00 Course Outline

Prerequisites:  TBD

Initial course outline

1. Introduction
   1. History of blockchain
   2. Blockchain 101
   3. Decentralization/centralization
   4. Distributed ledger-private vs public
   5. Mining and consensus mechanisms
   6. The role of digital health in healthcare (Natalie P)
      1. Intro to healthcare on blockchain including Medical records FHIR, HL7
2. Healthcare Challenges & Opportunities
   1. Challenges
      1. Rising Costs
         1. Population living longer, more active lifestyles
         2. In many countries, the healthcare costs are rising faster than inflation (and expected to continue)
         3. Very troubling for healthcare and insurance leaders
         4. Leaders must find alternative methods to combat the rising costs of care. Options include:
            1. Grants & funding for research and setting up new programs to adapt to rapid change
            2. The Health Services Research Information Central (HSRIC) provides a list of grants, funding and fellowships
            3. Partner with innovative companies in proof of concept projects

1. Regulatory Challenges
   1. Philosophical differences between major political parties combined with increasing financial pressures result in shifting legal and regulatory requirements.
   2. The change in administrations or control over branches of government have profound impacts on national healthcare policy.
   3. This causes changes in administrative rules to ripples through the healthcare system.
   4. The existing regulatory framework is complex and results in strains on the healthcare system. These include requirements resulting from:
      1. Health Insurance Portability and Accountability Act (HIPAA)
      2. Centers for Medicare and Medicaid Services (CMS), and the
      3. Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
   5. This highlights the need for document and records management systems that have integrity, are easy to verify and are unalterable.
   6. Blockchain solutions may be excellent solutions to address many of these challenges
2. Discussion Questions:

• What do we want the learner to learn from this section?
• The regulatory challenges to be solved by the technology?
• How current regulations make it difficult to use blockchain technology?
• The regulations any developer has to take into account to make technological solutions fully compliant to the (applicable) regulatory framework in a given country?

1. 3.  Medicinal & Technological Challenges

1. Healthcare delivery methods are changing
2. Healthcare providers are facing physician shortages and need “low-cost alternatives to office visits” and in-patient care
3. Telemedicne
4. Cyber doctor interactions
5. Interactive technology like wearables, remote diagnostic equipment and wifi enabled devices supports virtual visits
6. Virtual visits works well for common conditions such as colds, flu, pink eye and sprains” and “more easily manages patient care for chronic illnesses that require daily interventions
7. Need for new procedures, tools and techniques
8. Explosion of patent data
9. Storage & security concerns
10. Privacy concerns
11. New opportunities for data aggregation for research (still privacy concerns)
12. The pressure and “growing influx of patient data, legal requirements for strict privacy and security, rapidly advancing clinical technology drives up costs, and other factors.
13. Blockchain technologies and artificial intelligence can support diagnosis and treatment of patients whild addressing privacy, security

1. Training & Education Challenges
   1. The rate of new information concerning diagnosis, treating and monitoring is overwhelming
   2. Fueled by genomic research
   3. Personalized health
   4. Increasingly comprehensive public health system
   5. Exploding sources of healthcare data
   6. Healthcare data integrity becoming increasingly important
   7. How do we transmit trusted information to healthcare providers while maintaining the integrity of the information
   8. Blockchain and related technologies can provide solutions in the collection, analysis, assembly, distribution and validation of healthcare information.
2. Ethical challenges
   1. Healthcare fraud, waste & abuse
   2. Insurance fraud
   3. Counterfeit drugs & medical device knock offs
   4. False medical credential
   5. Falsified research data and conclusions
   6. Compromised pharmaceutical supply chains
   7. Many, many more….
3. Blockchain supports the providence, traceability and reliability of healthcare data
4. Interoperability and other obstacles of implementation (industry inertia, large data sets, inherent resistance to change)

1. Opportunities
   1. Healthcare Shared Ledger
   2. Potential workflows for the collection, use, and reporting of individual and public health data using blockchain technologies
      1. • Identify and describe the major actors in a healthcare ecosystem and describe potential data flows.
      2. Describe how financial data can be collected, recorded, aggregated and reported using blockchain technologies
      3. Describe how Biological data can be collected, recorded, aggregated and reported using blockchain technologies
   3. Cost Reduction
      1. PT empowerment 1 & 2 (digital health wallet with access driven by smart contracts, monetizing data for sharing)
2. Healthcare use cases appropriate for blockchain solutions
   1. AI technology (theoretical use cases)

