Blockchain- Everything's About to Change, Again...

Let's say you want to send me a list of your favorite Crayola colors: razzmatazz, magenta, and muavelous.  You might ask Google to send it to me from you using e-mail.  In this case, Google might say "you must use the gMail app, web application,  or some compliant e-mail client (ie. Outlook, etc.) to send Baber your message."  In this case, both you and I now have to comply with Google's rules in order to have that transaction.  More apprehensively, Google HAS A COPY of your list of favorite Crayola colors, forever.  But what if you could just send me your list directly, without any intermediary?  Almost like the good old days when you could just write your list on a piece of paper and hand it to me...

There are plenty of terrific videos, articles, and podcasts about blockchain technology on the web, like this one from renowned technologist Don Tapscott.  However, like the first Bulletin Board Service (BBSs) were in the 1980s, blockchain technology is kind of an abstract idea for most people and even for those that do understand it well, it has a very technical implementation procedure.  It's a hard thing to understand and even harder to make it actually work.  These and many other hurdles need to be overcome before blockchain will become mainstream.  Still, this is no excuse for the rest of us to at least know the basics about it- because it's already here!  Healthcare information technology enthusiasts and professionals especially should become familiar with it as it has the answer to quite a number of the problems we are facing in today's healthcare environment.  Most of these are very expensive problems and represent huge opportunities for innovators.

This post will focus on what and why you need to know about blockchain.  It will also attempt to highlight some of the healthcare applications of this technology.  But most importantly, you should walk away from this understanding that blockchain has the real potential to change the world on the same level as the Internet and the Smartphone.

What is "The Blockchain"?

The biggest problem with the Internet is that it is simply not secure.  Although there are very good encryption schemes, the problem is that there are too many points for hackers (as well as well-intentioned entities) to violate the integrity of our exchange of information, aka transactions.  The biggest value of paper as mentioned in above example is the fact that there can only be one original paper document, ie. the dollar bill.  We lost this in a big way with digital technologies and have been struggling to realize this feature has been missing ever since.

The blockchain is a system of managing transactions that is permanent (immutable), highly secure, and open for anyone (that is allowed) to validate.  By transactions, we're talking about the exchange of any information- financial, personal, e-mail, or even a list of favorite colors or medications.  The difference is that the TRANSACTION is written to the blockchain network- which may consist of millions of supercomputers.  It takes significant processing power to encrypt the "blocks" of data and some blockchain transactions can take as long as 10 minutes for the supercomputers that are processing them to eventually be formally addended to the chain.  This also means that everyone on the blockchain knows that something was sent from your device to mine and another transaction was added right after this one using the unique address of the block (of this one) as part of it's encryption.  This creates a chain of blocks that are cryptographically linked together so that if some hacker wants to change one, she would literally have to change them ALL, at the same time!  It is this key feature that makes the blocks on a blockchain both immutable and highly secure.  The common terminology for this system is a cryptographically secured, distributed-ledger otherwise known as the blockchain.  Here's a great video using a cake as metaphor for passing information on a blockchain.

So let's take the above example again- you create your list of favorite Crayola colors using whatever software you want (Word, gMail, or any other app), it gets encrypted, and sent to me after the transaction is logged on the blockchain.  If it doesn't get logged, it doesn't go through. Now all 10 million "nodes" on that blockchain have a record of the transaction and if it's public, anyone can verify it- go ahead hackers, have at it, and good luck!!  And like putting a "Beware of the Dog" sign on your front door, most of the smarter ones will find easier targets to go after...

Smart Contracts

If you followed the above example, congratulations!!  You now understand the basic elements of blockchain technology!  Smart Contracts extend the blockchain to another level.  Imagine you are a budding new, brilliant musician.  You and your band get together and produce your masterpiece of a song as an MP3 file.  Now you have two choices: find a well-known distributor to help promote your song or do it yourself using the blockchain.  The distributor will encrypt your music file and put it on the Play store or iTunes so that others can pay for it and stream it- how much of that money do you think you will you see yourself?  Inevitably, some unscrupulous person will figure out how to decrypt the stream of music they got on iTunes and post your MP3 on the Internet for anyone to download. 

