At my closing keynote at the #ehealthweek, organised by the Dutch Ministry of Health and HIMMS, at first I reflected a bit on the current state of developments in health. Next I also introduced three new launches at Radboud University Medical Center in Nijmegen.
Director of REshape
In collaboration with SNS Bank N.V. and Deloitte, the REshape Center has developed a proof of concept of a blockchain application that makes it easier for chronic health consumers to acquire their repeat medication. The blockchain is a technology that enables two unknown parties to transfer a unique piece of digital property, without the need for a central authority – all in a safe, trustworthy and guaranteed way. The product uses iDIN, an online authentication service provided by banks, as a means to connect to the blockchain. iDIN delivers the same safety, reliability and user-friendliness as internet banking.”
Change: when faced with it, most people tend to look away. We at REshape Center see this a lot with nascent technologies. Even though some of them have the potential to drastically improve healthcare, most of us are inclined to resist this change and linger on in the status quo, no matter how poor. One of these upcoming technologies is called blockchain. Even though it is getting more and more traction, especially in the field of finance, large scale adoption is still far away. Not in the last place because of the bad reputation of bitcoin, the digital currency that made headlines in the last couple of years. Bitcoin is the first application running on blockchain technology. But it’s just that: oneapplication running on blockchain software! So forget about bitcoin and its dubious reputation and focus on the underlying technology and it’s potential for healthcare.
Why is the blockchain revolutionary?
Now what makes blockchain so revolutionary? Traditionally, for two unknown parties to enter into a trustworthy transaction, they required an intermediary, a central authority, to broker this transaction: banks, notaries, insurers, governments etc. They would trust this third party to maintain and administer a correct and up-to-date database. What a blockchain does, is take away this “trust function” from these central parties and spread it across a network of computers. This decentralized, digital trust is created by a shared, sequential database that can be appended, but not amended: an immutable digital ledger. This ledger contains every transaction ever made to it and is open for all to see and verify. This technology is not just for payment systems that record financial transactions, but can basically be used for any interaction that requires trust. It has the potential to change the way we interact with each other, just like the internet did in the nineties. What e-mail did to the postal system – cutting out the middle man by real-time exchange of information – blockchain does for the real-time exchange of value – cutting out the so-called Trusted Third Parties. Netscape cofounder Marc Andreessen described blockchain technology perfectly as “a way for one Internet user to transfer a unique piece of digital property to another Internet user, such that the transfer is guaranteed to be safe and secure, everyone knows that the transfer has taken place, and nobody can challenge the legitimacy of the transfer”. These characteristics are ideal for situations where there are lots of different, unknown parties and trust and transparancy are essential. Bringing us to healthcare. After all, healthcare is all about transactional data exchanges of sensitive information: transactions between healthcare providers and consumers, consumers and insurers, insurers and pharmaceutical companies and the list goes on. Lots of parties, means lot of interactions, which means lots of potential errors, abuse, time loss and unnecessary costs. Blockchain technology can help fight these problems.
When we at REshape learned about the characteristics of blockchain technology, we thought they could be perfectly used to fix some of the many inefficiencies healthcare faces today. So instead of putting our heads in the ground or look away, we decided to explore the possibilities of this new technology and stay ahead of the curve. In order for us to do this, we teamed up with two parties from different industries: SNS Bank N.V. and Deloitte. The thing we have in common: our desire to put the customer first.
Right now there’s a lot of talk about how blockchain technology can impact the healthcare sector, but we thought we’d get together to actually show what’s possible with blockchain technology as an underlying infrastructure instead. As an example we thought of a whole new way to prescribe and acquire medication by using the blockchain, because we think the current logistics around medication in the Netherlands are flawed and outdated. For this use case we focused specifically on people requiring ongoing medication because they suffer from chronic conditions; at present these healthcare consumers need to repeatedly renew their repeat prescriptions, every time confronting them with their illness. The proof of concept we developed, called PreScrypt, offers healthcare consumers a complete and up-to-date overview of the medication they are using and their (digital) prescriptions. The underlying blockchain makes it possible for these consumers to decide for themselves which healthcare provider to share their information with and which supplier to send their prescription to. By putting the consumer in control of his information, instead of several other parties, there’s always one complete set of information; a massive change compared to the multitude of siloed, often incomplete data sources consumers and healthcare providers face today. This product brings information ownership back to the healthcare consumer. To get all of this up and running we made excellent use of Deloitte’s extensive blockchain expertise.
Despite all the great characteristics of blockchain technology, there’s one problem it couldn’t solve however: how do you link the physical identity of the healthcare consumer to his digital identity on the blockchain? This is where SNS Bank N.V. came in. SNS Bank N.V. connected their iDIN service to PreScrypt. iDIN is a service provided by banks that makes it possible for users to authenticate themselves online, with the same reliability as internet banking. Users can use the same safe and trusted login methods as they use at their own bank – SNS Bank in our case. Similar to blockchain the customer is always in control of what data is being sent, to what party.
This proof of concept reduces the lack of information, the uncertainty and some of the hassle chronic health consumers have to deal with in order to obtain their repeat medication, thereby reducing the “burden of disease”. But it doesn’t only benefit the customer. Because all the exchanges are registered on the blockchain, everyone can check if the data is still valid. Think of the suppliers of medication: they can instantly verify if, and when, the prescription is “signed” by a certified doctor and if it hasn’t been used to order medication before.
PreScrypt is of course in no way a complete product. We’ve built this product in just a couple of days to demonstrate the power of blockchain technology; to show to everyone that it is technically possible to use blockchain for healthcare scenarios. In our view this use case is just the first step towards a comprehensive digital health environment consisting of an abundance of far richer applications. Think of ways to streamline the economic activities in healthcare from consumer to insurer to provider, Internet of Things applications that can communicate over the blockchain, a complete PHR instead of one just focusing on medication etc. We envision that many different providers can build their own applications onto the same infrastructure, each being able to securely communicate with the healthcare consumer’s data and each other. We at REshape will continue to look into this amazing technology and you’ll be hearing more from us soon.