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Blockchain distributed ledger technology bears big potential and poses challenges for health IT applications; supporters and skeptics debated blockchain at a government workshop.
Proponents of blockchain healthcare applications see a time not too far off when blockchain will revolutionize secure and private storage and exchange of patient health data.
Leading pro-blockchain healthcare theorists convened in September 2016 at a workshop cosponsored by the National Institute for Standards and Technology (NIST) and the Office of the National Coordinator for Health Information Technology (ONC).
This podcast, recorded on site at the blockchain healthcare conference, includes voices from both sides of a burgeoning debate that is growing as fast as blockchain technology itself as it spills out of the financial industry and into other sectors, such as healthcare.
"We see strong potential for blockchain applications in healthcare," says Brian Kalis, managing director in the digital health practice of consulting firm and government contractor Accenture LLP, in the podcast. "We are seeing emerging interest from health systems and health CIOs. However, it's still [in the] early stages."
Accenture's 11-page proposal -- on integrating existing health IT systems with a private blockchain distributed ledger environment to drive interoperability and better patient outcomes -- was among 15 finalists in ONC's "Blockchain Challenge" last summer. Seventy-seven proposals were submitted.
Brian Kalismanaging director, Accenture LLP
The IBM plan conceptualizes three detailed use cases: creating a healthcare preauthorization payment infrastructure, preventing and detecting counterfeit drugs and boosting accountability and openness in clinical trials.
With its own software systems and as a founding member of the Linux Hyperledger Project, "IBM has made a huge investment in the blockchain ecosystem," Udit Sharma, account manager for IBM's Global Business Services unit and an author of the proposal, tells SearchHealthIT in the podcast.
A critic, Steve Wilson of the Constellation Research consulting firm, also is heard in the podcast.
Wilson cautions that healthcare may not be as suitable for blockchain technology as financial services, where the digital currency bitcoin has flourished atop a blockchain spine.
Wilson explains how blockchain solved a central dilemma in currency exchange -- "double spending" -- by verifying the integrity of each transaction on the blockchain and so enabling anonymous value transactions in a "cash-like experience."
"Almost everything that people say about blockchain at this time is wrong," Wilson says. "The very fact that blockchain solved an unsolvable problem with this magic cryptographic trick has made people think, 'Wow, maybe there's no limit to what this thing can do.'"
However, Wilson concurs with many supporters of the technology in healthcare in acknowledging that blockchain is "highly distributed; it's highly redundant, it's highly secure."
"Of course, electronic health records feel like that, too," he adds. "But it's a big jump."
The final thoughts in the podcast come from a physician and fan of blockchain in healthcare, Bryant Joseph Gilot, M.D., a Philadelphia-based surgeon, who concedes that even with blockchain's promise, "we are in the embryonic stages right now."
Photos courtesy of Shaun Sutner.
Transcript - Blockchain healthcare promise, problems aired at government conference
Shaun Sutner: Hi, this is Shaun Sutner, news and feature for SearchHealthIT. I'm here at NIST, Blockchain and Healthcare Symposium with Brian Kalis of Accenture.
Brian Kalis: Hi, this is Brian Kalis. I'm the managing director of Accenture within our digital health practice.
Sutner: Brian, you guys gave a pretty comprehensive proposal for budget and healthcare which is up on the ONC website too, I believe. You're one of the 15 finalists -- could you distill what this means? What kind of potential do you see really for blockchain in healthcare coming obviously from the financial industry perspective, but how soon, how fast, how real is this?
Kalis: We see strong potential of blockchain or applications in healthcare, however, it's still early stages. We believe experimentation and testing and learning are key at this stage of the adoption web cycle.
Sutner: All right, do you see commercial potential in terms of providers, payers, health systems? Do you see it really materializing? Do you see that kind of interest yet, let's say from CIOs?
Kalis: Yeah, we are seeing emerging interest from both health plan and health system CIOs to explore applications of blockchain within healthcare. On the health plan side, we're seeing aspiration both in revenue cycle management as well as provider data management, and with health systems exploring the ways of using it as a form of interoperability and patient consent.
Sutner: I noticed you were linking your proposal fairly close to some ONC goals which they asked for in the original challenge but ... can you just talk a little bit about how blockchain might help with the two biggest problems of healthcare: interoperability ... or, let's say three big [pain points]: interoperability; access to records; security and privacy?
Kalis: Yeah, with that we see three core applications. One, being the potential solution for interoperability related to secure medical records, as well as the ability to bring in patient-generated health data into the mix in the equation. Two, related to identity and the concept of linking identity and solving the identity matching challenges. And then third, patient consent as well as proxy management related to how you can authorize access to records both from patient to provider, patient to patient, etc.
IBM's point of view on blockchain in healthcare
Sutner: Hi, I'm Shaun Sutner, news and features writer for SearchHealthIT. I'm here at the Blockchain and Healthcare workshop at NIST in Gaithersburg, Maryland with ...
Udit Shurma: With Udit Shurma from IBM. I'm the company manager for public sector.
Sutner: Okay, so, Udit, what are you and your colleagues from IBM going to be talking about at this conference and what are ... what's in essence ... IBM's for blockchain and healthcare?
Shurma: Today we’re going to present the IBM's point of view, and we call it IBM's point of view because we're not talking about a particular use case or we're not talking about a particular problem, but we are actually targeting the entire healthcare community and the healthcare industry and how blockchain is going to impact it. And that was one of our prime goals when we submit a paper, was IBM’s point of view.
So we're going to talk about a few use cases and also about IBM's investment in blockchain which is that IBM is a founding member of the Hyperledger Project which has been a leading voice in collaboration with various organizations. And IBM has made a huge investment in the blockchain ecosystem for which we have developed a Bluemix Garage which is a sandbox environment where you can go and run your blockchain. We are also going to be doing one of the largest investment blockchain within IBM where we're going to implement it on the IBM Global financing team. And also as you saw was already we’re going to be working with blockchain, and some announcements are going to come in the next few quarters.
