F033 Blockchain in Healthcare: A new comprehensive book guide

Anyone who wishes to learn about blockchain in general or specifically in healthcare can get overwhelmed by the number of results offered by a Google search. Awareness of the difficulty of finding credible, helpful and nuanced information around blockchain, was among the triggers for the book Blockchain in Healthcare Innovations that Empower Patients, Connect Professionals and Improve Care.

The book, edited by Vikram Dhillon, John Bass, Max Hooper, David Metcalf, and Alex Cahana, is a collection of topics from more than 50 authors, presenting the technical side of the technology, practical applications of blockchain around the globe, considerations of the economical impacts of blockchain and more. The book’s structure is divided into three parts: reflection on the past and present developments with an outlook to the future. The content covers specific areas from personal health records, clinical trials, data management, market situation, use in scientific research and more through explanatory articled and personal stories of contributing authors.

In episode 33 of Faces of digital health editors, David Metcalf and Alex Cahana share their view on the current blockchain in the healthcare landscape, accompanied by a comment about industry discussions seen at HIMSS 2019 Global conference, where the book was presented to the public for the first time.

“Looking at the Gartner hype curve, I would say we reached the bottom of the hill with cryptocurrencies, but started climbing on another hill of real value of the blockchain technology, often in ways people did not expect initially,” says David Metcalf, Director of the Mixed Emerging Technology Integration Lab (METIL) at UCF’s Institute for Simulation and Training, who got involved in blockchain projects already between 2012–2015, and in 2017 co-authored a book titled Blockchain Enabled Application. One of the first projects he was involved in was HealthShares — a wellness record system on the blockchain.

Listen to the podcast in iTunes, Stitcher or Podbean.

EHRs are not going to be on blockchain very soon

Somewhat interestingly, the Blockchain in Healthcare book place EHRs on blockchain in the section about the future potentials of blockchain technology. Alex Cahana explains this is due to the complexity of the electronic health records space. Hundreds of electronic healthcare records on the market show the interest of the industry in this specific digitization area of healthcare, which changed the patient-doctor dialogue and caused plenty of dissatisfaction on many sides. In enabling better care and EHR management, blockchain will have a huge role alongside voice technology and AI.

In the chapter on precision payments and precision contracts John Bass writes that in many ways, today’s healthcare enterprises compete with the very patients they serve. Instead of focusing on patient outcomes, the traditional system focuses more on billing, narrowing choice, shifting costs, creating leverage, maximizing reimbursement, and retaining patients. Benefiting at the expense of the patient is no path to value.

The system change needed for blockchain adoption in healthcare will require at least as much time as the technological development, comments Metcalf. As added by Cahana, a culture change will need to happen in all healthcare systems, no matter the country they serve.

He likes to illustrate blockchain adoption through the theory of 5 stages of grief — denial, anger, bargaining, depression, and acceptance. We are currently in stage four — depression — where many people have been discouraged from contributing to the blockchain space, but those who stayed are excited about the rising maturity of discussions and ideas.

Present projects and discussions at HIMSS 2019

There’s a lot happening around blockchain in the US — the CDC is piloting projects for epidemics detection, healthcare providers and insurance companies are connecting through pilot projects, Pharma companies from Abbvie, Genentech and Pfizer are dipping their toes in the space, etc.

Judging by the HIMSS 2019 participation, Cahana has the impression that the industry is still trying to figure out what to do with blockchain. Metcalf, on the other hand, sees a more mature situation where industry leaders are trying to determine where will blockchain be strategic to their business. Many have started pilot projects. The first successes can be expected in supply chain projects, clinical trial, Metcalf is also very eager to see how blockchain movement will reshape verification of scientific discoveries, which is covered comprehensively in the new book in the chapter written by Sean Manion from Science Distributed.

Both editors of the book, participating in the podcast believe that economic incentives enabled by blockchain could be interesting in promoting patient outcomes. According to Cahana, we are years away from large institutions recognition of the potential blockchain technology has to change healthcare. At the same time, ideas around what will blockchain cause, are changing as well. “Instead of thinking about disintermediation, we need to start thinking about reintermediation with the repurposing of the middle stakeholders. In the digitized world we should stop talking about competition and instead consider the opportunities of collaborative competition because, in the rapidly developing digital space, no one company is going to be able to solve all the problems alone,” says Cahana.

Listen to the podcast in iTunes, Stitcher or Podbean.

Some questions addressed:

The trigger to start thinking about a book was the difficulty of finding credible, helpful and nuanced information around blockchain in the sea of blogposts and articles online.What topics are in the book, how were contributors chosen?
How is the blockchain landscape today different compared to 2012, and where are we going?
The new book — Blockchain in Healthcare Innovations that Empower Patients, Connect Professionals and Improve Care — was presented first at HIMSS 2019 conference in February this year. What did the debate around blockchain look like this year, compared to previous years?
Which blockchain healthcare projects are most far ahead at the moment? What will be the first practical implications?
EHRs on blockchain are in the future section of the book. Why?
What is the potential of blockchain for addressing the opioid crisis?
What will be the role of regulation in blockchain implementation, since the transparency the technology enables, might not be in the interest of healthcare market players?
Where are we heading with blockchain in healthcare?