Blockchain in Healthcare Today <p><strong>Blockchain in Healthcare Today (BHTY) </strong>is the world’s first peer reviewed open access journal that amplifies and disseminates distributed ledger technology research and innovations in the healthcare information systems, clinical computing, network technologies and biomedical sciences.<em> </em>Fields of interest include utility for data integrity, privacy preservation, health information systems interoperability, permissioned security for health data, clinical support and clinical trials management, supply chain management, revenue cycle automation, cost and impact, and the integration of AI and machine learning tools in this emerging specialty field of research.</p> <p>The preeminent international journal is published on a continuous basis to accelerate sharing rigorously vetted theoretical and experiential knowledge required for a global multi-disciplinary ecosystem. A world-class peer review board endeavors to offer rapid peer review and includes constructive commentary to strengthen work.</p> Partners in Digital Health, 241 Hamilton Avenue, Suite 21 Stamford, CT 06902, USA en-US Blockchain in Healthcare Today 2573-8240 <p><span style="color: #4b7d92;">Auth</span><span style="color: #4b7d92;">ors retain copyright of their work, with first publication rights granted to Blockchain in Healthcare Today (BHTY). Read the full <a href="">Copyright Statement</a>.</span></p> <p> </p> <p> </p> Accelerating Digital Health Trends and Transformation through Scientific Communications <p>The editorial is taken from commentary presented at the ConVerge2Xcelerate (#ConV2X) 2021 Symposium entitled "Blueprint for a New Digital Health Era."</p> <p>Tory Cenaj is the Owner and Publisher of Partners in Digital Health (PDH). The views expressed are solely her own and do not reflect those of the editorial board, reviewers, ambassadors, licensees or staff members affiliated with PDH.</p> <p> </p> Tory Cenaj Copyright (c) 2021 Tory Cenaj 2021-12-22 2021-12-22 10.30953/bhty.v4.192 Blockchain for Health: 101 Primer for Students Jim Nasr Copyright (c) 2021 Presenter: Jim Nasr, CEO, ACOER 2021-04-16 2021-04-16 Leveraging the Hyperledger Fabric for Enhancing the Efficacy of Clinical Decision Support Systems <p>Adopting and implementing the Clinical Decision Support System (CDSS) technology is a critical element in an effort to improve national quality initiatives and evidence-based practice at the point of care. CDSS is envisioned to be a potential solution to many current challenges in the healthcare sphere, which includes information overload, practice improvement, eliminating treatment errors, and reducing medical consultation costs. However, the CDSS did not manage to achieve these goals to the desired levels and provide context-appropriate alerts, although integrated with the electronic health records (EHRs) (<a href="#CIT0001_154">1</a>). Clinical decision support alerts can save lives, but frequent ones can cause increased cognitive burden to clinicians, worsen alert fatigue, and increase the duplication of tests. This ultimately increases health care costs without refining patient outcomes. Studies show that 49–96% of clinical alerts are ignored, raising questions about the effectiveness of CDSS (<a href="#CIT0001_154">1</a>). Blockchain, a decentralized, distributed digital ledger that contains a plethora of continuously updated, time-stamped, and highly encrypted virtual record, can be a key to addressing these challenges (<a href="#CIT0002_154">2</a>). The blockchain technology if integrated with the CDSS can serve as a potential solution to eliminating current drawbacks with CDSS (<a href="#CIT0003_154">3</a>). This article addresses the most significant and chronic problems facing the successful implementation of CDSS and how leveraging the Hyperledger Fabric can alleviate the clinical alert fatigue and reduce physician’s burnout using patient-specific information. The proposed architecture framework for this study is designed to equip the CDSS with overall patient information at the point of care. This then empowers the physicians with the blockchain-integrated CDSS, which holds the potential to reduce clinician’s cognitive burden, medical errors, and costs and ultimately enhance patient outcomes. The research study broadly discusses how the blockchain technology can be a potential solution, reasons for selecting the Hyperledger Fabric, and elaborates on how the Hyperledger Fabric can be leveraged to enhance the efficacy of CDSS.