It’s not about what blockchain can do in healthcare, but what it’s already doing

It’s not about what blockchain can do in healthcare, but what it’s already doing

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A panel discussion at the upcoming MedCity INVEST meeting in Chicago will look at real-world applications of blockchain technology in healthcare and biopharma.

Much of the focus on blockchain in healthcare and biopharma has been on the theoretical – what the technology could potentially do and where it could potentially be applied. But increasingly, that focus is shifting from potential to reality.

Real-world applications of blockchain in healthcare – not just what it can do, but what it is doing – will be the topic of a panel discussion at the upcoming MedCity INVEST conference, taking place April 23 in Chicago, with KKH Advisors CEO Kimberly Ha as moderator. The panel will bring together Health2047 Managing Director Charles Aunger, vice president for medical and regulatory affairs at drugmaker Boehringer Ingelheim’s Canadian division Uli Broedl, Embleema head of blockchain consortium Alexis Normand and Medable vice president for life sciences Tyler Pugsley.

A timely example of blockchain’s implementation came last week when Embleema, based in New York, announced it would work with the government of Armenia for an effort to use blockchain to modernize digital healthcare in the country. The aim is to offer physicians there better access to health data while connecting Armenia to international research, particularly in areas like oncology, immunotherapy and molecular medicine.

“I think it’s the first proof-of-concept of using blockchain at the national level,” Ha said in a phone interview.

But numerous efforts have taken place in the private sector as well. At the annual Healthcare Information and Management Systems Society conference in February, Boehringer Ingelheim and IBM announced a partnership that they said would mark blockchain’s first use in clinical trials in Canada. In particular, the US technology giant and German drugmaker said they would test whether blockchain can provide a decentralized framework to enable data integrity, provenance, transparency and patient empowerment, along with automation of processes for clinical trials. The partnership’s aim is to improve trial quality and patient safety, given that current processes are often seen as inadequate, leading to erroneous trial records that threaten safety and interpretability.

Realistically, for now blockchain’s application in clinical trials will likely be in postmarketing Phase IV studies, as opposed to earlier trials used for proof-of-concept or regulatory approval, Ha added.

For the time being, a number of questions remain that Ha and Aunger said they would like to see brought up in the panel. One, Aunger said, is what are the benefits people are seeing from using blockchain. “Everybody asks that question all the time – nobody gives a really good answer,” he said in a phone interview. Additional questions include whether the blockchain platform is being built for the betterment of the patient or organization; whether it truly has privacy; and how to get past the marketing hype, he said. “The other question is who regulates it – should it be government, or should it be someone else,” he said.

Ha said she would like to talk about incentivizing in terms of how blockchain facilitates the creation of a marketplace type of platform enabling patients to provide data and control what is done with it. “After I join a clinical trial, I don’t know where my data is being sold,” she said. “Lack of security around patient data is a massive vulnerability.”

 

 

 

Alexa, What Is Blockchain?

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The last few years have seen a rise in technologies that promise to change the world as we know it. Blockchain is one of the technologies at the center of this universe. We’ve seen headlines like, “Audit dead in a decade?”, “Blockchain isn’t so bad …,” and “Blockchain will start to become boring.” Blockchain is going to change how business is conducted today and into the future, just like any other business application. The billion-dollar questions are how and when. Let’s start with blockchain fundamentals.

Fundamentals

Blockchain, as most know it, is a public, decentralized distributed ledger that can store and confirm all transactions recorded to the ledger. Wait, what? Let’s break down that sentence into what it means to you and my mother. Public simply means available for anyone to use. Decentralized means reducing the power any one party may have over the other and in the end being less likely to find our data being at the mercy of a single institution. Distributed ledger is the avenue used to store and share valuable data and could be anything from a home deed to digital currency.

Public vs. Private

Many think of blockchain transactions as being available to the public, similar to bitcoin. But what happens when I transfer my bitcoin to a public exchange, conduct business on that exchange and withdraw my bitcoin? The business that was conducted on the exchange is not public information, just like stock trades in your brokerage account.

Blockchain provides the opportunity for public and private ledgers to work together and provide the best of both worlds. Imagine paying your employees through blockchain, whereby the transactions are recorded within your private general ledger, and the payroll taxes, retirement funds, and health insurance information are recorded within a consortium (hybrid) ledger. In a case like this, only invited parties would have access to participate in respective ledgers, and then payments would be remitted on a public ledger in the form of bitcoin to those respective vendors.

