Download - BLOCKCHAIN AND THE FUTURE OF HEALTHCARE
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BLOCKCHAIN AND THE FUTURE OF HEALTHCAREINTEROPERABILITY
“THINK BEYOND”
September 17, 2016
Peter B. Nichol
@PeterBNichol www.linkedin.com/in/peternichol
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1. Who has read at least one article on blockchain?
2. Who thinks blockchain has value?
3. Who could explain blockchain to a friend?
Quick Survey
@PeterBNichol www.linkedin.com/in/peternichol
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(8:30 – 9:45) Blockchains impact on business
(9:45 – 9:00) How blockchains work
(9:00 – 9:45) Creating new value for healthcare with blockchains
Purpose
@PeterBNichol www.linkedin.com/in/peternichol
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Peter is a healthcare business and technology executive
recognized for digital innovation by CIO100, MIT Sloan,
Computerworld, and PMI.
Peter’s specialties include digitizing complex platforms, leading
large scale program management, driving application of
emerging technologies to enhance business systems, improving
and innovating new consumer experiences, driving better
patient outcomes. Peter builds world class teams that redefine
value and deliver outstanding results.
Peter is a healthcare expert at PA Consulting Group. Prior to
joining PA in 2015, he was a CIO and has held leadership
positions in various healthcare organizations.
Peter has a B.S. in C.I.S from Bentley College, earned his
PMP® in 2001, a Certified Scrum Master, and Six Sigma Master
Black Belt.
As a Commercial Rated Aviation Pilot, Master Scuba Diver, and
Yachtsman, Peter understands first hand, how to anticipate
change and lead boldly.
Introduction to the Speaker – Peter B. Nichol
@PeterBNichol www.linkedin.com/in/peternichol
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Blockchain’s impact on business
1. Which industries are paying attention to blockchain?
2. What has been the investment to-date in blockchain technologies?
3. Why is just the beginning?
Objectives
@PeterBNichol www.linkedin.com/in/peternichol
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Theme 1: Is change predictable?
The impact of change on visibility
@PeterBNichol www.linkedin.com/in/peternichol
Blockchain’s Impact on Business
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Theme 1: Is change predictable?
The impact of change on visibility
@PeterBNichol www.linkedin.com/in/peternichol
$1.2 billion has been
invested in blockchain startups
Blockchain’s Impact on Business
Source: [1]
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Theme 1: Is change predictable?
The impact of change on visibility
@PeterBNichol www.linkedin.com/in/peternichol
Investment will reach
$10 billion by end of 2016
Blockchain’s Impact on Business
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Theme 1: Is change predictable?
The impact of change on visibility
@PeterBNichol www.linkedin.com/in/peternichol
By 2025 10% of GDP
will be stored on blockchains
Blockchain’s Impact on Business
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10@PeterBNichol www.linkedin.com/in/peternichol
It all started with…
Blockchain’s Impact on Business
“ Financial crisis 2007-08
The world believed . . .