</p> Ramya Gangula Sri Varun Thalla Ijeoma Ikedum Chineze Okpala Sweta Sneha Copyright (c) 2021 Ramya Gangula, Sri Varun Thalla, Ijeoma Ikedum, Chineze Okpala, Sweta Sneha 2021-02-18 2021-02-18 10.30953/bhty.v4.154 A Proposal for Decentralized, Global, Verifiable Health Care Credential Standards Grounded in Pharmaceutical Authorized Trading Partners <p>The twin forces of privacy law and data breaches have fundamentally challenged how we collect, store, and share sensitive information. Within this landscape, healthcare information is sacrosanct – and intimately tied to identity and data ownership. Building on prior work with UCLA Health, Genentech (a member of the Roche Group), Sanofi, Amgen, Biogen, and others, we offer this opinion piece to promote the development of a standard for decentralized Verifiable Credentials (VCs). This will empower Authorized Trading Partners (ATPs) in the pharmaceutical supply chain to trade and exchange information in compliance with the US federal law. Starting with credentialing and interoperability for the ATP community, our ultimate goal was to chart a path to a global standard for all health care VCs – providing individuals and health-care professionals control over their own data. By sharing our results and releasing essential components of the work to the public domain, we hope to align and connect with other foundational efforts, thus evolving standards within a truly open framework with broad stakeholder involvement.</p> Victor Dods Ben Taylor Copyright (c) 2021 Victor Dods, Ben Taylor 2021-04-29 2021-04-29 10.30953/bhty.v4.175 Blockchain Predictions for Health Care in 2021 <p>With coronavirus (COVID) spreading across the world and the health care system being pushed toward more digitization and technology, last year was a unique year of human tragedy. There is a silver lining to this tragedy, that is, providers, payers, and pharma companies have shifted quickly toward better technologies, including artificial intelligence (AI) blockchain, and so on.</p> Prasad Kothari Melanie Nuce Ingrid Vasiliu-Feltes Dominique Hurley Mercury Fox Sweta Sneha Wendy Charles Jim Nasr Radhika Iyengar Copyright (c) 2021 Prasad Kothari et al. 2021-02-10 2021-02-10 10.30953/bhty.v4.162 Commercially Successful Blockchain Healthcare Projects: A Scoping Review <p><strong><em>Background</em></strong>: The healthcare industry is the new frontier for blockchain technology. Given its properties of immutability and decentralization, blockchain represents an opportunity for unprecedented level of privacy and security for all stakeholders by ensuring data integrity while giving patients control over their own health data. On a backdrop of rising interest in blockchain in general and blockchain healthcare applications in particular, there has been a proliferation of blockchain healthcare projects over the past few years. The aim of this review is to identify and understand real-world blockchain healthcare projects that have attained commercial success in the highly competitive blockchain market.</p> <p><strong><em>Methods and findings</em></strong>: A scoping review was performed in January 2021 on all projects in the CoinMarketCap database. Following a pre-defined inclusion and exclusion criteria, eligible projects were selected. A single reviewer then reviewed each project’s official website and whitepaper (where available) and performed data abstraction; 10 blockchain healthcare projects fulfilled the selection criteria. The review found that these projects made up 0.24% of the total number of actively tracked projects on CoinMarketCap. In terms of market capitalization, the total market capitalization for the projects was US$65,078,849, comprising less than 0.01% of the total market capitalization of all projects. Among the projects, the most frequent type was for personal health tracking.</p> <p><strong><em>Conclusions</em></strong>: This review revealed that blockchain health projects currently comprise a small fraction of the overall number of commercially successful blockchain projects. However, because this sub-industry is still in its early stages, there are reasons to be optimistic that many more blockchain health projects will emerge and attain commercial success in future. Findings from this review done from an entrepreneurial perspective should help with the identification of future projects most likely to succeed.