New Medicine for a Sick Patient: Blockchain in Healthcare
Blockchain is the technology story of 2017. While the public has been captivated by the rise and gyrations of the cryptocurrency Bitcoin, behind the scenes a not so quiet revolution is taking shape. Across myriad industries and use cases, blockchain is being developed and tested in ways too numerous to count.
One area that deserves special attention is healthcare. In our blog post “Can Blockchain Transform the Healthcare Industry?“, we explored the foundations of blockchain technology and concluded that blockchain is a good fit when it comes to the interoperability issues that healthcare is facing by transferring the ownership of data from the siloed institutions to the patients. But what is the current state of blockchain in healthcare, what are the most compelling blockchain projects, and how might they lead to the future?
Making the Case for Blockchain
Healthcare is certainly a subject that has been in the headlines this year as well. But beyond the obvious politics, there are numerous fundamental issues with healthcare that call out for attention. In addition to rising costs, healthcare is characterized by a lack of interdisciplinary standards, poor information sharing, and very real concerns regarding cybersecurity. While blockchain in no panacea for the complex and myriad issues confronting healthcare, it is a step in the right direction. To illustrate the potential for this technology, let’s look at health records, clinical trials, and supply-chain provenance as examples of how blockchain is going to transform healthcare.
Case # 1: Addressing Issues in Health Records
No one is well-served by the current state of health records. Information is stored in multiple locations that do not have the ability to share, retrieval of data is slow at best and inaccessible at worst, patients lack control over their own personal information, and researchers are unable to utilize metadata that could hasten the development of new treatment options. An effective blockchain implementation could reverse these conditions by making it possible to share information across siloes and thereby improve both the availability of information and the speed that it is shared. Importantly, the locus of control of data would shift from the provider to the patient and the centralization of data would lead to greater availability for drug and treatment research.
One experiment in this area comes from MedRec. Started by graduate student researchers at MIT, MedRec tracks records like blood work, vaccinations, prescriptions, and other treatments in an architecture that addresses the key issues of slow access to data, interoperability, patient control of their personal data, and generating quality data to support research. MedRec is built using Ethereum, an open-source platform featuring smart contract functionality, and is designed to be “run” by researchers, who validate the blockchain records in exchange for access to permissioned metadata for their research efforts. The proof of concept for MedRec was launched in 2016 at Beth Israel Hospital in Boston and has shown enough promise that the effort is being expanded further.
Case #2: Supporting Success in Clinical Trials
An excellent candidate for application of blockchain technology is clinical trials for treatment protocols, medicines, and medical devices. These examples are costly and cumbersome exercises that are carried out by a relatively large number of participants who happen to have divergent, and in some cases, competing interests and objectives in subject areas that are sensitive and require a high degree of security. Further, in some cases the credibility of clinical trials can be questioned due to factors such as missing data, endpoint switching, data dredging, and selective publication. Blockchain is an excellent tool to address these issues in a way that accelerates results, while lowering costs and satisfying the divergent needs and requirements of participants.
As a proof of concept, researchers from Thomson Reuters proposed a permissioned blockchain network that could be used by regulators, contract research organizations (CROs), and pharma companies to improve the transparency of data in clinical trials. The POC used a private blockchain based upon Ethereum and considered data regarding influenza inhibitors such as Tamiflu (oseltamivir) in the U.K. to be used in conjunction with traditional clinical data management systems (CDMSs). The authors conclude that blockchain smart contracts “can be used to improve the transparency of data management in clinical trials” and that “systems built using smart contracts should help to increase trust in the data they hold and the credibility of trials findings, allowing medical professionals to make better-informed decisions…”1.
Research funded by Thomson Reuters Global Resources proposes a permissioned blockchain network consisting of regulators, pharma and contract research organizations. Source: F1000 Research
Case #3: Protection for the Entire Journey
The tracking of assets along the full supply chain has emerged as an area of particular interest for blockchain applications and this is particularly true for healthcare. This is an issue not only of lost profits, but also patient safety. According to industry estimates, pharmaceutical companies lose up to $200 billion per year due to drug counterfeiting and an estimated 30% of all drugs sold in developing countries are counterfeits. The successful application of blockchain to the drug supply chain would result in greater safety in manufacturing, holistic tracking as drugs move from manufacturer to consumer, improved visibility for regulators and health management and monitoring organizations, and, ultimately, better health outcomes for consumers.
Efforts in this area are still in early stages with some experts suggesting that it will be another 18 months before the pharma industry can understand all of the issues well enough to be able to generate an acceptable model and begin field trials. Two significant efforts in this area are being pursued by iSolve with their Advanced Digital Ledger Technology (ADLT) for “BlockRX”2 and The Center for Supply Chain Studies (CSCS), which is researching how blockchain could improve drug safety in the context of the U.S. Drug Supply Chain Security Act (DSCSA)3.
Blockchain is Happening
Blockchain is less than ten years old and the concept is so new and unique that it’s safe to say that there is more ignorance than knowledge about the subject in the general population. While it’s understandable and largely desirable to harbor skepticism and a “wait and see” attitude for new technologies, the growing acceptance of cryptocurrencies like bitcoin validates that there is very real potential for blockchain. In the realm of healthcare, a general case for applicability and opportunity is on display in the eastern European country of Estonia. There, blockchain is being used to secure the health records for over 1 million Estonians. A patient portal creates a central ledger for all health records and provides patients not only with a one-stop location for medical documents, referrals, prescriptions, insurance information, and personal issues such as decisions regarding organ donations, but also gives them never before seen control over their own records. In Estonia, blockchain is already transforming healthcare.
More broadly, the healthcare industry is one of the most aggressive when it comes to investment in blockchain, with 35% planning to deploy some form of blockchain by 2018 according to research from Deloitte. So, even as knowledge about blockchain is only being formed in many minds, the development and deployment of working blockchain solutions is likely to mushroom in the near future.
What Will the Future Bring?
How might that burst of blockchain adoption look? Several possibilities include:
- Large advances in blockchain adoption are likely to arise in the developing world where little or no infrastructure is already in place. For example, the Gates Foundation awarded a grant in late 2016 to blockchain firm Factom to develop blockchain implementations for medical records in developing nations. In theses instances, the twin condition of greatest need for solutions and the carte blanche of being able to develop systems from scratch rather than on top of existing infrastructure creates the perfect storm for advancement.
- There will be a continued swell in the number of POCs for private blockchains as companies try to get comfortable with the technology. FOMO rules the day: blockchain is viewed as being so important that no company feels that it can miss out and fall behind the curve. Anywhere that there is complexity, high cost, a need for security, and underserved segments will be ripe for blockchain experimentation. Likely areas for successful development include multinational payments and research efforts in large pharma companies.
- Pervasive, sustained success is most likely in permissioned, or hybrid, blockchains. Opportunities that unite disparate and previously unrelated or even competing interests stand to have the most to gain from the heightened trust and cooperation that are inherent traits in blockchain. Interesting use cases include drug development or disease prevention and treatment research where a medical company interfaces with regulators, multiple research institutions, and universities. Blockchain acts as a catalyst to both align the interests and satisfy the needs of parties that typically have divergent interests. In this way, blockchain can change everything.
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