BLOCKCHAIN AND THE FUTURE OF HEALTHCARE

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BLOCKCHAIN AND THE FUTURE OF HEALTHCAREINTEROPERABILITY

“THINK BEYOND”

September 17, 2016

Peter B. Nichol

@PeterBNichol www.linkedin.com/in/peternichol

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1. Who has read at least one article on blockchain?

2. Who thinks blockchain has value?

3. Who could explain blockchain to a friend?

Quick Survey


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(8:30 – 9:45) Blockchains impact on business

(9:45 – 9:00) How blockchains work

(9:00 – 9:45) Creating new value for healthcare with blockchains

Purpose


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Peter is a healthcare business and technology executive

recognized for digital innovation by CIO100, MIT Sloan,

Computerworld, and PMI.

Peter’s specialties include digitizing complex platforms, leading

large scale program management, driving application of

emerging technologies to enhance business systems, improving

and innovating new consumer experiences, driving better

patient outcomes. Peter builds world class teams that redefine

value and deliver outstanding results.

Peter is a healthcare expert at PA Consulting Group. Prior to

joining PA in 2015, he was a CIO and has held leadership

positions in various healthcare organizations.

Peter has a B.S. in C.I.S from Bentley College, earned his

PMP® in 2001, a Certified Scrum Master, and Six Sigma Master

Black Belt.

As a Commercial Rated Aviation Pilot, Master Scuba Diver, and

Yachtsman, Peter understands first hand, how to anticipate

change and lead boldly.

Introduction to the Speaker – Peter B. Nichol


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Blockchain’s impact on business

1. Which industries are paying attention to blockchain?

2. What has been the investment to-date in blockchain technologies?

3. Why is just the beginning?

Objectives


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Theme 1: Is change predictable?

The impact of change on visibility


Blockchain’s Impact on Business

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$1.2 billion has been

invested in blockchain startups


Source: [1]

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Investment will reach

$10 billion by end of 2016


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By 2025 10% of GDP

will be stored on blockchains


10@PeterBNichol www.linkedin.com/in/peternichol

It all started with…


“ Financial crisis 2007-08

The world believed . . .

"trusted third parties" could be

eliminated from financial transactions

“


Decentralized Consensus: On Distributed Communications


Source: [3]

P. Baran

Aug 1964

Circuits

Yap

Datacenter

Single point of failure

Franchise model

Finite points of failure

Blockchain

No single point of failure


Intermediaries, the trusted third party

BEFORE

AFTER


Source: [4]

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Industries interested in blockchain

Energy Financial ServicesUtilities Real Estate

Compliance Insurance TravelManufacturing

Aviation Recruitment GamingHealthcare



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1. Banking (Vault OS)


Thought Machine – Cryptographic Ledgers

Source: [9]


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2. Payments and Money Transfers (ABRA)


Direct Payment Flow – Money Transfer

Source: [9]


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3. Cybersecurity (Guardtime)


No Intercept – Estonian Gov’t

Source: [9]


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4. Car Leasing and Sales (Visa & DocuSign)


Visa & DocuSign – Click, Sign, & Drive

Source: [9]


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5. Networking of IoT Devices (IBM & Samsung, Filament)


IBM & Samsung – ADEPT

Source: [9]


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6. Insurance (LenderBot & Lemonway)


Democracy of Devices – Backbone of Cloud

AirBnB, Tujji, and WimduSource: [9]


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7. Access To All Physical Objects (Slock.it)


USN & Thought Machine – Cryptographic Ledgers

Source: [9]


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1. $1.2 billion invested to-date, soon to be $10 billion in 2016

2. Medical devices, healthcare, financial, real-estate, energy, utilities, government, and more

3. What if? Some visionaries see the future.

Wrap Up: Blockchain’s Impact on Business


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How Blockchain’s work?

1. Key terminology

2. How blocks (transactions) are created?

3. Why blockchain is secure?

Objectives


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Blockchains vs. Blockchain technology


Blockchain – a network; distributed database or

permissionless public record of transactions in

chronological order.