So what if you did it yourself using a Smart Contract and the blockchain?  The Smart Contract is essentially a piece of code that becomes part of the MP3 file itself and lives on the blockchain.  Now, if a casual listener (even from iTunes) wants to listen to it on their personal device, you allow them to do so for free or for a nominal cost- your choice.  If a commercial director wants to use it in one of her ads, you can charge an appropriate dollar/BitCoin value for this purpose- may be different if it's a feature film- either way, it's your choice.  If someone wants to make a ring tone out of it, that might be a different set of costs and rules- it's your choice.  The Smart Contract executes at the time of the transaction, you don't worry about any of it- any financial exchanges would be neatly deposited into the right accounts and any data would be sitting in the appropriate inbox- as you previously defined.  Think of them as electronic escrow accounts that you program to do all the work for you.  Some consider these Smart Contracts "microbusinesses" capable of running on their own.

Why Do You Need to Know about the Blockchain?

The blockchain essentially liberates us all from middlemen.  Do you think this is a little threatening?

Blockchain technology is already here in the form of a number of public blockchain networks- you've probably heard of the BitCoin blockchain.  There is also Etherium and more recently, Mycelium and Coinbase.  Understandably, there is much controversy about blockchain- any good middleman would agree.  Amazon was accepting BitCoin a couple of years back but has turned that option off in US markets now because of some of these controversies.  However, it's important to understand that there will be far more private blockchains than public!!

So wouldn't it be great to have a way for a physician to send a prescription to a patient's blockchain?  Why should ANYONE beside the physician and the patient know that the patient is on a certain medication?  The patient can then decide which pharmacy, home care agency, or hospital will have ACCESS to that information at the time they need to and not a second more.  This includes the payers.  Why should ANYONE have a record of a patient's health information once their episode of care is over?  Though I myself don't really care or mind- shouldn't I?  Like Don Tapscott said in his TED Talk, we are leaving digital trails of our most personal and financial information all over the internet- in all kinds of hands.  Why are we doing this?  But I digress...

What about the Internet of Things- when one device uses the resource of another device for a valuable service (perhaps finding the location of a third resource) how is that going to happen?  We'll need a way for this information to be tracked and paid for- especially when the drone that the pharmacy sent to deliver your medication is using some ISPs network to drive because I'm guessing having reliable internet service will be a valuable thing to these devices.

What About Healthcare?

There are VAST applications in healthcare: claims processing, clinical trials data, managing interoperability between systems, patient identification and tracking, provider credentialing, health information exchange, public reporting of outcomes, pre-authorizations, opioid diversion, and the list goes on and on...

The problem with healthcare is also an advantage: we are deep-rooted in our clinical systems and in my brief time asking around I've found most of them are not even AWARE of blockchain technology!!  Hence the reason for this post.  It's advantageous that we are in this position because if, for example, the government were to require that all public reporting would be made on blockchain technology, our vendor partners would have no choice but to comply.  It will take significant political power to make this happen- remember, all politics is local, so if any of the above makes sense to you, be sure to let your politicians know about it.

Summary

This was a brief overview of blockchain technology.  You should understand the basic tenants of a blockchain network, the way security and payments are inherently built-in, and that information on the blockchain is immutable.  I'm hoping that you also see the enormous potential of these networks and the fact that ANYONE that is in the business of being a middleman might not find this technology as cool as we do.  This includes juggernauts like AirBNB, Uber, and thousands of other companies that have capitalized on serving users more efficiently than their predecessors.

Most importantly, blockchain technology has the ability of LIBERATING our people.  From the way we vote for our politicians (and hold them accountable) to the way we identify ourselves (currently using governments), blockchain technology has a broad and diverse set of applications.  The key is going to be in the way we first implement this technology and make it seamless to its end-users.  Who knows, maybe my next blog post will be on the blockchain??