Vasja Bočko is the CEO of Iryo. He was a product lead at 3FS for two years before joining Bitstamp, one of the longest-standing and most respected cryptocurrency exchanges. There he gained a deep understanding of blockchain and cryptocurrency-related processes. Vasja strongly believes that blockchain has the potential to revolutionise industries that have traditionally seen little advances through IT. As leader of the Iryo team, he aims to build the next generation healthcare platform, addressing current downfalls like data security, global interoperability and self-sovereign medical identity.
What was it that first attracted you to work in this field?
For all of the Iryo team, the concept of the Bitcoin blockchain sparked huge initial excitement. Understanding that the creation of a cryptocurrency means being able to transact safely, securely, and peer-to-peer with no need for intermediaries – even if the parties reside in 2 different parts of the world and don’t trust each other – is an incredibly important development. But when you go on to understand what that really means and what else you can do with the technology, the implications are even more wide reaching.
Why do you think that blockchain technology has the power to reform healthcare systems?
If I can just limit myself to healthcare IT for the moment, we believe that so far technology has actually let down the whole healthcare community. Whereas IT has really helped other industries become more efficient and helped consumers use services more effectively, the same is not the case in healthcare. There are many reasons for this, including cultural and political barriers, but it is certainly true that most European citizens can think of examples of healthcare IT failures in their own systems.
What blockchain brings are two things that are new and can help to break down these barriers. Blockchain technology brings a level of security and transparency we have not seen before. It also brings in the possibilities of a token economy – and I will explain what I mean by that in a minute.
Security and Transparency:
If we look at security and transparency, these are fundamental problems to solve because most large IT systems today are heavily centralised. This means there is a much greater risk of security breaches due to a rogue actor inside the system (an inside job) but also, crucially, because they are inside the system that bad actor also has the tools to cover their own tracks. Using blockchain technology, we are able to create a more decentralised system – you don’t even need to decentralise the whole thing, only certain parts of it – and suddenly you have vastly improved security compared to the past.
The Token Economy:
When it comes to the token economy aspect, we now have thousands of different tokens or coins or cryptocurrencies out there. Clearly not all of them will survive but what is important about the growth of the token economy is that using tokens helps to align the interests of end users with other actors in the system. Our current, out-dated health systems usually have a top down approach that doesn’t incorporate the users’ point of view at all. Healthcare IT solutions are sold business-to-business so they tend to serve the needs of the system rather than of the patients. By issuing tokens, suddenly you involve patients directly in their care and you are telling them that their opinions matter. End users can be part of the system and influence how it operates which will drive change from the bottom up and fundamentally alter the landscape of healthcare technology.
What is Iryo doing as a company and where does the name come from?
Iryo is an old Japanese word for medicine, which we think holds a lot of symbolism for what we are doing. Our mission is to improve health care through improving healthcare information technology and so, in a way, we want to be the medicine for the healthcare industry. It is definitely not an easy industry to be in and it is especially tough for newcomers. Probably one of the toughest industries to enter of them all. You could compare healthcare systems now to banking before the arrival of fintech – it’s a slow-moving, heavily regulated industry, which is very resistant to change. Yet, it is a global industry and every person in the world is a participant. We interact with healthcare systems either when we are ill ourselves, or when people we know become ill. We, as IT professionals, know that healthcare systems are in a terrible place as regards security, scalability and usability. Iryo believes we don’t have to just accept that status quo. It will be painful and will be a tough nut to crack but there are reasons for optimism and blockchain is definitely a big one. Thanks to tokenisation, the capital raising process is changing and many companies are raising funds to solve these problems. We always say that Iryo may not be the one to succeed but someone has to try because things in healthcare need to change so that it becomes sustainable. What good is healthcare if nobody is able to afford it? So much activity in the field is a good sign because it shows entrepreneurs are aware of this problem and they care. I wish great success to everyone tackling it and I really hope together we can make it happen.
Several blockchain companies are trying to offer Electronic Healthcare Records (EHRs), how does Iryo differ from them?
The term EHR has become very loaded and quite unpopular because it has been done before and done badly. We therefore often try to avoid using it and instead we envisage the problem on a more fundamental level in which we are building an ecosystem for managing healthcare data. Data in the system will come from a number of places – from medical records, from wearables and from Internet of Things (IoT) data, for example. Data will be combined in a secure and transparent system so that researchers and others who we validate can tap into that rich database and mine the data they need without compromising privacy. The patient will be in control of who has access to that data and can allow access or revoke access according to their own needs.
In terms of how we differ from other providers, there are three main points of differentiation: 1) public blockchain, 2) open standards, and 3) open source.
We believe that we need to use a public blockchain to deliver our approach. Permissioned blockchains can be useful in a pure business-to-business context but if we are talking about building a system for sharing healthcare data, we need maximum security and transparency. We need a public blockchain for that.
