I created this presentation for a client who wanted to understand how blockchain technology can be used in healthcare, particularly for eHR (electronic health record). They wanted a non-technical overview.

1. See the future….
Blockchain and
how it is being
used in healthcare
Susan Dart
Commercial in Confidence  The Frame Group Pty Limited 2017

2. Overview
Genesis of blockchain
Blockchain is for real
Blockchain is a general solution
Blockchain use across many areas
How does Blockchain work?
Examples of existing blockchains
How blockchain is being used in healthcare
Examples of healthcare blockchain uses
Benefits and challenges for healthcare
Key companies to watch for healthcare
Blockchain ecosystem
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3. Non-technical definition of blockchain
3
Blockchain is an open-source technology
that maintains data as a shared record
distributed over many computers of people
that do not know each other. Instead of
having centralised access or a central
authority, the entire network of combined
computers is responsible for the integrity of
the data and needs to approve changes
made to that data (Philips Blockchain Lab)
Trust machine:
Manufactured
trust through
clever code

4. History is still to be
written about
Blockchain
“Imagine a technology that could
preserve our freedom to choose
for ourselves and our families, to
express these choices in the
world, and to control our own
destiny, no matter where we lived
or were born. What new tools and
new jobs could we create with
those capabilities? What new
business and services? How
should we think about the
opportunities?” (D.Tapscott)
PHILOSOPHICAL
Form independent
communities free
from corrupt societies
Security for what
underpins society
Software applies the
law!
TECHNICAL
Computer-science
Distributed replicated
databases
Cryptography
Decentralized
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5. 5
At least 120,000 transactions
per sec. for bitcoin requiring
450 thousand trillion solutions
per sec
65% major banks will be using
blockchains by 2019
Worldwide development
network for United Nations is
pursuing blockchain projects
“I’m a big believer in the ability of
blockchain technology to effect
fundamental change in the
infrastructure of the financial
service industry” Bob Greifeld,
CEO of NASDAQ
There is a growing agreement
among technology companies
that blockchain is essential to the
unlocking the potential of Internet
of Things (IoT)
“It’s hard not to be fascinated by
something so transformative. This
technology is being used in ways
that have implications for central
banking that span all the functions
we have” Carolyn Wilkins, Deputy
Governor of Bank of Canada
We are paying close attention
to..blockchain, recognizing this
may represent the most
significant development in many
years in payments, clearing and
settlement” Federal Reserve
Governor Brainard
IBM is working with 6000 clients
on blockchain and IoT
Microsoft has released a cloud-
based blockchain-as-a-service
platform
Blockchain is creating a firestorm of interest

6. Blockchain is a general solution
 Tamper-proof open-source database
 Ownership of asset (art, music, land, fish,
health record)
 Blockchain transfers value
 Anything of value (cryptocurrency, contract,
title, EHR)
 Secure (cryptography)
 Public and private blockchains (peer-peer)
 Consensus mechanism as to how to update
the blockchain
 Provenance (audit trail with time stamping)
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 Suits a supply-chain problem where there is no
governance and ownership passes between
each step in the transfer cycle
 Suits keeping “global truth”

7. Blockchain is used in many areas
 Cryptocurrency – blockchain contains the
payment history of every bitcoin in circulation
and proof of who owns what at any point in
time; Bitcoin
 Smart contracts - creating invoices or share
certificates at end of transaction; Ethereum
 Create your own blockchain – build your own
platform for private networks; Multichain
 Banking fintech 44 banks consortium - R3 CEV
 Fishing supply chain - Provenance
 Diamond trading - BlockGem
 Art, Music and games – Ujo Music
 Government – USA, UK, Australia
 Land registry – Chicago
 Healthcare – Estonia
 Stock exchanges – ASX, NASDAQ
 Tourism – Dubai’s Loyyal
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8. 8
Australia’s role is standardisation of Blockchain
Australia will lead the international development of standards governing blockchain
The committee's work will focus on "technical solutions including protocols and interoperability" rather than
legal obligations and regulatory matters, which Standards Australia said should instead be addressed by
governments
The committee - which will include 35 ISO members like the US, UK, Germany, Canada and Japan - will be
tasked with creating a common language for "interoperability systems, privacy, security and terminology"
The Australian Securities Exchange is looking at the technology as a replacement for its equities clearing and
settlement system
The federal Treasury and Data61 (CSIRO) are studying potential use cases
Australia's biggest banks are part of an international consortium looking at using blockchain for bond trading

