Why healthcare does not need blockchainby David Paré Chief Technology Officer – Healthcare & Life Sciences

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While the IBM paper refers to trailblazers who have implemented blockchain applications, the level of investment by the technology community in healthcare blockchain capabilities remains limited, at least on the provider side. And although blockchain might have potential for national healthcare systems, it has yet to gain traction and demonstrate real benefits. The only example of commitment at a national level is Estonia, which has been working with start-up Guardtimeiii to secure public healthcare records using its signature infrastructure blockchain, which is integrated into the Estonian eHealth Foundation ‘s database. Even they, admit it will take many years to see this program to completion.

Today, blockchain is mostly used for secure payments – claims adjudication for health insurer and supply-chain integrity – which have little to do with healthcare delivery.

The issue for healthcare is that it struggles with a good model for sharing information across the system because data is fragmented across thousands of siloed applications. The challenge is not so much the ability to securely share data across system, but the complexity of reaching all the applications that sit on top of a general practitioner’s desk, at the basement of a hospital pathology department or in a State data warehouse. Blockchain can help make the exchange more secure and untempered through distributed ledgers but it will not accelerate or solve this challenge for healthcare.

A reality-check on the value of blockchain in healthcareGlobally, many healthcare start-ups are betting on blockchain to solve industry challenges. However, if you look closely, many of these companies are using blockchain not only to solve actual problems but as a marketing tool to promote their solution, leveraging the hype around the technology.

How these companies fare remains uncertain. Already, healthcare blockchain flagship company Gem Healthiv, which worked closely with the Philips health blockchain lab, has decided to opt out of healthcare as an industry for their blockchain platform. Its chief communications officer, Chitra Ragavan, said Gem was too early in the healthcare market and while big companies are educating themselves with Gem’s help, the big contracts seem years away. That is the reality-check I am talking about.

There has been a lot of hype around blockchain, particularly its potential to secure data access and financial transactions across all industries. But does healthcare need blockchain? Can it solve healthcare challenges related to the fragmentation of information?

Following its survey of 200 healthcare executives across 16 countries, IBM proposed four main areasi where blockchain has the potential to bring significant efficiencies: health records, medical data device integration, adverse events, and clinical trials. And Deloitte has said blockchainii has huge potential for supporting integration and improving data integrity.

i https://www-01.ibm.com/common/ssi/cgi-bin/ssialias?htmlfid=GBE03790USEN

ii https://www2.deloitte.com/us/en/pages/public-sector/articles/blockchain-opportunities-for-health-care.html

iii https://guardtime.com/

iv https://gem.co/health/

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Two big players, Microsoft with HealthVaultv and Google with GoogleHealthvi, launched an online platform allowing patients and consumers to store and share their personal health information. Unfortunately, they both realised that patients didn’t really want to work to transfer their data into a cloud and thus the market place fell apart along with its non-viable business model. That does raise questions as to how others will make their projects financially viable. We have to remember that, although it is starting to change, most people do not pay attention to their health data until they get really sick.

Another challenge created by the plethora of blockchain start-ups is the creation of multiple company-specific cryptocurrencies. If every blockchain start-up comes up with its own platform and cryptocurrency, how will the marketplace deal with all of these? It would be like travelling Europe before the introduction of the euro and having to change currency in each country.

The value of blockchain in healthcare is undeniable, but mostly for payers and life sciences organisations through secure payments, claims adjudication and supply-chain management. On the provider side, blockchain, although a viable technology, does not really solve anything and will not “shift the dial” in regard to data fragmentation – at least in its current state. As always, we are looking for a silver bullet but there is none. It is just a complex problem that will take time to fix.

Niche blockchain players emerging in healthcareSo far, I have challenged the value of blockchain in healthcare, particularly its ability to solve our data fragmentation problems. I took a somewhat harsh perspective to help us all realise that it will be some time before blockchain shifts the dial on the provider side of healthcare. However, I also wrote that blockchain is already delivering great benefits in the supply chain of life sciences organisations, as well as securing transactions for claims adjudication on the payer side of health.

Although I believe blockchain has a long way to go before it takes its place as a transformative technology on the provider side of healthcare, I want to highlight some niche players that are starting to emerge and are doing clever things with blockchain to solve some real challenges of the health system.

Three main start-ups are emerging in the Australia-New Zealand region: ScalaMed, bron.tech and dHealthNetwork.

