Electronic Health Records should be controlled by the user/patient. We can all agree with that statement. Today our Electronic Health Records are controlled either by companies or governments. Which you think is better is largely defined by your political view, but we can all agree that Electronic Health Records should be controlled by the user. Self sovereign identity on the Blockchain could enable that. Today that is in the realm of tech geeks, far removed from practical use by mainstream users. That is the normal way that disruptive innovation comes to market, so park your skepticism at the door and stay tuned.

This is Part Two (Chapter 11) of The Blockchain Economy serialised book. Part Two is where we focus on real world use cases. Today is the massive healthcare market (over 20% of GDP in America alone). For the index/table of contents of The Blockchain Economy book please click here.
• why the current Electronic Health Records business is broken
• why self sovereign identity on the Blockchain could be the answer
• what would this future look like
• who is positioning in this market?
• four factors that are holding up adoption
• where we are likely to see early adopters
• what role will governments take?
• in which country will this happen first?

Why the current Electronic Health Records business is broken

There is a reason why we call the consumer/customer in the healthcare system a patient. You have to be very patient to endure filling in yet one more form or getting your records when you need to switch provider.
The current system is geared to the provider - if they control patient records, patients will have lot of friction when moving (and exit friction reduces churn and improves profit). This is a classically broken market, where the consumer/customer wants a new solution but needs a great entrepreneur to use disruptive technology to bring it to them in a way that is totally simple. Fortunately, the disruptive technology is available.

Why self sovereign identity on the Blockchain could be the answer

Your Electronic Health Record is valuable. Like money. In the Bitcoin era many have become accustomed to the idea that money is simply data and that data should be controlled by private keys (rather than entrusted to institutions). It is then a short step to using that same technology to control other valuable data that you own - such as your Electronic Health Record. This is critical to the evolution of this market, because an entrepreneur does not need to reinvent any wheels, they can use a lot of the technology used to safeguard cryptocurrency data.

What would this future might look like

You go to a new medical provider. You select your Electronic Health Record in a wallet on your phone. You select the provider name. The system has that provider categorised (such as general practitioner, cardiologist, oncologist). It suggests what parts of the Electronic Health Record they should be entitled to receive - not necessarily all of it. When you send that data, the agreement they sign is that all input that they make to that Electronic Health Record will be sent back to your service provider (with clarity on who owns the data).

Who is positioning in this market?

There are many different types of venture that are positioning in this market:
• Wallet providers that offer to manage and store your data. They may not be healthcare focussed. They may view healthcare as simply one vertical market. Their core competence is combining safety and user control (decentralised under private key control) with a mobile user experience as easy as social media.
• Healthcare incumbents (eg Providers and Insurers). They have the market today and abide by current regulations such as HIPAA. The problem is gaining trust from users and, even more difficult, gaining trust of other incumbents (who would prefer a neutral non-competitive venture).
• Healthcare disrupters who are using Blockchain but are 100% focussed on healthcare. The problem they have is raising enough capital to go after a conservative, slow moving market with big entrenched incumbents.
• Big Tech moving into Healthcare. Both Google and Apple are making big moves. They have no problem with being disruptive, as they not invested in the current way of doing things (no innovators dilemma) and have plenty of capital to go after this big broken market. Their big problem is that they are conflicted on privacy (which is a mandatory feature for Electronic Health Records).

Four factors that are holding up adoption
1. Incumbent opposition. Blockchain based user control is not in the interest of the providers and insurers.
2. Political uncertainty. It is hard to make meaningful change happen when healthcare is such a political football.
3. Big Tech is conflicted on privacy.
4. The age issue.Typically Millenials are early adopters. The problem for this market is that most Millenials are too young and healthy to care much about healthcare.
Where we are likely to see early adopters

The market needs early adopters who sit at the intersection of this venn:
A. Crypto savvy, so using private keys in a wallet feels as easy as sending an e-mail.
B. An anti-establishment bias, so they tend not to trust a big institution holding their data.
A and B often go together. But these alone might not be enough to motivate somebody to take action.
C. Some health condition or other situation that makes them understand the value of having control over their health records. This is what drives them to action.

What role will governments take?

This is where it gets political. We trust governments with data such as passports, driving licenses and social security. If the government has a national health service (eg UK) or a single payer system (many countries) the government maybe trusted as the data manager, as long as the rules and tech are open source and transparent.

In which country will this happen first?

I don't know, but I do know that whichever country does this will increase the health and wealth of their citizens.
A lot of current activity is in UK. A report published in 2016 by the UK’s chief scientific advisor, Sir Mark Walport, on blockchain in the NHS said;
“In the NHS, the technology offers the potential to improve health care by improving and authenticating the delivery of services and by sharing records securely, according to exact rules.”
Google’s British AI division, DeepMind, has announced the launch of a blockchain like ledger for managing healthcare data.
The action in UK centers around Clinical Trials, which is a special use case with Electronic Health Records.

Clinical Trials is a special use case

The UK is where global pharma giants Pfizer, Amgen and Sanofi are exploring blockchain’s application in candidate recruitment for clinical trials.

This has potential because it is win/win for patients and Pharma:
- Patients get access to more trials if they enter their data. This can be life-saving, so motivation is high.
- Pharma get a more efficient process to find, recruit and retain patients in trials.
The idea is to be a match-maker, using AI to crunch the data, so that patients are matched to the right trials.
In some services, patients control the data. In others, it is the companies running the trials who control the data.
Trust is an issue in the latter case. Sometimes the patient has to trust a big Pharma company not to misuse the data. There are laws to protect patients and the patient’s motivation to get life-saving drugs is high, so this unlikely to be a showstopper issue.

Bernard Lunn
Founding Partner, Daily Fintech Advisers
www.dailyfintech.com

Bernard Lunn is a serial entrepreneur, senior executive, adviser and a strategic dealmaker. He worked in Fintech before it was called that with startups, growth stage and turnaround ventures (incl. Misys, Temenos, IMS, ITRS). He has lived and worked in America, India, UK & Switzerland and is adept at cross border deals.

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