Hi Pradeep – Thanks for joining us this week on Chain Reaction to discuss medtech and how distributed ledger technology is transforming healthcare systems.
Blockchain technology is not the easiest thing to explain to newcomers. As a regular public speaker, how do you go about explaining it to a non-technical audience and which types of arguments and examples do you find to be the most effective?
There are as many answers to this question as there are people – and indeed the Blockchain community is still trying to find the best definitions of the value of blockchain to external audiences. Sitting in my former seat as an insurance company CIO, I would ask myself about any medtech: “What is the business value?”. When you look at it from that perspective, the true value to business is that you can take centralised functions and decentralise them but without sacrificing control and security. You are no longer building walls around data but using data to create consensus and achieve efficiency by consensus. In a distributed system the community continuously assesses, verifies and validates every transaction and you can use that to move trust-based transactions out of your system. Let’s take a simple example. Eligibility processes in insurance companies previously involved customers having to ring up and be verified by a call centre. The insurance company was the only trusted source of information. In blockchain the same enquiry can be made independently via the network and I can be sure that the answer will be the same as mine. The implications are profound – this technology can empower the doctor, the patient, and the pharmacy to do things on their own. Most importantly, it changes where I invest my IT dollars and my call centre dollars and how I serve my client, allowing healthcare organisations to transform and rethink their entire transaction flow.
What are the types of new innovations you are trying to build at Solve.Care Foundation? How are the healthcare applications you are building creating a step change and what problems are they solving that couldn’t be solved before?
What Solve.Care is doing is taking the same concept described above and applying it to three very core issues that plague health systems around the world and represent the fundamental needs of healthcare systems and their users. I have spent 25 years working in the US healthcare system in different capacities and I have got to know the system intimately well, be it from the perspective of the government, the insurance company, or the end user.
The first element needed is care co-ordination of all stakeholders – how to keep all elements of the system in synch without having to integrate systems or attempting to achieve interoperability. Interoperability of healthcare systems was a well-intentioned pillar of Obamacare but it’s actually got worse and it is costing US hundreds of billions of dollars. Instead, we are now replacing the massive, unattainable goal of point-to-point systems with Distributed Ledger Technology (DLT). We can envision a model where all care providers, pharmacies, labs, the insured population, administrators, auditors etc can be part of the same ledger of events, and therefore they can coordinate, collaborate and operate far more flexibly and efficiently.
Currently, healthcare CIOs spend up to 90% of their information technology budgets on duplicative functionality. If this can be freed up, it represents an enormous resource to use for care administration and outcome priorities.
The second important element is data transparency and convenience of care. Blockchain or DLT allows people to handle and reschedule their own events and manage their own eligibility for insurance claims. It shifts the focus away from non-functional to functional spending which has a massive impact on quality of care. Medical professionals then also have a much greater ability to rapidly measure quality of care against other providers, achieving a whole new – previously unthinkable – model of care co-ordination where just to take one simple example, availability of clinical lab results become instantly visible and shareable among multiple parties.
The third element is payment administration. Healthcare payments are notoriously complex, error-prone and fraud-prone because they typically involve multiple parties and 3rd party reviews. Most of this fraud and waste depends on latency – the time lag which occurs between systems sharing data. Also, the lack of ability to accurately replay a healthcare event chain that happened in the past accurately is a root cause of inefficiency, avoidable duplication of care, for example duplicative lab tests, and gives fraudsters the opportunity to abuse the system.
Using DLT, we can close the door on much of this fraud, waste and abuse. The latency is a fundamental gateway to fraud, 90% of which will be eliminated by DLT. This might sound like an ancillary problem but research by economists shows that between 15-22% of the annual cost of Medicaid is lost to over utilization, over billing, waste, inefficiencies and outright fraud – from overall healthcare spend perspective, this percentage represents $700bn to $1trn a year lost to inappropriate care and administration.
Multiple layers of reviews require recreation of the entire chain of events – it’s like replaying the history of what happened 90 days ago. Re-enacting the care cycle is ironically often more expensive than the care itself. Instead, if we use blockchain as a shared event ledger, which has appropriate transparency but not a wide-open payload in terms of content – we can now recreate these events and seek permission to look deeper, if needed. It is astounding how much cost and efficiency – as well as human pain and suffering – can be saved. It was this realisation that got me to working full-time on blockchain solutions for healthcare. Our vision is to address these 3 core inefficiency factors in one stroke. We have a full roadmap, which will attack these various administrative functions step by step and achieve immediate ROI for our clients and every stakeholder.
How will things change for patients and for the medical profession if these new systems you are talking about get put into place?