1. Healthcare Domains
   1. Financial
      1. Insurance/Claims management
         1. Insurance (eligibility, reduced overhead, claims-processing)
         2. Healthcare Delivery
            1. Value-based care and concepts (discuss outcome-based smart contracts)
            2. Pharmaceutics
            3. Blockchain and mIoT (new delivery models)
            4. Supply chain and verification
               1. Supply chain (substandard and falsified medicines, divergence, compliance with DSCSA)
               2. Logistics
            5. Patient-centric Health? Moving part of the responsibility back to the patient (following the prescribed treatments, healthier habits, …)
            1. Administration
               1. Quality
               2. Regulatory Compliance
                  1. Patient identity
                  2. Privacy – Describe the privacy impacts and concerns related to the benefit of public health management
                     1. HIPPA
                     2. GDPR
            2. Research
               1. Pharmaceutical (Drugs development?)
               2. Clinical trials
2. Healthcare Blockchain Technology
   1. Identify and describe the features and limitations of several blockchain platforms as they relate to healthcare data
   2. Medical devices, Wearables, IoT
   3. Patient adherence monitoring (with tokenized incentives-could also discuss with pt. empowerment), incentives, etc.
   4. Datasets
   5. Technological Challenges
      1. Security – Uploading critical healthcare data into a blockchain where hackers and other illegal parties can sight the information is simply not an alternative for most companies if we are to consider the sensitivity and ethical dissemination of the underlined:
         1. Electronic Medical Record (EMR): which are very private and sensitive information. It’s improper to ever have that information overtly evident on public blockchains, by this means jeopardizing patient privacy
         2. Identity Verification Data: such as sensitive security numbers cannot be publicly stored in a public smart contract.
         3. Credential Management such as passwords and keys have no place in an open, unsecured smart contract.
         4. Financial Credentials such as employee salaries should never be publicly linked with addresses that are easily noticeable.
      2. Performance
         1. At present, all public blockchain consensus protocols have a challenging limitation: every fully participating node in the system must process every transaction which means that no middle party is accountable for securing and maintaining the schematic structure. As an alternative, every single node on the system is answerable for securing the structure by handing every transaction and maintaining a copy of the entire status
            1. Decentralization agreement method gives us the major benefits of blockchain that we all prefer like security assurance, political nonaligned status, restriction resistance, which comes at the cost of scalability.
            2. Considering the SLOW/LOW implications here:
            3. Slow transaction period: The time required to process a block of transactions is slow. For example, Bitcoin block times are 10 minutes, while Ethereum block times are around 14 seconds. These times are even longer during peak moments. Compare that to the nearly instantaneous confirmations you get when using services like Square or Visa.
            4. Low output: Blockchains can only process some degree of a number of transactions
            5. consequently, public blockchains are required to make a swap between low transaction throughput and a high degree of centralization.
            6. Meanwhile, as the size of the blockchain grows, the rations for storage, bandwidth, and compute power essential by fully participating nodes in the system thus increase. one day, it becomes bulky that it’s only feasible for the few nodes that can stand the resources to process blocks that lead to the risk of centralization.
            7. Then, we’ve made a complete cycle turn and gotten back to a centralized system that involves reliance on a few bigwigs. while what we want is a network that handles thousands of transactions per second with the same levels of decentralization that cryptocurrency promised to offer.

Transforming Healthcare

1. Blockchain Impact on Healthcare Business Models
   1. Blockchain doesn’t need to be used to try and solve the legacy processes problems the internet was supposed to solve (and hasn’t – my doctoral research was on the transfer for health dollars from providers who would not communicate with their patient via the internet tech, to those who would… in 1999).
2. Blockchain as a Driver for Healthcare Innovation
   1. The opportunity we have with blockchain is to CHANGE THE BUSINESS MODELS of healthcare. We need crazy people to figure out ways to accomplish this and most will not come from inside the industry. So we need to target entrepreneurs who wish to bring their drive and passion for helping to solve healthcare’s problems.

Other Notes

• We should enable startups to gain an education
  • Q1) live or online?
  • Q2) desired format?
  1. a) workshop 1-3 days
  2. b) 4-6 weeks online
  3. c) 12 weeks intensive online
• Q3) audience
  1. a) anyone
  2. b) executives

  Q4) If we use term blockchain  ” specialist” we need to clearly outline what exactly they will be specialists in?

  Definitely not in Blockchain Technology (  from our outline)

  Applications of Blockchain in Healthcare  ( ?)