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Using Blockchain Technology to Create Positive Social Impact

May 16, 2018
by Randall Minas
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Blockchain technology could be used to enable the WHO and CDC to better monitor disease outbreaks over time by creating distributed “ledgers” that are both secure and updated hundreds of times per day.

During the 2014 to 2016 Ebola outbreak, many doctors and nurses relied on the World Health Organization (WHO) and the Centers for Disease Control (CDC) to stay updated on disease exposure, monitoring guidelines, and the progress of the epidemic. Both organizations compiled disease counts and provided updated weekly or monthly reports. But imagine the possibilities if the process of compiling epidemic statistics was simplified and provided real-time data accessible to any and all healthcare personnel with an internet connection?

The technology to take this next step exists now, is incredibly secure, and has the potential to transform the way we track epidemics like Ebola or influenza.

“Blockchain” technology creates a continuously updated, distributed ledger used by bitcoin and other cryptocurrencies. Recently, there has been growing interest in using blockchain outside of cryptocurrencies, especially in the banking industry. However, discussion of the use of blockchain technology has reached beyond banking and accounting to focus on increasing sustainability or other social impacts as noted in “Digital Currencies and Blockchain in the Social Sector.”

Healthcare is yet another area where blockchain can make a substantial impact. Blockchain technology could be used to enable the WHO and CDC to better monitor disease outbreaks over time by creating distributed “ledgers” that are both secure and updated hundreds of times per day. Issued in near real-time, these updates would alert healthcare professionals to spikes in local cases almost immediately. Additionally, using blockchain would allow accurate diagnosis and streamline the isolation of clusters of cases as quickly as possible. Providing blocks of real-time disease information—especially in urban areas—would be invaluable.

In the United States, disease updates are provided in a Morbidity and Mortality Weekly Report (MMWR) from the CDC. This weekly report provides tables of current disease trends for hospitals and public health officials. Another disease reporting mechanism is the National Outbreak Reporting System (NORS), launched in 2009. NORS’ web-based tool provides outbreak data through 2016 and is accessible to the general public. There are two current weaknesses in the NORS reporting system and both can be addressed by blockchain technology.

The first issue lies in the number of steps required to accurately report each outbreak. A health department reports an outbreak to the NORS system, the CDC checks it for accuracy, analyzes the data, then provides a summary via the MMRW. Instantiating blockchain as the technology through which the NORS data is reported, every health department in the country could have preliminary data on disease trends at their fingertips without having to wait for the next MMRW publication.

The second issue is the inherent cybersecurity vulnerabilities using a web-based platform to monitor disease reporting. As we have seen with cyberattacks both domestic and abroad, cybersecurity vulnerabilities underlie most of our modern-day computing infrastructure. Blockchain was designed to be secure because it is decentralized across many computer networks and, since it was designed as a digital ledger, the previous data (or “blocks”) in the blockchain are difficult to alter.

While the NORS platform could be hacked with malware to gain access to our electricity and water infrastructure, instituting blockchain technology would limit the potential damage of the malware based on the inherent security of the technology. If this does not sound important, imagine the damage and ensuing panic that could be caused by a compromised NORS reporting a widespread Ebola outbreak.

The use of blockchain in monitoring epidemic outbreaks might not only apply to fast-spreading outbreaks like the flu, but also to epidemics that have lasted for decades. Since blockchain allows an unchangeable snapshot of data over time and can be anonymous, partner organizations could provide HIV test results to an individual’s “digital ledger” with a date of the test and the results.

Individuals could then exchange their HIV status securely, in an application, before engaging in high-risk behaviors. Since many municipalities provide free or low-cost, anonymous HIV testing, the use of blockchain would allow disease monitoring and exchange of status in a secure and trusted manner. The LGBTQ community and other high-risk communities could use an application to securely exchange HIV status with potential partners. With widespread adoption of this status-exchange system, an individual’s high-risk exposure could be limited, further reducing the spread of the epidemic.

While much of the creative application around blockchain has focused on supply chain-like models, including distribution of renewable energy and local sourcing of goods, it is important also to think innovatively about how blockchain can be used outside of supply chain and accounting.

In healthcare, blockchain has been discussed frequently in relation to electronic health records (EHRs), yet even that could be underappreciating the technology’s potential. Leaders in the blockchain arena should invest in application development for epidemic monitoring and disease control using blockchain technology. Philanthropic organizations should call for grant proposals on instantiating blockchain for epidemic and disease control. Newly developed applications could be integrated and eventually replace web-based platforms currently in use at the WHO and CDC. In addition, application development at the individual level would provide another tool in the arsenal of fighting decades-old epidemics like HIV.

Applying blockchain technology to epidemic monitoring and disease control could yield high value and create even greater positive social impact.

