Blockchain in Life Sciences for Patient Engagement

Jayanthi Repalli, PhD

Feb 20, 2017

This presentation explores Blockchain’s potential role in patient engagement solutions, and discusses how it might improve existing solutions and patient outcomes.

© All rights reserved 2

What is patient engagement?While the definitions for patient engagement differ, they all converge to the purpose – that active patient engagement improves patients outcomes.

Our patients want more than medicine. They want to know that their medicines have been developed with their needs in mind, and that we are willing to share health and disease information that can help them and their doctors make the best decisions.

-Pfizerhttps://www.pfizer.com/files/investors/financial_reports/annual_reports/2015/patient-engagement.htm

Patient engagement is providers and patients working together to improve health.

-HIMSShttp://www.himss.org/library/patient-engagement-toolkit

Patient engagement is about personalized medicine. Patients actively working with their healthcare providers to set goals, stay healthy, manage conditions and follow plans to maintain their own health and wellness.

-Vigyanixhttps://www.pfizer.com/files/investors/financial_reports/annual_reports/2015/patient-engagement.htm

Patient engagement is used to describe everything from patient portals to social media strategies, from tracking vitals with wearables to patients actively participating in their own health and wellness.

-Healthcare IT Newshttp://www.healthcareitnews.com/news/what-does-patient-engagement-really-mean

 Patient engagement is a broader concept that combines patient activation with interventions designed to increase activation and promote positive patient behavior, such as obtaining preventive care or exercising regularly.

-Health Policy Briefshttp://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=86

© All rights reserved 3

What’s in it for

everyone?

• Better informed and connected• Responsible and decision maker• Improved disease management• Effective adverse effects

management• Increased satisfaction

• Personalized medicine• Preventive medicine• Real time patient monitoring• Better outcomes

Providers

Pharma

Patients

Each party of healthcare ecosystem has tangible and strategic benefits from improved patient engagement.

Why is it important?

• Better value proposition• Increased negotiation power with payers• Improved patient compliance• Better outcomes• New relevant products and services

© All rights reserved 4

Trends impacting patient engagement

• Mobile devices usage such as tablets and smart phones have grown 4X in the last 5 years.

• Wearable technologies have evolved and able to offer insights in real time.

• The computing power has grown exponentially, which enable gathering and analyzing big data.

• An aging population is growing and requiring new healthcare and home care models, which span beyond four walls of provider facilities including supporting services and insurance models.

• Analytics capabilities have advanced significantly – able to perform predictive and prescriptive analytics focused around patients.

• Patients want access to their health data on demand.

Patient expectations and new technology trends such as wearables, analytics and IoT are driving new business models and patient centered engagement solutions.

The wearable technology market is expected to reach to $51.6B by 2022 with CAGR of 15.51%.http://www.marketsandmarkets.com/PressReleases/wearable-electronics.asp

$173BGlobal healthcare IoT market is expected to grow at CAGR of 38%, to $173B by 2020.https://vigyanix.com/blog/iot-and-patient-engagement-how-iot-is-defining-three-es-of-engagement-infographic/

94%American social media users are willing to share their health data to help doctors improve care.https://nam.edu/wp-content/uploads/2015/06/VSRT-PatientDataSharing.pdf

$51.6B

$29.5 BAdvanced analytics market is expected to reach to $29.5B in 2019 with CAGR of 33.2%. http://www.marketsandmarkets.com/PressReleases/advanced-analytics.asp

© All rights reserved 5

Patient engagement solutions

Portals

Apps

Wearables

Emails

Texting

Web interactive programs

Patient engagement solutions provide personalized insights to patients on a variety of media – portals, apps, emails, and wearables – through synthesizing and analyzing data from a variety of sources by using advanced analytics.