9. Blockchain – key concepts
 It offers a way for people who don’t know
each other to create a record of who owns
what that will compel the assent of everyone
concerned; it’s a way of making and
preserving truths
 Replicated ledger of value transactions
across a distributed network
 Value exchange protocol is the heart of the
software and hardware
 Validation via consensus that a transaction is
valid
 Block: a (provenance) list of time-stamped
approved transactions with keys
 Chain: blocks cryptographically connected in
the distributed network
 Miner: special computer that competes with
other miners to be the first to approve a block
and is rewarded (typically with bitcoins)
 Digital ledger is shared and cannot be
updated without validation from a majority of
users (miners)
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10. How does
blockchain work at
its simplest level?
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11. Examples of existing blockchain
projects
 Colu – colored bitcoin for local currencies
(Barbados, Israel)
 Everledger – protect luxury goods by adding
attributes for an item’s proof of identity
 Onename – stores personal information in
order to do away with passwords
 CoinSpark – acts as a notary
 Velox.re – Chicago property transfer
 Guardtime - Estonia health
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 Bitcoin, Altcoin – cryptocurrency
 Colu – colored bitcoin for local currencies
(Barbados, Israel)
 Ethereum, Symbiont – smart contracts that
execute themselves automatically
 Sixchain - derivatives
 Factom land registry for Honduras, Greece
(only 7% of land mapped)
 NASDAQ recording trades in privately held
companies

12. Blockchain transaction dashboard – Ethereum example
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13. Blockchain transaction dashboard – Bitcoin example
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14. Bitcoins in circulation as of 4 September 2017
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15. Blockchain in healthcare - expectations
 Disrupt the complex and frustrating
healthcare system in a positive way, mostly
revolving around simplifying the management
and transfer of health records and information
 “Busting down the silos in healthcare could
be the beginning stages of a healthcare
revolution” CIO at Humana, Chris Kay
 Data needs to flow between primary health
care providers, specialists and holistic
medicine practitioners for each patient
 Data security is a big driver in the push to
adopt blockchain
 90% of companies have had a data breach!
 Often, more than 300 people touch a single
medical claim (USA)
 Industry recognises it is spending on new
technology but not making the care any
better
 Solving the master patient identifier problem
 Global healthcare interoperability
 Protected ecosystem
 Blockchain has at least started the
conversation to improve this!
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16. 16
Typical usage expected of blockchain in healthcare
For clinicians, blockchains can support universal identifiers for any data entered into an EHR, which is then
available to other authorized providers and care team members
Patients can monitor their own health information, approving, denying or sharing changes to their data, ensuring
a higher level of privacy and engagement
Researchers will benefit from better data integrity and reliability, creating a ‘platform of trust’ for data sharing
Payers will have better data reconciliation, fewer errors and frauds, reduced administrative and claim processing
costs, and the potential to reach underserved markets
Healthcare providers can send encrypted personalise medical recommendations to patient using their own digital
identifier (key)

17. DNA wallets
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An Israeli startup named
DNA.Bits is planning to
store genetic and medical
data which is secured via
the blockchain and
accessed using private
keys
This could allow healthcare
providers to securely share
– and possibly monetize –
patient data, helping
pharmaceutical companies
to tailor drugs more
efficiently
This will form
a “DNA wallet”

18. Healthcare
payments
 In a similar style to Factom and HealthNautica, BitHealth is looking
to store and secure medical records using the blockchain
 This system also facilitates Bitcoin payments, giving patients
additional options for how they pay their healthcare insurers
 Insurers who offer this method will likely have a competitive
advantage over their peers
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19. 19
Block Verify is looking to use
blockchain in the fight against
counterfeit drugs
In a similar way to M-Pedigree
technologies (African social
enterprise), it features panels on drug
packages that can be peeled or
scratched off to reveal a unique
verification tag
This is then cross referenced with the
blockchain to ensure that the
pharmaceutical product is legitimate
Counterfeit medicines often contain the
wrong quantity of active pharmaceutical
ingredients, which can result in illness or
death. The system from mPedigree assigns a
code that is revealed by scratching off a
coating on the drugs’ packaging. This code
can be text messaged by the consumer or
medical professional to a free SMS (short
message service) number to verify the
authenticity of the drug
If the drug packaging contains a counterfeit
code, the consumer will receive a message
alerting them that the pack may be a fake, as
well as a phone number to report the incident
“Pharmaceutical safety regulators in Ghana
and Nigeria are working to ensure that the
concerns of users are promptly addressed
Anti-counterfeit drugs and blockchain