"trusted third parties" could be
eliminated from financial transactions
“
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11@PeterBNichol www.linkedin.com/in/peternichol
Decentralized Consensus: On Distributed Communications
Blockchain’s Impact on Business
Source: [3]
P. Baran
Aug 1964
Circuits
Yap
Datacenter
Single point of failure
Franchise model
Finite points of failure
Blockchain
No single point of failure
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12@PeterBNichol www.linkedin.com/in/peternichol
Intermediaries, the trusted third party
BEFORE
AFTER
Blockchain’s Impact on Business
Source: [4]
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Industries interested in blockchain
Energy Financial ServicesUtilities Real Estate
Compliance Insurance TravelManufacturing
Aviation Recruitment GamingHealthcare
@PeterBNichol www.linkedin.com/in/peternichol
Blockchain’s Impact on Business
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1. Banking (Vault OS)
@PeterBNichol www.linkedin.com/in/peternichol
Thought Machine – Cryptographic Ledgers
Source: [9]
Blockchain’s Impact on Business
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2. Payments and Money Transfers (ABRA)
@PeterBNichol www.linkedin.com/in/peternichol
Direct Payment Flow – Money Transfer
Source: [9]
Blockchain’s Impact on Business
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3. Cybersecurity (Guardtime)
@PeterBNichol www.linkedin.com/in/peternichol
No Intercept – Estonian Gov’t
Source: [9]
Blockchain’s Impact on Business
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4. Car Leasing and Sales (Visa & DocuSign)
@PeterBNichol www.linkedin.com/in/peternichol
Visa & DocuSign – Click, Sign, & Drive
Source: [9]
Blockchain’s Impact on Business
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5. Networking of IoT Devices (IBM & Samsung, Filament)
@PeterBNichol www.linkedin.com/in/peternichol
IBM & Samsung – ADEPT
Source: [9]
Blockchain’s Impact on Business
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6. Insurance (LenderBot & Lemonway)
@PeterBNichol www.linkedin.com/in/peternichol
Democracy of Devices – Backbone of Cloud
AirBnB, Tujji, and WimduSource: [9]
Blockchain’s Impact on Business
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7. Access To All Physical Objects (Slock.it)
@PeterBNichol www.linkedin.com/in/peternichol
USN & Thought Machine – Cryptographic Ledgers
Source: [9]
Blockchain’s Impact on Business
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1. $1.2 billion invested to-date, soon to be $10 billion in 2016
2. Medical devices, healthcare, financial, real-estate, energy, utilities, government, and more
3. What if? Some visionaries see the future.
Wrap Up: Blockchain’s Impact on Business
@PeterBNichol www.linkedin.com/in/peternichol
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How Blockchain’s work?
1. Key terminology
2. How blocks (transactions) are created?
3. Why blockchain is secure?
Objectives
@PeterBNichol www.linkedin.com/in/peternichol
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Blockchains vs. Blockchain technology
@PeterBNichol www.linkedin.com/in/peternichol
Blockchain – a network; distributed database or
permissionless public record of transactions in
chronological order.
Blockchain technology – an
infrastructure; creates a decentralized digital public
record of transactions that is secure, anonymous,
tamper proof & unchangeable.
“a shared single source of truth”
How Blockchains Work
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The principles of blockchains
@PeterBNichol www.linkedin.com/in/peternichol
How Blockchains Work
1. Distributed – across all the peers, participating in the
network. Blockchain is decentralized, and every full node
has a copy of the block chain.
2. Public – the actors in a blockchain transactions are
hidden, but everyone can see all transactions.
3. Time-stamped – the date and time of all transactions
are recorded in plain view.
4. Persistent – because of consensus and the digital
record, blockchain transactions can’t catch fire, be
misplaced, or get damaged from water.
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Terminology
@PeterBNichol www.linkedin.com/in/peternichol
Blocks – a record of a transaction.
Chains – series of connected blocks (transactions).
Mining – is the process of computers solving a
mathematical puzzle. Puzzle verification occurs before
before a transaction is confirmed and added to the
blockchain.
Hash – A hash algorithm turns an large amount of
data into a fixed-length hash (random number)
How Blockchains Work
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How to create a block (transaction)
@PeterBNichol www.linkedin.com/in/peternichol
How Blockchains Work
TRANSACTIONS MINERSBLOCK PUZZLE
PROOF OF
WORKMINERSVERIFICATION
BLOCK
10 minutes of transactions
are broadcast to all miners
Miners create a blockMiners try to
solve puzzle
The successful miner
broadcasts its proof of
work to other minors
Miners solve puzzle and
gets a proof of work
Miners verify the
proof of work
Repeat
Source: [5]
2
1
3
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Why You Can’t Cheat
How Blockchains Work
1. Say
everyone is
working on
block 91
2. But one
minor wants
to alter a
transactions
in block 74
3. The miner
would have to
make and redo
all computations
for blocks 74-90
and do block 91.4. Also, he’d
have to do it all
before everyone
else in the Bitcoin
network finished
just block 91.
