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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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One Health Policy Researcher on the Current State of Blockchain in Healthcare, and its Potential Future

October 22, 2018
by Heather Landi, Associate Editor
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Blockchain technology is generating a lot of interest and excitement in healthcare because of its potential to improve transparency, relieve administrative burdens and reduce costly waste within the system. However, there are also those within the industry that caution about the realistic prospects for the adoption of blockchain technologies in U.S. healthcare as well as the challenges of implementing this still-emergent technology.

In August, a Deloitte survey found that most global executives see great value in blockchain’s potential to reinvent processes across the business value chain, while there is interest and investment in a wide range of use cases. The research revealed that 74 percent of all respondents reported that their organizations see a “compelling business case” for the use of blockchain—and many of these companies are moving forward with the technology.

As an academic researcher, Tim Ken Mackey, an associate professor of anesthesiology and global public health at UC San Diego School of Medicine, has been exploring the possibility of leveraging blockchain to enhance supply chain management in healthcare, as well as other use cases.

Mackey is the director of healthcare research and policy at UC San Diego – Extension, and he also is the director of the Global Health Policy Institute. He holds a Ph.D. in Global Public Health from the joint doctoral program at UC San Diego-San Diego State University. His work focuses on a broad array of multidisciplinary topics, including research in disciplines of public health, health technology and innovation, supply chain, pharmaceutical policy, and public policy and law.

Mackey will bring his blockchain expertise to the upcoming Convege2Xcelerate conference taking place Oct. 22 at Columbia University in New Yok City. The conference is sponsored by Partners in Digital Health, publisher of Blockchain in Healthcare Today and Telehealth and Medicine Today, and will feature sessions on transformational technologies including blockchain, telehealth and artificial intelligence (AI).

While Mackey is a proponent of exploring the use of blockchain in healthcare, and sees real-world applications for U.S. healthcare, he also sees a number of ethical, technical, regulatory and business issues that need to be resolved. Recently, Mackey spoke with Healthcare Informatics Associate Editor Heather Landi about blockchain’s potential and challenges in healthcare. Below are excerpts of that interview.

From an academic research perspective, what is your interest in blockchain and what use cases are you exploring?

I was first brought into it because we were exploring how it could relate to combatting counterfeit medication, so using blockchain in the context of supply chain, and seeing whether it’s a good tool to combat the illicit trade of counterfeit drugs. I originally came into blockchain from my public health experience, and from there, I’ve been looking at blockchain in a number of different use cases and different healthcare verticals. The primary one is drug supply chain, but that could be a lot of different things within the drug supply chain; it could be recall management, pharmacovigilance, and it could be track and trace.

Outside of supply chain, we also look at different design principles and different use cases of blockchain and how they are supposed to fit a particular healthcare challenge. Genomics is one area that looks more towards consumers sharing their data. That’s different from a supply chain blockchain, which is more for compliance purposes, versus also an EHR (electronic health record) blockchain, which is intended to share different healthcare records and improve different population health outcomes across different health systems, but at the same time, keeping the patient data within the health system and providing provenance to that data.

Also, medical devices might look at blockchain more for contractual issues like maintenance of products and making sure there is an audit log for recall. Medical devices oftentimes have blockchains to pull in data from other sources to get people to share data with their devices, so they can create more data to hopefully improve the continuity of care across that device. There’s a lot of different use cases out there, and the interesting thing is that a blockchain has to be malleable to whatever healthcare challenge it is trying to address, and the design principles, which are primarily—is it a permissions blockchain versus a non-permissions blockchain, is it a private blockchain versus a public blockchain, what’s the consensus mechanism? Those principles have to map to those use cases, and oftentimes, they don’t.

Could you expand on that idea of mapping blockchain to particular use cases?

A good example of blockchain adoption that is happening pretty rapidly, although it’s not fully into production, is in the clinical trial space. And let’s keep in mind those three principles—public versus private blockchain, permissions versus non-permissions, and consensus mechanism. For a clinical trial, you can have one component of that clinical trial process that is a public blockchain. What I mean by that is, if you want to recruit patients and you want to access patient registries, or you want verified information that patients have certain conditions, then a blockchain would be amenable to that, to match patients and make recruitment a lot more cost effective. That could be a very public blockchain that doesn’t really have any permission structure that allows people to share their data in a verifiable way.

