Interest Ideation Challenge - Blockchain Healthcare
Partner Chamber of Digital Commerce
Start Date 2016-06-00
Notes Overview: On June 20, 2016, the Office of the National Coordinator for Health Information Technology (ONC) requested submissions of white papers on the “Blockchain and Its Emerging Role in Healthcare and Health-Related Research,” in what the ONC called the “Ideation Challenge.” The goal of the Challenge was to investigate the relationship between blockchain technology and its use in Health IT and/or Health Related research. The 15 winners of the Ideation Challenge are summarized below. Announcement of the Blockchain Challenge Department of Health and Human Services Submissions Instructions: List of ONC Blockchain Winners 1. Blockchain and Health IT: Algorithms, Privacy, and Data [PDF – 507 KB] - PDF A peer-to-peer network that enables parties to jointly store and analyze data with complete privacy, with the potential to empower precision medicine clinical trials and research. MIT’s Experimental Learning calls for the adoption of the OPAL/ENIGMA program, an encrypted platform that is able to create a stable environment for the storage and analysis of healthcare information to address privacy and security concerns of stakeholders. This proposed program resolves supply chain issues, and the storage and manipulation of health information. MIT’s Experimental Learning expressed concerns on how to comply with different state regulations, specifically regarding patient privacy and rules on health information exchange, leading to the development of an interoperable health IT ecosystem. This system preserves health IT infrastructure but also provides an immutable, auditable record of actions for patients and practitioners alike. MIT calls for the support of the ONC because OPAL would be the ideal data repository architecture based on a peer-to-peer network through a permissioned blockchain. The data stored in OPAL is secure but can also be queried to be accessed with credentials through the blockchain. OPAL can also be applied to precision medicine in order to improve trials and executing adaptive platforms to allow data abstraction from electronic health records. Authors: Ackerman Shrier A, Chang A, Diakun-thibalt N, Forni L, Landa F, Mayo J, van Riezen R, Hardjono, T. Organization: Project Pharm Orchard of MIT’s Experimental Learning “MIT FinTech: Future Commerce.” | 13 | DEPARTMENT OF HEALTH AND HUMAN SERVICES DOCUMENT SUBMISSIONS PART II: SUMMARY OF TOP 15 BLOCKCHAIN CHALLENGE WHITE PAPERS Chamber of Digital Commerce 1133 15th Street, NW 12th floor Washington, DC 20005 Phone: +1-202-765-3105 Email: [email protected] Website: 2. Blockchain: Securing a New Health Interoperability Experience [PDF – 609 KB] - PDF Blockchain technologies solutions can support many existing healthcare business processes, improve data integrity, and enable atscale interoperability for information exchange, patient tracking, identity assurance, and validation. Accenture proposes integrating current health IT investments with a permissioned blockchain/DLT environment in order to drive better patient outcomes. Distributed Ledger Technology (DLT) could solve issues with data integrity, privacy, creating highly robust audit trails, and securing healthcare records. It could also solve issues with identity proofing and recording patient consent. The DLT’s ability for non-repudiation and auditability of each healthcare transaction can empower patients. The benefits of using a blockchain identity include enabling complete record integrity and transparency. The integrated nature of the blockchain means that the technology links the disparate identities of authenticated patients to the points of care for both patients and healthcare professionals. This concept envisions the storage of actual patient and provider data “off-chain” with access via a secure hash function stored on the blockchain, satisfying the ONC’s desire for regulatory structure. The blockchain in this proposed solution would ensure that each transaction is anonymous. Authors: Brodersen C, Kalis B, Mitchell E, Pupo E, Triscott A. Organization: Accenture LLP 3. Blockchain Technologies: A Whitepaper Discussing how Claims Process can be Improved [PDF – 1 MB] - PDF Smart contracts, Blockchain, and other technologies can be combined into a platform that enables drastic improvements to the claims process and improves the healthcare experience for all stakeholders. Culver proposes a solution to engineer a platform to leverage both blockchain technologies and Fast Healthcare Interoperability Resources in order to increase efficiencies, enable real time adjudication, decrease fraud, and make agreements between stakeholders transparent. Culver wishes to limit his proposed blockchain to a consortium where smart contracts are developed to support providers and health plan agreements, as well as agreements between patients and health plans. The consortium would consist of three stakeholder groups including the government, the provider, and the health plan. This platform would make each enrollment and disenrollment public, enabling providers and patients to have conversations about out of pocket costs and other complications, which would drastically reduce billing and insurance related costs. Author: Culver K. Organization: Unaffiliated | 14 | Chamber of Digital Commerce 1133 15th Street, NW 12th floor Washington, DC 20005 Phone: +1-202-765-3105 Email: [email protected] Website: 4.Blockchain: Opportunities for Health Care [PDF – 