Sutner: Okay, Udit ... how do you envision blockchain technology from IBM to be used in healthcare more for security, more for patient access to data, more for interoperability, more for auditability? What are the use cases, a couple of them?
Shurma: A couple of them, I mean, it would be like a combination of most of them, but yeah, electronic medical records. So IBM is one of the largest depositories of medical records with the number of clients we work with and also apart from that, we have, like you said, we are developing that ecosystem. So we're not just talking about one aspect but all aspects of it, so whether it's patients, patient access whether you’re talking to payers, clients, claims, or we’re talking to various financial industries at the same time. It's all a combination of that.
Sutner: And ... what's the timeline, do you think? I mean, it's still a pretty new technology, at least for healthcare; what kind of timeline are you envisioning commercial applications of this in the next two years, five years, 10 years?
Shurma: I would say that, currently we are like Internet was in 1995 when people ... everyone had it, some people didn't understand it and protocols were still being developed. I think 2016 is the year of blockchain coming out of the bitcoin shadow and still we are talking about, as you can see in this workshop also, people are still trying to understand what blockchain is, we are still trying to implement the standards. And the way it would move forward will be that a consensus has to be developed among the global concerting. Just one of them was just announced where the standards would be developed, and I think the various use cases that various organizations will target together will actually develop the entire blockchain protocol as we call it.
"The one thing you need to know"
Sutner: Today I'm here with ...
Steve Wilson: Steve Wilson from Constellation Research.
Sutner: Good morning, Steve. So you told me earlier that there's one thing everybody should know about blockchain.
Wilson: The one thing you need to know is that almost everything that people say about blockchain at this time is wrong.
Sutner: How so?
Wilson: The blockchain was developed for a really specific purpose; it was to solve this Holy Grail in e-currency called the double spend problem. It's kind of an arcane problem but electronic cash involves, how does ... send real value to each other without knowing anything about each other to produce a cash-like experience? You don't want to know anything about people, so it's a very specific problem.
It was magic and I think the very fact that blockchain solved an unsolvable problem with this magic cryptographic trick has made people think, "Well, maybe there's no limit to what this thing can do."
Sutner: That's correct, and a lot of people in healthcare are eyeing this as the biggest thing since electronic health records.
Wilson: So the thing that I think is really important and the thing I tell my clients is, "Let's be really precise about the problem that you're trying to solve." So the drive problem in e-currency is, what is the double-spin problem? How do you stop somebody from doing the same thing with the same results twice? I look at most healthcare applications and they don't really look like that.
Now blockchain has got some other properties, it's highly distributed, it's highly redundant, it's highly secure, and of course ... electronic health records feel like that, but it's a big jump. There's a number of ways of skinning that cat. You can have immutability, you can have redundancy, you can have global distribution in a number of different ways but the question is, do you need to use this blockchain engine, this incredible consensus engine that is, again I'll say it, it’s all about stopping double spend?
People talk about consensus and then talk about validity of transactions, blockchain is very specific, it doesn't really look at the validity of transactions per se, it looks at the validity of the order of events in the blockchain. That's technically very different from most things in healthcare.
Sutner: Yet, I sense there is an array of optimism somewhere buried in there as long as you're precise about it.
Wilson: Yeah, for sure. And my optimism is that we see this in disruption all the time. The first disruptive idea is like a prototype, and my favorite example, talk about this, is the Wright brothers' flyer. They said it couldn't be done, they said you couldn't fly, the Wright brothers pulled together this contraption from paper and silk and string, and it flew. And it generated an incredible rush of invention and innovation.
Now we've already [been] seeing second-generation blockchain -- it’s like in the form of a theorem and ripple, third generation like hash graph -- it's been very precisely focused on a particular problem and identity. So they're not just picking up something that solves a magic trick in e-cash and then apply it to everything else.
So a lot of the people are caught between two schools. The original blockchain: It's very well proven, it's open source, it's available, people want to use that but, frankly, I don't think it's in the right solution for health. So I tell my clients, "Let's be patient, let's be careful engineers, let's work out what problem we're trying to solve in healthcare and drive backwards to the big innovation labs." People are doing fantastic research on hyperledger, R3 and PIN identity.
Four pillars of blockchain benefits
Sutner: Hi, this is Shaun Sutner, news and feature writer for SearchHealthIT. I'm here at the Blockchain and Healthcare Symposium at NIST, in Gaithersburg, Maryland. I'm with Bryant Joseph Gilot, M.D., who's a surgeon out of Philadelphia, who has some really interesting things to say about blockchain and healthcare. What are the main areas you see as promising for blockchain and healthcare Dr. Gilot?
Bryant Joseph Gilot, M.D.: I think the benefits of blockchain for healthcare will really rest on probably four different pillars. I think those pillars are probably number one, identity. Number two, access control as far as data exchange. Number three, I would say is payments as far as all of the medical payments that occur between payer and provider, and I think the final thing is identity. Yes, so we need some way of identifying the providers, the patients, and even to a certain degree the entities that are involved in the entire payer-provider relationship as well.
Sutner: Okay. Given that we're in the, really, development stages of blockchain for healthcare, when do you expect to see fruition in terms of products that people like you can use, patients like myself can use? Two years, four years?
Gilot: I think we are very much at the embryonic stages at the moment. We're actually here at a conference right now just exploring where the possibilities might exist, where the benefits might exist. Before we even get any point where we can realize this, there has to be some agreement and consensus about how we're going to actually implement those. And I would say we're probably talking, probably at least five years before it has a reasonable and real impact on the way we do things today.
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