Stream: blockchain
Topic: Blockchain in Healthcare Debate
Peter Jordan (Mar 01 2018 at 03:40):
https://www.linkedin.com/pulse/blockchain-healthcare-disruptor-distractor-himss-ontario/
"Healthcare's interoperability challenges are because of weak adoption of content, coding and communication standards; because of unclear (or absent) data governance policies/agreements; and because of poor market incentives for health data exchange (or even perverse dis-incentives against it). Sadly, blockchain technology addresses none of these."
Grahame Grieve (Mar 01 2018 at 03:41):
no that's not sad. that's the point....
Peter Jordan (Mar 01 2018 at 03:44):
...fortunate then?
Grahame Grieve (Mar 01 2018 at 05:36):
for some. yes
Grahame Grieve (Mar 08 2018 at 05:54):
http://www.healthintersections.com.au/?p=2778
Grahame Grieve (Mar 21 2018 at 21:34):
https://healthcaresecprivacy.blogspot.com.au/2018/03/blockchain-as-platform-for-supply-chain.html: "Blockchain, keeps fidgeters occupied, not bothering others" - @John Moehrke a lol moment for me
John Moehrke (Aug 16 2018 at 14:18):
The ONC InteropForum last week had a whole morning dedicated to BlockChain in Healthcare. The only takeaway I got from it was the response to my question: Given that blockchain use will be use-case specific, what healthcare use-cases have been brought before the panel members that resulted in a decision the use-case is a poor use of blockchain? They all reacted shocked at this question. They then all declared that the clear decision they have all come to is that putting 'the' healthcare data onto the chain is a bad idea. Regardless of how it is protected. Putting pointers to the data that lives in a classic (e.g. FHIR Server) is the right solution. What the functionality of the blockchain in these cases is still use-case specific, thus not yet defined.
John Moehrke (Aug 16 2018 at 14:23):
All previously identified use-cases are still the best possibilities: payment for services, supply-chain, research project participation contracts, provider directory credential validation, authenticity/integrity signatures, and possibly some form of audit trail. -- See my 2017 article that is still valid https://healthcaresecprivacy.blogspot.com/2017/11/healthcare-use-of-blockchain-thru.html
John Moehrke (Aug 16 2018 at 14:24):
This mean that the blockchain never holds anything FHIR... but that doesn't mean that FHIR has no relevance. FHIR is critical due to the RESTful nature, as far easier to integrate with blockchain.
Grahame Grieve (Aug 16 2018 at 20:40):
what's the point of a link to something in blockchain, given that access to the reference is subject to further ownership questions?
Grahame Grieve (Aug 16 2018 at 20:41):
I'm trying to imagine bitcoin working by putting a reference to transaction value somewhere else, rather than in the block chain directly
John Moehrke (Aug 17 2018 at 12:30):
Good question... usually the smart-contract in the blockchain includes the clauses that unlock a OAuth token... Thus the access control of the FHIR Server is typical OAuth, but the rules behind issuing that OAuth token from that OAuth Authority are driven by blockchain smart-contract terms. I do outline one of these possibilities on my article in the section on Clinical Research contracts.
John Moehrke (Aug 17 2018 at 13:48):
I just isolated that Clinical Research use-case as an article https://healthcaresecprivacy.blogspot.com/2018/08/blockchain-for-patient-to-sell-their.html
Gustav Vella (Aug 20 2018 at 07:10):
I just isolated that Clinical Research use-case as an article https://healthcaresecprivacy.blogspot.com/2018/08/blockchain-for-patient-to-sell-their.html
I read your piece. Am no Blockchain expert but would argue that you could do them all without blockchain in a sane way? As to the cases per se: All 8 are interesting. I'd try and qualify the first one. I think direct payment to the patient - while in some cases OK - is often problematic. I'd rather not start a philosophical debate on positive vs. negative liberty but IMO patients need professional intermediaries to protect them from profit oriented entities and I'm not sure the blockchain & the smart contract alone can handle that. Be it a smart contract in solidity or an old school LKIF/OWL approach - there's always the semantic gap between the code and a human readable pitch your average stressed out patient will want to grasp.. an trust that someone is reviewing those contracts in their interest. I'd not go there without first sorting out how smart contracts are governed.
John Moehrke (Aug 20 2018 at 12:45):
@Gustav Vella I agree, and thought that I said those things in the article... However, the article is there as a way to focus attention on the kinds of things blockchain 'can' be better at than elsewhere. The smart-contract and visibility of transactions is key. I think they are highlighted by this use-case.... That said, many clinical research projects do pay money for the data; they just pay it to the custodian rather than the individual. That seems to be more unethical in my view.
John Moehrke (Aug 20 2018 at 14:57):
Nice article from IBM on Self-Sovereign-Identity-why-Blockchain, where they explain why no PII should go on ledger, and do explain useful things to be on the ledger -- https://www.ibm.com/blogs/blockchain/2018/06/self-sovereign-identity-why-blockchain/
Wish it was a bit more clear on the self-sovereign-identity as being special feature of blockchain. They fail to leverage the community of endorsements, vs some authority endorsing.
John Moehrke (Aug 30 2018 at 14:42):
New "Blockchain HealthIT" conference https://rscouncil.org/blockchainhealthit/
Last updated: Apr 12 2022 at 19:14 UTC
