March Meetup – Ep002

In this episode, join us in our March Blockchain Meetup held in Nashville, TN. Our guests are Kevin Clauson, Associate Professor in the College of Pharmacy and Health Science at Lipscomb University, and Corey Todaro, COO of Hashed Health. The topic for today’s discussion is the future of pharmacy in blockchain.

Full Podcast Transcript

[00:00:06] Hello I’m Philip Claudio. And you’re listening to the Hashed Health podcast. This show is dedicated to everything health care and blockchain related. Here at Hashed Health we have begun this incredible journey of developing blockchain solutions for health care. And we have the privilege of being able to talk with amazing people about this subject every single day. The goal of this show is to include you in these conversations. Join us as we host meetups, attend conferences and conduct interviews with our friends and other industry thought leaders. You can find more content like this at health dot com. That’s W W W H A S H D E D H E A L T H dot com or connect with us on Twitter @HashedHealth.

[00:00:54] Here we go.

[00:00:57] So I’m John Bsss the CEO of Hashed Health and welcome to our office and we’re glad to have a good turnout for. What I’m sure is going to be a really great conversation that I want to make to make sure you guys are included in that.

[00:01:14] So we want this to be a bidirectional thing. It’s not just us up here talking we want to make sure you guys are engaged in the conversation. But I really am excited to have you here and I want to start by thanking our sponsors. Frost Brown Todd.

[00:01:35] BTC media Hashed Health and our food and beverage sponsors tonight is Honky Tonk Brewery for their interesting and flavorful selection of local beer. And as you can see this is we continue to kind of step up our program here at the Nashville blockchain meetup. We are actually starting to podcast these.

[00:02:03] Meetups.

[00:02:05] We plan to include Kevin here is the first of a lot of really interesting speakers we have lined up for the spring and the summer so we’re starting to kind of plan these things out. We’re going to be including people from all over the actually all over the world in these in these events going forward. So we’re really thrilled to have Kevin here. And we’ve got a great lineup of future speakers and events that we’ll do monthly going forward.

[00:02:37] And so part of this is starting a series of podcasts so Hashed Health will begin in collaboration with our sponsors be releasing podcasts that are reflected of this event every month as well as every couple of weeks we will release a podcast out of our studio here in Nashville.

[00:03:00] So that’s an exciting and exciting program that we’re glad to be launching tonight. The Nashville blockchain meetup up is now I believe over 210 people which is which is great because just a couple months ago it was basically 15 of us sitting in a bar drinking beers. And so we’re glad to see that what we’re doing seems to be resonating in the Nashville community. Generally about 75 percent of the attendees are healthcare folks. There is you know we get some education in some music or entertainment industry folks as well usually but most of our meet ups are geared towards the healthcare industry although we will be mixing it up a little bit. Next month we are considering a few different options for the next couple of meetups one being a cryptocurrency discussion. It’s amazing how many people you talk to in Nashville. My parents for example who don’t understand what Bitcoin is or what crypto there is like I’m speaking a foreign language I need to create a forum for discussion around what are cryptocurrency is you know What is Bitcoin and there’s actually an interesting local company called Ercoin that started up that I want to introduce you all to. And so there’s some really interesting things going on in the cryptocurrency space that will be a topic that we expect to do soon. We also expect to go technical. So we want to go deep into some of the technical topics. So we plan to have members of Hyper Ledger hopefully an enterprise Etherium and some other more technical conversations.

[00:04:56] For those of you who want to get it go deep on the technical aspects of block chain and distribute Ledger technologies so point is there’s a lot this is a great conversation and we’re going to keep we’re going to keep upping our game and it’s going to be it’s going to be a great spring and a great summer for the Nashville blockchain meetup.

[00:05:15] We’re probably one of the faster growing blockchain meetups out there. So.

[00:05:22] Let’s talk about tonight’s topic, distributed pharma solutions and the future of pharmacy. One of the number one areas of interest that Hashed Health is is hearing from all the constituents in healthcare we talked to is specific to pharma. And that pharma conversation takes a lot of different angles. Certainly supply chain serialization track and trace are are kind of a gateway project and we’re certainly going to talk about that tonight in a clinical trials, data sharing also revenue cycle, revenue management, contract management, pharmacy benefits, management formularies, genomic precision medicine know these you know wearables all of these things have relation to how drugs are created and released and then monitored over time. And then managed on a day to day basis and the blockchain has really interesting applications in a whole lot of those areas and Hashed Health and many many other people, David Lipscomb University being a great example for us. For tonight have some really interesting expertise to share on these topics and that’s why we’re excited to present to you a discussion about the future of pharmacy and distributed pharmacy solutions on the blockchain. So without further ado I’ll hand it over to Jiles Ward to kick off our our evening.

[00:07:09] Here. OK. Thank you all for being here.

[00:07:11] I’m really excited to do this topic it is so broad that we could spend hours talking about it. So I think we can focus fairly narrow. Well we can we can take it wherever you want. From the questions. But I think we can start with a sort of track and trace and clinical trial discussion here and then we’ll see where it goes. But I’ll go straight to it. I’m pleased to introduce Kevin Clausen our guest here. The first time I sat down with Kevin I think the deck he had on blockchain was more extensive than anything I’d been than I’d done anything we’d put together and we were focused on blockchain so I’ll give him credit for that. I like to think we’ve caught up fast since we’ve not had to focus on teaching students and running other things but I think he’s a great example of the expertise in this town and why this is a good forum just to get get that knowledge out there and introduce the people that are at the at the forefront of this thought. So I’ll let Kevin introduce himself and talk about the program at Lipscomb and then we’ll jump into the pharma discussion.