Blockchain or DLT in healthcare, done correctly, creates a fair and equitable system that people will actually want to participate in. How do we empower people? We do so by educating them and giving them actionable information. But healthcare information has to be given on a timely basis, not on a retroactive basis. For example, nowadays it is common practice to get a text on your mobile phone about a suspicious transaction on your bank account. You can even reply by text so that your account is not deactivated. There is no more tolerance for waiting 7-10 days for a letter. That used to be considered acceptable but it is not any more. In healthcare, timely information is key but also key is our ability to take action. This doesn’t yet happen in healthcare – systems are not set up that way because the consumer is not trusted to make the decisions. Lab results frequently get lost, or are sent in old-fashioned ways such as via courier to the doctor. The patient is left waiting passively not knowing what has happened to their test results. However, a health consumer in a blockchain-based system now has the right to know in every step of the process and be a custodian in the process so that patient becomes a more informed stakeholder. Where are my results? Can I know who has access to them? Can I also then get a second opinion? This creates a much more meaningful dialogue between patients, care providers and care information providers. Transparency empowers the patient greatly and transforms costs to the system by increasing patient understanding and compliance. Portals like Wed MD – one of the largest medical information portals in the world – give information in a user-friendly way but it’s generic not specific information. Imagine if these tools could be employed to give information specific to a patient’s actual care. The system is also much more empowering for the physician – who is able to measure the quality of their care protocols and make better treatment decisions. Having this data allows professionals to pick and choose which areas are worth focusing on for improvement. Blockchain redefines healthcare all over the world – no matter what kind of system you have, whether you are in an African village or the UK NHS or an American hospital.
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 government are ready to embrace this change?
It’s déjà vu all over again. I have heard that argument around practically every technical advance in healthcare over the past 30 years. You could replace the word ‘blockchain’ with the word ‘internet’ or ‘client server’ or ‘the Cloud’. Exactly the same arguments were made about the Cloud five years ago: “My CEO will never agree”, “It’s not secure enough”, “There is too much regulation for this to work”. Everyone will now tell you that Amazon cloud security is better than their own security. A lot has changed in five years – and at an astonishing speed. Blockchain will be no different.
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? And what are the things that could go wrong with implementation of blockchain healthcare applications – the things that we need to guard against?
What are the barriers to adoption of blockchain? There are barriers in any industry and healthcare is no different. The key challenges are balancing the very transparency which makes blockchain so compelling with the security and privacy of the data. But there is no need for despair – there are solutions emerging now and more will emerge over time. Some are being pioneered by us; some by others in the field. Everyone is working on this problem at breakneck speed. The second key element is scalability in a consensus-based system – which is a fundamental tenet of the technology. A Blockchain network is a bit like me shaking hands with someone in front of the whole village – no one would disagree that it happened, whether you asked the whole village or only 5 villagers. However, someone could corrupt those 5 villagers and get them to lie. So you have to go and ask 5 more. But maybe we don’t need to ask the whole village, maybe we could just ask those standing closest to us when we shake hands – we just need to find ways to get to consensus with the least amount of computing power. The third challenge is more social and cultural. It relates to the public’s confusion of Blockchain with the negative press they may have seen about bitcoin or other cryptocurrencies. The technology is seen as risky due to its association with volatile currencies or bad actors on the dark web. Any technology is a tool, however, which can always be used for good or bad. So we need to keep on clearly differentiating what this technology is – and explaining what it is not – to take away the perceived risk. Every disruptive technology goes through risk of misinterpretation so the blockchain community just has a responsibility to keep on educating the public.
What is your predicted landscape for the healthcare sector in 5 years time? How will things look for the startups of today as well as for the incumbents who may be challenged by this new wave of innovation?
There is a very clear recognition now in executive suites that the velocity of change in technology is so much faster than 25 years ago. It is expected of the modern CEO and CIO to understand that change will not come at the pace we like; it will come when it comes. People recognise that disruptive technologies and medtech, which includes not just blockchain but other technologies like Artificial Intelligence, Virtual Reality and so on, are not going to slow down. We will actually see it changing faster than other technologies once we solve some of the current hurdles. If we can achieve the fundamental bedrock we need around security, scalability, and affordability, I think we will see very fast adoption. Blockchain adoption will be no different than any other disruptive technology in that it will ultimately be driven by return on investment and by the societal impact. I actually think it will happen faster than the Cloud – I can’t be certain (since one can never be certain) but that’s what I feel is happening in the ecosystem.
Pradeep will also be speaking at our upcoming event Healthcare: Unblocked on 13 October in London.