What Happens to Your Auditors?

I’ve seen the headlines, read the articles and contemplated my career when they say, “Your job will be gone in five years.” Here is a direct quote from an accounting professor: “The distributed ledger reduces the need for audit by 97%. Audits in the future will be competed on the basis of productivity, which will essentially mean who has the fastest hardware and software. And fraud, in the classical sense, will be all but impossible.”

Wow, our professor has overestimated that everyone and every business will be on a gigantic, public, decentralized distributed ledger where anything is possible! That would require an unbelievable amount of trust in a system in less than 10 years that leads to everything being verifiable. I’m not ready to hand over all of my data to a decentralized system where my cash inflows and outflows, including my daily coffee habits, are public knowledge. Are you?

For blockchains to eliminate auditors, there must be a problem within the current state according to the public, a return on investment for the investor and commitment to 100% adoption by all companies. Audits will continue to evolve, as they have over the last several years; that is a statement you cannot argue with. However, the assumption that all transactions are recorded, categorized correctly and authorized is why accounting professionals are still needed. For example, the argument that you didn’t pay your taxes because you were unaware of your obligation doesn’t fly with the IRS; ignorance in this case will be no different.

Data analytics is a great example of a similar “game changer” that has been discussed and highly touted over the last 5-10 years. While some companies have jumped on board, many others are still hesitant to employ these strategies. Similarly, ask lawyers their thoughts on LegalZoom, which first started offering legal service products to the public in 2001. The last time I checked, lawyers haven’t disappeared, right? In fact, a counterargument could be made that they are doing more work than before LegalZoom to help correct their client’s intentions. In other words, blockchain will change how business is conducted; however, it will not be perfect and will not be nearly as fast as many are implying.

This implementation timeline is another concept that many are not fully aware of. There are some significant barriers to overcome, the largest being the sheer computing capability necessary for blockchain to operate effectively. People mine bitcoin, and it takes weeks to make a coin. The more secure the “chain,” the longer it takes to register something on the ledger. That makes sense, right? If the lock is more complex, it will take longer to open it. Currently, without quantum computing, it would take over 100% of the electrical grid capacity to power the computers to do everything blockchain promises to accomplish.

Three Areas Where Blockchain May Make Your Life Easier in the Future

  1. Cash: Bitcoin and others may or may not be the answer to a lot of problems within our current system; however, when you break it down into the simplistic view that it is utilized by independent companies as a secure way of transacting business with nearly instant settlement in comparison with the current banking system, the possibilities start to expand. That is one of the reasons a large bank such as JPM is coming out with its own coin or Fidelity with its own crypto exchange, both in 2019.
  2. Smart Contracts: Why so smart? Smart contracts allow entities to connect multiple inputs to prove contractual obligations are met. Upon those obligations being met, payment would be disbursed and recorded to other blockchains. Put another way, smart contracts in their simplest form are decentralized automation that facilitate, verify and enforce the performance of a transaction. To provide a simple example, a company ships a product to a customer; however, the funds will not be released until the tracking information shows that the product was delivered to the customer.
  3. Supply Chain Management: Wal-Mart is one of the largest and most well-known examples in blockchain supply management, which will soon require lettuce and spinach suppliers to utilize their blockchain database, which will allow rapid location of the source of any contamination. Now let’s take it a step further: Consumers can scan a code from their phone to see the origins of that spinach, including when it was picked. Now imagine that instead of tracking just spinach, you’re able to track the ingredients of your pasta sauce using the same app on your phone. Blockchain will allow large amounts of data to interact with end users in a way we’ve never seen before, and that will only continue to evolve year over year.

In summary, blockchain will change the general concept of how we think of accountants. As routing tasks are automated, the role of accountants will become more and more focused on advisory and analysis, rather than traditional “ticking and tying.”

The burning question is when. Depending on who you ask, you may get a very different timeline, so what is the answer? Generally speaking, we overestimate the amount of technological change that is going to occur in the next 2-5 years, and we underestimate the amount of technological change that is going to occur in the next 10-20 years. Blockchain is no different. Stay tuned.

 

The Biggest Growth Opportunities in Healthcare

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Healthcare growth opportunities for 2019 should pivot around the three big themes: digital transformation, value-based care, and patient-centricity, according to a new report.