Blockchain technology – an

infrastructure; creates a decentralized digital public

record of transactions that is secure, anonymous,

tamper proof & unchangeable.

“a shared single source of truth”

How Blockchains Work

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The principles of blockchains



1. Distributed – across all the peers, participating in the

network. Blockchain is decentralized, and every full node

has a copy of the block chain.

2. Public – the actors in a blockchain transactions are

hidden, but everyone can see all transactions.

3. Time-stamped – the date and time of all transactions

are recorded in plain view.

4. Persistent – because of consensus and the digital

record, blockchain transactions can’t catch fire, be

misplaced, or get damaged from water.

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Terminology


Blocks – a record of a transaction.

Chains – series of connected blocks (transactions).

Mining – is the process of computers solving a

mathematical puzzle. Puzzle verification occurs before

before a transaction is confirmed and added to the

blockchain.

Hash – A hash algorithm turns an large amount of

data into a fixed-length hash (random number)


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How to create a block (transaction)



TRANSACTIONS MINERSBLOCK PUZZLE

PROOF OF

WORKMINERSVERIFICATION

BLOCK

10 minutes of transactions

are broadcast to all miners

Miners create a blockMiners try to

solve puzzle

The successful miner

broadcasts its proof of

work to other minors

Miners solve puzzle and

gets a proof of work

Miners verify the

proof of work

Repeat

Source: [5]

2

1

3

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Why You Can’t Cheat


1. Say

everyone is

working on

block 91

2. But one

minor wants

to alter a

transactions

in block 74

3. The miner

would have to

make and redo

all computations

for blocks 74-90

and do block 91.4. Also, he’d

have to do it all

before everyone

else in the Bitcoin

network finished

just block 91.

Block 91

Source: [6]


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1. Blocks are linked to other blocks to form chains of transactions

2. How to create a transaction

3. Miners solve mathematical puzzles to create blocks and announce the results.

Wrap Up: How Blockchain’s Work


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Creating New Value for Healthcare

1. How blockchain can be applied to healthcare?

2. Discuss the most practical use cases for healthcare?

3. What about blockchain will be hot tomorrow?

Objectives


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Blockchain for Healthcare Use Cases

Identity Counterfeit drugsAsset Exchange Genomics Research

EMR Storage Proof of Insurance SecurityQuantified Self

Smart Assets Clinical Trials Service BiddingOutcome Payments




Use Case: Identity & Self-SovereigntyCreating New Value for Healthcare

What?• Individual autonomy

• Patient source of data

• Patient owned of data: user-key

permissions

How?• Blockchains create trust

• Patient, Provider, Profile, and Access

Benefits1. Authenticity of medical records

2. Availability of medical record (P2P)

3. Confidentiality to access record

Story:

1. Privacy is a concern until it

isn’t


Use Case: Health Asset ExchangeCreating New Value for Healthcare

What?• Distributed repository of health data

(hashed)

• Health asset exchange

• Collaborative crowdsourcing for price

transparency

How?• eBay for health data

• Aggregated disease information

Benefits1. Transparent prices across health

entities

2. Incentives for patients to engage

Story:

1. Medical asset exchange

2. Patient generated, patient

owned (health tokens)


Use Case: Quantified SelfCreating New Value for Healthcare

What?• Analyze the data that someone does

• Wearable data integrated into a

health blockchain

• Medical devices

How?• DNA wallets (physical and mental)

• Health tokens and maintenance

Benefits1. Sound body (chronic diseases)

2. Sound mind (Lumosity, CogniFit,

Elevate)

3. Realign people’s well-being

Story:

1. John’s Afib

2. Oil change


Use Case: Trusted EHRsCreating New Value for Healthcare

What?• Medical record that is authentic

• Clinical diagnosis based on latest

information

• Immediate confirmation for the

clinician of data integrity

How?• Blockchain receipt

• Confirmation of immutability

Benefits1. Accurate diagnosis

2. Assurance of a complete patient

medical profile

Story:

1. Verifiable medical record

2. Record extension


Use Case: Counterfeit DrugsCreating New Value for Healthcare

What?• The solution for transparency in

healthcare supply chains

• Demand for transparency is

increasing

• The impact of drugs we buy

How?• Provenance

• Chain-of-custody

Benefits1. Centralized systems can’t power

transparency

2. Fragmented effort lead to fraud

Story:

1. Starting with diamonds

2. Whole Foods

3. Vitamins to strawberries

One of these medicines is

fake. Can you tell which?