Providers

Public domain

Payers

Pharmaceuticals

Pharmacies

Patients

Big Data &

Analytics

Storage &

Process

Data sources and various parties Patient engagement tools and platforms

Academia

Sources: http://www.mtbeurope.info/content/ft1501001.htm, http://catalyst.nejm.org/patient-engagement-technology-tools-gain-support/

© All rights reserved 6

Patient journey and data streams

Patient feels discomfort and notices some symptoms; and searches online for relevant information.

Patient searches online and talks with friends, family and decides what treatment to take based on life style and goals.

Patient starts on treatment and ongoing changes are tracked with doctors office visits and also mobile devices such as wearables, apps, etc.

Patient visits a doctor. Doctor collects symptoms and other information and creates a health record.

Doctor diagnoses the disease using lab results, historical information, and symptoms and recommends potential treatment options.• Advocacy groups and patient

communities • Social media• Research data

• Claims data

• Environmental data

• Public Health data

• Pathology and laboratory test results

• Genetic and genomic data

• Electronic medical record• Electronic health record

Providers/patients submit claims to payers such as insurance, Medicaid etc.

• Mobile and tele health data• Automated sensors and smart devices• Digital pills

1 2 3

456

Many types of data are generated throughout the patient journey and is utilized by all parties across healthcare ecosystem. All these data streams are commonly collected, stored, and processed using traditional database or cloud storage systems.

• Advocacy groups and patient communities

• Social media• Research data• Public health data

Note: Text in grey color indicates data streams at each step of patient journey. They are not exhaustive. Source: http://www.mtbeurope.info/content/ft1501001.htm

Providers

Public domain

Payers

Pharma Pharmacies

Patients

Academic

Storage & ProcessBig Data & Analytics

© All rights reserved

Drawbacks of existing solutions

7

Existing patient engagement solutions employ the state of the art database and cloud technologies, processes and tools. However, security, data integrity, intermediation, and accessibility are still concerns.

SecurityCyber security is one of the primary concern, which could arise from many avenues such as data breach, unauthorized access, device hacking, etc.

Authorization and AccessMost of the solutions use cloud infrastructure for which tracking of authentication, users accessibility, and data locations is still a challenge. Unauthorized data access into the data stream is a growing concern.

AnalyticsAutomatic analytics is not typically part of the solutions. Data streams are not synthesized or streamlined to generate patient focused insights, which requires additional effort from providers and users.

Big Data or Right DataThe data generated by IoT devices is exponentially proliferating, but, big data is often underutilized, misutilized, and is not correlated to the patient focused solutions.

Interoperability and IntegrityCurrent solutions let the data streams collect and store in cloud, however, they do not ensure interoperability and data integrity across wide variety of IoT devices. The streams may not have similar structures and are not readily usable for further analytics without additional processing efforts.

Mobile appsWhile mobile apps are tremendously increasing, the quality, accuracy, and relevancy is yet to be improved, and so as the data from these apps. Also, the most of the apps are not well designed for clinical applications.

Controls and IntermediationUser doesn’t have a direct control over one’s own data. One needs to depend on this intermediary or service provider of storage systems for any of activities such as access, analytics, storage, data breach protocols, etc.

Sources: https://www.healthit.gov/sites/default/files/11-74-ablockchainforhealthcare.pdfhttps://www.healthit.gov/sites/default/files/6-42-use_of_blockchain_to_develop_proms.pdf

© All rights reserved 8

Blockchain solutions for patient engagementBlockchain solves some of the pressing challenges and makes health data available to all parties in real time and improves patient engagement.

Decentralized data offers no single point of failure

Cryptography keys and digital signatures ensure security

Information is ubiquitous, transparent to all parties in the network

Transactions are irreversible once verified or accepted

Transactions are verified in near real time

Peer-to-peer network, eliminates intermediaries

Traditional solutions

Blockchain solutions

Patient goes to a lab and gets some

tests performed

Results get distributed to everyone (doctors, patients

etc.) in the Blockchain (based on preferences)

Historical results are automatically populated and

available for the review

Patient goes to a lab and gets some tests performed

Day 1 Doctors get test results, but doesn’t have access to

historical data in real time as they are distributed in

different systems

Doctor manages to obtain and analyze data from different systems; and gets in touch with patient and share the

data

Day4Day2

Day1

Day2

Day2

• Patients have access to the lab results, historical data, and necessary insights, which help them in having meaningful discussions with doctors.