</p> Hao Sen Andrew Fang Copyright (c) 2021 Hao Sen Andrew Fang 2021-04-16 2021-04-16 10.30953/bhty.v4.166 Leveraging Blockchain Technology for Informed Consent Process and Patient Engagement in a Clinical Trial Pilot <p><strong>Objective:</strong> Despite the implementation of quality assurance procedures, current clinical trial management processes are time-consuming, costly, and often susceptible to error. This can result in limited trust, transparency, and process inefficiencies, without true patient empowerment. The objective of this study was to determine whether blockchain technology could enforce trust, transparency, and patient empowerment in the clinical trial data management process, while reducing trial cost.</p> <p><strong>Design:</strong> In this proof of concept pilot, we deployed a Hyperledger Fabric-based blockchain system in an active clinical trial setting to assess the impact of blockchain technology on mean monitoring visit time and cost, non-compliances, and user experience. Using a parallel study design, we compared differences between blockchain technology and standard methodology.</p> <p><strong>Results:</strong> A total of 12 trial participants, seven study coordinators and three clinical research associates across five sites participated in the pilot. Blockchain technology significantly reduces total mean monitoring visit time and cost versus standard trial management (475 to 7 min; <em>P</em> = 0.001; €722 to €10; <em>P</em> = 0.001 per participant/visit, respectively), while enhancing patient trust, transparency, and empowerment in 91, 82 and 63% of the patients, respectively. No difference in non-compliances as a marker of trial quality was detected.</p> <p><strong>Conclusion:</strong> Blockchain technology holds promise to improve patient-centricity and to reduce trial cost compared to conventional clinical trial management. The ability of this technology to improve trial quality warrants further investigation.</p> Baldwin C. Mak Bryan T. Addeman Jia Chen Kim A. Papp Melinda J. Gooderham Lyn C. Guenther Yi Liu Uli C. Broedl Marianne E. Logger Copyright (c) 2021 Baldwin C. Mak, PhD, Bryan T. Addeman, BSc, MBA, Jia Chen, PhD, Kim A. Papp, MD, PhD, FRCPC, FAAD, Melinda J. Gooderham, MSc, MD, FRCPC, Lyn C. Guenther, MD, FRCPC, FAAD, Yi Liu, PhD, Uli C. Broedl, MD, Marianne E. Logger, BSc 2021-10-14 2021-10-14 10.30953/bhty.v4.182 MarkIt: A Collaborative Artificial Intelligence Annotation Platform Leveraging Blockchain For Medical Imaging Research <p>Current research on medical image processing relies heavily on the amount and quality of input data. Specifically, supervised machine learning methods require well-annotated datasets. A lack of annotation tools limits the potential to achieve high-volume processing and scaled systems with a proper reward mechanism. We developed MarkIt, a web-based tool, for collaborative annotation of medical imaging data with artificial intelligence and blockchain technologies. Our platform handles both Digital Imaging and Communications in Medicine (DICOM) and non-DICOM images, and allows users to annotate them for classification and object detection tasks in an efficient manner. MarkIt can accelerate the annotation process and keep track of user activities to calculate a fair reward. A proof-of-concept experiment was conducted with three fellowship-trained radiologists, each of whom annotated 1,000 chest X-ray studies for multi-label classification. We calculated the inter-rater agreement and estimated the value of the dataset to distribute the reward for annotators using a crypto currency. We hypothesize that MarkIt allows the typically arduous annotation task to become more efficient. In addition, MarkIt can serve as a platform to evaluate the value of data and trade the annotation results in a more scalable manner in the future. The platform is publicly available for testing on <em><a href="" target="_base"></a></em>.