The recording, slides, and additional questions from the “Is there a role for blockchain in healthcare?” Pistoia Alliance Debates webinar held on Tuesday 20th June 2017 are available here:
First of all, thanks to our speakers: Gideon Greenspan, David Houlding, Nishan Kulatilaka and Darryl Glover. The webinar attracted lots of discussion and questions and we ran out of time answering them so here are the questions and some initial comments from our speakers.
We are looking at further blockchain activities and potential projects to support H&LS so please send your comments into either Nick Lynch, Carmen Nitsche or John Wise.
Q: Is there any technical limitation to the data that can be held in a block?
Data is data, and a blockchain doesn’t care what it contains any more than a file system. The only limitation is in terms of quantity, and this will depend on the specifics of each blockchain implementation. In our platform there’s currently a limit of 64 MB of data per transaction and 1GB of data per block, but there’s no principled reason why these can’t be grown in future. (GG)
Q: Is the block replicated across the network? If not, then how does the robustness increase?
Yes, all blocks are replicated across the network and stored locally by each node, and this creates the high level of robustness. Of course if some data is only stored off chain (e.g. with a hash of that data on the chain for timestamped notarization) then the robustness for that data will be lower.(GG)
Q: Can you throw some light on Healthcare Use case using blockchain?
There are numerous applications across the Life Sciences Industry. These include the gathering and tracking of patient data, track and trace, inventory management, movement and storage of patient records, research and development, clinical trials, etc. The number of applications is only limited by one’s imagination. The key is to remember that when data provenance is required and the creation of immutable and auditable records is important to assist in meeting regulatory requirements then the Blockchain is an ideal solution. (DG)
Q: For David: What exactly are B2B blockchain opportunities in healthcare that you see? If not patients, then do these B2B networks involve hospitals, primary care providers, pharma companies… and what data would they be exchanging exactly that aren’t supported by traditional databases and where disintermediation is needed?
There are many potential use cases in health and life sciences, e.g. see ONC announces Blockchain challenge winners.
For instance Intel are working on compelling use cases across provider, payer, pharma, life sciences and security spaces. Intel are also collaborating with PokitDok https://techcrunch.com/2017/05/10/pokitdok-teams-with-intel-on-healthcare-blockchain-solution/ around clearinghouse like transactions https://platform.pokitdok.com/documentation/v4/#available-api-endpoints that involve payers and providers. It is not always the case that these use cases are impossible with conventional DB’s and silos and associated inefficiencies and lack of transparency, but rather that blockchain offers benefits in transparency, operational efficiency, robustness / resilience, etc. HIE’s are another potential use case and existing network opportunity for blockchain that would involve collaboration across providers for health information exchange, where blockchain is serving the role of a record location service. In this case blockchain enables this use case without the HIE “middleman”. We don’t see disintermediation, but rather a change of role for intermediaries from a central bottleneck / trusted broker to more of an enabler and support role for participating organizations in the B2B blockchain network. (DH)
There are many other examples of this and we would love to hear your own views on this too.
Q: What is the state with HIPAA regulation for Blockchain? Will each node operator need to be HIPAA compliance?
It is important to understand that the HIPAA regulations are a guide to how patient data is handled, but there is no organization that states a product or service is HIPAA compliant. From the way a Blockchain is constructed, it would meet the requirements as a HIPAA compliant tool (DG)
Q: Is there a concept of versioning in blockchain? i.e. a point-in-time change in the type of data stored on the chain (increased granularity, richness, etc.). Where is the metadata managed that describes what’s stored in a given block or on the chain more generally?
Because blockchains are append-only ledgers, versioning comes for free. The blockchain itself can be thought of as a notarized, timestamped and secured log of signed transactions, where the final “state” of the database is the outcome of replaying those transactions in the blockchain’s order. So it’s straightforward to rewind the state of the database to any point in time, by reversing the most recent transactions.
As for metadata, this would be implementation specific, but we should distinguish between what’s in the blockchain (which is the definitive consensual truth from which everything is derived) and how a particular node decides to keep track of things. For example in our platform within the blockchain all metadata relating to blocks and transactions is stored inline within those blocks and transactions. However each node represents it in a much more structured way, for efficient querying. (GG)
Q: Can you elaborate on the Intel consensus algorithm you’re working on, and how does it differ from PoS (Proof of Stake) that is out there?
Details on Hyperledger Sawtooth Lake and PoET (Proof of Elapse Time) consensus algorithm can be found at https://intelledger.github.io/introduction.html . In summary, using PoET each blockchain node relies on a wait time retrieved from a trusted execution environment, eg SGX https://software.intel.com/en-us/sgx-sdk which is random so over a period of time each blockchain node can participate approximately evenly in validation and taking the lead in committing new blocks to the blockchain. This reduces risk of single / few points of failure that can happen in other consensus algorithms e.g. PoW that require massive hardware and power consumption and consequently just a few nodes in the blockchain network participate in such roles. (DH)
Q: How does the participant benefit from blockchain – monetarily
There are indirect revenue streams by gathering data of value to an organization that they have not previously had access to such as downstream inventory or patient level data. (DG)
Q: What are the views of regulators (e.g. FDA) about the role of Blockchain
The regulators are reviewing this technology, but to my knowledge they have not established any standards or endorsed the technology. However, they do not appear to be against it either. (DG)