[00:08:24] Sure. So my name is Kevin Clausen as mentioned and I’m an associate professor at Lipscomb University College of Pharmacy and health sciences. And so my original training was obviously as a pharmacist and then I went and took a little bit of a different path to go into research. And. Over the last 15 years or so most of those efforts have evolved along the digital health arena which is also kind of not completely understood, still evolving term but it is inclusive of a lot of things that that John mentioned. And so my day to day I teach this show mentioned in the cause of pharmacy as well as in our masters of healthcare informatics program. The director actually is here by the way Dr. Beth Breeden. I don’t know where she is but she’s somewhere around here I think. So make sense blocked by by mic. I don’t know what the terminology for that is. But in any event. So that brings a lot of opportunity to us. We one of the benefits of being in any kind of university setting is you always have that infusion of new ideas and new people some of them are here as well in and around technology and how to innovate right. So that’s been one of the most useful things to me over my career is partnering with students as well as other collaborators to try to develop in and among these lines.

[00:09:48] So great to be here. I’m also very interested to hear what your guys perspective on some of the topics we’ll be as well.

[00:09:56] Kevin thanks. Let me next introduce Corey Todaro. Corey’s with me at Hashed Health.

[00:10:01] He’s actually the COO and interesting background in health care I think. I’ll say for Hashed Health we all come out of healthcare so we’re approaching blockchain as a technology from a healthcare perspective. We still consider ourselves a healthcare company and I’ll let Corey do a quick self-introduction and I will.

[00:10:21] Dive deeper. So thanks for coming everyone Hashed Health is very proud to host and we were glad to see the population grow every month month over month interest in blockchain is fantastic. For myself I’m COO of Hashed Health.

[00:10:36] I’ve been working a lot on proof of concept designs as we are engaging with a variety of healthcare companies across the globe really and in helping them define their interest and their strategies for blockchain development. And I think it’s true that you come to blockchain with your own sort of understand in your own lens and you sort of see blockchain first through your through your own experience so I come out of the health system side I worked under our chief strategy innovation officer at Vanguard Health System which was the investor owned system here in Nashville before he was acquired by Tenet Healthcare in 2013. And when I first saw it when it first first clicked in my head I started to see all the hospital applications the health system applications of blockchain.

[00:11:19] Now over the past three months I’ve been researching pharmaceuticals on the pharmaceutical side of the industry and realized that there is just as much if not more potential applications and and on the pharmaceutical side and what what blew me away and I kind of always knew this but never really confronted it is that the pharmaceutical ecosystem from manufacturer to wholesale distributor to retail pharmacy to PDM is a bizarrely complex ecosystem with very complex contractual structures and the movement of product globally and it involves R&D and disease management and contractual and financial arrangements and it’s a whole ecosystem unto itself that we are actually and we’re very pleased to see that there’s a lot of interest in the pharmaceutical industry and potential blockchain applications all the way from the discovery of love of molecules and potential drugs all the way to how do we make sure that patients continue to stay on their therapies and continue to adhere to the therapies that their physicians have prescribed for them.

[00:12:21] So we’re heartened we’re heartened by that interest and we think there’s a lot of potential applications that we hope to explore some tonight.

[00:12:29] OK so Kevin we’ll jump back to you if you’ll give a little background on how you came to blockchain and then maybe we can jump into some of the research and study that you’ve done in your department and with your students at Lipscomb.

[00:12:44] Sure. So.

[00:12:47] Really what kind of first brought it to my attention and obviously I was familiar with cryptocurrency and may or may not have speculated a bit early on as probably a lot of people in this room have but a friend of mine who’s really the real most interesting man the world has his name is Cisco Hollis.

[00:13:04] He was doing some digital health teaching in Estonia and which probably you’re already you know what the next step is right. So he sort of said they’re doing some interesting early days things with echars in this thing called blockchain and so started looking at it started trying to kind of monitor what the developments would be relative to healthcare and one of our students actually Cameron Davidson was looking at the application of blockchain towards helping combat counterfeit medications which of course is another one of the global challenges as well as domestic challenges that we face. And so that sort of served as my entree into the area started looking at that and we started trying to figure out what that would look like. There’s some new legislation or new legislation the drug supply chain security actor that was came about in 2013 and it basically said all right over the next 10 years you guys are going to have to develop a system to do the track and trace to figure out what’s the point of origin of the medications whereas I go to be able to follow it all the way through until the patients. And as you could probably imagine that system did not and does not exist. So they set it out as a 10 year timeframe. So we’re a couple of years into that. So that has pulled a lot of interest. There’s a lot of utility in this area than the other piece and where we spend really the rest of our time specific to blockchain is looking at data sharing that goes back

[00:14:34] Last year I was in one of one of a group of folks invited to the White House for a precision medicine initiative event and ended up being put into a workshop with several folks from pharma, some researchers et cetera who were interested. How do we share data? How do we get the sort of data fluidity and enable that between all the way from the patient to the clinical trial and bac?. How do we free this how do we facilitate that? Can we also use that to help manage medication and improve adherence?. And so that’s really those two streams have brought us at Lipscomb University as from from students to some of our faculty and we’re trying to figure out what sorts of solutions that might offer.

[00:15:24] I know that Lipscomb has a got a very unique has a unique program in that it is one of the only joint pharmacy I.T. programs in the country. We talk about how that is. How are you using that program and how that program looks at blockchain and the possibilities that you guys see?