Randall Minas is the Hon Kau and Alice Lee Faculty fellow and assistant professor in the Information Technology Management Department at the Shidler College of Business at the University of Hawai’i at Manoa.

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Take the Lead to Deploy Emerging Technologies for Improved Outcomes

December 14, 2018
by Brad Wilson, Industry Voice, former CEO of Blue Cross and Blue Shield of North Carolina
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It is a thrilling time to work in healthcare. As the former CEO of Blue Cross and Blue Shield of North Carolina (Blue Cross N.C.), I have had the opportunity to be at the forefront of using new technologies to improve outcomes for our members. Now as a member of the CitiusTech advisory board, I continue that focus on emerging technologies, such as artificial intelligence (AI), and the potential to accelerate the shift to value-based care and improve the healthcare system in material ways.

AI is starting to make a distinct impact in helping providers deliver more effective care, lower costs and create a more consumer-friendly healthcare system. Blue Cross NC recently piloted the use machine learning, a type of AI, to identify spikes in prescriptions for a costly medication. The company reached out to doctors who had been prescribing the medicine in significant numbers. Alerting just one particular physician practice to a generic equivalent brought estimated annual savings of $750,000 for Blue Cross NC customers. The potential of AI is not measured only in dollars, but cost savings are an important consideration.

Machine learning works by applying sophisticated algorithms to rich datasets from electronic medical records (EMRs), patient-reported data, claims and a host of other sources. To be successful, this requires both access to data and significant investment to support the depth and breadth of data analytics capacity and capability.

Yet, historically, one of the biggest barriers to value-based models has been providers’ and payers’ possessiveness of their own data. There is a good business reason for that possessiveness: competitive advantage. The different parts of the healthcare system do not want competitors to use shared data to steal business. But the guarding of data drives healthcare costs higher and, more importantly, makes delivering better, more personalized healthcare more difficult. In the past, power came from hoarding information; today, there is power in serving as an information hub.  Healthcare providers and payers are starting to understand this and there is more willingness to work together in sharing what has traditionally been closely held information.

As consumers’ voices gain in numbers and decibels, it’s clear that analytics technologies that can lead to better care at lower cost are desperately needed, particularly for payers. But the entire healthcare industry needs to move more rapidly. Health plans need to enrich, deepen and widen their analytics capabilities as quickly as possible. If they don’t, we will continue to see disruptors like Google, Apple, and Amazon enter the healthcare market—companies that have a demonstrated ability to be nimble and maximize the impact of their data.

For both providers and payers, forward-thinking organizations recognize that building their own data analytics solutions is not always the answer. Often there is not enough time, resources or enough of the right talent to deliver the capacity and capability required. Fortunately, robust turnkey solutions coupled with deployment expertise are available to efficiently and cost-effectively integrate data and analytics within an organization’s clinical, financial and administrative processes.

As health plan executives map out their strategic plans, look to these emerging technologies as accelerators for leveraging data to manage risk, optimize performance, engage consumers, enhance population care, and improve clinical outcomes to reduce readmissions and further drive evidence-based medicine. The opportunity is here to transform healthcare delivery in significant ways. Success will go to those organizations that understand the potential of these new technologies and take the lead to deploy them effectively—today. 

Brad Wilson is former CEO at Blue Cross and Blue Shield of North Carolina and as a member of the new CitiusTech Advisory Board. Mr. Wilson joined Blue Cross NC in 1995 as General Counsel and held a variety of senior-level positions before being named CEO in 2010. Under his leadership, Blue Cross NC grew to a $9 billion company serving over 3.8 million customers. Mr. Wilson has also served as Director of the BCBS Association, AHIP and numerous other national and state healthcare organizations.


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Investors Have Strong Interest in HIT Sector, Despite Valuation Concerns

December 13, 2018
by Heather Landi, Associate Editor
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Healthcare IT remains a hot investment sector despite concerns about these companies being overvalued, according to KPMG-Leavitt Partners 2019 Investment Outlook, a survey of health care investment professionals.

Looking ahead to 2019, more than a third of respondents (34 percent) said they were most interested in investing in health care IT, followed by care management (31 percent), home health (23 percent), retail-centric medical groups (22 percent) and primary care practices (21 percent).

New York City-based KPMG and Leavitt Partners, based in Salt Lake City, surveyed 175 respondents online from corporations, health systems, investment banks, venture capital and private equity firms between September 17, 2018 and October 21, 2018. Of those surveyed 32 percent were C-suite executives; 29 percent were principal, partner or managing director; 32 percent were vice president or director; 6 percent were analysts/associates and 2 percent held other titles.

“We are not surprised by the great deal of interest in health care IT and care delivery outside the hospital,” Governor Mike Leavitt, founder of Salt Lake City-based Leavitt Partners and former Utah Governor and U.S. Health & Human Services Secretary said in a statement. “As health care continues to march toward value, the emphasis on moving care to lower cost sites and enhanced coordination will continue, and those who can increase quality and lower cost will win.”