</p> Jan Witowski Jongmun Choi Soomin Jeon Doyun Kim Joowon Chung John Conklin Maria Gabriela Figueiro Longo Marc D. Succi Synho Do Copyright (c) 2021 Jan Witowski, Jongmum Choi, Soomin Jeon, Doyun Kim, Joowon Chung, John Conklin, Maria Gabriela Figueiro Longo, Marc D. Succi, Synho Do 2021-05-05 2021-05-05 10.30953/bhty.v4.176 The Case for Establishing a Blockchain Research and Development Program at an Academic Medical Center <p><strong><em>Objective</em></strong>: To develop a research and development program to study factors that will support research, education and innovation using blockchain technology for health in an effective and sustainable manner. We proposed to conduct qualitative research to generate insights for developing a market strategy to build a research lab for the promotion of blockchain technologies in health in academic environments. The team aimed to identify the key barriers and opportunities for developing a sustainable research lab that generates research, education, and application of blockchain in healthcare at an academic medical institution and test those strategies in a real-world scenario.</p> <p><strong><em>Methods</em></strong>: The research team identified potential customers and stakeholders through interviews and snowball sampling. The team conducted semi-structured interviews with 4 faculty researchers, 10 industry leaders, and 6 students from a variety of disciplines and organizations. The findings of these research activities informed our understanding of the needs of stratified customers and helped identify key assets and activities the lab will have to offer to meet those needs.</p> <p><strong><em>Results</em></strong>: The research insights from data analysis were used to build the business model for establishing a blockchain in health impact lab. This systematic study of areas where blockchain technology can impact health will guide the future development of research agenda for the researchers on campus.</p> <p><strong><em>Conclusion</em></strong>: Based on our learnings, we hope to design a Blockchain in Health Impact Lab to serve as a platform for students and faculty to come together with industry partners and explore current challenges of blockchain in healthcare. The academic medical center’s partnership with other healthcare providers will help create real-world opportunities to demonstrate and implement new technologies.</p> Muhammad Usman Verena Kallhoff Anjum Khurshid Copyright (c) 2021 Muhammad Usman, Verena Kallhoff, Anjum Khurshid 2021-03-09 2021-03-09 10.30953/bhty.v4.161 Use of Blockchain Technology for Electronic Prescriptions <p><strong>Objective<em>:</em></strong> Distributed ledger technology can be used as a transparent, shareable ledger, that can record transactions between two parties efficiently and in a more secure, verifiable, and permanent way than the current electronic prescribing systems. We studied the use of a distributed ledger electronic prescribing programme, Prescription Abuse Greatly Reduced (PAGR) Prescriptions, to examine the effect of blockchain on provider prescribing efficiency at three family medicine clinics.</p> <p><strong>Design<em>:</em></strong> The PAGR was installed side-by-side to the electronic health record at three family medicine practice clinics in middle Tennessee. A prospective, convenience sample of patients at all three clinics was used for analysis. Trained observers were used in each clinic to document the side-by-side use of current prescribing practice versus the use of the PAGR electronic prescribing system by the individual providers.</p> <p>The primary outcome was total time to write the prescription. Secondary metrics included compliance with checking the state’s Physician Drug Monitoring Program (PDMP.) , accuracy of medicine reconciliation, use of patient’s eligibility on insurance, prescription benefits, and change in prescription caused by benefits analysis or drug-interactions. Provider satisfaction was measure on a 4-point Likert scale.</p> <p>Data were analysed using two-tailed, paired Student T-tests with alpha set at 0.05. A sample size of 107 patients was calculated to have a power of 80% to detect a 50% change in the prescription writing time.</p> <p><strong>Results<em>:</em></strong> The primary outcome of total prescription writing time was 171 ± 41 sec for current prescribing practice versus 63 ± 15 sec for the PAGR system (p = 0.0006). All providers were extremely satisfied with the use of the PAGR programme.