[00:15:44] Sure. And that’s really easy for me to brag on this program because I had nothing to do with creating it. I arrived after the fact but I still get to sort of claim it. So this is the Lipscomb University College of Pharmacy is the second in the country to have a dual doctor of pharmacy masters of healthcare informatics program. So our students can go through an accelerated process of getting that dual training. Obviously across healthcare particularly in pharmacy. The necessity of having certain core tech informatics skill sets is just going to continue to be of utmost importance. So it positions our students really well in terms of where that comes into play with blockchain. A couple of things I suspect were probably the first college of pharmacy and the first master’s of healthcare informatics programs to have a lecture topic on blockchain and healthcare as part of our course curriculum. But in doing that so that kind of goes back to what I alluded to. So when we have those driven students who are interested in that topic as with many Master’s programs right we have a capstone on longitudinal projects.

[00:16:53] So we’ve had an opportunity for some students to examine that as their main capstone projects and just enrolled another one in that recently so it basically provides sort of a fertile area for research development innovation with students alongside sort of seasoned researchers and pharmaticians and healthcare providers. Let

[00:17:20] me bring Corey back in. Corey you’ve talked to a lot of the a lot of companies along the pharma pharma supply chain. We talk a little bit about what you’ve seen and the kind of discussions you’re having and their thoughts on blockchain and that will come back to how it fits in locally.

[00:17:38] I’m seeing a lot of interest. I liken it and it’s a metaphor I use often. The healthcare industry is like a middle school dance right now around blockchain. Everyone is acutely interested. The same way middle school students are to each other. They all want to know who’s on the dance floor first right.

[00:17:57] Who else is doing this? What are they doing? So there’s a lot of peer interest out there in terms of practical use cases.

[00:18:09] We help bring and widdle down the universe of possible blockchain applications to things that make business sense for the particular party we’re talking to and we’re very keen at Hashed Health at not only understanding what the businesses that we’re talking to what’s their core business but who are their transactional parties and what are the pain points between them and those other parties and begin to articulate is there a way for us to bring together what we’re calling a minimally viable network of transactional parties together to explore a proof of concept. Blockchain application which just to review again is a transactional layer that sits between transactional parties that allows us to more efficiently move anything of value be that the currency, data, paper documents, and data around a variety of things. So when I talk to the manufacturers. They’re very interested primarily in I thought it would be supply chain. I go in thinking what I think they don’t like and I’m always surprised by the end of the conversation they’re most interested in CRO interactions which are clinical research organizations. So these are third parties. Contract is contracted by the manufacturers to help streamline that clinical research. The acceleration of the drug through the various stages of clinical trials to commercialization. And that’s their bread and butter right there. So if the drug can’t make it out of trials then their 10 year financial forecasts are severely delayed. And it sounds really challenging and crazy and complex and I’m no biologist or or pharmaceutical expert and so I ask so what are your pain points.

[00:19:48] And they said well we often we pay doctors to run clinical trials and we have to report the doctors we pay and how much we pay them and why we pay them. We have to disclose that to the government and we can’t agree with the CRO what the doctor’s name is really.

[00:20:04] We print off these Excel spreadsheets and we have to match up. Dr. AJ Smith is really Dr. Adam Smith and he’s Adam Smith and our system he’s AJ Smith in their system. It takes us a couple of weeks to figure this out.

[00:20:16] You’ve got to be kidding. You make hundreds of billions of dollars of revenue and this is your pain point. They said yes this is our pain point.

[00:20:23] So that’s one of the very simple use cases around what we’re calling provider data management of. Can can we build a transactional layer to sort of stay on top of Dr. X really as Dr. X and not Dr. Y and that helped streamline a lot of the regulatory requirements around reporting of paying physicians. When I talked to wholesale distributors I thought it was going to be supply chain again because that’s really their business. Moving the drug from from manufacturer to distribution point and I find it’s maybe supply chain and it’s actually are a lot around their interactions with retail pharmacies and how they can maintain and deepen their relationships with distribution points be they independent pharmacies or chain pharmacies or specialty pharmacies and how they can extend the power of those pharmacies to interact with the patient in a more meaningful manner and in a more streamlined manner. So it’s in their interest to get the drug faster into the patients hands. And that usually involves a whole lot of back end crazy transactions things from benefits investigation. So you’re you’ve got a disease and the doctor wants to give you a drug. Does your insurance cover it. They have to research that and figure that first before they figure out which which therapy you should be on and then it’s prior authorization or step therapy requirements which involve a lot of back and forth between a physician and a pharmacy and a payer slash PBM pharmacy benefit management company. And then you might actually start to get the drug and then it’s going to be the pharmacy is really interested in are you keeping up with your refills.

[00:21:51] Because if you’re a Medicare patient for instance the pharmacy is on the hook for maintaining that cadence of refills so they can get good quality ratings from CMS so they can get preferential reimbursement under the Medicare Part D program. And then there’s all kinds of other things there’s this thing called the 340 B program which is discounted pharmaceuticals for hospitals who serve patients in need under-served patients primarily poor uninsured patients. And the calculation of the price of a 340 B drug is just bizarre and involves a lot of back and forth and of course it’s highly regulated. So the government’s involved there so there’s a transparency and an audit requirement around it as well. And we think these kinds of complex interactions between multiple parties that often have a regulatory and compliance overlay are really well-suited for block chain because we can create a transparent layer for these parties to interact and share data in real time. And these are use cases that are noncompetitive. It’s not like I’m getting over on you by sharing this data with everybody it’s we’re all sharing these pain points and we all need to find a way to better transact instead of printing out spreadsheets to make sure my database is reconciled with your database on a monthly basis.