If you think about sharing images online, it would be a lot harder if we were not all able to use a standard format like JPEG. Healthcare data is a lot more complex than sharing photos but the same principle applies. Healthcare IT providers need to start working on the same standards, otherwise effortless data exchange and data aggregation will never be achieved. Our system us therefore full based on open standards (OpenEHR).
We believe open source software is more secure, better, more trustworthy and provides less vendor lock-in, Many in the medical community mistake that for ope access to data. That is not the case. It simply means that the source code of the software is publicly available for anyone to see and download Open source is already the norm in the general IT (think of Linux). It needs to become the norm in healthcare IT as well. That is why Iryo will be open-sourcing all software that we produce.
Many people have said 2018 is a make or break year for blockchain in terms of implementation of real world projects. Can Blockchain technology – and the huge wave of interest in Initial Coin Offerings (ICOs) – live up to the hype?
This is probably the toughest question and nobody really knows the answer. My sense is that ICOs will be even bigger in 2018 than in 2017. I don’t think it’s a phenomenon that will go away any time soon. The fundraising model has proved itself but this is still a very new and untested form of technology so the marketplace really needs to mature. In terms of the hype, probably nothing could ever live up to that level of interest and excitement and there are bound to be failures. Really the true innovation is at the protocol level rather than all the drama around issuing tokens. If you compare it to the development of TCP/IP, the significance of the protocol is similar but in that case there was nothing to buy, whereas now we have people making vast sums from buying and selling tokens. The hype is good in terms of generating awareness and healthy public debate but it would be dangerous to see these technologies as a universal panacea for all the world’s problems.
Do you think there is political will to implement cutting edge healthcare technologies like blockchain in European health systems and if so how can we get movement on this issue?
In the short-term we have decided not to focus on the European market because we think the leap of faith is actually too great. Although the EU and US are paying unsustainable amounts for healthcare, they are still resistant to reform. Developing countries have a lot less money but they have an urgent need to digitise and modernise their delivery of healthcare. If we can focus on projects in the developing world and prove ourselves there it may help EU countries to have more faith in adoption in the longer-term.
What is your predicted landscape for Blockchain in the public sector in 5 years time?
It is good that the media debate about blockchain and ICOs is sparking greater interest from governments. Most start-ups don’t need government funding and are not looking for grants but what we do need is support in the form of things like regulatory sandboxes so we can test things out without fear of breaking some out-dated laws that have not kept pace with the technology. I think the way we will get progress in the public sector is via doing successful small pilots and scaling it up from there. There is education to be done on both sides. Start-ups need to explain the technology better and get policymakers to understand all its applications and consequences. Sandboxes are a very positive way of helping both companies and governments themselves to demonstrate success by working together. I am encouraged that we recently had such a positive debate in Westminster and that the Slovenian government have been so supportive with initiatives like a government think tank focused on blockchain. If I have a criticism it is that both Fortune 500 companies and the public sector may have begun to understand the theory of blockchain but not its longer-term implications. They have not internalised what it really means to decentralise and give up control of something. This is why they tend to prefer private permissioned ledgers but I think, if that is all we do, it will be a wasted opportunity to really harness the true potential of blockchains for the public good.
I understand that Iryo is also providing humanitarian solutions for refugees – can you explain more about what’s happening with your ‘blockchain for good’ projects?
Over the past year or so, ICOs have been shown to be a very successful model for raising start-up capital. But there are a lot of scams and there is a lot of greed. We set ourselves the challenge to demonstrate that there is also a more humanitarian approach. Our advisor Brian de Francesca, CEO of the global telemedicine company Ver2 from Dubai, connected us to a non-profit organisation Walk with me, which is implementing humanitarian solutions in the Middle East in 12 locations across 6 countries – Lebanon, Syria, Iraq, Jordan, Egypt and Djibouti. We felt we could provide help on what they do in healthcare. In particular, these refugees need an electronic medical record that stays with them. A centralised approach can’t work in these circumstances not just because budgets are low but also because there is such a high turnover of staff, most of whom are volunteers from NGOs. Doctors may only be there for 2 months but the refugees can be there for 5-7 years before they are settled somewhere more permanently. Currently they have to keep track of patients manually using Excel spreadsheets, which is both time consuming and insecure. Despite their lack of food and shelter, most refugees somehow manage to have access to smart phones. Giving them portable medical records that go with them as they move about is hugely important for their healthcare and can be done at low cost. Other benefits are that they can have telemedicine consultations with experts all over the world and donations can be received in a frictionless manner. By running a pilot with refugees, we can create a Minimum Viable Product and have a strong proof of concept. It is good for the refugees, who desperately need our help, but it is also good for us to be able to demonstrate our approach in a real-world setting.
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