</p> <p><strong>Conclusion<em>:</em></strong> Use of the PAGR electronic prescription programme significantly saved a mean of 1 min 48 sec per written prescription at the three Family Medicine Clinics. The PAGR also provided accurate medicine reconciliation and complete PDMP checks for controlled substance prescriptions. The patient real-time benefits check and drug-drug and allergy-drug reviews resulted in the provider changing the prescription 28% of the time, enhancing safety and out-of-pocket patient expenses. Future enhancements include expanding the insurance benefits analysis and developing provider notifications when patients are non-compliant with filling their prescriptions.</p> Ryan W. Seaberg Tyler R. Seaberg David C. Seaberg Copyright (c) 2021 Ryan W. Seaberg, Tyler R. Seaberg, David C. Seaberg 2021-10-22 2021-10-22 10.30953/bhty.v4.183 Evaluation of Decentralized Verifiable Credentials to Authenticate Authorized Trading Partners and Verify Drug Provenance <p><strong><em>Summary</em>:</strong> In 2013, the Drug Supply Chain Security Act (DSCSA) was signed into law to address the growing threat of counterfeit drugs and to ensure prescription drugs remain safe and effective for patients. As part of this law, US pharmaceutical supply chain stakeholders are required to confirm the authorized status of trading partners for transactions and information disclosures, even when there is no prior business relationship. While larger Authorized Trading Partners (ATPs) have connectivity solutions in place, newer and smaller ATPs have not traditionally participated, including tens of thousands of dispensers. To unlock the full potential of the interoperable system mandated by the DSCSA, the authors tested eXtended ATP (XATP), a blockchain-backed framework for ATP authentication and enhanced verification in a real-world pharmacy with genuine drug packages. The objective of this research study was to prove that electronic authentication and enhanced verification can be achieved between ATPs using a mobile-based solution. Moreover, we tested accurate reading of drug and associated electronic med guides, flagging of expired and recalled drugs, and correct generation of documentation to support saleable returns.</p> <p><strong><em>Methods</em>:</strong> This study involved two dispensers and three participating manufacturers. Dispensers were onboarded to a mobile application and used supporting documentation to authenticate their identities, and then scanned 2D drug barcodes to submit drug verification requests to manufacturers (including 11 additional, randomly selected manufacturers). Genuine and synthetic drug package barcodes were used to test workflows against genuine and synthetic manufacturer serialization data records. Manufacturers authenticated the identity of requesting dispensers with verifiable credentials and responded to verification requests.</p> <p><strong><em>Results</em>:</strong> Enhanced drug verification was achieved, with 100% of requests successfully delivered to participating manufacturers and 88% of requests being delivered to other manufacturers (based on the pharmacist selection of random packages from the pharmacy). Drug verification matching against synthetic serialization data records resulted in 86% accuracy, with the 14% error rate attributed to human factors. All barcodes were successfully scanned and provided package-accurate data, and 97% of randomly selected packages successfully generated drug package inserts. All synthetic recalls and expired drugs were successfully flagged. Four of the manufacturers contacted were among the top 15 pharmaceutical manufacturers globally; all four responded.</p> <p><strong><em>Conclusions</em>:</strong> The XATP framework provides a secure, reliable, and seamless remote method to conduct enhanced verification as required by law. Interoperability between manufacturers and dispensers with no prior business relationship can be achieved on ‘day zero’ using mobile devices that enable digital authentication and rapid barcode scanning. As users retain control of their own private keys, the framework also mitigates the single-point-of-attack risks associated with centrally managed systems.</p> Ghada L. Ashkar Kalpan s. Patel Josenor de Jesus Nikkhil Vinnakota Natalie Helms Will Jack William Chien Ben Taylor Copyright (c) 2021 Ghada L. Ashkar, PharmD, Kalpan S. Patel, PharmD, MBA, Josenor de Jesus, PharmD, MBA, FACHE, Nikkhil Vinnakota, Natalie Helms, Will Jack, William Chien, Ben Taylor 2021-03-11 2021-03-11 10.30953/bhty.v4.168