20. Number crunching
and blockchain
 Stanford University used to rely on expensive super computers to
simulate protein folding as it happens incredibly fast
 This method was costly with a single point of failure
 Using blockchain, they can instead use a decentralized network
of over 170,000 computers to produce 40,000 teraflops of
computing power
 This could make its way into the analytical space by utilizing a
broad base of data for predictive analytics
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21. 21
Benefits of blockchain with Electronic Health Records (eHRs)
Blockchain technology can connect information on disparate networks to a common infrastructure in order to
create an integrated solution for existing health IT interoperability
It allows providers, patients and payers to share a single version of the truth about a patient’s healthcare
information
Multiple providers, at multiple sites, could access an uncorrupted, secure and universal patient record, avoiding
redundant tests, procedures or prescriptions
Payers with the right permissions could have access to relevant information in order to process claims rapidly
and with more precision
Patients would have transparency into the entire continuum of care
Blockchain would not be centralizing health information in healthcare exchanges, but instead, decentralizing the
system in a securely and interoperable manner
Blockchain logs every single event on the EHR (documents, prescriptions, patient interactions, payment
requests)

22. GemHealth
 Gem, a company providing enterprise
blockchain solutions, recently launched Gem
Health, a network for developing applications
and shared infrastructure for healthcare. Gem
Health hopes to connect users of wellness
apps, EMRs, patient ID software and more
on the same network.
 “This technology allows participants to move
data in real-time, without the need for
reconciliation, because each participant is
connecting to the same network, working on
shared information, and collaborating peer-to-
peer — all without exposing these channels
to theft, forgery and malice," according
to Gem
 "Because the integrity of this history can be
proved with mathematics, everyone can trust
that it is secure and true”
 "Disconnected parties — within an
organization or across an entire industry —
can now securely converge on the same
information, allowing for the development of
an entirely new class of applications that will
unlock wasted resources."
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23. GemOS example of EHR blockchain
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24. GemHealth Medical Management on blockchain
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25. Estonia who’s e-health solution is built on blockchain
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 In 2007, Estonia placed all
their citizen’s health
records online
 Guardtime partnership with
Estonian eHealth
Foundation for $1m
 Enables real-time visibility
into the state of patient
records
 Goal was to have forensic-
quality audit trail on patient
records
 Citizens have a chip-
embedded ID card (digital
identifier) that gives them
access to over 1000
government services via
one website
 Estonia is considered most
digitally advanced
societies in the world
 Everything can be done
on-line (except marriage
and divorce)
 Medical records have
sensitive information
 Estonia recognises that
cloud-based systems can be
breached
 Blockchain proves the
integrity of the record and
everything that has
happened to it over time
 Impossible to alter patient’s
information without it being
noticed
 Government can react to
incidents immediately

26. MedRec – EHR example
 MedRec gives patients a comprehensive,
immutable log and easy access to their
medical information across providers and
treatment sites
 Leveraging blockchain properties, MedRec
manages authentication, confidentiality,
accountability and data sharing—crucial
considerations when handling sensitive
information
 MedRec integrates with providers' existing,
local data storage solutions, facilitating
interoperability
 It incentivizes medical stakeholders
(researchers, public health authorities) to
participate in the network as blockchain
“miners”
 This provides them with access to
anonymized data as mining rewards, in return
for sustaining and securing the network
 MedRec thus enables the emergence of data
economics, supplying big data to empower
researchers while engaging patients and
providers in the choice to release metadata
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27. Medical researchers and blockchain
 Users share their health data while maintaining control of it
 Users can authorise and track the use of personal data
 Research institutions can prove full user consent
 Regulators have an independent record to conduct effective audits
 Health app developers can populate data inside “containers” which can be used to share with
research institutions
 The user has complete control over all data transfers and can decide how much data is
released to a research institution
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28. The Ledger
makes it possible
for you to get
credit for learning
that happens
anywhere, even
when you’re just
doing the things
you love
You can earn
Edublocks
from a formal
institution, like
a school or
your
workplace
When choosing a
subject to study in
the future, you
may wish to
choose the
subject whose
students are
earning the most
income
You can also use
the Ledger to find
investors in your
education. You can
offer investors a
percentage of your
future income in
exchange for free
learning hours
Education vision using blockchain: Edublock
Each Edublock
represents one hour
of learning in a
particular subject.
But you can also
earn them from
individuals or
informal groups, like
a community center
or an app
Your ledger
account tracks
everything
you’ve ever
learned in
units called
Edublocks
Your profile displays
all the Edublocks
you’ve earned.
Employers can use
this information to
offer you a job or a
gig that matches
your skills
The Ledger
keeps track of all
of the income
your skills
generate, and
uses that data to
provide feedback
on your courses