But, once you enter those people into the clinical trial, you’re probably going to have some kind of private or hybrid blockchain where the data is only available to certain entities—the clinical sites, the physicians, and the researchers—that are involved in the study protocol. In that case, that public blockchain turns into a private blockchain, or a very specific permission-structured blockchain, which is really meant to drive the study protocol within the clinical trial. So even within one vertical, you may have different business cases for the structure of a blockchain. However, many people are very much against private blockchains; they want fully public blockchains. Those design principles have to be thought out first within the context of the healthcare use case before we even think of the technology, and that’s the disconnect we often have.

There are some in the industry who believe blockchain is overhyped or that the challenges of implementing it might outweigh the benefits. Do you believe blockchain is showing its potential?

It depends on the vertical, but that doesn’t mean that blockchain can’t work for a particular vertical or that it’s not a good technology for that vertical, but that there may be regulatory considerations, such as GDPR (General Data Protection Regulation) and HIPAA (Health Insurance Portability and Accountability Act), or business considerations that make it hard for more widespread adoption. Blockchain is really primed for proof of concept development, but often the hard part is translating a proof of concept into something that can go into production and can be used by multiple parties, and that’s where the most benefit comes from blockchain; if you are allowed to share data, but keep ownership of it and have provenance of the data and trust in that data. Getting to that phase is going to be harder.

As one example, in supply chain there is much discussion is about how much data are we going to share on the blockchain. This is a fundamental question that is not about the technology, it’s more about different trading partners and how much they want to share data. That issue is not about trust of the data, but it’s about proprietary information that may be contained in the data, and how we govern the sharing of data. Those things are outside technology but rather are core business considerations that are different for supply chain than they are for consumer health. That’s often the roadblock to more widescale blockchain adoption. Proof of concepts and prototypes are pretty easy to stand up, but when it gets to real-world testing, and also the regulatory framework and whether the regulatory framework will absorb that type of technology or incentivize it, those are separate issues.

Those are some of the barriers, and they are not technology-focused. I think that’s why there is a bit of a disconnect between people who are technologists and think, ‘It’s a great technology and we should just use it,’ versus the healthcare space where people say, ‘These are our processes, and blockchain may be good for those processes, but there are inherent regulatory, legal and business issues, that make it hard to adopt.”

The core principles of blockchain are that it is an immutable shared ledger and it establishes provenance and integrity of the data. Those core elements are things we want with health care data. There are a lot of healthcare challenges and issues that could benefit from a shared ledger, such as reining in misuse of healthcare data as it relates to healthcare fraud and abuse and for drug recalls. And then there’s simple things like medical licensure, where the use of blockchain for credentialing could make that process more efficient. Many healthcare use cases relate to some component of data provenance, some level of sharing of data, and also the security of data. But, from a pragmatic view, there are some healthcare challenges where you don’t need those underlying elements, you just need to improve a process. And, if that process doesn’t require those underlying data provenance elements, then maybe this discussion about blockchain is going to distract more than it adds.


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One-on-One with Bon Secours Mercy Health’s President of Health Innovation

October 22, 2018
by Rajiv Leventhal, Managing Editor
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G. Anton Decker, M.D., president of health innovation at Bon Secours Mercy Health (the Maryland-based Bon Secours Health System and Cincinnati-based Mercy Health finalized their merger in September, thus establishing one of the largest Catholic healthcare systems in the nation), has been “around the healthcare block,” one might say.

Prior to his new role as president of health innovation at Bon Secours Mercy Health, and before the merger, Decker was the chief clinical officer for Mercy Health, with system-wide oversight of clinical operations and value- based care. Before that, he served as the president of Mercy Health Physicians, a multi-specialty medical group of over 1,300 providers, and prior to that, he was the chief medical officer and chairman of the board for Banner Medical Group.

Decker brings his experience and expertise to the Convege2Xcelerate conference taking place Oct. 22 at Columbia University in New Yok City. The conference is sponsored by Partners in Digital Health, publisher of Blockchain in Healthcare Today and Telehealth and Medicine Today, and will feature sessions on transformational technologies including blockchain, telehealth and artificial intelligence (AI).