787 KB] - PDF Presentation of an implementation framework and business case for using Blockchain as part of the health information exchange to satisfy national healthcare objectives. Deloitte addresses the fact that while blockchain technology might not be the cure for all data standardization issues or system integration challenges, it offers a promising new framework to amplify and support the integration of healthcare information across a range of uses and stakeholders. In order for healthcare organizations to use blockchain, they need to verify a patient’s digital identity, genetics data, or prescriptions history. A blockchain transaction layer could additionally enable immediate access to a rich set of non-patient identifiable information. This information can easily be made available to research institutions and existing government initiatives. Deloitte distinguishes the difference between permissionless blockchain and permissioned blockchain. While permissionless blockchain enables broader access to providers and patients alike for open-permissionless innovation, permissioned blockchain expedites a transaction process. Deloitte calls for a network of interconnected computer (i.e. nodes) to supply the computing power necessary to create blocks once transactions have been completed. Deloitte believes the implementation of blockchain technology will reduce complexity, enable trustless collaboration, and secure immutable information. Authors: Krawiec RJ, Barr D, Killmeyer K, Filipova M, Nesbit A, Israel A, Quarre F, Fedosva K, Tsai L. Organization: Deloitte Consulting LLP 5. A Case Study for Blockchain in Healthcare: “MedRec” Prototype for Electronic Health Records and Medical Research Data [PDF - 591 KB]. - PDF A decentralized record management system to handle electronic health records, using Blockchain technology that manages authentication, confidentiality, accountability, and data sharing. The MIT Media Lab proposed MedRec, a decentralized record management system to organize electronic health records using blockchain technology. MedRec manages authentication, confidentiality, accountability, and data sharing, while prioritizing patient agency. The blockchain content of MedRec represents data ownership and viewership permissions shared by members of a private peer-to-peer network. The platform also offers a designed contract that aggregates references to all of a user’s patient provider relationship, thus providing a single point reference. The member’s identity is then confirmed via cryptography. Additionally, Ethereum smart contracts would be used to create representations of existing medical records stored within the nodes on the network and would contain metadata regarding record ownership. Authors: Ekblaw A, Azaria A, Halamka J, Lippman A. Organizations: MIT Media Lab, Beth Israel Deaconess Medical Center | 15 | Chamber of Digital Commerce 1133 15th Street, NW 12th floor Washington, DC 20005 Phone: +1-202-765-3105 Email: [email protected] Website: 6.The Use of a Blockchain to Foster the Development of Patient-Reported Outcome Measures [PDF – 195 KB] - PDF Use of the Internet of Things (IoT) in combination with Blockchain technology for Patient. The National Quality Forum discussed how blockchain technology, by using the internet of things (IoT), could help with acquiring Patient Related Outcome Measures (PROMs) or outcomes that are directly related to the patient. PROMs include symptoms and other aspects of health that are related to quality of life indicators, such as physical or social function, treatment adherence, and satisfaction with treatment. One alternative to the use of standardized instruments in collecting data and providing a foundation for the development of a PROM is the use of technologies associated with the Internet of Things (IoT). There is a significant amount of data being generated through IoT devices, including electronic medical records (EMRs), quantified self-tracking devices, smartphone applications, and personal health records (PHRs) that can provide information on a patient’s health status. This information could be comingled with social networks, crowdsourced studies, and the Quantified Self community, which collects and shares biophysical assessments. Blockchain technology could then secure this data through a digital “fingerprint” that uniquely identifies the transactions and secures them on the blockchain or distributed ledger. The transactions could include: the current heart rate, blood pressure, current mood, compliance with daily medication protocols, number of calories burned over an hour, number of steps walked, etc. Reported Outcome Measures (PROMs). Author: Goldwater JC. Organization: National Quality Forum 7.Powering the Physician Patient Relationship with ‘HIE of One’ Blockchain Health IT [PDF-162 KB] - PDF ‘HIE of One’ links patient protected health information (PHI) to Blockchain identities and Blockchain identities to verified credential provider institutions to lower transaction costs and improve security for all participants. Dr. Adrian Gropper proposes utilizing blockchain technology in a way that will shif decision making and purchasing power regarding electronic health records (EHRs) from the hospitals to the physicians and patients. Blockchain technology can shif control of health IT away from the hospital by making it only accessible to physicians and patients, which will allow the appropriate decision makers to decide what type of healthcare to pursue, or what the paper describes as the “decision support at the point of care.” The technology can also be used to independently advise the patient of out-of-pocket costs, alternative sources, and typical risks while the patient and physician are engaged in making those important decisions. Author: Gropper A. Organization: Unaffiliated | 16 | Chamber of Digital Commerce 1133 15th Street, NW 12th floor Washington, DC 20005 Phone: +1-202-765-3105 Email: [email protected] Website: 8. Blockchain: The Chain of Trust and its Potential to Transform Healthcare – Our Point of View [PDF- 249 KB]- PDF Potential uses of Blockchain technology in healthcare including a detailed look at healthcare pre-authorization payment infrastructure, counterfeit drug prevention and detection and clinical trial results use cases. IBM believes that blockchain technology can support a new generation of transactional applications and business processes by establishing trust, accountability, and transparency. IBM is researching and applying blockchain’s distributed ledger and decentralized database solutions to the issues of interoperability, security, record universality, as well as in other areas. Some of the challenges that blockchain will be able to solve include: interoperability accessibility and data integrity, privacy and security, healthcare delivery models and cost, fraud and abuse, process and complexity, consumer engagement, procurement and contracting, and governance and compliance. Some of the ways these problems can be addressed through blockchain is smart contracts, encryption and cryptology, and increased efficiency and transparency. Organization: IBM Global Business Service Public Sector 9. Moving Toward a Blockchain-based Method for the Secure Storage of Patient Records [PDF – 270 KB] - PDF Use of Blockchain as a novel approach to secure health data storage, implementation obstacles, and a plan for transitioning incrementally from current technology to a Blockchain solution. Ivan D. sees the current methods of recording and sharing data as limitations that restrict the patients’ access to their clinical records, reduce availability of essential data to care providers, and create barriers to innovation in the US healthcare system. The proposed solution involves using a patient controlled blockchian based system for clinical record maintenance and sharing. The patient’s Electronic Health Records (EHRs) would be encrypted, then sent to and stored in the public healthcare blockchain. Afer the documents are stored, patients would use a web based or mobile application to view their blockchain contents, as well as to grant or revoke access to specific parties. 10.Author: Ivan D. 11.Organization: Unaffiliated | 17 | Chamber of Digital Commerce 1133 15th Street, NW 12th floor Washington, DC 20005 Phone: +1-202-765-3105 Email: [email protected] Website: 10.ModelChain: Decentralized Privacy-Preserving Health Care Predictive Modeling Framework on Private Blockchain Networks [PDF – 272 KB] - PDF ModelChain is a framework used to adapt Blockchain to enable privacy-preserving healthcare predictive modeling and to increase interoperability between institutions. The University of San Diego Department of Biomedical Informatics, along with the Division of Health Services Research & Development of the VA San Diego Healthcare System, emphasized how important cross institutional healthcare predictive modeling is when it comes to accelerating research, as well as facilitating quality improvement initiatives. However, they note that it also increases the chance of releasing sensitive patient information. The authors found that the current models for sharing medical information are built around centralized architecture, which present security issues as this info is being shared. By using their proposed ModelChain, however, blockchain technology can help develop the concept known as privacy-preserving machine learning. In this scenario, privacy preserving online machine learning algorithms are applied on blockchains. Next, metadata is used in transactions to disseminate partial models and other meta information. Finally, a new proof of information algorithm on top of the original proof-of-work consensus protocol is designed to determine the order of the online machine learning on blockchains to increase efficiency and accuracy. The white paper also discussed how blockchain technology can solve interoperability issues that were noted in the Nationwide Interoperability Roadmap of the ONC. Authors: Kuo T, Hsu C, Ohno-Machado L. Organizations: Health System Department of Biomedical Informatics, University of California San Diego, La Jolla, CA Division of Health Services Research & Development, VA San Diego Healthcare System. 