medical school, we had the opportunity to aid in the construction and testing of patient-centric blockchain identity and consent management system with a multidisciplinary team. This experience increased greatly our understanding of the healthcare system.
We think all medical students should be exposed, and, if possible, have the opportunity to work on projects that involve emerging technology —like blockchain. This would benefit student’s learning two-fold: they would get early exposure to technologies they will likely encounter in a clinical setting and they would get to help develop these technologies, allowing a smoother transition into their clinical years and decreasing the learning curve of the health record system or other instruments commonly used in medical practice. The potential of blockchain in healthcare is promising and will likely play a part in the future healthcare landscape.2
We have seen how to view one particular problem while realizing the type of team it takes to brainstorm a multitude of ideas addressing that problem. Working on this project gave us perspective on how emerging technology can shape healthcare, while getting the experience of working within an interdisciplinary team. As new health information systems are built to phase out the current electronic health record system and usher in new ones, it is vital that the teams working on these projects are composed of different backgrounds, so that intricacies of the system are not overlooked. Physicians work on teams to deliver the best outcomes to patients. It should be no different in development of technology to care for patients.
Early exposure to technologies that are likely to be implemented or already recently being implemented in healthcare settings will be paramount to the future physician. Going forward, we should expect medical students to be engaged in what our future looks like. We must learn how to build strong teams that include our counterparts from varying fields, and we must learn how it feels to work on a project with the potential to change the way medicine is practiced. If we don’t see how we can change the system we are in, we won’t.
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To celebrate our continued support for the multidisciplinary ecosystem, we’re sharing articles from past editions to inspire, educate and communicate the breakthrough research and innovation the technology presents for healthcare.
1. The Last Mile: DSCSA Solution Through Blockchain Technology: Drug Tracking, Tracing, and Verification at the Last Mile of the Pharmaceutical Supply Chain - William Chien, PharmD, et al
2. Leveraging Blockchain Technology to Enhance Supply Chain Management in Healthcare: An Exploration of Challenges and Opportunities in the Health Supply Chain - Kevin Clauson, PharmD et al
3. DMMS: A decentralized Blockchain Ledger for the Management of Medication Histories - Patrick Li et al
4. Blockchain as a Foundation for Sharing Healthcare Data - Marek A Cyran
5. Applications of Blockchain within Healthcare - liam Bell et al
6. Pragmatic, Interdisciplinary Perspectives on Blockchain and Distributed Ledger Technology: Paving the Future for Healthcare - Ron Ribitzky et al
7. Enforcing Human Subject Regulations Using Blockchain and Smart Contracts - Olivia Choudhury, PhD et al
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Transforming Health Care in the Wake of a Global Pandemic
Tory Cenaj, Publisher, Telehealth and Medicine Today
Some of the world’s top leaders and influencers in healthcare delivery transformation and health technologies, including blockchain in health tech and telehealth, converged at the 4th Annual ConVerge2Xcelerate (#CONV2X) 2020 Symposium held virtually from November 10th-12th, to exchange perspectives and solutions to shortfalls in global patient care exposed by COVID-19. The theme of this year’s symposium BHTY hosted was “US-World Health Transformation.”
Impact of COVID-19 on health care
The global COVID-19 pandemic showed how vulnerable healthcare delivery is to patients around the world. Healthcare systems in every country have been challenged – not only in treating patients with coronavirus, but in trying to maintain optimal care for non-COVID patients at the same time.
As a result, new advances in digital health technologies, including telehealth, blockchain, AI and others, are successfully transforming patient treatment models on an international scale. What this event proved is that healthcare transformation, via technology and new global models for greater access and more efficient and effective delivery of healthcare services to patients, is much closer to reality than ever before.
Many of the sessions over the two-day event focused on two main topics: healthcare interoperability, digital health, adoption, scale and equity.
On Day 1 of the event, this topic was highlighted by speakers from the UK, India, North America and the European Union. Interoperability is the ability of different healthcare systems and processes to communicate and share secure information with other healthcare systems and processes, either within or across organizational borders, in order to advance the effective delivery of healthcare. The consensus was that patients will enable interoperability through trust – a pivotal facet of adoption and scale.
Technology players will have to continue to grow in partnership with healthcare systems, which will be required for both the systems and for consumers.
According to Keynote speaker, Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, “Digital health is a new reality that will bridge disparity and access to those with lower income and the underserved.” Other Keynotes from Teladoc Health and Mayo Clinic Digital Platform emphasized transforming health care with digital health and virtual care delivery systems, which would make care affordable and equitable, decrease disparities among income levels and geographies, and create global standards and regulations for citizens and health systems around the world.
But digital health is a broad term, one that encompasses several technologies, including telehealth, virtual care, and digital tools and services, requiring standards and integrations that make health care delivery broader, easier and more flexible.