[00:23:08] OK. So the novel idea that somebodies name only needs to appear in one place on a shared ledger like that that does.

[00:23:19] I can see that applying in many places not just not just pharma. Can we talk a little bit. I know you guys have done some provenance and track and trace research and presentations. We talk a little bit about the work you guys done around that.

[00:23:35] Sure. I think one of the biggest potential pieces with it is it may be easier to do some sort of proof of concept around this than some of the other applications that we’ve talked about.

[00:23:50] And while it is still theoretical. One of those examples may be,

[00:23:55] Alright so we’ve got this new legislation that has a track and trace you’ve got to identify what the point of origin of the medication is you have to identify everything along that chain all the way to the distributor to the patient. So doing something that would be in compliance with that is desirable nationally, federally but it’s not something that you could really spin up on that sort of basis. And we’ll will focus domestically for the moment. It may be that there is a particularly fertile area where you could do something like that as a POC instead of having to scale up all the way and that one example may be in Puerto Rico. And so that’s a really fascinating potential case for a lot of different reasons. It’s a commonwealth territory right. So it’s part of the U.S. but it’s with and separate in some ways from the U.S. there’s if you’re not aware there is a massive massive presence of pharma manufacturing and more broadly in Puerto Rico which probably a lot of people don’t recognize if I hadn’t spent a decade in South Florida I wouldn’t have probably known that either. And finally unfortunately from a healthcare perspective from a financial perspective etc. Puerto Rico’s struggled in the last few years in particular with that various other things. So I bring that up not to impugn the island in terms of the struggles but to say if you’re looking for someone who’s willing to take a risk in health care you’re more likely to find them willing to take a risk if they’re struggling or not in a completely stable and happy state.

[00:25:39] Health care is the most disruption resistant industry or sector in the world and so you have to look for those types of things.

[00:25:48] So that’s that’s something we’re trying to figure out how we can pair with the local sort of versions of health ministry as well as their researchers and from a policy perspective. So previously I had I served as chair of a or director of a center for consumer health and for max research that was a WHO official collaborating center.

[00:26:13] And so part of that was I ended up working with some of the other center directors WTO center directors and PAHO center directors in Puerto Rico so that’s what one of the main sort of very tangible things were trying to pursue right now is see from a a policy and a rollout perspective if if that could work. Or the biggest stumbling block seems to be because of the financial crisis right now. Would that be too big of a stumbling block for us to be able to try to roll out implementation. But that would allow for a localized rollout for compliance with the requirements around track and trace and securing the supply chain.

[00:26:58] I like the idea of Puerto Rico as we’ve explored blockchain and then we’ve sort of put our names out as as that is a hopeful focal point of healthcare and blockchain and the focal point of the convergence of healthcare and blockchain. We’ve been surprised by the number of inquiries we’ve had from people solving problems outside the US. When we look at problems like the first discussions always the disruption and the that the weight of the legacy systems and a lot of the folks coming to us are like well we have no legacy systems so if you had a clean slate how would you build it and how would blockchain play into that? So Puerto Rico would be a great middle ground so some familiarity and they like the U.S. dollar and U.S. regulation but outside the sort of cumbersome system that we we’ve we’ve constructed here Corey you’ve got.

[00:28:01] Yeah I would just say that that’s the value conversation we’re continuing to have with large healthcare enterprises in the United States and it’s the question of what can blockchain do and can do it that much better than other technology to justify any level of investment in blockchain. And that two very easy examples there I’ve talked to some very prominent academic medical centers who say hey we’re interested in blockchain but you can’t talk to our IT department because they’ve just installed Epic and they’re going to be doing that for 15 years. And it’s a billion dollars and we’re not going to touch that system ever again. And so if you want to come in and tinker with things that can’t be anywhere near that. Similarly in track and trace when you talk to the the big three distributors there’s there’s a big three for everything it seems. But the big three distributors and they said oh no we’ve got track and trace we’ve got it covered. They’ve invested quite a lot of money in RFID chips and 2D barcode scanning and you know wrist mounted scanners and you know they’ve got all these stats on how great their systems are. And I come in with blockchain like, well is it really that much better and I’m in no position to offer them hard numbers at least at this point in the conversation. So it’s often those I’ll call them either green or brown fields depending of whether or not they’ve got they’re flush with resources and want to do something innovative or things are just so broken that you know there are no constraints on on what we can try here.

[00:29:31] That’s where I think we’re going to see some of the interesting conversations and some of the interesting developments take place.

[00:29:38] So let’s open it up. I know there’s a lot of expertise in the room particularly around pharmacy and pharma but this is a blockchain meetup so we can we can take questions on all on all fronts. So John…(Question)…

[00:30:23] I think that just the challenge of identity management and to either within the pharmaceutical company for physicians back to the example of AJ Smith versus Alex Smith and how you actually reconcile that and the challenges of who owns that identity who manages that identity. You and I are actually on the American Board Medical specialties advisory committee for databases and there is no motivation or incentive to dis intermediates. Their business model is actually how they make money. So where do we go as far as like reconciling that leveraging blockchain to solve identity management in healthcare and pharma.

