Blockchain in healthcare: The missing link

JULY 4, 2019 @7.25AM
Healthcaretoday, blockchain in healthcare, blockchain, healthcare, data management in healthcare, patient centred care, security risk to patients data, telemedicine, Ramsay Sime Darby, Dr Raymond Choy,
Blockchain simplified; consists of several blocks which represents digital information. Your digital health information would contain data while the chain represents the public database. So, you’d see the digital data running in the database publicly.

By definition, it is an immutable record of digital events shared peer to peer between different parties. It can only be updated by consensus of a majority of participants in the system, and it is a decentralised ledger.

​Centralised versus decentralised
Centralised which represents a centralised authority monitors what we do which is how the current healthcare operates in most of its space.
 
Decentralised means that there is no one single authority that could run the entirety – so there are multiple authorities and there is a whole network which is known as the distributor ledger which is what blockchain is about.

“Decentralising simply means a party holding a ledger for themselves with authorisation. No single party can hold one full authorisation themselves. A good example is the encyclopaedia with one server – pushing all the data and information to all users. However, nowadays, in a decentralised manner anyone can contribute information in the system pushing all the data and information to all users,” explained Dr Raymond Choy (pix), the Co-Founder of Doc2US while presenting at Telemedicine: 4th Industrial Revolution in Healthcare conference.

Some of the features in a distributed ledger, he said, is that it is recorded whereby stored information is time stamped, transparent where anyone can see the ledger of transactions and is decentralised where the ledger exists on multiple computers which are referred to as nodes.

Pain points
In our healthcare as well as any kind of data management services, we without fail deal with authority, services between users, developers, tier to tier. While doing so, we would be confronted with trust issues which is what blockchain tries to solve. Among the challenges that we would face is:
  • Insecurity – We all feel very insecure with our data being processed, being stored – where is the server? These are very sensitive issues in today’s world.   
  • Inconsistency – Is our data being transferred in a very consistent manner?
  • Inaccuracy – Is our data transferred accurately or being conveyed?

Power of blockchain
Blockchain offers three i’s:  
  • Integrity – because of data transfer, management and storage.
  • Interoperability - Raymond points out that blockchain is not the answer to the system being interoperable, but that there are other ways to make the data do so.
  • Lastly, instant whereby blockchain in terms of data transfer and data communication is instantaneous.

Why use blockchain?
Blockchain is cost effective yet works with increased speed, security, reduces fraud and risk.
 
Types of blockchain
There are three types of blockchain:
  • Public which is permissionless, whereby you do not need permission to access the data. This might not be very applicable to health data as we are dealing with sensitive data.
  • Private. This is permissioned, where permission and authorisation are required before we can access the data. This is very important to have in the healthcare industry.
  • The third type is the hybrid model which is a combination of both.

​Healthcare today
“Healthcare comes with lots of pain points and issues. In today’s world, our patients are no longer the same as 20 years ago. Our patients are getting more inpatient, less forgiving and one minute could be equivalent to an hour.
 
So, here we are dealing with impatient patients. They’d still expect the quality of care, daily based care, human touch which are all fundamental in healthcare.

​Raymond again emphasises that whenever we speak of digitalisation, it has to go back to the people.

“This is what people are expecting. They have high expectation of healthcare services and healthcare products. Off course, today, patients expect more digital innovation, in their healthcare journey and experience. In todays world, people have high hopes in digitalisation because in other industries – they could carry out online booking, purchase air tickets and products, so why not healthcare?
So, the question is: What’s stopping healthcare in doing this and moving forward?

Fragmented health services
If you look at our healthcare system, we are the most complex industry. Just the hospital system alone - is one of the most complex.
 
“We are organised around specialities and department with private practice physicians, we measure process, compliance and charges, fee-for charges payments based on volume of services delivered, each hospital or practice offers a full line of services, providers limited to serving their immediate geographic area and multiple IT systems for specialities, services, procedures and billing.

“We are dealing with a complex system every day! The strategy can be fixed by organising into integrated units (IPU’s), measure outcomes and costs for every patient, move to bundled payment for care cycles, integrate care delivery across separate facilities, expand excellent services across geography and build an enabling information technology platform.

Patient centred care
Are we actually providing patient centred care or are we providing silo care?
 
“This GP not speaking to another GP, this pharmacist not speaking to another pharmacist – so there is no continuity of information and data flowing through each party which may compromise optimal care.
 
“Patient centred care should involve family members in making decisions with all strategic partners and stakeholders, community, hospitals and primary care. However, to achieve this end, it involves numerous stakeholders and takes effort, which is what we aim to achieve.
 
Citing Singapore Primary Care Network (PCN) as an example, he explained that when a patient is diagnosed with a disease such as diabetes, the doctor submits it online and the whole primary care network in Singapore would know that you have diabetes. When you go to the next general practitioner, they would have known.
 
“Once you’ve been labelled as diabetes, the care coordinating manager would then contact you to schedule appointments and nurses would conduct the screening.
 
Although, these are currently done in Malaysia, the question still persists if we are doing it in an orchestrated, coordinated manner.  
 
“In 2016, the third cause for death in the United States was due to medical error caused by silo data and isolated practices, delays in transferring data, discontinued data which all lead to medical error. Data is just data, yet it is crucial as it decides the patient’s journey, health and safety.
 
Security risks to patient data
In terms of data, centralised electronic health record (EHR) data can pose a risk to patients. As mentioned earlier, as long as we are connected – wired, we are subjected to cybercrimes.
 
“In the black market – your health data is worth 10 times of your credit card number. Your health data is crucial to a lot of people and every day, we are subjecting ourselves to all these risks. Our healthcare system also lack transparency which contributes to the increasing healthcare cost. When there is lack of transparency, fraud is another big issue.
 
Healthcare solutions
Raymond pinpointed to a good digital roadmap consisting of Artificial Intelligence (AI), blockchain, cloud computing, data analytics, EHR, field robotics, genomics and internet of things (IOT) and Internet of Everything (IOE).
 
He said that better system of today’s and tomorrow’s care offers user control, data security, borderless care, data interoperability, patient safety and transparency.
 
Application
  • Telemedicine
Offers real-time online consultation, permissioned – real time data access with privacy control. Patients would be able to enjoy cost-effective services, is convenient, data-driven consultation and provides continuity of care while to the doctor it offers flexible working pattern, efficiency, hybrid care and access to EHR.

  • Health data marketplace control
Medicalchain is a company that empower users to willingly sell their health data in the marketplace at their own control.
 
“You’d be given a token or coins to incentivise your behaviour. This connects users to research institutions to share selected permissioned data willingly. Patients are more engaged and empowered; they would have full control of their own data and are able to incentivise. The pharma on the other hand would have direct approach to user, would be more efficient and would be more transparent,” he said.

  • Potential insurance integration
Users allow insurers to access health data, trusted, reliable and verifiable data and is transparent. Users are able to incentivise, enjoy a lower premium, are more engaged, receive rewards and have better compliance.
 
The insurer would have verified and trusted data, immutable data, better client engagement, reduced frauds and have lesser claims.
 
As a conclusion, Raymond pointed out to 50 over companies that currently use blockchain.  However, in healthcare, he said that there weren’t many as we are still in the infancy stage.

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