A Keynote session titled, “Virtual Health: The Next Frontier for Healthcare,” with Alex Harris, Partner, McKinsey & Company and moderated by Lyle Berkowitz, MD, FACP, FHIMSS, CEO of Back9 Healthcare Consulting discussed he radical digitization of health care with supply and demand factored in. Healthcare has lagged behind other industries in terms of digitization. But on the consumer (patient) side, mindset and behavior changes have moved the needle on telemedicine visits, and it is projected that 60% of those over age 65 will avail themselves of this technology in the near future.
Physicians question the effectiveness of telehealth visits and financial compensation, and they wonder about adoption and when it will stabilize. Telehealth visits were high in April, but decreased, perhaps due to restrictions in movement as things shut down.
The challenges to adoption that still exist include funding and parity for certain services and long-term reimbursement. Fee-for-service vs. value-based is still unclear. So while providers are still wondering about financial implications, consumers are starting to feel more comfortable.
It is clear that this past year has presented both many challenges to healthcare delivery and opportunities for innovations. The manner in which health care is delivered is occurring at a time when traditional physical interaction between patient and provider has basically been a “cease and desist order” for the safety of both parties.
To learn more and get access to the agenda and program, visit https://conv2x-2020-ondemand.eventcreate.com/
For a top line introduction and select presentations visit BHTY at https://blockchainhealthcaretoday.com/index.php/journal/ConV2X2020
Emotional Wellness in the Times of Covid-19
Shanmugavel Sankaran, Founder, NixWhistle
There is no doubt that the COVID-19 has made a huge impact in all our lives now. It has become a part of history which the future generations will be studying about from the internet and maybe textbooks. From following our daily routine of getting up in the morning and heading to work/ education center and coming back in the evening, we are now stuck between the four walls of our house after getting used to the lifelong time of leading our monotonous lives. Although most of us are lucky to stay home and be with our families, there are so many people who were unfortunate to be left back in different cities once the lockdown was declared. There are many highly respectable providers of service and safety who are constantly working out there, battling with the virus and trying their best to not let it reach the citizens of the nation. But sadly, they are unable to go home to their families as they too will have to take precautions.
With so much going on in everyone’s lives now, the pandemic has begun to affect the mental peace of us human beings. We are all used to always staying out, being with people, socializing, and now, we are privileged to go out of the house only when we have to purchase essential items. Although staying indoors at such a time is highly important, it took a lot of people some time to get adjusted to the new yet temporary lifestyle. It was quite expected that some of us will be dealing with akathisia in this overwhelming situation the entire world is facing. It is not easy to just be sitting in one place and sticking to your laptop or phone when you are so used to moving about and exploring.
When it comes to children, they spend most of their time outdoors with their friends running around and playing for hours together. After they come back from school, they look forward to going and playing with their friends the most. But with the pandemic, it is most important for them to stay inside the houses without coming in contact with anyone from outside in order to avoid the spread of the virus. But what happens when a child is forced to stay at home for more than 2 days? They get highly restless and impatient if they are not engaged with something. This restlessness can lead to yelling and shouting because their brain would have heated up. This results in broken peace in the house and because they are young and going out to play is all they can think about, it can be difficult to make them understand the reason behind not letting them go out of the house. In the process of calming down their kids, even parents start losing their patience leading to a lot of disruption in the house.
It's extra overwhelming the ones living by themselves. So many thoughts, so many things to work on, so many thoughts in their minds, it’s just chaotic for them. Living alone might be looked at as having all the freedom where one can do anything as they wish, but the truth is, along with all that comes a lot of responsibilities. Taking care of their house, earning and paying rent, making meals for themselves, etc. They wake up and they don't have anyone around to look at, while having a meal, they’ll be by themselves with no one to speak to. Now this would have been an entirely different scenario when they were living their normal lives of going to work, being with their colleagues, going out with them and then coming back home for the night. But constantly having to be at home from the time they wake till the time they go back to sleep without having any sort of human interaction for more than a month can add a lot of anxiety and overthinking to their lives.
With the economy going down the drain, entrepreneurs are dealing with a lot of stress at this point in their lives. With no inflow of money in their accounts, they are finding multiple ways to reduce their expenditure and to live as minimalistic as possible. Individuals who had plans of beginning their entrepreneurial lives this year will have to postpone their plans to the next year as they would be seeing very little to no success at all if they started their company during a period where everything is shattering.
Blockchain based solutions like WellnessSpeak is all about hearing people out ensuring complete trust and assurance about their emotional turbulence. Such platforms has been made to help individuals having a bad time in this pandemic, speak their thoughts out while in return seeking some support online hoping to make these better for them. All the stakeholders like Tele Health providers and Emotional Wellness clinics are able to come onboard as additional stakeholders onto the platform.
There are so many more problems than the ones listed above which people are going through right now, but because the world is so busy fixing itself, the blockchain powered wellness platforms can be our virtual friend, counsellor or even a guide so that you won't feel like you are alone in this.
