Re-posted from @hashedhealth on Medium

Welcome to 2019!

As we think about our community’s 2019 goals and objectives in the healthcare blockchain space, I find it helps to reflect on the important and influential news of 2018. In this list, I have done my best to include projects and announcements that I consider real or indicative of a signal and not just noise. That does not mean there isn’t marketing and spin behind them. These announcements are from notable companies, but often have little detail. Several of them took me by surprise. It can be hard to tell how real they are. 2019 will tell us what kind of results are delivered from the strategies outlined in these events and announcements.

Upon reviewing this list, I noticed a few things:

• Maturation: We are still early in the evolution of blockchain technology in healthcare. The 2018 highlights offer a more mature view of blockchain / DLT success than what we have seen in the past. The HHS, Procredex, Synaptic, and Change announcements below all show various signs of strength and maturity. Much of this maturity is a result of non-technical achievements.
• Pivots, Acquisitions, and Wind-Downs: This maturity is also surfacing in announcements around acquisitions (Pokitdok), pivots (Gem pivots away from healthcare), and business model crisis (ICOs losing significant value). I enter 2019 realizing that many of the people I respect and who inspired me during my early days in the space are gone. Ted Tanner’s Pokitdok was acquired by Change. Micah Winkelspecht and Gem are now a crypto wallet company. Diego Espinoza is focused on fintech. It’s a reminder that innovation in healthcare is really hard work.
• B2B Trend: Most all of the success stories going in to 2019 are built upon DLT, not open blockchains. All of them look like B2B use cases.
• Health Systems Surprises: Health systems are generally considered to be fast followers at best. If they have $5 to invest, they typically put that money to use in a way that immediately and directly supports patient care (or an EMR implementation). However, our list includes three health systems who have stepped up with big announcements in 2018, as well as large name-brand health systems getting involved with more mature networks such as ProCredEx (credentialing) and Synaptic (directories).
• Provider Identity: Perhaps the two most mature networks of 2018 are ProCredEx and Synaptic. Both projects boast impressive product, business model and, perhaps most importantly, governance signs of life. Provider identity seems to be the drawing a lot of attention as the low hanging fruit.
• What 2018 Says about 2019: 2018 was not the year where we found out the true value of blockchain / DLT in healthcare, but at this point we do have an understanding of what use cases will get us there. The results of the efforts on this list will be told in 2019. If these results are positive, I expect enterprise interest in blockchain to spike to new levels in 2019 / 2020 as all the companies and investors who took a ‘wait and see’ approach jump in.

Here are my top 15 healthcare blockchain new highlights of 2018 (in no particular order).

1. Jose Arrieta & Oki Mek Become the HHS Blockchain Dream Team: Receive Federal Authority to Operate (ATO)

In December 2018 Jose Arrieta and Oki Mek received the first blockchain ATO (Authority to Operate) in the federal government. This announcement has made them like the Jordan and Pippen of the federal blockchain league.

While many others in the federal government and in the commercial space pilot and experiment, Arrieta’s team, with input from the Acquisition Workforce, has deployed a solution that improves access to a standard set of spend data in real-time and decentralizes the execution of logic from that data.

According to Arrieta, conservative estimates show HHS Accelerate having a measurable return on investment of over 800%. Those waiting for proof of value may have just found it.

This announcement proves that blockchain is being used to solve real problems in the government space. I expect Arrieta’s work to drive increased interest in blockchain solutions in the government space in 2019. This hard work has also created two of the federal government’s newest rockstars.

2. Change Healthcare Doubles Down on Blockchain / Acquires Pokitdok

Change Healthcare is the largest claims processor in the US. At the end of their 2018 fiscal year, they had processed nearly 14 billion transactions and $1.0 trillion in annual healthcare expenditures. They are a middleman with a unique perspective on the strengths and limitations of the current payment infrastructure in healthcare. They are also one of the earliest corporate adopters of blockchain technology in healthcare.

