healthcare, blockchain and smart contracts: emerging...
TRANSCRIPT
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Presenting a live 90-minute webinar with interactive Q&A
Healthcare, Blockchain and Smart Contracts:
Emerging Issues for Healthcare Counsel Leveraging Distributed Ledger Technology in Healthcare, Protecting Privacy and Security
Today’s faculty features:
1pm Eastern | 12pm Central | 11am Mountain | 10am Pacific
WEDNESDAY, OCTOBER 11, 2017
Jeffery T. Gorham, Esq., Frost Brown Todd, Indianapolis
Ryan S. Johnson, Shareholder, Fredrikson & Byron, Minneapolis
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Blockchains and Smart
Contracts Jeffery T. Gorham, Senior Associate,
Frost Brown Todd
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Blockchains and Distributed
Ledgers Defined
Blockchains
The technology behind cryptocurrencies.
Analogous to the TCP/IP Protocol that is the
foundation of the internet
Blockchains are Distributed Ledgers
Ledgers are historically centralized and private
Blockchains are Decentralized or Distributed
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Types of Blockchains
Permissioned vs. Permissionless
Blockchains
Centralized usually = “private”
i.e. only one party maintains
Decentralized usually = “permissioned”
i.e., must be “approved”
Distributed usually = “permissionless”
i.e., open to use; no approval
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How Blockchains work: Basics
Chronological Ledger
All transactions are “pseudo-anonymous”
All transactions are grouped together in “blocks”
Transactions are logged and stamped with
information about the time, amount, and
participants as if a notary is present at every
transaction
Blockchain is not centralized (does not have
one owner), therefore there are strict rules
about how it must be maintained
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How Blockchains Work: Maintaining
the Ledger
The individuals who maintain and update the
Blockchain are “miners”, and they are paid a
reward
Solving a complex mathematical problem
The Miners approve transactions by:
Bundling transactions into a block
Verifying the transactions are valid
Select a header of the previous block and insert it
into the header of the new block as a “Hash”
combined with an incremental number called a
“Nonce”
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How Blockchains Work: Amending the
Ledger (Hashing)
When all miners agree the problem has been
solved correctly, the block is added to the
chain and is visible to the entire network
The Hash is like a digital version of a wax
seal.
The unbroken Hash (seal) confirms that the
block, and therefore every block before it, is
legitimate
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How Blockchains Work: Amending the
Ledger (Hashing)
Recall: Transactions must be validated by
other network miners
Miners incentivized to add “valid”
transactions via a reward; invalid
transactions are rejected, and thus, no
reward is given
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Blockchain Characteristics
Security
Pseudo-anonymous but not secret
Transactions are programmable (like
monthly mortgage payments) or conditional
(like holding and releasing an escrow)
Has difficulty dealing with unanticipated
events
“If/then” scenarios are easy to program
Variations to programmed tasked cannot be
accounted for
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SMART CONTRACTS
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What Are “Smart Contracts”
Self-automated computer programs that can
carry out the terms of any contract
Mostly based on objective conditions
precedent
“If, then” criteria
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What Are “Smart Contracts”
(cont.)
Variables: Readily Verifiable Data
Reliable sources
Social Security DMF
FAA Records
National Weather Service
Crowdsourcing
Voting
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What Are “Smart Contracts”
(cont.)
Think: Escrow Agreements
Money held in escrow until performance is met
Once performance is validated, money released
Regulated by an unbiased party, which only seeks
the objectively “right” answer, devoid of outside
influence
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Distributed Autonomous
Organization (DAO)
DAO: the most popular Smart Contracts platform
A DAO is “a tightly packed collection of smart
contracts written on the Ethereum blockchain”
A DAO’s smart contracts amount to a series of
by-laws that determine how its constituency —
anyone around the world who has bought DAO
tokens with ethers — votes on decisions.
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Distributed Autonomous Organization
(DAO) (cont.)
Ether: Entry Token used to:
Record transactions
Vote on outcomes
Purchase other tokens within the ecosystem
Transactional process (sharding)
Top level retains “master ledger”
Lower level nodes run Proof of Stake
Much more efficient from a scaling perspective
(compared to Bitcoin simple Proof of Work)
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Healthcare and Blockchain
Ryan S. Johnson, Esq.
(612) 492-7160
© 2017 Fredrikson & Byron, P.A.
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Healthcare: Current System
• Closed, controlled operating systems
• Lack of interoperability
• Inefficiencies
• Security Issues
© 2017 Fredrikson & Byron, P.A.
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Healthcare: Blockchain Potential
• Data Integrity
• Data Sharing
• Connectivity
• Part of Digital Health Revolution: AI, IoT, Big
Data, etc.
© 2017 Fredrikson & Byron, P.A.
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Healthcare: Blockchain Potential
Applications
• Audit and Compliance
• Financial and Contract Management
• Internet of Things (IoT)
• Data Liquidity
• Cyber Security
• More Efficient: cost reductions/faster transactions
© 2017 Fredrikson & Byron, P.A.
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Some Examples
• Sunshine Act Compliance
• Payment and Reimbursement
• Supply Chain Management
© 2017 Fredrikson & Byron, P.A.
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Legal Issues
• Privacy and Security
• Governance
• Fraud and Abuse
© 2017 Fredrikson & Byron, P.A.
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Privacy and Security
• HIPAA
• Other Federal and State Laws and Regulations
© 2017 Fredrikson & Byron, P.A.
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Governance
• No Central Authority
• Software as Law?
© 2017 Fredrikson & Byron, P.A.
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Fraud and Abuse
• Antickback
• Stark Law
• False Claims Act
• State Fraud and Abuse/Self-Referral Prohibitions
© 2017 Fredrikson & Byron, P.A.
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Closing Thoughts
© 2017 Fredrikson & Byron, P.A.
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