To preview the core health IT topics the conference will focus on, Healthcare Informatics interviewed Decker about how he, and his organization, take on innovation opportunities and how digital health plays a role in operational strategies. Below are excerpts from that discussion.  

Can you explain your role—president of health innovation?

I explore innovative partnerships with a focus on data and digital innovation.

Looking at some of the healthcare disrupters out there, non-traditional companies, what picture does that paint for the future?

One may argue that the U.S. health system ran out of money 20 years ago and it’s only catching up to us now. Because hospital reimbursement from commercial payers has still been favorable, health systems could survive. As commercial and governmental reimbursement declines, however, the only option will be for them to reinvent themselves or be disrupted. It’s not simply a light switch; it is happening to us right now, often without realizing it. I am an optimist and believe that the future is bright, although the journey to get there will be rocky.

Previously you have held roles such as chief clinical officer, overseeing clinical operations and value-based care. Can you talk about some of Bon Secours Mercy Health’s specific value-based care initiatives and how things are progressing?

We have a strong commitment to value-based care and are in many shared savings and risk sharing agreements with private and governmental payers.

 What advice can you give based on the lessons you have learned?

Be very careful before you go at risk. Many health systems have lost their shirts not realizing how difficult it is. I would advise to take it gradually; first do a shared-savings arrangement with a payer. Understand the nuances, succeed at that for a year or two, and then take on financial risk.

It’s critical to invest in physician leadership and the required infrastructure. Be careful of creating a “shadow health system.” Instead, utilize and improve on the existing system.

 From a digital health standpoint, be it products or services, what’s catching your eye these days?

Telemedicine is here to stay, but I don’t know if it will transform healthcare the way some may have hoped for. There are many digital solutions that are seeking to establish their place in the healthcare ecosystem. Ultimately, they will all face the same challenges: engaging consumers and maintaining their engagement; reimbursement; evidence of clinical effectiveness; acceptance by providers; and interoperability with electronic health records (EHRs).

This event is going to have a large blockchain focus. What’s your take on the blockchain “buzz” and if the hype is real or not?

Our health system is exploring the role of blockchain in healthcare. I think the possibilities are numerous, not only from the provider and vendor side, but also from the patient’s perspective. Yes, there is some hype, but that will settle down and blockchain and the application of a distributed ledger in healthcare is here to stay.


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AMA Creates Digital Health Playbook to Guide Providers on Implementations

October 18, 2018
by Rajiv Leventhal, Managing Editor
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The American Medical Association (AMA) has created a new resource that aims to help physicians extend care beyond the exam room with technologies that are changing the way patients interact with healthcare.

The resource, called the Digital Health Implementation Playbook, offers a guide for providers on the path to applying digital health solutions, including key steps, best practices, and resources to accelerate and achieve digital health adoption. The AMA made this announcement in conjunction with the Digital Health Collaborative and Connected Health Conference taking place in Boston this week.

According to AMA officials, physicians are optimistic about the potential of digital health innovation to benefit medicine and expect to use more digital health tools in the near future. However, complex factors inhibit adoption.

The Playbook is designed for care teams and administrators in medical practices of all sizes and areas of specialty. Officials note that it’s a living document that will be updated to include new content over time. As the Playbook evolves, it will provide a 12-steps process to guide the implementation of a variety of digital health solutions. The first six steps are core to the implementation of any digital health solution, while the subsequent six steps focus on specific digital health solutions and the unique considerations relevant to that specific technology.

As it stands now, the Playbook provides resources for the implementation of remote patient monitoring (RPM) using devices, trackers and sensors to capture and record patient generated health data outside of the traditional clinical environment.

And as more connected devices and wearables are validated as accurate and reliable healthcare tools, the medical community will increasingly look to integrate digital health and mobile health technology into medical practices to better understand and manage chronic diseases outside of the practice environment as healthcare shifts toward value-based reimbursements, note AMA officials.

"Implementing digital health technology has been a challenge for those without a clear course to success," said AMA Chair-elect Jesse M. Ehrenfeld, M.D. "The AMA is committed to making technology an asset, not a burden, and the Playbook provides the medical community with widespread access to a proven path for implementing digitally enabled health and care.

More than 80 physicians, care team members, healthcare administrators, patients and digital health thought leaders contributed their expertise and input to the Playbook, according to the AMA.

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