In 2017, they hired Emily Vaughn Bailey from Gem (who, in 2018, pivoted away from healthcare and their blockchain OS to being a crypto-wallet) to lead their blockchain strategy. In 2018, they doubled down on their blockchain position with a series of announcements.

First, in January 2018, Change announced the general availability of “the first enterprise-scale blockchain solution for healthcare.” Their solution, which is built on Fabric processes a daily payload of 50 million claim events and scales up to 550 transactions per second.

Then, in December 2018, Change announced they were acquiring Pokitdok who, under the leadership of Ted Tanner, was an early leader in the blockchain space.  From the press release it seems that Change is focused on the Pokitdok assets (API technologies, blockchain use case assets, network assets), rather than its talent. The combination of Pokidok’s API marketplace with Change’s legacy payment infrastructure could open the door to some excellent opportunities for Change.

3. Senator Bill Frist’s Distributed:Health 2018 Keynote

One signal of the maturation of the blockchain market were the companies on stage and in attendance at this year’s Distributed:Health conference. Distributed:Health is the premier healthcare blockchain conference in the world.  What began in 2016 as a relatively obscure conference of early thought-leaders has evolved in to a legit healthcare conference of over 700 people from around the globe.

The day one keynote speaker was former Senate Majority Leader Bill Frist (followed by an excellent panel with Michael Painter of The Robert Wood Johnson Foundation), who summarized his experience at Distributed:Health 18 and his thoughtful view of how the technology has matured in this Forbes article published in October.

4. Provider Data Management, Part 1: Procredex Announcement at HIMSS 2018

2018 was a year when the world discovered which would be the first use cases to prove the value of blockchain-inspired technologies in healthcare. After all the talk of ICOs, cryptocurrencies, and medical records on the blockchain, a series of use cases focusing on provider data management have surface as the low-hanging fruit.

Procredex was announced at HIMSS18 as a new solution to the old problem of physician credentialing. Using a distributed ledger to solve for the authenticity of verified provider credentials enables a new business model that the world has never seen before. In addition, a string of announcements introduced a network of health systems and health plans who are coming together to bring this product to market in 2019. Procredex seems to have found the sweet spot between the technical solution, a new business model, and the governance structure necessary to make the use case stand up in a meaningful way.

5. Provider Data Management, Part 2: Synaptic Announcement

Procredex is not the only provider data management use case to show viability. The Synaptic Alliance was announced in April 2018 as an inter-company data-sharing solution aimed at the problem of provider directory data. The Synaptic solution is similar to Procredex in that it deals with physician data, but instead of credentials, the Synaptic Alliance focuses on provider demographic data.

Like Procredex, Synaptic has an equally impressive consortium of healthcare enterprisese. Synaptic is an excellent example of a group of “competitive” organizations coming together under a common mission to solve an industry problem. Kyle Culver from Humana, Mike Jacobs from Optum, and the other founders of this project have been very thoughtful in their approach, especially in terms of governance objectives. Synaptic is definitely a project to watch in 2019.

6. Two Medical Records ICOs Announce Agreements with Major US Health Systems

In 2018, we saw a pair of brand name medical records announce that they were exploring medical records on the blockchain. What made these announcements even more interesting is that the agreements are with Initial Coin Offerings (ICOs) Medibloc out of South Korea, and MedicalChain which is based in the UK.

In June 2018, UK- based MedicalChain announced an agreement with Minnesota-based Mayo Clinic to explore storing patient data on a blockchain. At the time, blockchain thought-leader, Robert Miller, was at MedicalChain and is rumored to have brought the deal together. Miller has since left the organization to begin his own initiative, Honeycomb Health in New York. It is not clear what, if any, effect this will have on the working relationship with Mayo.

Then, in December, Mass General announced a partnership with Korean ICO MediBloc to explore the storage and sharing of PHI. Under this agreement, Mass General will “explore potentials of blockchain technology to provide secure solutions for health information exchange, integrate healthcare AI applications into the day-to-day clinical workflow, and support [a] data sharing and labeling platform for machine learning model development.”