According to Frost & Sullivan’s report, “Global Healthcare Market Outlook, 2019,” digitization of products, services, and commerce models are democratizing current healthcare systems, manifesting a new era of healthcare consumerism.

“Now the new vision for healthcare is not just about access, quality, and affordability but also about predictive, preventive, and outcomes-based care models promoting social and financial inclusion,” says Kamaljit Behera, transformational health industry analyst at Frost & Sullivan, and author of the report. “This makes digital transformation and realization of long-pending policies reform a key growth priority for healthcare executives and major health systems during 2019 globally.”

According to Behera, increasing pricing pressure and shifting the focus of the healthcare industry from a volume- to value-based care model demands that drug and device manufacturers elevate their business models beyond products to customer-centric intelligent platforms and solutions.

“In 2019, the healthcare market will continue to transit and stick into the value-based model,” Behera says. “More sophisticated outcomes-based models will get deployed in developed markets, and emerging nations will start following the best practices suited to their local needs.”

Despite the promise of digital transformation, the potential promise and actual commercial application still remain the poles apart from some of the most touted technologies like AI and blockchain, according to Behera.

“Current technology is often perceived to increase the barriers between patient and providers,” he says. “In order to bridge these gaps, healthcare executives need to change the debate around digital transformation and start look beyond the mirage of technology novelty and really focus on the outcomes.”

Behera predicts that these five areas will be the biggest areas of growth for healthcare in 2019:

1. Meaningful small data

Healthcare data analytics focus will shift from ‘big data’ to ‘meaningful small data’ by hospital specialty, according to Behera. “Increasing digitization of healthcare workflows is leading us to a data explosion along the care cycle, globally,” he says. “This makes insights generation from existing healthcare data for targeted use cases a relatively low-hanging opportunity relative to other emerging technologies. Additionally, health data being the ‘holy grail,’ the analytics solutions are considered the first foundational step to catalyze complementing technology promises leveraging healthcare data (e.g., artificial intelligence, cloud computing, and blockchain).”

Entailing this, Frost & Sullivan research projects the healthcare analytics market revenue to cross $7.4 billion in the United States by the end of 2020.

 “The key pivotal theme driving this growth opportunity includes population health management, financial performance improvement, and operational automation by patients, payers, physicians, and procedures,” Behera says. “Also, the rise of value-based care and outcomes-based reimbursement programs will continue to boost the demand for specialized analytics solutions.”

In 2019, payers and providers will continue to prioritize and leverage the potential of specialty-specific analytics solutions to investigate drug utilization, treatment variability, clinical trial eligibility, billing discrepancy, and self-care program attribution specific to major chronic conditions, according to Beherea.

2. Digital health coming of age with increased focus on individual care

“During 2019, we project application of digital health will continue to go far beyond the traditional systems and empower individuals to be able to manage their own health,” Behera says.

Favorable reimbursement policies (e.g., toward clinically relevant digital health applications) will expand care delivery models beyond physical medicine to include behavioral health, digital wellness therapies, dentistry, nutrition, and prescription management, according to Behera.

“For example, major insurance bodies are already using digital health services to communicate with patients,” he says. “Traditionally, lack of formal reimbursement processes is actually a deterrent to the uptake of these—wearables, telehealth etc. The next 12 months will see a relaxation of reimbursement rules for digital health solutions.”

The global aging population and an expanding middle class are major contributors to the chronic disease epidemic and surging healthcare costs, Behera says. “This year will be a pivotal year for defining value for healthcare innovation and technology for digital health solutions catering to aged care and chronic conditions management to bending healthcare cost curve,” he says.

“Telemedicine in emerging markets will become more mainstream and will aim to become a managed services provider [rather] than being just a telemedicine platform,” he says. “Telemedicine will move into the public health space as well, with countries like Singapore is testing the platforms in a regulatory sandbox. Finally, as the lines between retail, IT, and healthcare continue to blur, non-traditional players such as Amazon, Apple, Google, Ali Health, Microsoft, and IBM, among others, will continue to make further headway into the individual care space— providing the required impetus to public health systems to ensure accessibility and affordability of care-leveraging, patient-centric digital health tools and solutions.”