29. Benefits of healthcare in adopting blockchain
 Security and privacy of records
 One source of truth
 Adoption by health entity enables evolution
across the industry to a similar level of
technology
 Less fraud and counterfeit
 True provenance of research clinical data
 Reduced costs and complexity
 Supply chain management
 A shared ledger with smart contracts
 Reduced risk and increased trust
 Patients could own their own records, sharing
them seamlessly and securely
 Generate new insights about population
health
 Stop the selling of medical records by
cybercriminals
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30. Challenges for blockchain in healthcare
 Privacy models – blockchain is open source, transparent
 Need to access pieces of health data (different representations for different purposes)
 Education
 Skills and having enough software developers
 Scaleability
 IP development – patents pending
 Different protocols and reward systems
 Remembering your password (private key)
 Office of the National Coordinator for Health IT (challenges)
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31. Office of the National
Coordinator (ONC) for
Health IT competition
principles
Competition for application of the
Blockchain technology must be
applied to address a healthcare
workflow and ecosystem from the
start as it is introduced to this
emerging digital industry
 Validated transactions through
consensus:
The current work in Health Information
Exchanges (HIEs) relies on a mutually
agreed on submission process and
exchange of information based on
accepted standards and content to
facilitate continuity of patient care between
organizations. Blockchain simplifies and
enhances this capability
 Provenance:
Many actors touch information that is
aggregated through the chain of patient
care; call centers, administrative clerks,
nurses, physicians, billing clerks and so on,
each of whom can contribute to the
documentation of what happens to a
patient on their journey through the system.
In a paper-based system, the provenance
of information, while not always accurate,
had less chance of lapses than the
electronic system. As an area critical to
establish accountability and trust,
provenance in healthcare is ripe for a
solution like Blockchain-applied
appropriately
 Immutability:
All actions are recorded - so correcting an
error has the action and actors
documented in the transaction. In the
paper system, an error in documentation
should be corrected with the author’s
information and time and date. Blockchain
tracks these actions as attributable to
actor and reflect both initial documented
action as well as correction
 Finality:
There is one place to determine the
ownership of an asset (in this case, the
author of information in documentation of
care) and the completion of a transaction
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32. Result of blockchain
competition at ONC
70 submissions and 15 winners – some examples
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Smart health
profile: tie a smart
profile to a patient
so that Medicaid
(Medicare) patients
can easily re-enrol
and re-qualify for
health services
(means tested)
Processing
claims: put claims
data on private
blockchain
accessible to
organisations that
exchange the data
and have it updated
in real-time
MedRec: secure,
store and exchange
EHR
PGHD (patient
generated health
data): blockchain
becomes the storage
for health readings
from patients’ mobile
devices such as Fitbit,
Jawbone and Apple
Watch

33. 33
Companies to watch for healthcare blockchain solutions
Factom, Medvault, Tierion, Health Nautica, MedRec, Blockchain Health Co, Apple - EHR
PokitDok – APIs for blockchains
Hashed Health consortium – collaborative working solutions (policy guidance)
Hyperledger Healthcare Working Group
Philips Blockchain Lab
Office of the National Coordinator of Health IT (USA) - innovation
GemHealth: information exchange between patients, healthcare providers, payers
Hexoskin smart shirt – PGHD, wearable body biometrics
Healthbank – privately owned HER
Guardtime – Estonia
DNA.Bits – genetic data
BitHealth – payments using bitcoins
BlockVerify – fight counterfeit drugs
Stanford Uni – distributed supercomputer simulations

34. Blockchain ecosystem – digital economies, Internet of Things
“The expected proliferation of hundreds of billions more (devices) is at the threshold of a
transformation sweeping across the electronics industry and many others. Yet, the dream of a
smart, safe and efficient future is threatened by subscription fees, ubiquitous advertising and
intrusive surveillance. Our study shows that a low-cost, private-by-design “democracy of devices”
will emerge that will enable new digital economies and create new value while offering consumers
and enterprises fundamentally better products and user experiences.”
IBM’s report titled “Device Democracy”
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35. Blockchain ecosystem – democratic internet
 US Commodity Futures Trading Commissioner J. Christopher Giancarlo believes, “if allowed to
thrive, blockchain may finally give regulators transparency”
 DAO: Decentralised Autonomous Organisations … virtual companies investment club
 Libertarians dream of a world where more and more state regulations are replaced with private
contracts between individuals which blockchain makes self-enforcing (The Economist)
 “Privacy is the foundation of free societies…We believe that the economy works best when it
works for everyone, and this new platform is an engine of inclusion” (Tapscott)
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36. Conclusion
 Blockchain is playing a major role in the evolving digital economy
 Health data is officially a new asset class (2011 World Economic Forum)
 “My data, my choice, my healthbank” is possible with blockchain
 Healthcare projects using blockchain are underway
 Estonia is a prime example of a digital economy managing its citizens via a digital healthcare
solution using blockchain
 To healthcare professionals: It’s time to become familiar with blockchain and how it can
improve your industry
 How many data breaches of medical databases will happen before the industry switches to
blockchain technology?
The Frame Group thanks Mark Klose https://www.linkedin.com/in/mark-klose-6559291/
for his support in progressing this project. 36

37. The Frame Group Pty Limited
www.framegroup.com.au
1300 252 789
Sydney | Canberra | Melbourne | Brisbane
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