Use Case: Genomic ResearchCreating New Value for Healthcare

What?• Next-generation sequencing (NGS)

• Enabling precision medicine for

individual patients

• Linking biomarkers to access clinical

outcomes

How?• 2001 $100M, 2007 $10 mil, 2016 $1k

• NGS run against an evolving

database of viruses and illnesses

Benefits1. Identification of factors affecting your

health

Story:

1. BIDMC CIO / Storage

2. Expert to Novice


Use Case: Outcome Payments & ReportingCreating New Value for Healthcare

What?• Simple reporting for Medicare Access

& Chips Reauthorization Act of 2015

(MACRA)

• Easy auditing of Alternative Payment

Models (APM), Chronic Case Mgmt.

(CCM), and Comprehensive Primary

Care plus (CPC+)

How?• Digital immutable record

Benefits1. Auditable record

2. Trusted record of payment

Story:

1. Fraud / Red Cross

2. Payment reform


Use Case: Clinical TrialsCreating New Value for Healthcare

What?• De-identified information with

authenticity

• Research targets population required

How?• Broadcast to P2P network for

candidates

• Orchestration and transfer of health

data securely

Benefits1. Unlimited pool of qualified subjects

2. Raw health data never provided

3. No issues with limited use

Story:

1. Research cancer

2. N-of-1 / consumables


Use Case: Service BiddingCreating New Value for Healthcare

What?• Doctors and medical professionals

bid to provide medical services

• Creation of exchanges and tradenets

for electronic and mobile bidding

• The service providing the “value of

health”

How?• Think the “Uber for Health” buys eBay

• Globally secure information network

Benefits1. The most comprehensive review

network the world has even seen

Story:

1. Diving

2. Smart contracts for

healthSource: [7]


Use Case: Proof of InsuranceCreating New Value for Healthcare

What?• ZKP running smart contracts

• Validate patients medical history,

patients prescription, or patients

name

• Hospital (verifier) knowing nothing

except fact is valid/invalid

How?• Convince verifier of the truth

• Verified does not learn anything

except statement is true

Benefits1. Dapps validate patient information

Story:

1. Hospital check in

2. Verifier/Prover


Use Case: Health Information ExchangesCreating New Value for Healthcare

What?• Population health management

• Measuring patient outcomes

• Connecting outcomes with prevention

How?• Blockchain based health-record

• Linking medical outcomes e.g.

outbreaks

Benefits1. Ubiquitous security infrastructure

2. Verifiable identity and authentication

3. Representation of authorization to

access data

Story:

1. APCDs

2. OI/OO

BONUS!

Source: [8]


Use Case: Smart AssetsCreating New Value for Healthcare

What?• Changing the definition of preventive

• From telemedicine to bioelectronics

• Direct and indirect patient care robots

• Medical device maintenance

(nanobots to ultrasounds)

How?• Autonomous maintenance

• Device-to-device updates

Benefits1. Permanent record of device status

2. Simple asset transfer

3. Transparent maintenance records

Story:

1. Toaster challenge

2. Signals


Use Case: Healthcare SecurityCreating New Value for Healthcare

What?• Captured and time-stamped

healthcare data

How?• Data authenticity chain-of-custody

• KSI, scalable digital signature

authentication for electronic data,

machines and humans (Guardtime)

Benefits1. Data integrity

2. Transparent truth, not trust

3. Prove healthcare data has not been

compromised

Story:

1. Breach / Duty to verify

integrity

2. Data Transmission

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Mainstream blockchain companies

Create a verifiable

record of any data or

business process on the

blockchain.

Gem's blockchain application

platform transforms the way

companies and industries

connect to solve impossible

problems.



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Blockchain up and comers

Node-RED is a tool for

wiring together devices,

APIs and services.



