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Blockchain in healthcareBasics, challenges, opportunities

Maria Marenco

Public Affairs and Communications - HIMSS Europe

Mirko De Maldè

COO - Lynkeus

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Healthcare Megatrends and relevant challenges

Improve chronic disease

management

Focus on prevention and

patient engagement

Growing availability of

patient generated data

How do we consolidate

different data sources for improving

prevention and personalized treatments?

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Objectives of a blockchain-enabled data management

system

Patient security, right care, right time, right

place

Creating a secure space for citizen/ patients data

Identity Management

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Advantages of

the technology...

Blockchain philosophy

Democratize- inclusive, expansive, transparent

Remove intermediaries

Citizen/ Human centric

Decentralization

Security- Cryptography to protect digital transactions against hacking, tamper- proof and data integrity guarantees

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#Blockchain4EU,

Blockchain4…?

New business models

New Processes

Ecosystems

Multidisciplinary collaboration

What else does

DLT bring to the

table?

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Blockchain opportunities

Blockchain opportunitiesThe blockchain/DLTs might be helpful a complex environment such as healthcare where:

a) Multiple actors (professionals, nurses, patients, payors, researchers)…b) …need to access and exchange data in a secure manner…

c) …while respecting relevant regulations…d) …ensuring data integrity …e) …interacting with external stakeholders (research centers, biomedical industries…)f) …without necessarily trust each others

Blockchain and DLTs can hopefully support such a process addressing the current shortcomings and offering an alternative way to:

• Filling the «trust gap»

• Automating data exchange, business processes, and relevant policies’ enforcement

• Ensure regulatory compliance

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From the centrality of the hospital to the centrality of the

patient

HOSPITAL-CENTRIC MODEL

• Focusing on acute care

• Low scalability• Short term

interaction

PROVIDERS-CENTRIC MODEL

• Focus on improvement of chronic diseases management

• Improved scalability

• Medium-term interaction

PATIENT-CENTRIC MODEL

• Focus on prevention

• Great scalability• Long-term (entire

lifespan) interaction

CENTRALISEDARCHITECTURE

DISTRIBUTEDARCHITECTURE

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Blockchain can mean different things for different actors

• For hospitals it might be a way to solve data insecurity and

interoperability;

• For doctors it might help manage professional identity and simplify

payments;

• For pharma and medical device companies distributed ledgers can

assist in supply chain, inventory management and fraud detection.

• For patients it can provide the opportunity to control and own their

data, their insights and their health

•Improved access to data

•Identity management tools

• Longitudinal health recordData Access and exchange

•Supply chain transparency

•Provenance tracking

•Reduce drugs counterfeitingDrugs authenticity

•Improve transparency and auditing

•Improve relationship management among stakeholders

•Facilitate protocol and consent management and updatesClinical trials

•Improve data flow on the spread of contagious diseasesEpidemiology and public health

•Encrypt and share securely patient generated data

•Ensure privacy and security and identity of the medical deviceMedical IoT

•Improved control and transparency over access to health services by individuals, including visit to GPs, drugs consumption, access to Emergency roomsImproved service management

•Improve engagement of individuals, encouraging healthy behaviours or facilitating access to specific services

Introduce reward system of service tokenisation

•Improve health insurance services providing , tamper-proof claim management and fraud reduction, reduction of administrative burdens, as well as enabling personalised services, dynamic pricing, improved access

Blockchain-based claims billing management / health insurance

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Blockchain 101

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Distributed

• Each participating node has a full copy of the ledger and contribute to maintain it

• No central authority is involved

Append-only

• Information can only be added but not deleted or altered

• This ensures trustworthiness of the information contained in the ledger

Tamper-proof

• Is difficult for individual nodes to manipulate records

• Each node can independently verify transactions and overall integrity

Based on consensus

• Consensus mechanisms are used to reach agreement on the status of the ledger

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What blockchain can’t do/is not• Blockchain is not bitcoin, nor is only for fintech

– Bitcoin is only the first and most famous application of blockchain

• Blockchain is not a cloud database for large volumes of data

– Large volumes of data still need to be stored in dedicated database “off-chain”

• Blockchain can’t ensure correctness of an information at the source

– It can only ensure that the information is not tampered with once entered in the chain (data integrity)

• What is stored in a blockchain does not become automatically public

– Depending on the specific implementation, you can decide what information need to be visible and to whom

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Blockchain benefits

• Ability to create trust in trustless environments;

• Security mechanisms for the transfer of value;

• Efficiency in streamlining business processes between

different entities

• Enhanced auditability and transparency

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Smart contracts• Smart contracts are computer programs that autonomously execute

instructions when triggered by external events, used to automate

business processes across different entities

• The output from executed smart contracts can be audited and verified by all participants in the network

• When the defined condition are met, the smart contract is activated

• The execution is automated and autonomous (no human intervention needed)

• All nodes execute the smart contract

• Two or more parties define a contract and the conditions of its execution

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Characteristics

and

Components

Ledger Smart ContractsWhat Transactions

occur on the blockchain

What are the blocks on the chain

What is immutability

How is transparency

achieved?

How is trust achieved?

How is a high level of faultless

transactions achieved

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Permissioned VS Permissionless blockchainRead Write Commit Identity

Open

Public permissionless

Open to anyone Anyone Anyone

PseudonymousPublic Permissioned

Open to anyone Authorised participants

Authorised participants

Closed

Consortium Restricted to an authorised set of participants

Authorised participants

Authorised participants

Known IdentityPrivate Permissioned

Fully private, restricted to a limited set of authorised participant

Network operators only

Network operators only

A set of criteria for considering blockchain solutions

Should transactions be public?No, in most cases.

Do you need to be able to control functionality? (e.g., node distribution, permissioning, engagement rules, etc.)Yes, to express/enforce policies

Do contributors know and trust each other? Are relevant interests aligned?No, there are many mis-aligned incentives between healthcare professionals, hospitals, payors, patients, families and regulators,

Do you require shared write access?Yes, as many (if not all) members of the network will need to input into the ledger

Are there multiple stakeholders involved in the process/value chain?Yes (hospitals, GPs, doctors, nurses, payers, health institutions, patients)

Are you managing a contractual relationship or value exchange?

Yes. Here blockchain could help in reducing unnecessary friction and cost in the supply chain or during payments.

Do you want/need to rely on a trusted party?Yes, given roles and liability as set forth in relevant regulations (see GDPR)

Do you intend to store large amounts of non-transactional data as part of your solution?No, large volumes of data from images and genomics will continue to reside on dedicated databases.

Do you require high performance rapid transactions?Not necessarily – depend on use cases

Is there value in an immutable record? Or is an immutable record a requirement?Yes, immutability is surely a value in specific use cases (access control and auditing, e.g. claims management, drugs authenticity).

Are you working with digital assets and can you create a permanent, authoritative record of the digital asset?Yes (EHRs)

Challenges

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Challenges

• How secure?

• Scalability of permission-less blockchain

• GDPR

• Computational and energy requirements

• Integration with legacy systems

• Policy & Ethics

• Education

• Trust

• “Interoperability issues on a protocol level”

Open issues…

Blockchain is only a part of a larger ecosystem

Thank you!