Adoption of distributed ledger technology will benefit patients
and providers
Blockchain is more than just a technology that allows us to do what we already do better,
faster and cheaper. This peer-to-peer new technology has the potential to create a more
inclusive economy, where patients can benefit from health data ownership.
One reason people don’t understand Blockchain
is because we describe it rather than explain
it. When we say Blockchain is a distributed
ledger to someone who is not familiar with appendonly
databases, this is meaningless. It’s like saying
water is H2O without knowing the table of elements.
In order to explain, not describe something, you must
talk about the why or the intentionality behind it. If
you say that water is the source of life, it sustains us,
it makes more sense, it becomes meaningful.
So what is Blockchain? It is a distributed ledger,
but the intention behind it is to obviate the need
for a “trustful’ intermediary. With Blockchain through
encryption, transparency, immutability and verifiability
of data you can directly rely on the truthfulness
of information through a distributed trust network.
The human-driven approach
The potential of Blockchain goes hand-in-hand with
the human-driven approach or holacracy. Holacracy
is a type of self-governance, which not only follows a
mission but is also evidence-based, data-driven and
situational-aware. You don’t just see holacracy in
start-up or entrepreneurial worlds; you see it in agile
corporations and in the military. When battle ensues,
military units take initiatives within their frameworks
and start to self organise in order to complete the
mission. This is very different from political representative
democracy where we freely elect someone else
to do our work. In fact, what we have seen is that the
representatives we elect can collude, do things that
are counter to ‘the mission’ they were elected for and
can be self-serving. In comparison to other forms of governance, holacracy is selfless and fearless in the
way it achieves objectives.
The whole idea of Blockchain is based on not
needing to rely on a privileged minority operating
behind closed doors. This doesn’t mean this is the age
of distrust, but rather trust has shifted into a new form
of distributed trust. Instead of trust flowing upwards
to institutions, experts, authorities and regulators, it
now flows horizontally to peers, friends, colleagues
and fellow users. This distributed model creates a
decentralised ecosystem that is attack-resistant,
collusion-resistant and censorship-resistant, when
compared to centralised organisations, institutions
and governments.
Empowering patients with Blockchain
If you take the attributes of censorship and collusion
resistance and translate them into healthcare, you can
understand it will bring a few important changes in
how we practice healthcare. First, you can make sure
that health data is not only secure but also private,
and that the ownership of that data is controlled by
the patient (aka self-sovereign).
Second, if you look at monetary transactions, it
can disintermediate all kinds of third parties that lack
value and create unnecessary friction that currently
make the healthcare experience less pleasurable
and increase costs. Third, and most importantly is
that through behavioural economics using monetary
(rewards) and non-monetary (reputation) incentives,
Blockchain-based solutions can transformation
people from being passive health service consumers
into health producers.
What makes Blockchain even more interesting is
that what we can add to value-based or outcomebased
care the opportunity to generate wealth
through the use of tokens (utility tokens) or digitised
assets (security tokens). What that means in
practical terms is, today I wear a fitbit and it gives
me information that stimulates me to be a health
producer. But the data that this fitbit generates
doesn’t belong to me. It belongs to a company that
can sell it without my consent and they will make
money on it while I won’t. That’s not fair. Blockchain
technology creates a more inclusive economy where if
a company makes $10, 000, for example, on my information,
I can get half of it and I can earn it through
a utility token. In addition, through the use of security
tokens, I can actually have fractional ownership
of fitbit stock, which will incentivise me even more to
use the platform. Blockchain really enables a human driven
approach in the sense that I can be the owner
and earner of my information.
Blockchain adoption is a question of
time.
Blockchain will be more important for people who
need it the most. In the western world, a lot of people
sacrifice their privacy and their health and, to some
extent, their wealth for the convenience and comfort
of their lives. But the more you are existentially threatened
and don’t have the luxury to give up that health
and wealth, the more you seek tools that empower
you directly to be the master of your data. I can argue
that I am too comfortable in my life to be bothered,
but when will I be bothered? People will start to care
when they understand the demands on their health,
wealth and environment are unsustainable.
I also think it’s a generational matter. Many people
don’t understand what self-sovereignty is in the sense
they’re are so used to living in a centralised system
that is opaque and full of friction, they sacrifice their
sovereignty for convenience or because they don’t
believe a centralised world can be changed.
However, my 12-year-old daughter and her generation
learn digital citizenry and what an interconnected
interdependent world means. From their
perspective, Generation Zers interact through nonmonetary
incentives leveraging their contributions to
society through reputation (think YouTube or social
media) as opposed to money. The younger generation
doesn’t expect parents or governments to help. They
already practice holacracy by creating chat groups
where they directly ask how to solve problems and understand that bad actors who badly impact the
community will be expunged because they make the
whole system unviable.
What’s in it for healthcare?
What Blockchain does it is it changes the equation
of value. Value today is usually thought of as quality
divided by cost (V= Q/C). So if something has high
quality and low cost, it has high value. How does this
equation work in healthcare? Mostly by lowering the
denominator, in other words doing more for less.
However excessive cost suppression (like not covering
preventative care) has actually caused healthcare to
be more expensive and people are dying younger and
younger. So the current healthcare system offers a
low quality proposition.
What Blockchain does is it transforms the value
equation into what you are willing to give divided by
what you want to get (V= give/get). Using this equation,
a patient who is not willing give up unhealthy
behaviours (smoking, drinking, sedentary life), offers
a zero-value proposition. A drug company that offers
cost-prohibitive treatments and is not willing to give
up profit has a zero-value proposition. A government
that wants all of its citizens to be healthy but isn’t
willing to provide affordable care offers a zero-value
value proposition. The Blockchain economy doesn't
want everything cheap and easy, but is about creating
a sustainable and resilient business-ecosystem,
where all stakeholders share a common mission,
taxonomy and sense of purpose.
Key points
- Blockchain is a foundational technology that allows implementation of holacratic
- human-drive approach.
- Trust is embedded in the technology, through decentralisation
- Blockchain can make health records self-sovereign
- Patients will own their health data and its monetisation, incentivising long-term healthy behaviors
- The decentralised society Blockchain creates is already accepted by Generation Z