[00:31:05] I’d give them a new business model. And that’s something we’re actively exploring. So there are a whole bunch of third parties out there which currently sell access to a database of data that’s proprietary to them. So in the case of the American Board of Medical specialists whether or not a physician is board certified or not in a specialty or subspecialty you and they sell that data access to that database to hospitals and for you know payers and everybody else in the same way that the A.M.A. or a company called IMS does the same thing in pharma with this is a prescribing doctor and in fact we know the relationship between his or her name and their NPI number and they actually think that that data is proprietary to that. So can we create a nascent transactional network where we can offer them a new way to monetize delivering that data to a transactional layer.

[00:31:56] Can we do it on a per click basis on a micro transaction basis instead of saying hey I’ll sell you a SAS license to my database?

[00:32:04] Can I tie my database into your blockchain and we can ping it every time there’s a query to make sure that you know this doctor is board certified or that really is their NPI number? We can do this with Hopefully state licensing boards and the American Board of Medical Specialties.

[00:32:21] And you know all kinds of actors out there. And I think the marketplace will help determine whether or not the data that they want to charge for is really worth what they claim it is. But I think if we can entice them out into a sort of a marketplace kind of transactional model we can begin to settle some of the issues around the current siloed gate SAS license walls that we kind of hit right now. But you know that’s that’s kind of vague but that’s that’s what I’m thinking about right now and trying to tease out what those economic models look like.

[00:32:56] The only thing I would add to that is I think it’s for me the most interesting part in a sense was about the sort of data ownership or ownership who owns it.

[00:33:05] And I think about person generated data along the same lines. And so you know you’d mentioned wearables et cetera. There’s a guy Hugo composts who has implanted cardiac device. And so he felt like he was starting to pick up on some sort of patterns of when he drank a certain amount of caffeine when he took certain actions that it would exacerbate his his cardiac condition as measured. Right. And so he contacted the company had a bit of a background and he said hey could you send me my data feed stream from produced from me. I’d like to examine it see if I can pick up any sort of patterns tie it to some of the other sort of Quantified Self things that I’m doing. And the answer may surprise you. No, you may not have the data produced by your body and interpret through our device because we own it. That is ours. You may not have it. So there is a lot of those types you know. I’m aspirational when thinking about the data sharing pieces and hearing particularly from pharma about what they would like to do with freeing aspects of the data or relocating the locus of control the data. But there are some really really fundamental questions that have to be answered first before we can move ahead.

[00:34:29] And I think we’ve seen like if you could give a provider a single place to update that just one place. There’s

[00:34:36] real benefit to that because right now and we’ve seen examples of a provider that bills through their part of 10 or 12 networks and they will update the data in the one or two networks they use the most. But that that that pair that they send a couple of claims a year to.

[00:34:57] It’s just not on their radar. So they’re not going to get they’re not going to realize they haven’t updated that until a claim rejects.

[00:35:05] So if you could move that back to the provider say a few update this in a single place on the block chain and all of those payers all of those pharmacies all of those are all of the touch points around the physician that can go to a single place to see if that license active is that Doctor Who he says he is or who she says he is then you know I think you could get by in from the providers themselves. Just it’s it’s it’s a single point of updates. So the ease of the ease of update fixes a wide range of pain points. So Walker…(Question)…

[00:36:23] Repeat the question quickly. So those are the applications are low hanging fruit out there in the CRO or or clinical research base for blockchain? I was going to say did you in since given your question we got a couple.

[00:36:36] The first would be the physician compliance in the U.S. that’s called the Sunshine Law and it tracks how pharmaceutical companies pay physicians and what they pay them for. To make sure that you’re not just buying off physicians to prescribe your drug. So there’s a lot of physicians who are paid for their the second one is the patient recruitment and patient consent. So an informed consent for participation and a trial updating that informed consent making sure it’s available to all the parties that need to have access to that.

[00:37:06] And third is a what’s the term when you you define the goal for the study. There’s been some there’s been some some work. This is over a year ago actually where someone said hey can we encode that on a blockchain so that we don’t get study drift. So often a pharmaceutical company says hey our goal is to prove that this drug will reduce blood pressure and of course the trial doesn’t show that but the trial shows something else.

[00:37:30] And they said oh no no the trial was really about you know whether or not I can restore my hairline and look at that. Yes. The study is successful.

[00:37:40] So can we actually keep the researchers honest by sort of saying hey disclose to the blockchain up front what you’re hoping to find and registering that on a chain kind of as a proof of evidence and time stamped so that when the trial concludes we can say yes the study goes I don’t know the term of art is actually still still relevant and still applies.

[00:38:01] The primary objective. Yes. There we go. Thank I knew there was the technical term I’m pulling myself so I’m really quashing my inner geek on all of this because like with Adrift you’re talking about there’s actually a term called bio creep in clinical trials right where the new way they don’t even have to prove it’s better.

[00:38:18] You know the it’s the most commonly adopted methodology is a non-inferiority trial. So which is a really interesting word right. Non-inferiority What does that mean. Well typically when you ask a group of health care providers they’ll say well it’s not worse than the comparator.

[00:38:35] Seems reasonable. Technically it means it’s not worse than the comparator by a certain amount called the non-inferiority margin. And so the drift comes when you say okay well this one is only that much worse. So it’s not a fear. But then that’s the comparator for the next one. So they compare it to that one. And it’s that much worse than that one little race to the bottom.

[00:38:56] Yeah it’s a race to the bottom. Can I ask a question. I don’t know if that’s allowed.

[00:39:00] So I’m curious going back to some of your previous comments. One of your first ones I think was one of the things that we look at is hospital readmission rates right. And so one of the biggest contributors to that is a lack of data continuity for that continuity of care so patients get discharged from the hospital, they’re supposed to be this plan where they follow up.