These are two announcements I was not expecting, given a) the relative immaturity of blockchain technology for medical records storage; b) the unclear business model related to the medical records use case; c) questions around regulatory concerns with PHI on the blockchain; and d) the 2018 ICO landscape and the perceived risk around crypto-focused blockchain projects. It will be interesting to see whether these projects gain real momentum and publish results in 2019 or if these announcements fade.

7. Mount Sinai Places its Bet on Blockchain

Another big health system announcement came in July 2018 when Mount Sinai announced their Center for Biomedical Blockchain Research, which is being led by Joel Dudley (Executive Vice President of Precision Health at Mount Sinai, Mount Sinai Endowed Chair of Biomedical Data Science, Associate Professor of Genetics and Genomic Sciences, and Director of the Institute for Next Generation Healthcare) and Noah Zimmerman (Assistant Professor of Genetics & Genomic Sciences and Director of the Health Data and Design Innovation Center). Besides having extremely long professional titles, Dudley and Zimmerman will be leading academic evaluations of blockchain solutions, leading partnership and consulting opportunities with various companies, and building their own systems within Mount Sinai.

8. CDC + IBM EHR

One of the most popular topics at Distributed:Health in 2018 was specific to the opportunities for blockchain to help with the opioid crisis. In September, IBM and the CDC discussed this use case with Fast Company. The two companies are hopeful the technology can be used to track patient symptoms and treatments.

9. Amazon Rising

At times it seemed that Amazon was making healthcare technology news every week. Certainly, it was not all about blockchain, but it all seems to add up to a long-term healthcare strategy that includes blockchain-inspired technology. It is clear that Amazon sees a number of opportunities to capitalize on the chaotic, irrational marketplace that exists today. I think they are right.

Here are a few of the many Amazon headlines that caught my attention:

1. CBInsights Amazon in Healthcare Briefing: This was required reading at Hashed. Great research by Nikhil Krishnan and the CBInsights Team (who, by the way, did great work in 2018).
2. The Amazon, Berkshire, JPMorgan Health Venture
3. The Pillpack acquisition
4. EHR-focused machine learning designed to improve physician workflow.
5. Amazon announces their Quantum Ledger Database (QLD) a “fully managed ledger database that provides a transparent, immutable and cryptographically verifiable transaction log. Owned by a central trusted authority.”

These a few of the many interesting Amazon initiatives that set the stage for a lot more news in 2019 that will push healthcare to innovate faster.

10. Signal Stream Announcement at Distributed:Health

Distributed:Health has become the premier event where companies announce new products and initiatives. Over the years, healthcare’s leading companies including Change Healthcare, Hyperledger, Gem, Hashed Health, TIBCO, PokitDok and others. 2018 was no exception.

The most significant new product announcement at Distributed:Health 2018 was Signal Stream, a new platform that enables healthcare enterprises to automate multi-party or multi-system workflows and agreements. It solves existing administrative issues related to contract adjudication (ex. outcomes-based contracts and other types of multiparty workflow tools) and creates a new way to innovate on contract design.

It seems that payments and value-transfer seem to be an area where blockchain will be able to solve real problems for real companies in 2019.

11. ConsenSys Hunkers Down (and re-positions itself in Healthcare)

On their flight to the moon Consensys encountered some turbulence in 2018. Things seemed to change very quickly in late 2018. One example of how fast things changed was Civil, a seemingly high quality journalism network project. I was surprised when I saw the announcement that Civil failed to raise their floor and would refund investors.  That failure provided further validation for the general cooling of the ICO market. It also said a lot about the marketability of projects following the framework of the Brooklyn Project and the general lack of appetite for application token sales. The project approach seemed like a risky strategy from a securities standpoint. It was an unexpected, high profile public failure that seemed an indicator of where the crypto market is in 2018.

This disappointment was followed by a string of negative press related to announcements of layoffs and the cutting off most of its 50+ “spoke” companies.

