Antidote: Pharma cos want access to your medical history

Health is indeed your real wealth. In this era, driven by technology, it will not be a surprise if one can sit back at home and consult an expert doctor and diagnose, cure a major disease like cancer. In this developing field, what you will simply require is a record of your medical data on blockchain (a software platform) that needs to be shared with specific persons of your choice, when required. This would also help drug manufacturers realise whether a specific drug of theirs is better for a disease when compared to others.

Blockchain is a decentralised, democratised yet secure data management system that stores clinical data in blocks which will be accessible to all authorised users. It stores all the relevant data relating to a person’s medical history, treatment and diagnosis. 

The patient databases are always in sync and any interaction with the blockchain will alert all participants, including patients, doctors, health insurance companies, researchers etc, for verification before adding to the log. The blockchain solution ensures data never leaves the originator, instead, a data signature of that information is transferred and stored. 

Real-time data, medicine and technology have been making innumerable promises to mankind, especially on how this combination can revolutionise health-care. Nowadays, we are sharing our personal data to various stakeholders and there will be a better future for health care if drug makers make use of real-time data in combination with disruptive technologies such as blockchain and Artificial intelligence. Yet there are no single or multiple sources of data available in case of emergencies and doctors have no way to obtain the vital medical history unless a patient provides them.

Imagine a situation where even a small clinic can get a patient’s vital records. This can be a lifesaver. It is a necessity that each person should have a medical record. Even drugmakers require people’s medical records to understand how their medicines work in real time as the traditional clinical trials have intrinsic limitations. 

In traditional clinical trials, since there are strict patient inclusion and exclusion criteria, it studies only the effect of a medicine in a homogenous set of people. Patients enrolled in these trials are closely monitored. Patients with more than one disease will not be able to participate in clinical trials even though in clinical practice co-morbidity diseases are a regular phenomenon.

Real-time clinical trials are failing to reflect on circumstances in life that play a vital role in healthcare due to lack of data. Even though social media such as Google, Facebook, Twitter etc. have repositories of our data, there is no social media in the world of medicine. 

As the world is debating on privacy of data, real-time data in medicine which includes age, gender, historic health record, details of sexually transmitted diseases, among others, is Personally Identifiable Information (PII) and cannot be shared publicly. 

Furthermore, adding to the complications, there are different approaches to data privacy and data access in different parts of the world. Apart from privacy, to harvest the full potential of Real World Evidence (RWE) several obstacles must be addressed, including inconsistent adoption of Electronic Medical Records in the medical community, ensuring the quality of data sourced, stored and restrictions on access to relevant data.

With increasing amount of sensitive data and transactions arising from a growing number of stakeholders in the healthcare industry, blockchain technology which is the backbone of bitcoin is gaining steady popularity due to its ability to maintain data. Bitcoin may be overhyped but the underlying technology when put to use is of value.

Blockchain relies on established cryptographic techniques. The blockchain public or private key encryption scheme constructs identity permission layers to allow patients to share specific details with specific health care organisations as required. Thus, it reduces the vulnerabilities of storing PII and allows data access time limits to be introduced by patients.

Health industry in India lacks seamless information exchange between hospitals, labs and patients. The concept of interoperability is practically non-existent here and there is no ecosystem to provide trust, security and data exchange between all stakeholders. Due to extensive possibilities, the healthcare industry certainly wants to embrace blockchain. A study from IBM found that 16% of the survey participants from healthcare industry have a solid plan to implement blockchain in a year and by 2020 it is expected that a 56% of the surveyed participants will wish to implement blockchain technology.

Giving people more control over their medical records could yield immediate health benefits swiftly. This is facilitated to an extent that blockchain allows users to insert information into their health records which includes data from wearable electronic devices such as Fitbits and also reports, X-rays, CT Scans or Mammograms.

The ultimate goal of many players, who are securing real-time data, is to train AI algorithms on the data they solicit using blockchain. With this real-time data, pharma companies can put a check on counterfeit drugs that currently cost around Rs 4,000 crore to the industry. 

Invoicing of Prescriptions- Patients could forward to their chosen pharmacy a prescription that is digitally issued by a doctor, and the pharmacy would then provide and bill for the drug. The decentralised validation of these transactions by all network users would prevent billing fraud.

Additionally, using smart contracts can ensure that clinical trials will proceed in the correct chronological order, leading to more reliability, security and transparency. 

Leading drug maker Novartis is using real data for oncology, heart failure treatment and treatment of age-related macular degeneration. They are using all   patient data related to heart failure biomarker, genetics and proteomics to find additional drug targets for heart failure, thereby linking data that is coming out of the clinic, back to the lab, for further drug discovery.

In another instance, MedRec by researchers at MIT, is a prototype using blockchain. It demonstrates a solution tuned to the needs of patients, the treatment community, and medical researchers. 

Recently five health-care organisations United Healthcare, Humana, MultiPlan, Quest Diagnostics, Optum have launched a pilot programme to see if blockchain technology can keep health plan provider directories up to date.

Even though, blockchain technology is finding use in giving medicines with precision, patient care and outcome research, the biggest challenges in its implementation for data management is engaging regulators early on in the process and making sure they’re fully supportive and in line with the goals of deploying it.

(Inputs from Ms. Kalpana B, Head- Robotics and Cognitive Automation KPMG India; Dr. Subodh Deshmukh, Head Global Drug Development, Novartis India; Kashyap Kompella, founder of Blockchain, India.)