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1. Identity, marketplaces, EHRs, clinical trials, security and more

2. Most practical for sharing information, without a trusted 3rd party

3. The future Node-Red, Gem, and others.

Wrap Up: Create New Value for Healthcare



Upcoming healthcare blockchain events

Focused on healthcare

Austin, Texas

Oct 20, 2016:

http://summit.ulahealth.me/

Story:

1. New Toaster

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Questions?

617-480-9147

[email protected]

Personal Blog: www.LeadersNeedPancakes.com

Professional Blog: www.cio.com/author/Peter-B.-Nichol/


Thank you!


ONC and NIST blockchain challenge

..to investigate

Blockchain technology and

its use in..

health IT and health

research.


Co-Creation of Trust for Healthcare: The Cryptocitizen Framework for Interoperability with Blockchain

The aim of this paper is to

introduce the concept of co-

creation of trust for healthcare

and propose applications of

blockchain to positively impact

aspects of healthcare

interoperability.

… blockchain health ecosystems

and the patient-centric

interactions that underpin the co-

creation of trust. Source: http://doi.org/10.13140/RG.2.1.1545.4963


Micro-Identities Improve Healthcare Interoperability with Blockchain: Deterministic Methods for Connecting Patient Data to Uniform Patient Identifiers

This paper presents a hybrid

model, integrating HL7 FHIR,

interoperability standards…for

exchanging electronic health

records using blockchain

technologies for better patient

access to health information.

…research expands traditional

identity matching strategies to

formulate a new solution for

healthcare entities to match

patient identities. Source: http://doi.org/10.13140/RG.2.1.3118.3605


New applications for blockchain interoperability

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http://bit.ly/5MinBlockchain

If I only had 5 minutes to explain blockchain


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[1] Outlier Ventures. (2016). Outlier Ventures » Investing in

blockchain 2016. Retrieved from

http://outlierventures.io/investing-in-blockchain-2016/

[2] Venture Scanner. (2016). Bitcoin Visual Map1 (image).

Retrieved August 27, 2016, from

https://venturescannerinsights.files.wordpress.com/2015/04/

bitcoin-visual-map1.jpg

[3] Kalra, A. (2016). Bitcoin and Blockchain: The difference and

what does their future hold? Retrieved September 6, 2016,

from http://irishtechnews.net/ITN3/bitcoin-and-blockchain-

the-difference-and-what-does-their-future-hold/

[4] Edwards-Playne, L. (2015). 3 Essential Takeaways From

The MIT-Microsoft Bitcoin Talk. Retrieved September 6,

2016, from https://medium.com/@liamzebedee/3-essential-

takeaways-from-the-mit-microsoft-bitcoin-talk-

54a4cd71a702

[5] Insly. (2016). The Evolving Focus of the Blockchain in

Insurance (image extended). Retrieved September 6, 2016,

from https://www.insly.com/lv/blogs/the-evolving-focus-of-

the-blockchain-in-insurance

[6] Peck, M. E. (2015). The Future of the Web Looks a

Lot Like Bitcoin. Retrieved September 6, 2016, from

http://spectrum.ieee.org/computing/networks/the-

future-of-the-web-looks-a-lot-like-bitcoin

[7] IBM. (2016). Blockchain: The Chain of Trust and its

Potential to Transform Healthcare – Our Point of

View. Retrieved from

https://www.healthit.gov/sites/default/files/8-31-

blockchain-ibm_ideation-challenge_aug8.pdf

[8] Krawiec, R., Filipova, M., Quarre, F., Barr, D., Nesbitt,

A., Fedosova, K., … Tsai, L. (2016). Blockchain

Opportunities for Healthcare. Retrieved from

https://www.healthit.gov/sites/default/files/4-37-

hhs_blockchain_challenge_deloitte_consulting_llp.pdf

[9] cbinsights. (2016). Banking Is Only The Start: 20 Big

Industries Blockchain Tech Could Disrupt. Retrieved

September 8, 2016, from

https://www.cbinsights.com/blog/industries-disrupted-

blockchain/

References


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References: Images


Documents

BLOCKCHAIN AND THE FUTURE OF HEALTHCARE