At the top of 2018, while awakening from the Crypto Winter, a gaggle of noted healthcare professionals led by Mayo Clinic’s John Halamka predicted that 2019 would be a pivotal year for blockchain within the healthcare industry. They said blockchain would become an important a part of consent management, improve remittances and enhance the monetization of private data. it might tokenize non-cash assets, like patient outcomes, as an incentive to enhance health.
How much of this agenda was actually realized? the solution is a few, but not all. we’ve seen blockchain deployments in supply chains and for physician credentialing, but not yet implemented as an architecture of electronic health records intended to rework them into self-sovereign, patient-driven digital assets.
Why is that, or more fundamentally, why use blockchain in healthcare at all?
Healthcare is problematic everywhere the planet. From a patient point of view, healthcare isn’t always readily accessible and in many cases too expensive. From a healthcare professional’s perspective, there’s an excessive amount of paperwork. For hospital executives, unchecked job rate of growth has not translated into better patient outcomes. the longer term of pharma and digital therapies is fraught with uncertainty. And even insurance brokers have experienced reduced or eliminated commissions on the sale of individual health plans.
At least, we will all agree that the healthcare ecosystem may be a multi-stakeholder, mal-aligned, friction-full, opaque, heavily-regulated, lacking-of-trust, data-rich environment. From there, we will agree on the necessity for brand spanking new responses and approaches, including the utilization of blockchain. It seems that blockchain-based platforms are ideal for handling the characteristics that plague healthcare.
Robert Miller, of ConsenSys Health, produced a superb report this summer summarizing major trends within the blockchain health space. These include the formation of major new business networks around healthcare use-cases, greater VC funding, and as already mentioned, the utilization of blockchain for credentialing.
This year, half a dozen consortias (like IBM’s Health Utility Network [HUN], Coalesce Health Alliance and MELLODY) announced projects to exchange healthcare and bioscience data on using permissioned distributed ledgers. That’s an enormous deal. Together, these consortia touch the lives of many customers (HUN covers 80 million beneficiaries) during a multi-billion dollar market (MELLODY includes pharma companies with a collective value of quite $300 billion).
Venture capital flows have actually slowed, reaching $25M in VC funding this year ($16M of them for Chronicled). This amount remains less than the $100M-plus raised in 2018 and represents a ridiculously miniscule fraction of the $6B VC funding for non-blockchain digital health projects. As for STOs, the nearly $1B raise in 124 deals included only seven healthcare projects (like Healthbank, Healthereum, Verseon and Agenus), with no significant reported raises.
Supply chain applications and physician credentialing are the foremost common use-cases in healthcare blockchain. The Drug Supply Chain Security Act (DSCSA) of 2013, which mandated the creation of an electronic, interoperable system which will trace and identify distributed prescribed drugs, catalyzed the event of a couple of large scale blockchain-based platforms (like IDLogiq, MediLedger, Rymedi and TraceLink).
As for physician credentialing, we’ve seen a mess of DLT credentialing solutions emerge (like ProCredX developed by HashedHealth, Blockcerts employed by the Federation of State Medical Boards, IntivaHealth that maintains records for continuing education and Truu, employed by the united kingdom National Health System). But currently these solutions (except Truu) are exclusively business-to-business and don’t address the matter of physician identity or improve professional mobility.
So what can we expect in 2020?
As Nikhil Krishnan correctly predicted in his CB Insight report, the growing blockchain and healthcare landscape (48% CAGR till 2027) is currently dominated by closed consortia, where patient data is minimally used, under strict HIPPA or GDPR regulation. the thought that private health information within the hands of patients are a part of an immutable, master health record has been implemented in Estonia. But it’s like US adoption are going to be impeded thanks to a scarcity of political, regulatory and social appetite to vary healthcare from a centralized, corporate, for-profit system into a self-sovereign, decentralized, doctor-patient-driven one.
Whether 2020 are going to be an incremental or transformational year depends on three factors in my opinion.
First, will we educate healthcare professionals by employing a better, refined language? Already we recoil from using the words “crypto” and “blockchain,” related to hacking and greed (thank you Mt. Gox and ICOs) and use the term DLT. But if we actually want to recruit the general public, we also got to mention re-intermediation rather than disintermediation, coopetition (collaborative competition) rather than competition and distinguish between a sustainable “open” market (open to producers) vs. a non-sustainable “free” market, that has also non- and counter-producers that manipulate and destroy the market (for details, examine Radical Markets here). In other words, the story shouldn’t be about technology, but what technology are able to do for healthcare and its stakeholders.
Second, will we start to elucidate why we should always use blockchain and stop just describing it? Yes, for blockchain to figure it must be, as Toufi Saliba, CEO of the TODA Network says: SECSI (Secure, Efficient, Confidential, Scalable, Interoperable). But doctors don’t care that blockchain may be a ledger and aren’t curious about explanations about PoS, PoW, sharding and DAGs. Healthcare professionals got to understand that the “secret sauce” behind using Blockchain in their practice is that their relationship with patients has an inherent value. By promoting patient health, doctors actually engage during a peer-to-peer economic activity and may reward patients and be rewarded for healthy behaviour. Patient outcome is thus an invested asset (store of value) which will be traded not only by companies (Google, FitBit, 23andMe and ZocDoc) but also by patients and professionals themselves.
And third, the 2020 US election outcome. As institutional trust erodes (think government, certain media outlets, Facebook), distributed trust has emerged as an attack-, collusion- and censorship- resistant model to acquire, curate, store, manage and analyze data and knowledge. But the general public doesn’t understand the difference between universal access to healthcare, which is enhanced when employing a distributed, decentralized economic model, and Medicare-for-All (or Amazon-for-All) which may be a centralized, friction-full monopsonistic system. Resolving this confusion are going to be important for blockchain’s future prospects within the healthcare space.
As healthcare remains the highest issue on voters’ minds this year, the country remains evenly split on whether we should always have a really centralized system (Medicare-for-all), a somewhat centralized one (ACA or “Obamacare) or state-based “distributed” (but not decentralized) healthcare. I doubt DLT are going to be horizontally integrated this year or leveraged as a tool to rework healthcare’s business model and searching ahead to 2020, that future seems how off given the largely centralized, corporate, for-profit healthcare system within the us.
Nonetheless healthcare provides a really strong, if not perfect use-case for blockchain software solutions. It uses a shared repository (EHRs) with multiple writers (doctors, nurses, staff) and it’s transaction dependencies (adherence to treatment plans, payments, regulations) with multiple intermediaries (professionals, patients, payors, regulators) that haven’t any or minimal trust between them. Blockchain is poised to remedy many of those shortcomings.
Finally, rather than remarking what blockchain is missing, or fret that its purpose is unclear and changing, or hedge on what blockchain will become, allow us to state clearly what blockchain does. it’s an attack, collusion and censorship-resistant solution that facilitates peer-to-peer economic activity. And during a world that suffers from a fear of faux products (fake posts, fake news and faux data), the role of DLT as solving the matter of social “fakes” is salient.