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Bitcoin creation and transfer is based on an open source encryption protocol and is not managed by any central authority. The creation of new bitcoins is automated and may be accomplished by servers, called bitcoin miners that run on an internet-based network and confirm bitcoin transactions by adding codes to a decentralized log, which is updated and archived periodically.

Each bitcoin is subdivided into million smaller units called satoshis, defined by eight decimal places. Please kindly be advised that Bitcoin is very volatile. The data layer represents where data can reside on the blockchain, primarily either storing data on the blockchain itself on-chain storage or storing the data in a different source but including a pointer or using a distributed application as an intermediary off-chain storage.

The core functions of the blockchain should also assess certain design considerations in far right yellow box , including whether the blockchain is public, private or consortium, the consensus mechanism to be used, the type of permissions structure, where data should reside and how it should be managed, and the governance of the blockchain who are the users, peers, validators, nodes, etc. The published papers evidence the wide variety of use cases that are being researched for health blockchains, including management and interoperability of healthcare data e.

However, it is important to note that the published literature represents only a snapshot of global blockchain activity, as many health-related blockchain projects are published in white papers, news articles, press releases, presented at conferences, or are otherwise undisclosed as they are developed for commercialization purposes. Reflecting the fact that it is still early days for health blockchains, there are few real-world examples of blockchain systems that have gone into production and that also have strong commercial or user adoption in healthcare.

In contrast, other sectors of the economy have seen much faster adoption, including financial technology services and supply chain and logistics. Importantly, when assessing the viability of a blockchain for health, what core blockchain characteristics and design principles need to be taken into account, and how can they address the real-world legal, regulatory, privacy, business, and provider and patient-centric considerations unique to healthcare?

The framework questions are based on six principles, as follows: 1. Blockchain design types: Decision of whether your blockchain design will be a public blockchain generally open to participation by anyone and not permissioned , private blockchain involving limited participation and having permission structures , or a hybrid blockchain systems with both public and private designs. Decisions need to be made about what type of data will be shared with and among participants, if any, whether data will be stored on-chain, off-chain or on a side-chain, and the type of permission structures that will be utilized.

Decisions about blockchain governance: Governance is a crucial component to the design of a blockchain system. Finally, how these actors will make decisions about how to govern the blockchain including choices regarding consensus mechanisms, permissions, and data governance will also need defining. Ultimate healthcare goal of the blockchain: Although it may seem obvious, a critical issue that must be addressed is the definition of the ultimate goal of the blockchain to improve healthcare.

Beyond the core benefits of a distributed, immutable, transparent, and higher trust system, the unique benefits a blockchain system can provide for healthcare processes over other existing technologies must also be assessed.

Not all blockchains will have the same goal s. For example, some may be designed to simply lower healthcare transaction-related costs by improving and automating processes such as the use of smart contracts , removing intermediaries, or reducing administrative burden. Others may focus on creating mechanisms to drive revenue generation. Some will prioritize enabling better data collection, use, and sharing from patients, consumers, and providers through the offer of incentives such as tokens.

Further, others may focus on more indirect benefits such as increasing compliance or preventing fraud. Eventually, some blockchains may be designed to achieve multiple goals, yet may start with the most pragmatic use first. The need for a blockchain: A final question may simply ask whether the healthcare-related challenge or goal really needs a blockchain, or if it can be better facilitated by another form of technology.

The aim of this article is to explore different perspectives about key design elements, challenges, opportunities, and best practices for the future health blockchain landscape. To accomplish this, the article brings together a diverse and multidisciplinary group of experts from academia, the private sector, healthcare startups, and professional technology associations to discuss use cases in healthcare records, clinical trial management, medical credentialing and licensing, genomics and precision medicine, pharmaceutical supply chain, and biomedical research.

It closes with a discussion from the IEEE Standards Association about the importance of setting technical and industry standards to ensure blockchain in healthcare moves forward and realizes its potential as a revolutionary force for 21st century healthcare. Using privacy-preserving predictive models and blockchain technology for electronic health records Tsung-Ting Kuo Fig.

Blockchain healthcare record management focuses on the sharing of data across different healthcare stakeholders, while preserving the source, provenance and, oftentimes, privacy of such data in a way that can enable more powerful data analysis and insights from population health analytics [ 25 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. Among healthcare record applications, this section focuses on an example of blockchain-based privacy-preserving prediction modeling that leverages many of the strengths of blockchain technology [ 35 , 36 , 37 ].

His research focuses on blockchain technologies, machine learning, and natural language processing Full size image In this specific use case, hospitals or healthcare institutions aim at training a machine learning model from the healthcare records stored in their electronic healthcare record EHR systems, and then using the learnt model to predict patient outcomes e.

However, these state-of-the-art methods are mainly centralized i. In this blockchain-based solution approach, the users are the hospitals or healthcare institutions participating in the cross-institutional model learning. In such a blockchain network, the peers are actually the same as the users. Additionally, training errors are used to guide the order of the online learning on the blockchain, based on an intuition that the site containing data with higher error may provide more information to improve the model.

This iterative learning process is repeated until a consensus predictive model for all peers is identified. In this way, blockchain provides specific benefits for problem solving such as protecting privacy by exchanging models only, avoiding the single-point-of-failure, and generating immutable logs for the learning process.