Block 91
Source: [6]
@PeterBNichol www.linkedin.com/in/peternichol
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1. Blocks are linked to other blocks to form chains of transactions
2. How to create a transaction
3. Miners solve mathematical puzzles to create blocks and announce the results.
Wrap Up: How Blockchain’s Work
@PeterBNichol www.linkedin.com/in/peternichol
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Creating New Value for Healthcare
1. How blockchain can be applied to healthcare?
2. Discuss the most practical use cases for healthcare?
3. What about blockchain will be hot tomorrow?
Objectives
@PeterBNichol www.linkedin.com/in/peternichol
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Blockchain for Healthcare Use Cases
Identity Counterfeit drugsAsset Exchange Genomics Research
EMR Storage Proof of Insurance SecurityQuantified Self
Smart Assets Clinical Trials Service BiddingOutcome Payments
@PeterBNichol www.linkedin.com/in/peternichol
Creating New Value for Healthcare
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31@PeterBNichol www.linkedin.com/in/peternichol
Use Case: Identity & Self-SovereigntyCreating New Value for Healthcare
What?• Individual autonomy
• Patient source of data
• Patient owned of data: user-key
permissions
How?• Blockchains create trust
• Patient, Provider, Profile, and Access
Benefits1. Authenticity of medical records
2. Availability of medical record (P2P)
3. Confidentiality to access record
Story:
1. Privacy is a concern until it
isn’t
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32@PeterBNichol www.linkedin.com/in/peternichol
Use Case: Health Asset ExchangeCreating New Value for Healthcare
What?• Distributed repository of health data
(hashed)
• Health asset exchange
• Collaborative crowdsourcing for price
transparency
How?• eBay for health data
• Aggregated disease information
Benefits1. Transparent prices across health
entities
2. Incentives for patients to engage
Story:
1. Medical asset exchange
2. Patient generated, patient
owned (health tokens)
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33@PeterBNichol www.linkedin.com/in/peternichol
Use Case: Quantified SelfCreating New Value for Healthcare
What?• Analyze the data that someone does
• Wearable data integrated into a
health blockchain
• Medical devices
How?• DNA wallets (physical and mental)
• Health tokens and maintenance
Benefits1. Sound body (chronic diseases)
2. Sound mind (Lumosity, CogniFit,
Elevate)
3. Realign people’s well-being
Story:
1. John’s Afib
2. Oil change
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34@PeterBNichol www.linkedin.com/in/peternichol
Use Case: Trusted EHRsCreating New Value for Healthcare
What?• Medical record that is authentic
• Clinical diagnosis based on latest
information
• Immediate confirmation for the
clinician of data integrity
How?• Blockchain receipt
• Confirmation of immutability
Benefits1. Accurate diagnosis
2. Assurance of a complete patient
medical profile
Story:
1. Verifiable medical record
2. Record extension
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35@PeterBNichol www.linkedin.com/in/peternichol
Use Case: Counterfeit DrugsCreating New Value for Healthcare
What?• The solution for transparency in
healthcare supply chains
• Demand for transparency is
increasing
• The impact of drugs we buy
How?• Provenance
• Chain-of-custody
Benefits1. Centralized systems can’t power
transparency
2. Fragmented effort lead to fraud
Story:
1. Starting with diamonds
2. Whole Foods
3. Vitamins to strawberries
One of these medicines is
fake. Can you tell which?
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36@PeterBNichol www.linkedin.com/in/peternichol
Use Case: Genomic ResearchCreating New Value for Healthcare
What?• Next-generation sequencing (NGS)
• Enabling precision medicine for
individual patients
• Linking biomarkers to access clinical
outcomes
How?• 2001 $100M, 2007 $10 mil, 2016 $1k
• NGS run against an evolving
database of viruses and illnesses
Benefits1. Identification of factors affecting your
health
Story:
1. BIDMC CIO / Storage
2. Expert to Novice
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37@PeterBNichol www.linkedin.com/in/peternichol
Use Case: Outcome Payments & ReportingCreating New Value for Healthcare
What?• Simple reporting for Medicare Access
& Chips Reauthorization Act of 2015
(MACRA)
• Easy auditing of Alternative Payment
Models (APM), Chronic Case Mgmt.