Healthcare executives should prioritize their roadmap for growing IoMT and connected health ecosystems (device-, wearables-, and mHealth-generated individual health data) in order to monetize these new sources of innovation and service-oriented future revenue streams, according to Behera. “The future focus should shift from drug and device mind-set to intelligent solutions/services, demonstrating outcomes-based health benefits to individuals and their caregivers,” he says.

3. AI

In next 12 to 18 months, the priority will be to bring AI/cognitive platform technology use cases closer to clinical care to augment the physicians and even patients with actionable decision-making ability, according to Behera. “In next two to three years, AI will become a common theme across all digital initiative and platforms.”

AI-based work flow optimization use cases will represent more than 80% of the workflow market contribution. These include:

  • The elimination of unnecessary procedures and costs
  • In-patient care and hospital management
  • Patient data and risk analytics
  • Claim processing
  • Optimizing the drug discovery process

“For example, Google is already at work to use machine learning for predicting patients’ deaths, and the results boast a flattering figure of 95% accuracy, which is better than hospitals’ in-house warning systems,” says Behera. “AI application across clinical and non-clinical use cases will continue to show hard results and further bolster the growth in the healthcare space in 2019.”

AI-powered IT tools that manage payers’ and providers’ business risks (including clinical, operational, financial, and regulatory) continue to be important for the market, according to Behera. “Across all regions in the world, AI-based cognitive technologies are proving to be the most useful for medical imaging and clinical diagnostics—as a decision-support tool—followed by AI application to derive intelligence on remote patient monitoring data to promote outcomes-based personalized care.”

4. Regenerative medicine

Cell-gene therapy combinations are rapidly gaining momentum, which make use of gene-editing tools and vector delivery systems to devise innovative curative therapies, according to Behera.

“There is also a pipeline of induced pluripotent stem cells (IPSCs), mesenchymal stem cells (MSCs), and adipose-derived stem cells (ADSCs) for novel therapeutic treatments for neurological, musculoskeletal, and dermatological conditions, among others,” he says.

These are poised for growth because rising pressures to decrease healthcare cost globally, the emergence of value-based reimbursement models, and healthcare digitization trends are transitioning the treatment model from “one-size-fits-all” to stratified and outcomes-based targeted therapies, according to Behera.

“Many factors determine the rate at which the stem cell therapy market advances,” he says. “It is driven by the success of stem cell treatments in curing life-threatening diseases such as cancer, heart diseases and neuromuscular diseases in the world’s aging populations. Emerging gene-editing techniques such as CRISPR/Cas9 that offer high precision, accessibility, and scalability, compared to other genome editing methods, such as ZFNs and TALENs for cell and gene therapy applications will continue to attract high investment both from venture capital and pharma companies.”

As regenerative medicine is redefining medical technology synergies by combining stem cell technology with tissue engineering, market participants should be investing in innovative models such as risk sharing, in-licensing/out-licensing deals, fast-to-market models, and in-house expansions, according to Behera.

“With cell-therapy manufacturing being time sensitive, biopharma companies should implement IT-based solutions for improved manufacturing capabilities,” he says. “Despite the promises with novel cell and gene therapies such as CRISPR/Cas9, questions around ethical application challenge its future potential. This makes it necessary for the life science research executives to work closely with regulators in developing guidelines and regulations [that will] guide ethical and real-word unmet needs of the healthcare industry.”

5. Digital therapeutics

“Digital therapeutics are about to become a true medical alternative that will utilize communication-based technologies, apps, and software to improve patient outcomes and help to lower the cost of healthcare,” Behera says. “Digital therapeutics offer the benefit to improve patient outcomes and reduce treatment cost by replacing the need for a drug or augmenting a standard of care, but they are not endorsed by a regulatory body, such as the FDA.”

Frost & Sullivan projects that the overall digital therapeutics market is to grow at a CAGR of 30.7% from 2017 to 2023.

“Digital therapeutics will become an exciting healthcare option that adds a curative dimension to technology,” he says. “As care for these chronic diseases expands in scope, prevention and recovery are becoming the new focus areas—apart from diagnosis and treatment. This demands a holistic view of individual health, lifestyle, and environmental data beyond the clinical health records to efficiently stratify at-risk patients for a preventive and targeted treatment paradigm.” 

Defining digital therapeutics appears at first glance to be a simple task, but challenges develop when attempting to define digital therapeutics as a market opportunity, according to Behera.