[00:39:24] There is a bit of what’s done to try to manage that situation but it’s largely very poorly and the reason why it’s so important is institutions are incentivized to make sure they don’t get re-admitted and disincentive is right. So if they do get readmissions under certain conditions they don’t get reimbursed for the care that they provide for those patients. So there’s a lot of really good pieces built around that.

[00:39:48] So my I’m wondering given your comments in the previous conversations did you get much unsolicited sorts of questions or points from those groups about that particular problem in using this because that’s to me that’s not something where they can say well we’ve already we’ve we’ve we figured out that fix.

[00:40:09] So you know why is it that much better because it’s still right the distribution of what’s called the CCD or continuity of care document upon discharge is actually a longstanding problem.

[00:40:18] I know some startups going back to 2008 which are trying to crack this and will build a will build a database and will provision access to it for all the primary care docs in our network or maybe in an affiliated network but maybe not some of those docs. Yeah there’s questions about whether or not how visible We want to make those documents and whether that can travel with the patients. I know there’s a lot of pain points around medication therapy management adherence in management and I know there’s some software systems out there that help score pharmacies on whether or not their patients are compliance and now it’s pretty clumsy it uses claims data which is a old and B and untextured completely. They didn’t fill. Why didn’t they fill? Well I got I got samples from my doctor. I can’t afford it. You know oh my doctor actually reduced my dosage and the pharmacy doesn’t know that the pharmacist doesn’t know that but they’re on the hook for that score that they didn’t fill the script. So there’s all these kinds of subtle nuances of data out there that doesn’t show up in in regular health system data systems.

[00:41:23] So we’re pretty excited not only about readmission avoidance but patient engagement at the pharmacy level providing perhaps new entry points, new contributions of new types of data perhaps patient originated that can contribute to a richer view and understanding patient adherence and refilled patterns. Thanks. We’ve heard some discussion recently about more continuity of care than readmission rates like if you go see your primary care doctor and they send you in CT scan and then a day or two later you crash into the ER.

[00:41:59] They don’t have access to that. They don’t know that and they send you back out for another CT. So you know both the primary both the first imaging center and the hospital get the bill for that CT. There’s no there’s no penalty for that. That excess dose of radiation that the patient got but it would take a fairly small network to just have a, just a flag in the system to say oh by the way this patient saw their primary care this week they got a CT this week one phone call would solve would would avoid that second scan.

[00:42:34] So the continuity of care across platforms, across systems, across caregivers is a big piece of that. So Chris. (Question) This is a. This so what. Let me repeat that question just for you.

[00:44:04] Why why should we expect the health care adopting blockchain would break a pattern of health care being 10 to 15 years behind solutions available other other industries?

[00:44:17] And part two why blockchain so um so.

[00:44:24] So a couple of quick comments. First those are excellent questions that we should all be asking. Period. Right. I would say what’s making it a little bit different now that people from pharma that we’ve spoken with tend to be a little bit more progressive thinking than their peer group. In some cases by orders of magnitude. So they’re looking for solutions with an eye going ahead and one of the big things that changing right is how reimbursement works. Maybe we’ll see.

[00:44:55] But but you know if we’re looking at reimbursement based on patient outcomes versus quantity of procedural pieces performed what we’re doing now doesn’t work and it won’t it hasn’t had the negative consequences on a reimbursement or payment perspective with the system that we’ve used based on more of a procedural quantity versus do the patients do well or not. And so with an eye towards those I think that you’re you’re we’ve got those forward looking executives and innovators trying to figure out if this is a tool to help bring that about. I think the other thing why blockchain versus other is people once they spend a little bit of time looking at it tend to see that it has or perceived to have greater utility than other standalone siloed solutions that would be used three different solutions to address these three problems. There is at least the potential that it could hit all three of those probs. And so that’s the sense that I’ve gotten from the people that are looking to make investments or try to create something.

[00:46:07] And I would also say that we are approaching healthcare enterprises with what could be considered point solutions using blockchains or you’ve got a particular problem. We think blockchain could be an interesting application to help move data in a new way when data liquidy or it can be a source of truth of audit and compliance reasons but our longer play and what we’re hoping to communicate to people is that these are foundational plays that have legs and they’re not point solutions.

[00:46:36] They’re really the first steps in an interactive network of transactions that we can start to layer on top of more and more additional use cases. It scales well and it does require radically new investments of hardware to add those use cases to blockchains we’ve got to define new data models perhaps, new transaction types. Perhaps those are associated with tokens perhaps new permissions structures. But if we’ve got nodes operating ledgers we fundamentally have the pieces in place to do a lot of different things so yeah let’s invest now reasonably because it’s an immature technology. It’s risky but let’s invest around a point solution and see where we can extend these solutions in a variety of different ways. And that’s something we can’t do by signing a B.A.A. and saying OK I’ll grant you a data dump every night from my database and I’ll pass it off to you and a JSON and XML file. You know that’s that’s that’s a workaround that’s clutchy. Hopefully we can start building something that that has you know a longer play and a wider variety of utility than just the point solutions that we’re proposing.

[00:47:46] But if I don’t propose the point solution they’re going to say hey you’re utopian you know you’re trying to envision a future that no one’s going to get to.

[00:47:54] I and we are trying to tease out those those first sort of nascent steps to say we know you have a pain point and those pain points are usually around I’m transacting with someone else and it’s it’s painful for me to do so. You know my data systems don’t talk to each other inside much less anybody else.