(CCM), and Comprehensive Primary
Care plus (CPC+)
How?• Digital immutable record
Benefits1. Auditable record
2. Trusted record of payment
Story:
1. Fraud / Red Cross
2. Payment reform
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38@PeterBNichol www.linkedin.com/in/peternichol
Use Case: Clinical TrialsCreating New Value for Healthcare
What?• De-identified information with
authenticity
• Research targets population required
How?• Broadcast to P2P network for
candidates
• Orchestration and transfer of health
data securely
Benefits1. Unlimited pool of qualified subjects
2. Raw health data never provided
3. No issues with limited use
Story:
1. Research cancer
2. N-of-1 / consumables
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39@PeterBNichol www.linkedin.com/in/peternichol
Use Case: Service BiddingCreating New Value for Healthcare
What?• Doctors and medical professionals
bid to provide medical services
• Creation of exchanges and tradenets
for electronic and mobile bidding
• The service providing the “value of
health”
How?• Think the “Uber for Health” buys eBay
• Globally secure information network
Benefits1. The most comprehensive review
network the world has even seen
Story:
1. Diving
2. Smart contracts for
healthSource: [7]
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40@PeterBNichol www.linkedin.com/in/peternichol
Use Case: Proof of InsuranceCreating New Value for Healthcare
What?• ZKP running smart contracts
• Validate patients medical history,
patients prescription, or patients
name
• Hospital (verifier) knowing nothing
except fact is valid/invalid
How?• Convince verifier of the truth
• Verified does not learn anything
except statement is true
Benefits1. Dapps validate patient information
Story:
1. Hospital check in
2. Verifier/Prover
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41@PeterBNichol www.linkedin.com/in/peternichol
Use Case: Health Information ExchangesCreating New Value for Healthcare
What?• Population health management
• Measuring patient outcomes
• Connecting outcomes with prevention
How?• Blockchain based health-record
• Linking medical outcomes e.g.
outbreaks
Benefits1. Ubiquitous security infrastructure
2. Verifiable identity and authentication
3. Representation of authorization to
access data
Story:
1. APCDs
2. OI/OO
BONUS!
Source: [8]
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42@PeterBNichol www.linkedin.com/in/peternichol
Use Case: Smart AssetsCreating New Value for Healthcare
What?• Changing the definition of preventive
• From telemedicine to bioelectronics
• Direct and indirect patient care robots
• Medical device maintenance
(nanobots to ultrasounds)
How?• Autonomous maintenance
• Device-to-device updates
Benefits1. Permanent record of device status
2. Simple asset transfer
3. Transparent maintenance records
Story:
1. Toaster challenge
2. Signals
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43@PeterBNichol www.linkedin.com/in/peternichol
Use Case: Healthcare SecurityCreating New Value for Healthcare
What?• Captured and time-stamped
healthcare data
How?• Data authenticity chain-of-custody
• KSI, scalable digital signature
authentication for electronic data,
machines and humans (Guardtime)
Benefits1. Data integrity
2. Transparent truth, not trust
3. Prove healthcare data has not been
compromised
Story:
1. Breach / Duty to verify
integrity
2. Data Transmission
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Mainstream blockchain companies
Create a verifiable
record of any data or
business process on the
blockchain.
Gem's blockchain application
platform transforms the way
companies and industries
connect to solve impossible
problems.
@PeterBNichol www.linkedin.com/in/peternichol
Creating New Value for Healthcare
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Blockchain up and comers
Node-RED is a tool for
wiring together devices,
APIs and services.
@PeterBNichol www.linkedin.com/in/peternichol
Creating New Value for Healthcare
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1. Identity, marketplaces, EHRs, clinical trials, security and more
2. Most practical for sharing information, without a trusted 3rd party
3. The future Node-Red, Gem, and others.
Wrap Up: Create New Value for Healthcare
@PeterBNichol www.linkedin.com/in/peternichol
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47@PeterBNichol www.linkedin.com/in/peternichol
Upcoming healthcare blockchain events
Focused on healthcare
Austin, Texas
Oct 20, 2016:
http://summit.ulahealth.me/
Story:
1. New Toaster
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Questions?
