Hi Vidushi – Thanks for joining us on Chain Reaction to discuss how using blockchain technology can empower both patients and doctors.
What got you interested in Blockchain and, more specifically, how did you get involved in building Blockchain solutions for the healthcare sector?
Healthchain is really the culmination of all my experiences in life. I went to medical school in India and then came into the US system when I did my residency. I was struck by how different the US system was – but not necessarily always an improvement on the system in India. I could see simple solutions to various systemic problems I encountered on a daily basis but I was not in a position to implement any of the changes I came up with. After my fellowship at Stanford I felt really burnt out and felt like I already wanted to retire! Although I love psychiatry and seeing patients, I couldn’t face dealing with all the hassle and administrative burden involved in working in the US healthcare system. I started bouncing ideas around about what I could do about it and this led to us starting Savant Care to try to solve some of the pain points I was experiencing. For example, doctors are so overwhelmed by data so instead of dealing with reams of written notes we wondered if we could create a graphical record of patient data so we could see at a glance how depression, mood, weight and medication were correlated. We made some improvements to the system but Savant Care only solved some battles, it didn’t end the war. My assistant still spends 25% or more of her time on the phone trying to get copies of patient notes and chasing up missing pages sent via fax (yes, fax!). When I heard about Blockchain and explaining its potential uses, I started to see how this could solve the next layer of problems and that led us to founding Healthchain.
What are the types of new innovations you are trying to build with Healthchain and what problems are they solving that couldn’t be solved before?
Our vision is to develop the first personal healthcare record on the blockchain. Patients would then be able to own and have secure access to their own authentic, immutable and chronologically ordered healthcare data. Hospitals currently ask a small fee for access to records – in combination with the time taken, the forms to be filled and the cost, this all adds up to a lot of barriers which makes the patient feel even more helpless. And even when they get their information, they are usually only given access to limited data. EPIC is the most commonly used software in the US healthcare system and is used by 54% of the population, including in many university hospitals. It is supposed to have interconnectivity but I have tested it and that’s not really true, either as a patient or as a doctor.
How will things change for patients and for the medical profession as these new solutions you are talking about get put into place?
By using blockchain we will be able to change this and make an electronic health record which is not only more secure but also easier to share. We need to make sharing healthcare data as easy as sending a text message. Patients currently have access to a wealth of health apps but not the data that would really make those apps valuable. Only the most motivated of patients are able to get hold of their own data and make use of it in an app – let’s say a blood sugar tracker for diabetes or a weight loss app. What if patients could access their data from a secure healthcare record and feed it directly into an app? Suddenly patients become more empowered and more responsible for their own healthcare. Clinicians will also benefit by being able to access more structured and correlated data instead of just reams of PDF files and paper-based notes. This will ultimately help to inform better decision-making and improve patient care.
Many people are sceptical about the prospects of patient medical data on the blockchain. As a heavily regulated sector, do you think the healthcare industry and/or governments are ready to embrace this change?
Scepticism comes from not knowing that word ‘blockchain’ and finding the concept of a blockchain difficult to grasp. It will take time for people to catch on and some companies and people may end up being followers rather than leaders. It is important to stress that we, as Healthchain, will never see patient data as it will be stored on the InterPlanetary File System (IPFS) – a protocol designed to create a permanent and decentralized method of storing and sharing files – and these files can only accessed by the patient’s secure private key. From my side, the greater scepticism comes as to whether Electronic Health Record vendors are going to be willing to share data. However, the The Health Insurance Portability and Accountability Act (HIPAA) legislation is on our side in this respect. And the impact goes beyond just access to data but how about the societal impact more broadly. What if we get ill when we are travelling? Now we are able to instantly access our records so a doctor abroad can find out if we have an allergy or other factors, which could impact on our care if a physician was not aware of them. Or what about the need to create a better pharmaceutical market – using smart contracts and blockchain we could eventually create an online pharmaceutical marketplace so that US patients on tight budgets don’t have to waste hours shopping around multiple pharmacies for the cheapest price.
Isn’t the creation of a secure identity layer one of the key challenges to public acceptance of using blockchain for something as sensitive as medical data?
The ID layer is very do-able and there are lots of companies and open source collaborations already popping up to do this – companies like Civic and uPort, for example, or the work being done by Decentralized ID (DID). It may also be possible to use doctors’ registries to help identify patients.
What are the things that could go wrong with implementation of blockchain healthcare applications – the things that we need to guard against?
The biggest danger is patients losing their private key or having poor security settings on their phone but there are ways to get around these problems and have backups and rescue methods. So scaling blockchains to meet speed and demand is probably the biggest hurdle. The other challenge is adoption in the sense that in order to create a research marketplace we need enough users of the system to create meaningful data. People are naturally curious so we need to make it very simple to use and then draw on their curiosity in finding own more about their own health.
What is your predicted landscape for the healthcare sector in 5 years time? How will things look for the start-ups of today as well as for the incumbents who may be challenged by this new wave of innovation?
I think one of the biggest disruptions is going to come in insurance because the industry is still so paper-based. In future, given the cost savings and efficiencies brought by blockchain in healthcare, there is no reason why groups and communities could not band together to risk pool and self-insure themselves, for example. We might even get rid of the claims industry altogether. I think we will also see multiple versions of Electronic Medical Records (EMRs) and they will all be interoperable with differing features. There could be a marketplace of EMRs for specialised conditions so you pick the one that is best at helping manage your cancer treatment or improve management of your heart condition. Pharmacies will be disrupted too so we will see pharmaceutical costs coming down, insurance costs coming down and overall healthcare costs coming down since the US healthcare system is currently very inefficient. There is so much space for innovation – and not just in the US but also all over the world, including in developing countries that will hopefully be able to move straight to this technology and avoid a lot of administrative and managerial hurdles. Blockchain will empower both doctors and patients and, perhaps most importantly, it will allow the healthcare system to serve its users rather than the system serving itself.