[00:48:12] You know how can we help solve this problem. And I want to solve those problems because those are important problems to solve. But we were also looking forward. So around track and trace for instance, track and trace it in and of itself.

[00:48:23] You know I’m constantly debating with myself is it doesn’t have enough value given other technology that’s been applied to this and perhaps yes perhaps no I think a lot of that has to do much less with the technology and more so how much of you already invested and track and trace to your point about Puerto Rico for instance. But we’re also thinking track and trace is also the first step in perhaps contract management. So manufacturers have these really complex arrangements with distributors to say hey you move my drug for me and if you hit these volume levels then you can apply discounts to that. How do I know when I’m hitting those discounts. How do we both agree that we’ve reached that threshold and we can execute those discounts now. Well we can do it with track and trace data on a blockchain that you’ve received your fiftieth crate or pallet or whatever, a lot of pharmaceutical in fact we can also encode it in smart contracts hopefully so we can automate those those kinds of discounts that go on so that’s an additional use case a top what is normally an audit of in compliance use case around drugs ply trade security act.

[00:49:29] I’ll jump in real quick. Why blockchain. And I think this is significant. We’re approaching six trillion dollars in five trillion dollars in national spend like that’s approaching a quarter of GDP 20 percent of GDP.

[00:49:49] We were at Hims two weeks ago and there are 40,000 people down there and thousands of booths and all of these solutions we’re just nibbling around the edges. They were improving response time on nurse call. There were new ways to get patients to treatment. They were new ways to engage patients but they were incremental changes around the edges of patient care. I think the blockchain. Given that we’ve got to take some baby steps and there’s a long way to go but blockchain is the first thing that fundamentally it could could take a middle third out of that 5 trillion there the friction layer and health care is astounding.

[00:50:34] Like the clearinghouses and the data management and the data scrubbers and the subscriptions to provide a network like it’s it’s mind boggling the amount of time and money spent just managing data. And if you had a central point and a shared ledger how much of that friction just goes away. So.

[00:51:07] If you think of it if you think of a ledger and what a ledger is it’s that it’s the transaction it’s the where it’s the place in which a transaction is recorded and if if you boil the healthcare down to its base the patient is the ledger. Everything in the healthcare system is happening to that patient every test, every scan, every interaction with a provider, every bill, every prescription, every co-pay, the patient is that central piece.

[00:51:34] And I think the blockchain is the one thing that we’ve seen in the law in in decades that could actually recenter the focus recenter health care around the patient as the central point of a healthcare encounter. Now… (Audience talking & question)

[00:53:14] (Audience talking & question)

[00:53:28] I’ll try to address some of that so I think some of it is a change in expectations by consumers slash patients, right. The expectations are different. The expectations are elevated and so trust is a piece of that as well as is a greater awareness of security. The number of people who are on social media channels posting the letters that they’ve gotten from their insurer or something they’ve bought a product from that says Your information was probably compromised.

[00:53:59] Here’s a voucher for free $20. Your medical identity may have been stolen. Sorry about that. But even if you look at products how products are positioning themselves around technology. If you go to like an HP’s site for their elite business they lead with here’s why you’re not going to get hit by ransomware and malware and all these different things so I think across the board there is a greater driver from a little bit of either awareness or fear, depending on what sort of perspective or mood the here and at the time. And so those are some of the drivers as well as again those elevated expectations by the consumer or patient about what their experience is going to be. And they’ve already picked up on things like a hospital’s reimbursement is affected by patient satisfaction with their stay federally, nationally which is a massive change. So those are two elements I believe are contributing.

[00:55:02] I think that the the the millennial generation is driving a lot of this. I think there is there there.

[00:55:09] This less brand loyalty they want. They want services provided. When they want them where they want them and they are their life they want an app that’s going to point them there.

[00:55:18] So that’s going to force systems to to have more transferable data structures so that they don’t lose out on patients just because the next appointment time doesn’t happen to be with who you source who someone saw last or who the app connects you with.

[00:55:39] So I think systems are being forced to reconsider locations of care, points of care and ways of looking for ways of connecting that care with with consumers.

[00:55:54] You also want to remind us that the I’m not sure exactly number but I think it’s 1.2 million people are using Bitcoin now to move currency without a bank. And so that’s I think that’s it for me that was a foundational importance to starting Hashed Health. The fact that those people are able to move assets without a bank without an intermediary without a third party controlling that process is a fundamental thing that’s never happened before. So think of all the assets that exist in healthcare.

[00:56:33] Your identity, your medical record, claims the fingerprint of a pharma item moving across the supply chain.

[00:56:43] There’s a lot of them.

[00:56:44] But then imagine doing that without anyone controlling that process. Imagine a peer to peer transaction for that asset whatever your asset of choice is. That’s the opportunity and that’s what that’s what’s disruptive and should really either make people scared or make people leap for joy. In the hope. The next great hope that we can remove a lot of cost and put the patient at the center of health care like they should be.

[00:57:33] (Audience Question)

[00:57:48] Sure. What can people in the room what what are the opportunities for us here to think up new roles for ourselves to play in the emerging ecosystem that could be enabled by blockchain? I think that’s that’s a that’s a really interesting question. You know we talk about whether or not it’s a human interface. Do we want to give another interface for a physician to update their data. Sure in a demo environment yes. But I’m thinking ultimately no I want to enable the physician to say hey there are devices on my body right now which you know know where my office is. My phone knows where my office is without me telling it OK it knows where I’m going every day. No let’s ask permission. Hey do you want to let other people know this? Yes or no.

