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At the Florida Health IT Summit, a Candid Look at the Promise and Pitfalls of Blockchain in Healthcare

July 25, 2018
by Mark Hagland
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Dr. Ben Schanker shared his perspectives on the future of blockchain in U.S. healthcare

On Wednesday morning at the Florida Health IT Summit, sponsored by Healthcare Informatics, and being held at the Hilton St. Petersburg Bayfront in St. Petersburg, Benjamin D. Schanker, M.D., M.P.H., director of the American Board of Medical Quality and a practicing physician at the Zuckerberg San Francisco General Hospital and Trauma Center, as an employee of the Department of Public Health of San Francisco.

Dr. Schanker’s morning keynote address, “Blockchain and the Future of Digital Health and the Clinical Experience,” covered a range of questions and issues around that timely topic. He began by giving his audience a very broad overview of blockchain itself, explaining the concept of blockchain, some of its uses in other industries, and its current, still-emergent state in U.S. healthcare.

Moving into the subject of the use of data in healthcare, Schanker noted that “Data is overwhelming in healthcare. Deloitte published a study that found that it takes a physician 50 minutes per patient to adequately review a single patient medical record. I know as a clinician that I don’t have time for that. In healthcare,” he said, “we’re very good at putting data into [information] systems, but very bad at taking it out of them.” One of the initiatives he’s involved in at the Institute for Human Optimization/the Precision Medicine Research Group, he noted, is that “We’re looking at tying together personalized medicine and broad research around populations.”

Moving onto some specifics about Bitcoin, Schanker asked, “Is Bitcoin really the promised land of healthcare? Will it solve all our problems? I say, hold your horses.” After explaining the fundamental theories behind the use of blockchain—it is a distributed, decentralized ledger database that uses “blocks” of data, linked together in a chain,” and accessed by a peer-to-peer network of equal partners—he went on emphasize that the “immutable distributed database” undergirding any chain “engenders trust. When Alice and Bob want to share information,” he said, referring to two archetypal individuals involved in a blockchain community, “they can share that information with other parties who are on the chain. The data is immutable. It can’t be changed, because a number of different parties have validated it.” And, importantly, any new block of data added to the ledger must be validated by a consensus protocol, typically meaning 51 percent of the parties involved in that particular chain. “There is no single point of failure,” he emphasized. “If Alice falls off the face of the earth, there are still multiple copies in existence. In practice, this means having a backup of your database.”

All of those elements hold major implications for the adoption of blockchain in healthcare, Schanker noted. On the one hand, he conceded, “Blockchain is very difficult to implement, because it’s a democratic database. Oftentimes, there are hierarchies in organizations, and they are necessary to make things happen.” And that factor works against blockchain adoption in healthcare.

Benjamin Schanker, M.D., at the Health IT Summit

Also, there are many types of data in healthcare that are simply too big or complex to be used well in healthcare. For example, he said, “You would never want to put an MR”—magnetic resonance scan—“on a blockchain, because you’d have massive data that would have to be validated.” Instead, in many cases, clinical data in healthcare might be incorporated through the use of digital pointers, which can lead trusted parties to the digital locations of such data.

Still, some organizations are beginning to experiment with blockchain technology for some niched purposes. One project that he himself is involved in is “CareCoin, one I’m working on at UCSF,” Schanker noted. “It’s designed to incentivize patients to ‘act better.’ It is a tool to align incentives among doctors and patients, where both parties are incented to work together.” It provides rewards to both physicians and their patients for engaging in certain behaviors.

Elsewhere, Schanker noted, “In South Korea, there’s a project called MediLedger, in which they’re using blockchain for medication supply chain purposes, validating data from the pharmaceutical producer to the manufacturer, to the distributor. MediLedger shares information across that supply chain of medications among the parties.”

He also noted the development taking place of something called the Robomed Network, which is described on its website as “a revolutionary medical blockchain project connecting healthcare providers and patients via smart contracts and ensuring output-based approach in the relationship. Launched in Dubai and Russia, this is a great step towards value-based healthcare,” the Network’s website states.

He further referenced SolveCare, being sponsored by the government of Estonia, and Universal Health Coin, a U.S.-based initiative.


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