This text is the first in the series of publications ‘Blockchain in Healthcare’ by Leo Petersen-Khmelnitski (LinkedIn)
Most articles on blockchain adoption start with explanation of what blockchain is, I will omit it to refer readers to the following excellent links by 101blockchains, IBM, and Deloitte.
It is perhaps more important to compare blockchain platforms with traditional centralised platforms. The summary of the differences is presented in the table below:
|
Traditional centralised solutions |
Blockchain based solutions |
|||
|
Data handling |
Supports four primary operations: create, read, update, and delete |
× |
Only read and write options are available |
✓ |
|
Authority |
Controlled by the administrator (centralised) |
× |
Decentralised even in private blockchains |
✓ |
|
Data integrity |
Data can be altered |
× |
Data are immutable and auditable |
✓ |
|
Data privacy |
High chances of malicious attacks |
× |
Data are stored using cryptography technology |
✓ |
|
Transparency |
Databases are not transparent |
× |
Data are stored in a distributed network |
✓ |
|
Quality assurance |
Administrators are needed to authenticate data |
× |
Data can be tracked and traced right from its origin using cryptography technology |
✓ |
|
Fault tolerance |
High risk of single point of failure |
× |
Distributed ledger is highly fault-tolerant. |
✓ |
|
Cost |
Easy to implement and maintain as it is an old technology |
✓ |
Uncertainty in the operating and maintenance costs |
× |
|
Performance |
Fast (more transactions processed per second) and offer great scalability |
✓ |
Can handle a limited number of transactions per second, scalability is a challenge to address |
× |
Early adoptions
Linux Foundation launched a Work Group on Public Health in 2016. The number of health related blockchain adoptions increased to encompass such major developments as a drug provenance blockchain commissioned by the US Food and Drugs Administration.
Blockchain adoptions in the global healthcare sector started with several Ethereum based ICOs in the famous ICO rush of 2017, ranging from launch of new consensus mechanisms tailored to healthcare to micropayments in utility tokens to reward for a healthy lifestyle or for following recommendations by health professionals.
Most of these projects lost momentum when the SEC of the USA, a government watchdog for securities, announced in August 2017 that utility tokens are deemed as shares, and have to be registered as such.
In 2018, most efforts to adopt distributed ledger technologies in the healthcare sector were based on permissioned blockchains, such as Hyperledger Fabric.
More on the current state of adoption will be published in the next issue in the series “Blockchain in Healthcare”.
Covid
The Covid-19 pandemia gave a serious impetus to blockchain initiatives in the healthcare sector. First of all, due to Covid regulators worldwide turned their attention to distributed ledger technologies.
In the United States, these efforts culminated in the start of September 2020, when Members of the Congressional Blockchain Caucus sent a letter to the President and the heads of agencies involved in pandemic response encouraging them to consider blockchain solutions for managing the coronavirus response. The letter advocated bringing together private- and public-sector leaders to develop a coordinated strategy that would leverage blockchain technology to facilitate relief to those affected by the pandemic.
Hence, funds tracking became a new focus area for blockchain adoption. Many experts, including the Danish Red Cross, call for tokenization of grants, as it allows speedy peer-to-peer transfers of funds to unbanked individuals. A blockchain based pilot was conducted by the US Treasury in response to appeals by the Congressional Blockchain Caucus to use distributed ledger technology to deliver coronavirus relief payments instead of direct-deposit and paper checks.
Remote voting
Voting procedures that require no physical on site presence became yet another focus area for blockchain adoption since the Covid outbreak. The author of this report received numerous requests to explain, consult and present blockchain based software for corporate voting in a remote mode. Worldwide, governments faced the challenge to conduct local, regional, and general elections remotely. Already in February 2020, the U.S. Postal Service filed a patent application for a blockchain-based secure absentee voting system. The system separates voted identification and votes to ensure vote anonymity, and stores votes on a distributed ledger in a blockchain.
Social distancing
How to ensure social distancing in an urban center? In comes blockchain. In 2020, numerous initiatives (ranging from IBM to Chinese authorities) were proposed to try and limit the spread of COVID-19 from person-to-person contact by employment of a blockchain-based system that would allow authorities to limit the number of individuals in a specific area at any given time. Some solutions were based upon a mandatory compliance while others hoped that citizens/residents/tourists would voluntarily sign up for a blockchain-based mobile application that would provide them with time-based “movement passes” they could use to access public spaces. Local governments could restrict the number of passes for various places and times of day by verifying that only those with an active pass are attending an event or visiting a store, for example.
Covid pass
In many such projects, the blockchain would also accommodate geographic, biometric, financial and health data, and could become the basis to issue “covid passes”, or “immunity certificates,” should that be necessary. Existing decentralised digital identity standards are vulnerable to compromise and do not have privacy at their core.
Most notable attempts were announced by IATA and by WHO. The ID2020 Alliance, a public-private partnership with partners including Microsoft, Accenture and Hyperledger, has already begun to certify some ID proposals as a “good ID” to offer to governments (eg. MiPasa). Other notable projects: Rapid Medical Parts, Tymlex, and Civitas. China has more than 20 blockchain based apps in this field.
The World Wide Web Consortium (W3C), a membership-driven standards body, has laid out the standards for such certificates, upon which many of these privacy-preserving proposals are based. The body is also known for such standards as the early versions of HTML.
Generally, a digital identity is seen as a unique identifier connected to a set of variables, like a person’s name, citizenship or, in this case, immunity status. A goal of many companies in the blockchain space is the creation of a “self-sovereign identity,” which gives people the ability to control the way their identifiers can be accessed by others, without giving up their personal identity or information, as opposed to relying on a centralised government or company.
Informational support to vaccinations
The last 6-9 months saw vaccination programmes of unprecedented scale, in some countries up to 90% of populations were vaccinated multiple times. Such programmes require, and will do more so in the future, keeping track of everything, to the degree perhaps never experienced before. Who was vaccinated already? Which vaccine exactly did they receive? What was the manufacturing batch? Where did it come from? Was it stored properly, while it travelled 11 time zones?
Here blockchain may play a crucial role as the informational infrastructure behind global vaccination programmes. It will require the first-ever deployment of blockchain in the global distribution of a vaccine. Such global blockchain may ensure that:
● Manufacturers could track whether shipments are delivered on time to their destinations
● Distributors would provide a more efficient delivery tracking platform, including storage requirements verifications, and would be the first to know and notify if things go wrong
● Hospitals and clinics could better manage their stocks, mitigating supply and demand constraints. Furthermore, they would get guarantees concerning vaccine authenticity and proper storage conditions
● Individuals would have an identical guarantee for the specific vaccine they receive
Several blockchain companies already have experience implementing blockchain for supply chain use cases. Many supply chain and provenance solutions are driven by commercial or cost saving incentives, IBM Food Trust is one, perhaps, most famous example. Another one is Orbs, who partnered with a Fortune500 company on a supply chain solution to enable visibility in tracking counterfeit goods, a use case that can potentially save companies many millions of dollars. The difficulty does not lie in the technology, but rather in building and enlisting all of the multiple players to take part in the solution.
One main issue in blockchain based covid related certificates is choice of a consensus mechanism. Most such projects are based upon a “proof-of-authority” (i.e. a permissioned blockchain where any validator or quorum of validators may write to the chain, but not other actors like users). However, users can choose where to store their data, allegedly revoke their data and delete it if they chose, and store personal information hashed.
Other challenges in blockchain adoption in healthcare, as well as trends identified will be the topic of the text publication in the series ‘Blockchain in healthcare’