• 82.7% of patients (who had received an HbA1c or abnormal Pap) expressed that availability of lab results helped them to prepare the communication and increased access with providers. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919031/

Lab test results use case

© All rights reserved

Semi or fully private Blockchains

9

Semi- and fully-private Blockchains address concerns in privacy and access control of public Blockchains.

• Closed access: Nodes are private and only accessible to the participants of the network, which ensure compliance and security.

• Control and Access: Patient controls access and permissions to authorized users and designators in real time. Also, partial accesses could be granted (e.g., access to a provider to a particular portion of health record in a particular time frame).

• Custom consensus engine: As opposed to public chains, rules can be customized by participators for the participants.

• Transparency: patient would be able to monitor the flow of all data and its usability – data acquisition, storage, processing, queries, and analysis.

• Better Treatment Outcomes: Patient would be able to create a collaboration community of providers, advocates, family, and friends to keep them informed, receive better ideas, and manage disease effectively.

• Decentralized system: Decentralized data storage will prevent an adversary from posing threat to data or corrupt the network. Even if the adversary breaches network, the publicly shared indices and hash points and all the information would be encrypted, which ensures security.

Security: • Public Blockchains lack data privacy and present security

concerns for healthcare applications.

Scalability: • Limitations on block size and transactions present scalability

issues.

Large Size Data: • Replicating data across all nodes is not feasible for healthcare

applications; storing everyone’s data across all nodes may present enormous storage issues.

Access: • Permission less networks concept will present additional

unauthorized access or unintended usage of the data.

Limitations of public Blockchain Advantages of semi or fully private Blockchain

© All rights reserved 10

Blockchain• Consists a complete

indexed history, patient’s unique identifier, and an encrypted link to health record.

• Each record is time stamped.

• All patient records (historical) are together and stay with the patient.

• Patient has control over the permissions on whom to share with.

Example of a private Blockchain model for patient data management

A private Blockchain consists the parties of user’s choice, and a data lake that stores all the relevant data – time stamped and permanently. The metadata enables analytics and patient focused insights.

Data lake• Stores different types of health

data (e.g., images and lab reports).

• Consists structured and unstructured data

• Information is encrypted and digitally signed.

Healthcare players

Adds any medical record (e.g., prescription, pathology report) to patient’s block chain, who has a unique identifier and notifies patient.

Patient

Adds medical data to blockchain with digital signatures from IoT devices (e.g., mobile apps, wearables).

Index• An index is generated for each

health record or data stream.• Each index contains metadata

about the health record, fields, unique identifier and link to original data record location.

Analytics• Metadata is readily

available for queries.• Data could be mined for

patient focused insights.• Structured and

unstructured data analytics could be summoned.

• AI and machine learning could be employed.

Source: https://www.healthit.gov/sites/default/files/11-74-ablockchainforhealthcare.pdf

© All rights reserved 11

Closing remarks

• Patient engagement services play key role in enabling new business capabilities for life sciences.

• Patient relevant data is dispersed, tremendous, and overwhelming.

• Many organizations looking for solutions for effective data management and insights generation.

• Private blockchain could enable some of the essential capabilities including controlled access, real time data availability, security, and patient focused insights.

• This new technology enables seamless data integration without compromising security and confidentiality, which can readily provide data for predicative modeling and insight generation, which will improve patient engagement and outcomes.

• Though the full potential yet to be determined and proved, it opens an avenue for a new set of creative solutions.

© All rights reserved 12

Thank You!Please feel free to use content from this presentation. But, credit

the author appropriately when used.