The blockchain that popped the world was originally produced as the underlying technology of Bitcoin. It is a chained data structure that combines data blocks in a sequential manner in chronological order, and is a cryptographically guaranteed non-tamperable, unforgeable distributed ledger. In essence, it is a decentralized database.
The role of the blockchain is to provide trust in an untrustworthy environment that is urgently needed by the pharmaceutical industry. The author compiled and compiled the application scenarios of the latest foreign media coverage of blockchain technology in the fields of value-oriented medicine, precision medicine, patient care and drug supply, as well as future development trends.
Blockchain and value-oriented healthcare
Value-oriented medicine is a medical system that is opposite to the traditional "Fee for Service" (FFS), highlighting the concept of "patient-centered, efficacy-focused". With the advent of the value-oriented medical era, the global medical system has focused more on the "value" of medical services, and the competition rules in the medical market are also turning into "competition based on medical effects."
How to control medical expenses has always been a headache for various medical institutions and payers, and it is also one of the reference standards for evaluating medical services. Hashed Health is a health care company alliance focused on accelerating medical innovation through blockchain. Its chief product officer, Corey Todaro, said that traditional health care payment systems are too complicated and expensive. On average, hospital management expenditures account for approximately 14% of medical expenditures. The application of blockchain can definitely reduce such financial expenses, because “blockchain can match distributed care teams with smart payment systems, supporting different modes such as packaged payments and payment by disease.â€
As a technical architecture, blockchain can promote the development of value-based payment systems. Tapan Mehta, Head of Market Development for Healthcare Business at DMI, a mobile technology and services company, said that for blockchain-based payment systems, assessment and billing management are mature enough to provide practical solutions that maximize Reduce fraud associated with medical bills.
In view of the high number of fraudulent activities in the payer's improper medical billing and reimbursement, the blockchain has a considerable applicability in this regard. For example, in the case where the patient is working with the health care plan to process the contract, the blockchain can automatically verify and authorize the information and the contract process, eliminating the tediousness of the information going back and forth between multiple parties. This will increase the transparency and efficiency of payments, thereby reducing management costs, speeding up the processing of insurance claims, and reducing financial losses.
Blockchain and precision medicine
Blockchain-based systems can drive researchers to unprecedented collaboration in the field of medical innovation, especially in the area of ​​personalized medicine.
According to Maria Palombini, director of emerging community and project development at the IEEE Standards Association, blockchain can drive the development of a "patient-centric" healthcare system.
Maria Palombini said that the current lack of interoperability between personal medical network data systems is extremely detrimental to patient care and care. Data is critical to improving patient care and life safety, and is far more important than the risk of data being stolen. Because only with this data, their medical service providers can better treat them.
Palombini adds that there is already a tendency to educate patients to manage their health to better prevent disease, and this practice will generate a lot of data. If the blockchain can support an electronic health record system managed by the patient, what the healthcare provider needs to do is to provide services and treatments to improve the patient's health, rather than having the patient's health information.
Mehta believes that precision medicine in clinical trials provides another great opportunity for blockchain innovation. According to Igeahub, a medical consultancy, about 40% of clinical trials have not published their research reports. In fact, most of the drug research related to clinical trials is isolated, which circumvents collaboration between teams within the organization and creates gaps in knowledge between patients and healthcare stakeholders and policy makers. A serious security issue. Blockchain technology is bound to make a difference in this regard.
Blockchain and wearable devices
Wearable devices are portable devices that can be worn directly on the body or integrated into the user's clothing or accessories. It is not only a hardware device, but also a data system that can realize powerful functions through software support and cloud interaction. In the future, wearable devices are expected to be integrated into the healthcare IT ecosystem through blockchain technology.
Medical wearable devices are hoarding a wealth of critical information for clinical research, therapeutic effects, and disease prevention and management. However, in the current state, this information is usually just a bunch of raw data, stored in a database that is externally inaccessible and cannot be shared by other uses.
Under blockchain technology, such health data can be protected and shared in the blockchain after verification, enabling wearable devices to play a new role in many areas, such as clinical trial patient recruitment, clinical research, and disease treatment. .
In fact, patient-centered health data exchange offers tremendous opportunities for blockchain innovation in the medical field. Patients and data owners can control external access to their medical data by recording patient informed consent and data transfer activities through the blockchain.
