In the last two years, the hype around blockchain settled down, and now projects can focus more on development rather than managing attention. Many projects have gone from an idea to a pilot program or an actual implementation. However, we probably won't see patient medical records on the blockchain soon, says Robert Miller. 

Robert Miller is Director of Product Management and Strategy at Consensys Health. The blockchain community knows him because of his regular newsletter about blockchain in healthcare. He is regularly following and reflecting on the development of the industry.

As a refresher for those that are not that familiar with blockchain: a blockchain is, in the simplest of terms, a time-stamped series of immutable records of data. This record of data can’t be edited. It is managed by a cluster of computers not owned by any single entity. Multiple parties can see the record, but no one can change it without the changes being seen to everyone. Each of these blocks of data (i.e. block) is secured and bound to each other using cryptographic principles (i.e.chain). Because of the immutability of the information, blockchain has implications for addressing data security and privacy issues, as well as transparency. That’s especially useful in global supply chains where several stakeholders are involved.

In 2018 over 150 project worked on their idea of how to put medical records on blockchains. So why does Robert Miller think health records on a blockchain are still a dream at the moment? “The problems that exist with blockchain patient record space are not necessarily technical. The main problems relate to business incentives, governance and social challenges. One of them is interoperability. I find it very hard to see a traditional healthcare enterprise throwing away their billion-dollar EPIC or Cerner implementation and deciding to install some blockchain EHR. Maybe the path forward instead could be that the ONC (Office of the National Coordinator for Health Information in the USA) regulatory body in the US would enforce information blocking regulations. There will be standardized APIs that are easy for patients to request their data. This could be a way for patients to at least populate their health record with their information in a much easier way than they have been able to do that historically. Then perhaps you would have your information on your smartphone, maybe it's controlled by a blockchain there. ”

When does blockchain make sense?

Definitely not when there is a single party involved in the ecosystem, says Miller. Blockchain is useful when multiple stakeholders need a common platform to do things. “Blockchain is sensible for problems where no single party can own the infrastructure, where the parties don't trust each other, or may even be adversarial. A trust deficit is a necessary condition for a blockchain solution to work, but it's not sufficient. Even if that exists, you may still not have a good blockchain solution. There may not be the right business incentives for a blockchain solution to take hold.”

Pharma supply chains an example of where business incentives keep blockchains from being adopted.“Not all the stakeholders in the pharmaceutical supply chain have the same incentives. And maybe some of the benefits aren't good in a specific context. If there was full transparency, that would mean people who are selling you goods in a supply chain could see when you have low inventory. And as a result, they could charge you more money when you have low inventory. In this case, full transparency is actually not a good thing,” illustrates Robert Miller.

Among the projects he sees as most promising at the moment are blockchain project used for credentialing (for example read/listen more about HPEC here) of medical professionals, projects using blockchain to adjudicate business contracts between different parties, where adjudication normally happens in silos. “We see this problem in the space of pharmaceutical supply chains, wholesaler chargebacks as well as between any stakeholder in value-based payments of figuring out who owns how much money, depending on a patient's set of outcomes,” says Miller.

Federated learning and MELLODY

There’s also project MELLODY (Machine learning ledger orchestration for drug discovery). This is a collaboration among 10 major pharma companies that are using a blockchain-based infrastructure and federated learning to speed drug development. “In a simplified explanation, federated learning enables collaborative training of algorithm on the data of all ten parties. However, the data of each party is kept locally - which means that privacy is preserved. The key thing here is that major players started collaborating because this approach allows them to use others data, without really seeing the data. An algorithm is trained, but data is kept with the original owner,” explains Robert Miller.

MELLODY is a research project that launched in 2019. “The first year of the MELLODY project was focused on trying to ensure that there's a minimum level of privacy that could be guaranteed to all the participants before they actually use their sensitive information in the project. This is a remarkably difficult technical challenge today. You need third parties that are independent to audit and ensure that you're meeting that minimum level of privacy. The MELLODY project was able to do that, but it did take them a whole year.”

The upcoming two years are going to aim at trying to use the infrastructure. “The next two years of the project now are going from this minimum level of privacy that they have, and trying to maximize the accuracy of the algorithm that is being trained without sacrificing any level of privacy. In March, the project had not yet gone through all the auditing processes. So maybe if the pandemic had happened, eight months later, Melody could have been used to speed up vaccine development,” mentions Miller.

Further reading: Robert’s analysis of the data and privacy-related challenges in the MELLODY project.

Vaccination certificates on the blockchain

Among the public-interest inviting blockchain projects lately is the announcement in October that Estonian Guardtime and SICPA have announced a partnership with the World Health Organization to trace Covid-19 vaccines and provide tamper-proof vaccination certificates. Miller is a bit skeptical about using blockchain for vaccination certificates since there is no good way to tie a person to a private key. In contrast, as mentioned earlier, blockchain seems to be very promising to solve credentialing. “The reason why I'm more excited about credentialing and not the health passports is that in the credentialing case, the hospital that someone is getting onboard at will go to lengths to ensure that the person they're onboarding is really who they say they are. But in the immunity passport case, reminds me of a business that wants to know the identity of someone eating inside of a restaurant by scanning a QR code. They are not going to like request your birth certificate. I think the different levels of verifying someone's identity make the credentialing use case more viable. In credentialing the focus is on reducing administrative overhead compared to someone claiming they are vaccinated.”

Tune in for the full discussion:

Some questions addressed:

Robert, the blockchain community, knows you because of your newsletter about blockchain in healthcare. For a light start - how has the newsletter shaped YOU?

• What have you learned so far? What fascinates you most? 

• In October Estonian Guardtime and SICPA have announced a partnership with the World Health Organization to trace Covid-19 vaccines and provide tamper-proof vaccination certificates. How do you see the potential of the technology in the current pandemic? 

• Is blockchain technology ripe enough to be used in practice? Can you name a few use cases that go beyond pilot projects? 

•  How has COVID affected blockchain development? Do you see any impact? 

• In 2019 a project called MELLODY was announced. This is a collaboration among 10 major pharma companies that are using a blockchain-based infrastructure and federated learning to speed drug development. How are you following the MELLODY project? Has something like this been used in vaccine development?

• Your newsletter is your private project. For work for Consensys Health as the Director of Product Management and Strategy. Can you tell us more about the projects/solutions build by ConsenSys Health? 

• ConsenSys Health builds Ethereum-based solutions for cybersecurity, compliance, privacy, bioethics and identity, applying the deep technical capabilities of ConsenSys to advance the healthcare industry.

• What would you say to those who say blockchain is ok and has some positives, but existing technologies can already solve a lot of issues related to privacy and data security? 

• In 2018 when ICOs were a popular way of fundraising, over 100 teams tried to compete to create a blockchain patient record where patients would potentially be rewarded if they opened up their records. How do you see companies manage patient data with blockchain? 

• What challenges do you see in practical adoption up to date? How do companies decide whether they’d be interested in a public or private blockchain? And you can start with a short explanation of what a private vs. public chain is. 

• You’ve been writing a lot about Open Governance Networks and Neutral Platforms. Let’s talk a bit about that. What are Open Governance Networks and why are they interesting for healthcare? 

• What exactly are neutral platforms? Is the moment right to think about them in the era where interoperability is a cool thing to enable, at least 

• What’s your prediction about blockchain in the upcoming 3-5 years?