ScalaMed

The first of these, ScalaMedvii, has designed a secure prescription management system that has blockchain technology at its core. ScalaMed was launched by doctor and former pharmaceutical executive Dr Tal Rapke. The company developed the technology to allow patients to carry their prescriptions with them digitally, with the aim of improving decision making for doctors, service provision by pharmacies and convenience for patients. The challenge with such an offering is integrating it with the different platforms used by pharmacists, but it is a great idea that has legs.

Dr Rapke said he tried to influence Australian State health government agencies’ view on solving the issue around prescriptions but hit a brick wall and decided to move his start-up to the United States for the time being.

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v https://international.healthvault.com/au/en

vi https://en.wikipedia.org/wiki/Google_Health

vii https://www.scalamed.com/

viii https://bron.tech/#home

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bron.tech

The second start-up, bron.techviii, has built a data wallet called MyBron, which encourages users to contribute their data in exchange for a “Bron” token, cash or offers from the company’s business partners. The Bron token is a cryptocurrency that can be used as an exchange or to make transactions on the platform. The objective is to address consent management about personal data. Again, this is interesting and certainly has applications in healthcare, although in this scenario, blockchain does not really offer a solution to solve or accelerate information exchange across the system.

dHealthNetwork

The third company, dHealthNetworkix, is working to create a global platform where people store data on blockchain and then either sell their depersonalised data to life sciences companies or leverage it to ask for a remote consultation, paid for with a cryptocurrency created by dHealthNetwork. Essentially, it is a marketplace for health data controlled by the users, and it offers a raft of interesting features. Though it is a great example of how to democratise personal health data and empower patients to take control, the health data fragmentation issue remains, since this model relies on patients uploading their own data.

Each of these companies has raised funds and is gaining traction, so there is hope they will achieve success and materially shift the dial when it comes to health information exchange … only time will tell.

Globally, many healthcare start-ups are betting on blockchain to solve industry challenges. How these companies fare in the longer term will be worth watching. Given the failed experiences of large players such as Microsoft with HealthVaultx and Google with GoogleHealthxi, it is difficult to predict with certainty but we know it will not be an easy journey.

Several international health-related blockchain companies are adopting innovative approaches to implementing blockchain. Here are a few examples:

• Canadian company VitalHubxii is focused on addressing interoperability issues of healthcare apps across the mental health and long-term care sectors with its blockchain, mobile and web-based solutions

• US company Medrecxiii developed a way to manage medical information through smart contracts that act as an intelligent representation linking patients and providers to the addresses of existing medical records

ix https://www.dhealthnetwork.io/

x https://international.healthvault.com/au/en

xi https://en.wikipedia.org/wiki/Google_Health

xii http://vitalhub.com/

xiii https://medrec.media.mit.edu/

xiv https://blockchainhealth.co/

xv https://pokitdok.com/about/

xvi http://www.healthcombix.com/

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• San Francisco-based software company Blockchain Health Coxiv uses blockchain technology to create a direct connection between medical research and users

• Silicon Valley start-up PokitDokxv aims to change how healthcare stakeholders communicate by giving customers access to technology that will connect healthcare’s fragmented silos. The platform as a service lets payers, health systems and technology companies communicate and conduct transactions easily

• Seeking to get rid of healthcare middlemen, HealthCombixxvi created a blockchain-based care coordination program supporting community-based care while leveraging behavioural economics, social networking, cryptocurrency rewards, and telehealth

• And seed-stage on-demand nursing app PointNursexviiis a blockchain-based virtual care network platform for delivering direct primary care and care management services to targeted populations. The platform enables nurse practitioners and supporting team members to conduct direct primary care consults, health assessments, behaviour management programs and care coordination. PointNurse also has a cryptocurrency, Nursecoin, which will be used for a variety of activities, such as closing gaps in care, rewarding patient behaviour and provider performance, and improving healthcare delivery efficiency

• Not a start-up, but a leader in the field is Philips, which launched the Philips Blockchain Laboratoryxviii in Amsterdam to focus on blockchain technology in healthcare

As you can see, there is no lack of interest from vendors and start-ups for using blockchain to solve particular issues and create value despite the current difficulties. You must form your own opinion about its value, separating the hype from the real opportunities that may benefit your organisation.

About the authorDavid Pare is the chief technology officer for DXC Healthcare and Life Sciences in Australia and New Zealand. He is an innovative thinker with 20 years of experience in business and technology management consulting, helping organisations through their digital transformation.

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© 2018 DXC Technology Company. All rights reserved. MD_9175a-19. October 2018

xvii https://www.pointnurse.com/

xviii https://www.coindesk.com/philips-health-care-launches-blockchain-lab/

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