Shahram Ebadollahi, chief scientific officer at IBM Watson Medical, believes that in most cases today, it is difficult for patients to obtain their own health data or share it with researchers or medical providers. Providing patients with the ability to securely share their data with medical researchers or healthcare providers can create unlimited opportunities for medical advancement. Blockchain technology is expected to turn this possibility into reality.
As more and more patients begin to gain control over their health data, relevant data will flow more efficiently throughout the system, enabling the medical industry to have more accurate data, updated treatment options, and better treatments. result.
Blockchain and electronic health record
To achieve the role of the blockchain in the above links, the development of electronic health records (EHR) is a crucial part.
In patient-centered care, with the patient's consent, the blockchain will help the medical provider access the EHR for a comprehensive view of the patient's health data.
Currently, EHR focuses on collecting various clinical data. With the development of wearable devices, exogenous data from various mobile medical devices has grown exceptionally rapidly. Blockchain technology can connect data from these different sources to traditional clinical databases.
In fact, EHR data comes from a variety of sources, including hospitals, doctors' offices, laboratories, etc., and each source is the owner of the data generated.
Palombini believes that the disruptive trend of blockchain in the EHR field is to create, maintain and distribute EHR to patients. As a result, EHR will no longer be owned and operated by various healthcare companies. Instead, it will be a set of records containing multiple departmental data in the hands of patients, that is, extracting relevant data from the various entities providing medical services to the patient so that patients can add them to their health records.
These entities will no longer have a patient's health record, but will only provide data for them. The blockchain can completely overturn the ownership and maintenance rights of the current EHR, allowing patients to choose who to share, share, and share their health information, rather than obeying any medical system.
So, how far are we from this goal now? Dave Watson, chief operating officer of the online market research firm SSI Group, is cautious about this. He believes that EHR and blockchain cooperation still have a long way to go.
Watson believes that EHR providers have more and more urgent things to do. In the absence of clear and convincing relevant use cases, how can EHR providers advance the development of blockchain technology? Watson stressed, “Suppliers may put some general future positioning for blockchain technology to show that they can keep up with this trend, but that is not a viable technology deployment.â€
Blockchain and data security
One concept closely related to EHR is network security. This is also one of the areas where blockchain can have far-reaching impact. The blockchain can fundamentally change the way the Chief Information Security Officer (CISO) and the Information Security Team protect data.
Blockchain is not a patch, but a new way to manage and validate information in tamper-proof, distributed systems. It's not just a security system, it also forces every business professional to rethink the technology of their business operations in the digital arena.
Under the blockchain system, all transactions are time stamped and can be copied in the sections visible to each authorized user, but these data can only be added and cannot be modified. The decentralization of the blockchain provides the ability to anonymously distribute, encrypt data, and be authenticated by authorized users.
Blockchain technology provides traceability of all health data access and is completely transparent to auditors. Distributed ledger technology also preserves keys for accessing data, working with other systems to produce immutable audit logs, adding another level of security and making illegal access more difficult.
In the data security arena, the biggest opportunity for blockchain technology is how to reshape the data movement model in the healthcare ecosystem. Block chain enables the development of lightweight data-interchange model as possible, so that does not require large-scale availability of data transmission between partners or expand data. Both of these are important sources of cybersecurity risk today.
Blockchain and drug supply chain management
Blockchain's distributed ledger technology provides legislative, logistics, and patient safety benefits for pharmaceutical supply chain management. From the regulatory perspective of the US government, the technical and structural capabilities of the blockchain are in fact very consistent with the key requirements of the Drug Supply Chain Security Act (DSCSA), including drug tracking, product validation and benefits. Relevant persons issued notices about illegal drugs, etc.
Kevin Clauson, an associate professor at the University of Lipscomb's School of Pharmacy and Health Sciences, said that logically, blockchain is consistent with the federal government's efforts in drug management; from a patient safety perspective, one of the most promising benefits of blockchain It is to help prevent those inferior, counterfeit, and fake drugs from continuing to plague the pharmaceutical supply chain.
Mehta said that the prevention of counterfeit drugs is a major use of the drug supply blockchain. All kinds of counterfeit drugs cause up to 200 billion US dollars in losses every year. A blockchain-based system ensures the integrity of the chain of custody logs, allowing stakeholders to track every step of the drug or product supply chain.