11.Blockchain for Health Data and Its Potential Use in Health IT and Health Care Related Research [PDF – 1.5 MB] - PDF A look at Blockchain based access-control manager to health records that advances the industry interoperability challenges expressed in ONC’s Shared Nationwide Interoperability Laure A. Linn and Martha B. Koo discussed how blockchain technology can address many of the interoperability challenges that currently exist in the health IT systems, while providing the technical standards that would allow individuals, healthcare providers, healthcare entities, and medical researchers to securely share electronic health data. The American Recovery and Reinvestment Act required all public and private healthcare providers to adopt electronic medical records (EMRs) by January 1, 2014. The submission proposes a blockchain based control manger to control health records in way that would overcome the existing interoperability challenges made by the Office of the National Coordinator for Health Information Technology (ONC). The suggestion is to use a public blockchain in place of a private blockchain to keep track of the records because it would be vendor neutral and be able to have open standards. However, three challenges of this type of system will need to be addressed including: scalability, access security, and data privacy. Roadmap. Authors: Linn L, Koo M. Organization: Unaffiliated | 18 | Chamber of Digital Commerce 1133 15th Street, NW 12th floor Washington, DC 20005 Phone: +1-202-765-3105 Email: [email protected] Website: 12.A Blockchain-Based Approach to Health Information Exchange Networks [PDF-402 KB] - PDF A Blockchain-based approach to sharing patient data that trades a single centralized source of trust in favor of network consensus and predicates consensus on proof of structural and semantic interoperability. The Mayo Clinic proposes constructing a new platform that mirrors the Merkle Tree-based structure (or hash tree). The nodes of the tree represent patient record transactions and describe the addition of a resource to the patient record. These transactions on the blockchain would use the HL7 standard from the Fast Healthcare Interoperability Resources (FHIR) via the Uniform Resource Locator (URLs), which would allow institutions to maintain control over their data while maintaining the confidentiality of the provider and the patient. FHIR was chosen as the exchange format not only because it is an emerging standard, but also because it contains support for provenance and audit trails, making it a suitable symbiotic foundation for blockchain ledger entries. This new structure, in conjunction with the usage of the FHIR, can preserve the anonymity of users and the associated context of the data transactions. Authors: Peterson K, Deedvanu R, Kanjamala P, Boles K. Organization: Mayo Clinic 13.Adoption of Blockchain to enable the Scalability and Adoption of Accountable Care [PDF-500 KB] - PDF A new digital healthcare delivery model that uses Blockchain as a foundation to enable peer-to-peer authorization and authentication. Prakeash R. proposes a new digital healthcare model that uses blockchain technology to enable peer-to-peer authorization and authentication. This new model would result in significant reduction in operational costs and improvements in care delivery. The blockchain can enable providers to actively coordinate and collaborate with other care partners involved such as labs and pharmacies. The keys benefits that result from the adoption of a blockchain based peer-to-peer framework are in the areas of fraud prevention, achieving high quality healthcare, affordable care, and healthcare based on an individual’s clinical and socioenvironmental factors. Author: Prakash R. Organization: Unaffiliated | 19 | Chamber of Digital Commerce 1133 15th Street, NW 12th floor Washington, DC 20005 Phone: +1-202-765-3105 Email: [email protected] Website: 14.A Blockchain Profile for Medicaid Applicants and Recipients [PDF – 190 KB] - PDF A solution to the problem churning in the Medicaid program that illustrates how health IT and health research could leverage Blockchain-based innovations and emerging artificial intelligence systems to develop new models of healthcare delivery. The Institute of the Future proposes a solution to problems within the Medicaid system. The Medicaid system is inefficient. The current system requires its applicants to gather information about their age, citizenship status (including social security number and current residence), family income, and family composition, as well as medical information, such as disabilities. The current system also requires eligibility checks, frequently requiring high administrative costs. The blockchain could integrate this data to allow for a more efficient method of authenticating the participant’s eligibility. Three areas where blockchain technology could be effectively used when it comes to Medicaid applicants and recipients are: loss of benefits, reinstatement of benefits, and changes to the state of residence. Authors: Vian K, Voto A, Haynes-Sanstead K. Organization: Blockchain Futures Lab - Institute for the Future 15.Blockchain & Alternate Payment Models [PDF - 601KB] - PDF Blockchain technology has the potential to assist organizations using alternative payment models in developing IT platforms that would help link quality and value. Yip K. emphasizes that blockchain technology has the potential to assist organizations using alternative payment models in developing IT platforms that would help link quality and value. Unlike traditional IT databases and models, blockchains seek to create a “single source of truth” which can be securely accessed by its members. Blockchain technology has the potential to use claims data, provider information, global patient ID sofware, and electronic medical systems to provide a robust platform for advancing alternative payment models. Accountable Care Organizations (ACOs) are the most like places to adopt blockchain as they are not hindered by legacy infrastructure and because ACO specific IT platforms have not been fully developed. However, according to the author, payers and health insurance exchanges (HIEs) could still use blockchain in limited applications to increase engagement with their healthcare partners. Author: Yip K. Organization: Unaffiliated | 2