According to an October report from Rock Health, 2018 is already the most-funded year ever for digital health startups. Digital health funding in this past third quarter soared to $3.3 billion across 93 deals, pushing 2018 funding to $6.8 billion, already exceeding last year’s annual funding total, which was $5.7 billion, by more than a billion dollars.

Drilling down into respondents’ predictions for investment activity in 2019, in the health care and life sciences market, 96 percent of respondents see either a lot or a moderate amount of investment in health IT and data next year, while a similar percentage (90 percent) see significant or moderate investment in outpatient services. Forty-four percent forecast a lot of investment in post-acute care services, 39 percent predict significant investment in provider services and about a quarter of respondents believe there will be a lot of investment in managed public programs, payer service providers and pharmaceutical and biotech manufacturers. Eighteen percent believe there will be significant investment in medical device and diagnostics and medical equipment.

The survey results indicate there is concern that health IT is overvalued, yet investors believe there is some room to climb.

The majority of investment professionals see health care IT investments as an overvalued sector (64 percent), yet 40 percent expect the valuations to increase in 2019 while 51 percent see them staying the same. About two-thirds of respondents (62 percent) think the health IT sector will grow faster than the market in 2019, and three quarters of investment professionals see increasing competition in the health IT market. Investors also estimate that the average purchase price multiple, in terms of EBITDA, will be 12.5 for the health IT sector in 2019. Survey respondents expect ongoing demand for tools to help with consumerism will impact investment and deal making in the sector, according to the survey.

About four in ten respondents believe the healthcare market is experiencing a “moderate bubble,” while 9 percent believe the bubble will likely burst.

Care management solutions for risk-bearing providers, a highly competitive sector which helps coordinate care of the chronically ill or seriously injured, are expected to be the second highest sector for investment behind health care IT, similarly driven by trends of consumerism and increased focus on early care interventions.

Looking at potential drivers of M&A activity in the health care and life sciences sector in the coming year, 64 percent of respondents cited cost consolidation and economies of scale, while 45 percent cited accretive acquisition strategies. Forty percent of respondents see changing payment models as a driver of M&A activity, and 38 percent cited pressure from competition. Other drivers cited by respondents include expansion/divestiture of service areas (25 percent), geographic expansion/contraction (24 percent), revenue synergies (22 percent), need to deploy cash on balance sheet (17 percent), and regulations and legislation (13 percent).

“Deals are largely being driven by the need for savings, economies of scale, and improving cash flow or accretive earnings per share,” Carole Streicher, Deal Advisory leader for healthcare & life sciences at New York City-based KPMG, said in a statement. “Secondarily, there is a bit of a defensive posture motivating investments as health care organizations contend with competition and reimbursement models connected to quality and efficiency, as well as the entrance of tech firms investing in the sector.”


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Report: Massachusetts General Hospital Targeting Various Blockchain Use Cases

December 7, 2018
by Rajiv Leventhal, Managing Editor
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Massachusetts General Hospital (MGH) researchers are partnering with MediBloc, a Korean healthcare blockchain company, with the aim to improve patient data sharing and storing, according to an article in CoinDesk.

Per the article, the Laboratory of Medical Imaging and Computation by MGH and Harvard Medical School will be escalating research in a variety of broad areas “from medical image analysis to health information exchange by leveraging our cutting-edge technologies such as blockchain, artificial intelligence and machine learning,” according to Synho Do who is the laboratory’s director.

Do specifically told CoinDesk, “In collaboration with MediBloc, we aim to explore potentials of blockchain technology to provide secure solutions for health information exchange, integrate healthcare AI applications into the day-to-day clinical workflow, and support [a] data sharing and labeling platform for machine learning model development.”

Interestingly, MGH won’t be using any real patient data for its research, but rather simulated data, according to officials, since the various institutions that have the real patient data keep it in a way “that can’t be shared securely and often is in various incompatible formats.”

MediBloc’s CEO noted that the company is not only developing a distributed ledger for storing and sharing medical data, but also working on a tool that would convert data now held by hospitals from existing formats to a universal one, per the article.

For this initiative, MediBloc has already gotten partners across Asia, including eight healthcare organizations and 14 technology companies, officials said.

Earlier this year, a testing environment version of the blockchain was launched, and the network is expected to go live before the end of the year before becoming fully functional in the second quarter of 2019. Furthermore, there are also apps in the works that are planning to go live next year, with one of them, currently in a beta testing phase, “designed for patients to sell the information about their symptoms and the prescriptions they get to MediBloc. After that MediBloc will analyze that data and sell the analysis to pharmaceutical and insurance companies,” according to the story.

In the end, the main goal of the blockchain project will be to let patients independently decide what to do with their information.

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