It seems clear that, with the decline in the price of Ether, ConsenSys is now digging in for the long haul by doing what needs to be done. I am sure these weren’t easy decisions. I see these moves as healthy signs that ConsenSys has its eye on the future.

It seems that part of their strategy could include healthcare. ConsenSys has tapped one of the top minds in healthcare blockchain, Heather Flannery, as Healthcare Circle Global Lead. They could not have picked a better spokeswoman to represent their interests. If ConsenSys Health is given room to grow, it could be a leading player in the healthcare space in the coming years.

This is not ConsenSys’ first foray in to healthcare. Back in 2017, Diego Espinoza’s Healthcoin project joined ConsenSys as a spoke project. Once absorbed, that project quickly rebranded as “Linnea” and quickly lost its healthcare specificity. Diego is now working on a new fintech blockchain startup and it is not clear what Linnea’s fate will be in the new ConsenSys restructuring where most spokes are being spun out to survive on their own.

12. Crypto On the Ropes

As mentioned in #11 above, crypto had a really tough year.  There were announcements of ICO layoffs, SEC crackdowns, and horrible results reminding us that most of the $30B invested in crypto have “nothing to show.”  The 2017 healthcare ICOs are not immune to these criticisms. They come under fire for their lack of decentralization and massive declines in value.

As more ICOs come under fire for securities violations, the scary truth is that those electing recission must pay back FMV as of the date of the original investment and, I would assume, probably have to pay it back in fiat.

13. B2B Heating Up

While the crypto market is in question, the B2B market for blockchain and distributed ledger solutions continues to heat up as we enter 2019.  Recent research by Markets&Markets and others predicts significant growth over the coming years in areas such as supply chain, interoperability, payments, and other areas.

14. Harder Than We Thought

In 2018 we realized that successful blockchain use case development is harder than it seems. ICO projects are not the only ones struggling to prove themselves. ICO’s catch a lot of flack because they raised so much money and have produced so little, but we are all learning that meaningful work in the space is really hard. It requires a clever piecing together of technical, business, and governance concerns that often feel like a three dimensional chess match. Even as the technology matures, many good projects have failed or will fail for non-technical reasons.

15. Happy Birthday Bitcoin

This year we wish Bitcoin a happy 10^th birthday.  To celebrate, I went back and re-read the Satoshi Whitepaper which I first discovered in 2015. This vision of a totally decentralized digital currency and payment system changed my life. I saw it as an invitation to apply it to what I know about healthcare.

I like how Laura Shin (if you don’t listen to her podcasts you are missing out on a great source of information) recently described Bitcoin as a global, leaderless, user-owned IT department which is now more valuable than Goldman Sachs (over $100b market cap). And despite the value flowing through it, Bitcoin has never been hacked.

Our original summary of the Satoshi whitepaper can be found here. The Bitcoin genesis block was introduced ten years ago on Jan 3, 2009. It is amazing how far we have come and we are just getting started. Thank you Satoshi whoever you are.

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So there you have it.  The top 15 healthcare blockchain news highlights of 2018. These announcements indicate use cases that I think are real as well as some interesting new hype.

The announcements I’d like to see next year have everything to do with results from the projects announced in 2019 and host of new concepts.  In terms of a goal for 2019 for the larger healthcare blockchain community to strive for, I think we can aim for four (4) DLT or blockchain projects that are in production, being used by a network of real companies, and have publicly recorded results of value created by the end of the year. This is a goal for the larger community of which Hashed is a member.

At Hashed, our contribution to this goal comes through our efforts to solve real problems for real companies in today’s world while building bridges to a more rational, value-based, patient-focused future. Using blockchain and DLT, we build products that unlock new solutions to old problems in healthcare. I believe we will look back on 2019 as a banner year for Hashed, our network partners, and the larger healthcare blockchain community.

See the original Medium post here: https://medium.com/@hashedhealth/2018-in-review-6bf92c6d273d