Published: May 2020
Blockchain and Drug Supply Assurance in the Coronavirus Era
Ben Taylor, Founder and CEO, LedgerDomain
Over the past two years, our team at LedgerDomain has been working on bringing the drug supply chain out of the digital dark ages and into a secure real-time mode with blockchain. With the rise of COVID-19, need for real-time drug supply chain assurance has never been more pressing. While healthcare leaders and front-line workers rally together and fight this disease, we believe that a blockchain-based solution capable of tracking therapeutics, test kits, vaccines, and ventilators is necessary to accelerate their efforts to protect the public.
As part of a peer-reviewed study commissioned by the US FDA and published in Blockchain in Healthcare Today, LedgerDomain and UCLA Health joined forces to deploy and test BRUINchain, a last-mile blockchain-driven solution used by real caregivers to help deliver lifesaving medications. The study is among the first of its kind to reveal exactly how blockchain could save pharmacies billions of dollars in labor and safety stock costs alone. In this post I’d like to reflect on the key takeaways from the study and how we can map them onto the new health landscape.
Background on BRUINchain is available here.
Current State of Pharmaceutical Supply Chain
In today’s pharmaceutical supply chain, each transacting party typically manages its own database systems. These private databases allow each party to minimize external security threats while maximizing internal data consistency. However, this also means that there’s no shared global system of record representing the single source of truth describing the flow of items through the pharmaceutical supply chain. This leaves the supply chain as a whole more vulnerable to common attack vectors such as man-in-the-middle or spoofing.
Why Blockchain for Pharmaceutical Supply Chain?
In three years, under the Drug Supply Chain Security Act (DSCSA), the US pharmaceutical supply chain will be brought together by an electronic, interoperable system to identify and trace prescription drugs as they're distributed throughout the country. One of the core requirements of the DSCSA is that prescription medications must have a unique product identifier, which takes the form of a 2D barcode.
We realized that these federally mandated barcodes could be the foundational information building block for a common data model. Combined with blockchain, this could enable a system of record that would lessen the need to trade data integrity and privacy for global visibility and interpretability. In this way, blockchain can be a source of universal truth for hundreds of pharmaceutical and biotech enterprises and their vendors to work collaboratively and communicate with hundreds of wholesalers and tens of thousands of dispensers.
The BRUINchain Pilot Application
The keystone of our study was BRUINchain, a blockchain-based mobile solution and notification system designed to track and trace changes in custody of drug within a dispenser organization using FDA-stipulated barcodes. By combining blockchain with commercial off-the-shelf technology, BRUINchain makes it possible to track and verify drugs in a busy hospital or neighborhood pharmacy.
From the receiving bay to patient administration, caregivers scanned unique 2D drug barcodes using the BRUINchain mobile app. During their journey, drugs passed a series of checks until they were administered to the patient. New barcodes were routed to a trading partner for verification, and the drug was held back from being administered. At any time, the prescriber could view the progress of the drug through the pharmacy into the clinic.
BRUINchain Learnings and Outcomes
The BRUINchain pilot provided us with important insights into what a larger implementation of a DSCSA verification system would look like. It also validated the use of commercial off-the-shelf technology in a pharmacy that relies heavily on legacy systems. Barcode scanning was nearly 100% effective with commercial off-the-shelf technology. Drugs could be tracked at a highly granular level. The system was able to track expiration dates, verify barcodes, and make it easier for pharmacists to inspect and report problems.
During the study, we found that the rollout costs for DSCSA compliance could be massively reduced by a real-time blockchain system – a $183 million annual savings to dispensers in the United States, as well as a major bulwark against bad or fraudulent transactions. Real-time verification would also minimize the amount of safety stock that dispensers need to retain in the event of potential quarantine events, freeing up $20 billion in inventory.
Blockchain and COVID-19
So what does this mean in the coronavirus era? The unique identifiers mandated by DSCSA were essential to our pilot, but many types of medical supplies lack unique identifiers. We’ve heard again and again from industry stakeholders that the value provided by a blockchain leveraging these unique identifiers exceeds the implementation cost of unique 2D barcodes by an order of magnitude.
With that in mind, blockchain can play a role in three key areas. The first leverages existing unique identifiers on products for real-time track-and-trace solutions like BRUINchain. The second leverages unique identifiers for people, such as Social Security numbers, to provide patients, doctors, and health authorities with real-time updates. The third involves using blockchain in the absence of unique identifiers to power secure and private notifications related to issues at the lot or product level, such as recalls or expiry date extensions.
From the need for improved public hygiene to more robust track-and-trace systems, we will emerge from COVID-19 with some hard-earned lessons. As we rethink healthcare and global supply chain security in the United States and around the world, we have the opportunity to create new tools and systems to empower healthcare providers and patient. Not just against COVID-19, but in all areas of healthcare.
Published: May 2020
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