617-480-9147
Personal Blog: www.LeadersNeedPancakes.com
Professional Blog: www.cio.com/author/Peter-B.-Nichol/
@PeterBNichol www.linkedin.com/in/peternichol
Thank you!
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49@PeterBNichol www.linkedin.com/in/peternichol
ONC and NIST blockchain challenge
..to investigate
Blockchain technology and
its use in..
health IT and health
research.
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50@PeterBNichol www.linkedin.com/in/peternichol
Co-Creation of Trust for Healthcare: The Cryptocitizen Framework for Interoperability with Blockchain
The aim of this paper is to
introduce the concept of co-
creation of trust for healthcare
and propose applications of
blockchain to positively impact
aspects of healthcare
interoperability.
… blockchain health ecosystems
and the patient-centric
interactions that underpin the co-
creation of trust. Source: http://doi.org/10.13140/RG.2.1.1545.4963
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51@PeterBNichol www.linkedin.com/in/peternichol
Micro-Identities Improve Healthcare Interoperability with Blockchain: Deterministic Methods for Connecting Patient Data to Uniform Patient Identifiers
This paper presents a hybrid
model, integrating HL7 FHIR,
interoperability standards…for
exchanging electronic health
records using blockchain
technologies for better patient
access to health information.
…research expands traditional
identity matching strategies to
formulate a new solution for
healthcare entities to match
patient identities. Source: http://doi.org/10.13140/RG.2.1.3118.3605
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52@PeterBNichol www.linkedin.com/in/peternichol
New applications for blockchain interoperability
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http://bit.ly/5MinBlockchain
If I only had 5 minutes to explain blockchain
@PeterBNichol www.linkedin.com/in/peternichol
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[1] Outlier Ventures. (2016). Outlier Ventures » Investing in
blockchain 2016. Retrieved from
http://outlierventures.io/investing-in-blockchain-2016/
[2] Venture Scanner. (2016). Bitcoin Visual Map1 (image).
Retrieved August 27, 2016, from
https://venturescannerinsights.files.wordpress.com/2015/04/
bitcoin-visual-map1.jpg
[3] Kalra, A. (2016). Bitcoin and Blockchain: The difference and
what does their future hold? Retrieved September 6, 2016,
from http://irishtechnews.net/ITN3/bitcoin-and-blockchain-
the-difference-and-what-does-their-future-hold/
[4] Edwards-Playne, L. (2015). 3 Essential Takeaways From
The MIT-Microsoft Bitcoin Talk. Retrieved September 6,
2016, from https://medium.com/@liamzebedee/3-essential-
takeaways-from-the-mit-microsoft-bitcoin-talk-
54a4cd71a702
[5] Insly. (2016). The Evolving Focus of the Blockchain in
Insurance (image extended). Retrieved September 6, 2016,
from https://www.insly.com/lv/blogs/the-evolving-focus-of-
the-blockchain-in-insurance
[6] Peck, M. E. (2015). The Future of the Web Looks a
Lot Like Bitcoin. Retrieved September 6, 2016, from
http://spectrum.ieee.org/computing/networks/the-
future-of-the-web-looks-a-lot-like-bitcoin
[7] IBM. (2016). Blockchain: The Chain of Trust and its
Potential to Transform Healthcare – Our Point of
View. Retrieved from
https://www.healthit.gov/sites/default/files/8-31-
blockchain-ibm_ideation-challenge_aug8.pdf
[8] Krawiec, R., Filipova, M., Quarre, F., Barr, D., Nesbitt,
A., Fedosova, K., … Tsai, L. (2016). Blockchain
Opportunities for Healthcare. Retrieved from
https://www.healthit.gov/sites/default/files/4-37-
hhs_blockchain_challenge_deloitte_consulting_llp.pdf
[9] cbinsights. (2016). Banking Is Only The Start: 20 Big
Industries Blockchain Tech Could Disrupt. Retrieved
September 8, 2016, from
https://www.cbinsights.com/blog/industries-disrupted-
blockchain/
References
@PeterBNichol www.linkedin.com/in/peternichol
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References: Images
@PeterBNichol www.linkedin.com/in/peternichol