In terms of data sharing, the models and their meta-information e. Ultimately, the goals of this blockchain-based learning method for health records management include supporting comparative effectiveness studies, biomedical research, and eventually patient care.

Blockchain-enabled medical professional credentialing and licensing Kevin A. Clauson Fig. His investigation of blockchain for the health supply chain began in as a follow-up to his previous role as director of a World Health Organization Collaborating Center. He has received the Blockchain for Education Collaboration Award, recognizing the partnership between Lipscomb University and Hashed Health to build an Ethereum-based platform to allow degree verification.

His research is focused on digital health and his work has generated coverage by the New York Times, Forbes. In a more troubling case, a man falsified both degrees and transcripts to secure a federal leadership position for a technology role in law enforcement and security [ 46 ]. Thus, the dual threats of suboptimal processes and bad actors have negatively transformed the credentialing arena from a seemingly mundane activity to a time-intensive, cost-inflated pursuit that can even negatively impact patient safety [ 48 ].

Professional credentialing and licensure is also a critical function of most highly regulated sectors of the economy, including multiple actors in the healthcare system. Since the early s, hospitals have been required to verify the competency of physicians in their institutions [ 49 ].

Included in the process is independent verification of certifications, licenses, qualifications, education, relevant training e. Further, providers may maintain independent credentials with multiple systems based on their admitting privileges and may also have practiced in another state [ 52 ].

One model envisions accreditors, hospitals, medical schools and other educational institutions, licensing boards, national health agencies, and other sources of credentialing information serving as nodes and participants in the blockchain potentially reducing the need for medical credentialing services and other intermediaries.

Other models would position a blockchain structure that served as either interstitial or as second layer solutions that could provide connectivity for all of the current data silos involved in credentialing. One such credentialing lifecycle tool that has been conceived is the Comprehensive Learner Record, which includes coursework, degree s , competencies, co-curricular activities, experiential learning, microcredentials, and professional e. The Comprehensive Learner Record also includes the Open Badges functionality, which in turn is data aligned with Blockcerts standards.

As such, identity is central to all of these processes, but can be approached via public, private, hybrid, or consortium designs. One such example of a public design is through the Decentralized Identity Foundation, which aims to use an Identity Hub architecture [ 55 ] to help accomplish this goal. Within this broader framework, efforts to leverage the strengths of blockchain to secure provider identities and credentialing include private e.

While educational credentialing remains limited in scope and onerous to conduct for many institutions of higher education, and medical credentialing and licensure can be disproportionately resource intensive, thoughtfully designed blockchain-based systems and the enhanced functionality of smart contracts offer promise as a means to contemporize these fundamental but antiquated elements of education and healthcare.

Can we use blockchain to improve clinical trial management? Basker Gummadi Fig. He is the current team lead for projects focused on designing clinical trials to be more patient centric using blockchain technology. Prior to joining Bayer, Basker held various positions in the pharmaceutical industry, including Business Solution Manager at Hoffman-La-Roche, Assistant Director at Schering Plough, and Senior Analyst at Bristol Myers Squibb Full size image The benefits for blockchain in clinical trials management includes moving stakeholders into a distributed network with processes that can be more efficient when you eliminate the need for intermediaries [ 16 ].

This domain of healthcare is ripe to leverage core benefits of blockchain technology such as transparency, disintermediation, immutability, auditability, and trust. From a business perspective, a typical clinical trial process is expensive and involves numerous stakeholders [ 58 ].

Some of the most pressing challenges in clinical trials include 1 access and management of clinical trial data; 2 data integrity and provenance for clinical trial processes for regulatory purposes; 3 updating and maintaining patient consent; and 4 patient recruitment. Below, some blockchain approaches to address clinical trial management challenges are described, which also illustrate the variety of blockchain designs.

Arguably, the most important stakeholder in a clinical trial is the patient; currently, when a patient leaves a clinical trial, they rarely have access to any of their clinical trial results. On a blockchain platform, additional sources of data, such as from hospitals, care providers, genomic data, proteomic data, and other medical data e. More robust data access can also enable better patient recruitment into clinical trials. Blockchains can aggregate patient and trial data that is anonymized or else subject to patient-driven permissions [ 59 ].

With this challenge, permissioned-based blockchains with the patient at the center of data governance might be the best approach. Data integrity and data provenance are key in clinical trials. Sponsors and investigational sites have to prove data provenance and respond to queries from regulatory authorities to help ensure that clinical results maintain their integrity from data capture through to interim and final analyses.

Blockchain has an architecture that can transparently show the provenance of the data from the origin to the final clinical summary report. The underlying trust in the data is enhanced, accelerating the regulatory approval process, and regulatory authorities will be better equipped to evaluate clinical trial results and determine if a treatment is safe and beneficial to patients. With regards to clinical trial data management, the design of a blockchain will likely be on a private network, with only trusted nodes associated with the study protocol.

In the event of a regulatory inquiry, private key management could also enable a regulator to inspect the data for integrity [ 61 ]. Another challenge arises when sponsors are planning a clinical study, as the protocol often goes through several revisions and is revised even after patient enrollment to provide the best outcome for the patients. Sites managing the trial have to ensure appropriate patient consent often via paper format with the latest version of the protocol, which is a challenge as consent collection is a dynamic process.

Sponsors are accountable for this process, and it is a key area of focus for regulatory authorities in their inspections.

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