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Blockchain in healthcareBasics, challenges, opportunities
Maria Marenco
Public Affairs and Communications - HIMSS Europe
Mirko De Maldè
COO - Lynkeus
2
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?
3
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
4
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
5
#Blockchain4EU,
Blockchain4…?
New business models
New Processes
Ecosystems
Multidisciplinary collaboration
What else does
DLT bring to the
table?
6
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
7
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
8
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
10
Blockchain 101
11
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
12
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
13
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
14
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
15
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
16
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
20
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!