“Healthcare executives exploring the growth opportunities should prioritize their market positioning, which is often dictated by focused use cases (e.g., condition management vs. behavior management) rather than the technology novelty,” he says. “At present, many companies are either claiming to be or cited in the media as digital therapeutics, but only a small number of early-stage participants are seeking FDA certification based on randomized clinical trials. They make it critical for healthcare executives to keep a close watch on progressing regulatory developments, such as the FDA precertification program.”

 

 

 

Why The Next Evolution Of Global Health Care Will Be Blockchain-Based

https://www.forbes.com/sites/chrissamcfarlane/2019/02/07/why-the-next-evolution-of-global-health-care-will-be-blockchain-based/#13cba23e43ac

This distributed ledger technology can improve security, efficiency, and the coordination of health care systems as an answer to aging legacy infrastructures.

Health care systems are cornerstones of all modern societies since they provide vital services. As they grow, however, many become less efficient and secure, which can make health care services more expensive and less accessible to the general public. Beyond being the buzzword of 2017, blockchain opens the door to solutions in an increasing global healthcare expenditure that is expected to increase to USD $10.059 trillion by 2022.

Healthcare Today

While the digitization of healthcare has paved the way for modern infrastructure, current privacy laws, software, and databases have slowly taken the power from the patient. Our existing software faces a few key problems that have both short-term and long-term implications—affecting both healthcare providers and their patients. Inefficiency, disjunction between databases, the disempowerment of patients, high expenses, and security concerns are just some of the many problems the healthcare industry faces.

With a move towards ease of access to data and decentralization in a world where security continues to pose a serious risk, blockchain is becoming the answer to many industry-wide obstacles. Here is how blockchain is applied to many of industry’s burgeoning issues:

Security

Healthcare systems are being targeted by cyber attacks because their legacy infrastructures make data vulnerable. In 2017, the ransomware “WannaCry” crippled the National Health Service (NHS) in the United Kingdom and affected over 150 countries. In 2018 and 2019 respectively, hackers broke into Singapore’s government health database and most recently the HIV status of over 14,000 people leaked online, Singapore authorities say.

Given that blockchain is a distributed ledger technology and does not require third-party interventions, it allows institutions to decentralize their databases. Hence, by using blockchain, health care systems can significantly reduce their risk of being subject to cyber threats. It would take too much time and energy for hackers to access all of the nodes within the network and to infect the system.

It is highly important to create an environment where clinicians, administrators, and patients (also known as consumers of healthcare) know that their privacy and data are protected. Such an ecosystem can be enabled by blockchain, either by allowing users to own their information by joining the chain or by helping hospitals to secure their servers and distribute the data on a network.

Efficiency & Coordination

Health care systems are remarkably inefficient. Since they operate with many independent databases, especially in large centralized systems, there is a lack of cohesive communication between these distinct silos. By creating a unified ecosystem of data, distributed ledger software encourages cooperation between networks, improving payment processing, patient tracking, and enterprise workflow.

Sectors like the food industry are already seeing wins with blockchain that healthcare can emulate in regards to supply chain management.  Companies like Walmart implemented IBM’s blockchain for food traceability, impacting pharmaceutical stakeholders to participate in the non-profit Center For Supply Chain Studies DSCSA and Blockchain Phase 2 Study. The FDA who is behind this initiative, as declared by current FDA Commissioner Gottleib requires all entities governed under FDA  “full implementation of the Drug Supply Chain Security Act, [and] to make sure that every link in the U.S. Drug Supply must be secure.”

Other emerging use cases such as clinical trials involve the management of numerous locations, sources, and stakeholders, along with supervision of substantial amounts of sensitive data. Since blockchain may facilitate data storage, the technology can fuel innovation, as researchers will have greater access to medical record information.

The Future of Healthcare

Blockchain technology is expected to transform the way key players in health care systems interact with each other. Nonetheless, this technological revolution can only succeed with consortium thinking, which implies collaboration between all stakeholders in the sector. In the United States, Synaptic Health Alliance, a diverse consortium of healthcare organizations and other emerging startup consortia are working to identify and monetize shared opportunities in the blockchain space.

Blockchain is not without its problems.

Right now the initial costs can be high, and the integrations need to happen. Currently, most blockchain networks are designed so transactions are publicly accessible. While blockchain systems can be made private and permissible, making it so only certain parties can access boils down to aligned incentives. But it’s clear that the technology is there and can change healthcare for good.