The US distribution model consists of three main partners: manufacturers, wholesalers, and pharmacies. The current supply chain infrastructure is isolated and decentralized, and the improved approach is simply to integrate tracking and other technologies into these outdated devices. Decentralized infrastructure creates market opportunities for the development of Internet pharmacies and counterfeit drug transactions. It is difficult for a patient or entity in the drug supply chain to identify the true source of the drug.
After applying the blockchain technology, the partner needs to rely on the other party to ensure that the drug is delivered to the patient as safely and quickly as possible. The nature of the drug distribution model will allow the three partners to have the same level of transparency in auditing and tracking drug stocks.
As a result, all three partners can better understand the supply chain and verify the entire process from manufacturing to patient. If every entity in the supply chain is able to clearly understand the inventory situation and review the distribution of the drug, it will be difficult for the counterfeit drug to enter the market.
In addition, the blockchain will help streamline the drug supply chain process.
The complex and outdated central system operations employed by large pharmaceutical companies currently hinder the supply chain to achieve optimum efficiency. Through the blockchain, pharmaceutical companies can streamline the development, testing, and distribution of drugs, making supply chain management more flexible, transparent, and secure.
Through the blockchain, drug manufacturers can more accurately predict drug shortages and better conduct drug recalls. The autonomous and distributed nature of the blockchain simplifies the operation of the pharmacy supply chain, eliminating manual payment processes, invoices, and common human error.
Under the blockchain system, if the drug shipment process is interrupted or the drug is missing, the data stored on the distributed ledger can provide a quick tracking method for each party and determine where the drug is ultimately active. The public availability of distributed ledgers makes tracking of all drugs possible and can be traced back to the source of raw materials. In addition, the decentralized structure of distributed ledgers makes it impossible for any of the parties concerned to own the ownership of the ledger book and manipulate the data to obtain improper benefits.
Most pharmaceutical companies currently use a central database to manage their supply chains, and system administrators can edit, modify, or delete records. By applying blockchain technology, records will be permanent and cannot be modified in any way to ensure the most reliable data transfer. As a result, pharmaceutical companies can prevent human error, logistics delays, and the associated costs.
Blockchain technology challenges
Since the blockchain has so many technological advantages and potentials, one might wonder if the blockchain has become a good medicine for improving various fields of the medical industry. For optimists, the answer is yes. But to really implement the theory, there is still a long way to go.
Today, the real challenge that hinders innovation in healthcare systems is the inability to capture and share pure patient health data while protecting data privacy. The current data management system is difficult to negotiate the ability of all parties to share data with full protection of privacy. Therefore, safely storing data has become the top priority, and data sharing can only temporarily stand by.
The lack of data sharing mechanisms has become a real barrier to innovation in drug development and healthcare. The real value that a health care provider can provide in this area is not the service or product, but the data. These data are the key to innovation in finding treatments and preventing diseases.
The nature of the blockchain, the ability to publish information anonymously in an encrypted and tamper-proof environment, does provide a possibility to overcome important barriers to data sharing and privacy protection.
The "unchangeable" nature of the data in the blockchain can enhance the integrity of the data, thereby reducing the burden of data management. But Clauson of Lipscomb University admits that this improvement is still theoretical.
Some experts believe that applying technology for technology cannot solve all problems. In their view, the benefits of the blockchain are exaggerated and underestimate the sheer volume of leveraging the blockchain under existing taxonomies, protocols and policies.
Most experts admit that the blockchain, despite its potential, is not a one-time promotion in the medical industry.
IBM's Ebadollahi believes that in the next five to ten years, supporting the informed consent and data exchange through the blockchain can fundamentally change the way medical services are provided, so that relevant parties can retrieve the patient's longitudinal health data at any time. Open the door to new treatments and provide patients with new care models and better care coordination. He pointed out that blockchain precision medical and medical plans outside the medical system may have a major impact on treatment outcomes. "We need to keep in mind that now is only the beginning of the potential to develop blockchain technology, so the benefits it brings will take a while to fully realize, but we should never underestimate its potential."
Watson said that people still need to pay attention to the inherent limitations of the blockchain in terms of scalability, confidentiality and management.
Solving these thorny problems will be the only way for blockchains to be applied in the medical field. Trust and management will be key to this path, as the time between proof-of-concept and production quality technology is gradually shrinking. In addition, building blockchain networks requires strong support from software vendors and hospitals.
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