Copyright Scottsdale Institute All Rights Reserved.

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1 Copyright Scottsdale Institute All Rights Reserved. No part of this document may be reproduced or shared with anyone outside of your organization without prior written consent from the author(s). You may contact us at / (763)

2 St. Luke s Blockchain Innovation Project Blockchain Introduction

3 Introductions Chad Brisendine VP and Chief Information Officer St. Luke s University Health Network Chad.Brisendine@sluhn.org Rob Faix VP Technology Services Impact Advisors Rob.Faix@impact-advisors.com 2

4 Imagine a transaction framework that is Secure Immutable Decentralized Single unbroken ledger of transactions 3

5 Blockchain A Brief History Bitcoin: A Peer-to-Peer Electronic Cash System The blockchain is a fundamental architecture, originally proposed in 2008, during the height of the financial crisis, to establish a new model for financial transactions 4

6 Blockchain Beyond Bitcoin Financial Manufacturing Healthcare Retail 5

7 Technology behind Blockchains (and disclaimer) 1. What is a hash value & how does it relate to the blockchain? 2. How does the blockchain function? 3. What does a blockchain transaction look like? * Oversimplified technical discussion is about to begin 6

8 Hash Value The Fundamental Element Data of any length Lkl9kjsdf r0nf vnweo30dd Fdj sld 48? Converted to a fixed length hash value #A #B #C #D Hash values are combined to form a new hash value Hash #AB Hash #CD Combined has values are grouped to form a Block with the addition of the previous block s hash value, the timestamp, and an arbitrary string which is concatenated with the hash of the block, call the Nonce. (Block 10#) + (#ABCD) + (Timestamp) + (Nonce) Block 11 Block 10 Block 9 Block 8 7

9 How Does a Blockchain Work? (Block 10#) + (#ABCD) + (Timestamp) + (Nonce) Block 11 Block 10 Block 9 Block 8 Block 7 Block 6 Block 5 Block 4 Block 3 Block 2 Block 1 Consensus ensures that the shared ledgers are exact copies, and lowers the risk of fraudulent transactions, because tampering would have to occur across many places at exactly the same time. Cryptographic hashes, such as the SHA256 computational algorithm, ensure that any alteration to transaction input even the most minuscule change results in a different hash value being computed, which indicates potentially compromised transaction input. Digital signatures ensure that transactions originated from senders (signed with private keys) and not imposters. 8

10 How Does the Blockchain Work? 1 Send $ to Sam Transaction request is added to other transactions A new block is shared with participating nodes for validation Block 10 Block 9 First node to solve the hash value shares the results for validation by other participating nodes Sam Receives $100 Participating nodes confirm the solved hash value against their ledger The new block is added to the blockchain with all transactions being approved Transaction is completed 9

11 Considerations for Blockchain Benefits Distributed Ownership Increased Speed Increased Security Reduced Fraud Reduced Risk Barriers Solution Immaturity Proof of Concepts Cost Effectiveness Lack of Regulation Legal Enforcement 10

12 Five Blockchain Use Cases to Watch 1. Patient access to medical records 2. Interoperability between provider organizations 3. Supply chain management 4. Claims processing and fraud prevention 5. Clinical trial integrity Note: for detailed examples of potential blockchain use cases, see the winners of ONC s Blockchain Challenge: 11

13 Blockchain s potential level of impact on use case Blockchain Use Case #1: Patient access to information Potential role of blockchain technology: Supports transition to a complete patient-centric longitudinal record Patient-centric data control Patient is responsible for granting access to specific providers Blockchain Use Case #1: Patient access to information Considerations / dependencies: Identity management Represents significant shift of responsibility and control Readiness of patients to manage permissions? Potential timeframe 12

14 Blockchain s potential level of impact on use case Blockchain Use Case #2: Interoperability between provider organizations Potential role of blockchain technology: Enable all participating providers to have access to same longitudinal patient information Standard set of data stored on chain ; links to larger files off chain Access via APIs Considerations / dependencies: Participation in networks Consensus of stakeholders / involvement from federal government Standard data sets, etc. Enterprise EHR APIs still evolving Blockchain Use Case #2: Interoperability Potential timeframe 13

15 Blockchain s potential level of impact on use case Blockchain Use Case #3: Supply chain management Potential role of blockchain technology: Drive transparency Easier to track products throughout cycle since all transactions are immutable and time-stamped Ex., monitoring and verifying provenance of pharmaceutical drugs Considerations / dependencies: Management of permissions (manufacturer vs. wholesaler vs. provider, etc.) Stakeholder participation and engagement Blockchain Use Case #3: Supply chain management Potential timeframe 14

16 Blockchain s potential level of impact on use case Blockchain Use Case #4: Claims processing and fraud prevention Potential role of blockchain technology: Smart contracts (rules / logic) for more automated claims processing Fewer intermediaries Fewer delays related to incomplete or inaccurate claims information Potential to reduce fraud due to immutable, time-stamped ledger Blockchain Use Case #4: Claims processing Considerations / dependencies: Provider and payer participation Complexity (and variance) of contracts between payers and providers Potential timeframe 15

17 Blockchain s potential level of impact on use case Blockchain Use Case #5: Clinical trial integrity Potential role of blockchain technology: Track complete (time-stamped) history of clinical trial, protocols, and results Potential to: Reduce outcome switching Discourage selective reporting Foster greater collaboration Considerations / dependencies: Significant regulation and enforcement Stakeholder participation (potentially on global scale) Consensus / agreement on how to approach ownership of data Blockchain Use Case #5: Clinical trial integrity Potential timeframe 16

18 Healthcare Shark Tank! St. Luke s Blockchain POC 17

19 Potential Blockchain Applications in Healthcare Project Plan Consider what applications could be candidates for a Healthcare Blockchain POC 18

20 Potential Blockchain Applications in Healthcare Use Case Review Things to Consider How could the blockchain benefit your area? Where are there intermediators who could be replaced? Where do you need more? Trust Transparency Irrefutability Immutability Interoperability/Sharing Security/COOP Auditability 19

21 Potential Blockchain Applications in Healthcare Medical Internet of Things Device audits to ensure proper initiation, configuration, and operation Confirmation of device and patient identities Ensure devices are secure/uncompromised Ensure accuracy of results Device integrity Data integrity Detecting fraud and abuse 20

22 Potential Blockchain Applications in Healthcare Identity Chance to do the first global patient Unique Identifier (UID) Use the deep well of patient data to assist with identity registration/authentication/assertion for healthcare and other purposes Use the blockchain to secure these identities to enable all sorts of other functions Remote care Patient centric control of data 21

23 Potential Blockchain Applications in Healthcare Identity Patient-Centric Data Management Encrypted Medical Data Request for Record Audit Hash 360ofme Identity Dashboard Blockchain 360ofMe stores hash of all data movement within a blockchain 22

24 St. Luke s POC Goals POC Chosen by end of May Business relationships set by end of June POC construction begins in July POC complete by the end of 2017 Evaluate move to prototype for

25 Questions? Thank you