[00:58:37] And yeah sure. And then we can have an auto…automated feeds in to keep that data updated on a day to day basis or a weekly basis.

[00:58:48] Now some of them are administrative and you’ll never be able to sort of automate them. But I’m really envisioning an ecosystem where we’re simply giving permission to release data about ourselves that’s being collected. With our permission sometimes without our permission but put us in the driver’s seat to enable a richer faster more efficient ecosystem of data exchanges that have very little to do with me logging in remembering my password and remembering to do this or giving that assignment to my office manager is really what is going to be for a physician. And having to keep track of that. So yeah I think you’re just giving them another interface to log into is not going to solve the problem. I think we need to find easier ways for for all of us to share that data that someone else finds vitally important. I may think it’s silly that oh yeah I moved office why do you care. Well the health plans on the hook for the quality of their directory data they can be fined for it. So they’ve got a very keen interest in that maybe they can find their way to in sent me to enable an automated update from me around that. And can we find ways to build those permissions systems to build those distributed applications which touch an individual to enable them to transact more easily. So it’s the same thing in cryptocurrency can we build that our wallets and exchanges that are distributed applications to enable us to transact the same thing is going to happen in healthcare and what those applications look like are the real real innovations here.

[01:00:22] The block chain protocols will will will mature and evolve but it’s really that business application layer those those distributed applications. So we encourage you to start playing with them and start thinking about what those could look like. Mindful of the regulation though. You can’t pay doctors for certain things and you can’t pay patients for certain things.

[01:00:40] And so mindful of those kinds of rules let’s get creative. In context to blockchain I think a successful implementation like when we look forward 10 years 20 years if blockchain has reached a level of penetration and success that we haven’t even envisioned yet it will be that blockchain is not even a footnote in the discussion of what the solution enabled it will all be about the solution.

[01:01:12] It just happened to be on blockchain and that won’t even be relevant anymore. But we’re so far from there and there’s there’s so much opportunity to just start with small projects and hit hit real pain points that are that are addressed better by the blockchain than by anything else.

[01:01:30] So no one talks about how hey I’ve got this great application that uses TCPIP to push data to my mom I sent her a note over to see TCPIP. No one talks that way right. So it’s going to be the same for blockchain, it’s going to it’s going to recede into ubiquity.

[01:01:49] It’s there and we understand it and it enables really cool things but it’s not going to be the topic of conversation. Hopefully.

[01:01:56] Look look for things look for opportunities where it could accelerate something that’s already desired. Right so a lot of what you’re just saying that would fall under the sync for science and the precision medicine initiative million person cohort right there that’s the plan is to do execute basically what you’re describing. They don’t know how we’re going to do it. Could this be a way could you be the person that helps accelerate it. Maybe so I would look for those types of things. And by the same token make sure you’re not trying to solve a problem that someone else has already got too big of a head start.

[01:02:28] Let’s take a last question in the back of the room and then we’ll wrap up and continue the just networking here. (Question)

[01:03:04] I would say the first lesson that Thin Tech taught us is don’t build your own blockchain. And we saw a lot of that in 2014. So there are all these new There are all these protocols now and you know you’ve got R3 so we’re going to build new blockchain, Oh we built it. We’ve patented. It’s not a blockchain. We’re not a blockchain company anymore. And now they have to sell this protocol and build applications on it and create an ecosystem. I think the lesson we’ve learned and we’re standing on their, their, their hard lessons learned is that there’s a variety of protocols being developed now. There are a lot of open source options there’s a lot of focus on enterprise blockchain. And those were the hard lessons that Thin Tech had to learn. I think it’s a little bit different. You know on the financial services side because we’re talking about a much smaller transaction set for financial services than we are for health care. I mean health care is just dizzying and the types of data that gets transferred and the parties involved are just it’s a much broader much deeper industry and more complex there. That was the primary lesson that I took and we had conversations about that. Do we have to build our own protocol I hope not.

[01:04:13] Well that’s expensive and we need cryptographers and maybe Jonathan can help me on that. Maybe Jonathan’s thinking about building his own I don’t know yet I.

[01:04:27] Audience talking.

[01:04:34] Yeah. So everyone Sanders are like toothbrushes everyone has one but no one wants to use yours. Maybe I’ll just see who’s breath is freshest and go with theirs.

[01:04:45] I’ll give you the last word and then we’ll will thank our sponsors and wrap up.

[01:04:49] Sure. I guess the one maybe, a good takeaway would be don’t be completely hung up on the tech itself. We’re kind of talking. It’s an aspect of it it’s a challenge it may not even be the biggest challenge. Right. So we could see a situation where the tech is ahead of the policy and the others run running it. It could be it could be analogous to a solved fully autonomous vehicle. Right. The tech will probably exist close enough well before the regs will allow for it.

[01:05:18] So make sure you factor in the policy pieces, the human factors and those other sort of pieces just like we’ve seen in health care rollouts of technology have been knocked off of the axis because they didn’t get change management and all that sort of thing lined up first.

[01:05:39] OK. Well gang thank you all for being here. We’d like to thank for Frost Brown Todd for sponsoring this for BTC media Hashed Health for Honky Tonk brewery for supplying the beer to night.

[01:05:54] And then for Lipscombe and for Kevin for being willing to sit up here and like show what how Nashville is taking a taking the lead in this so thank you all.

[01:06:08] This group has grown from 10 less than a year ago to a more than 200 today so it’s remarkable to see the interest and we have an opportunity here in the city to become a center of blockchain and healthcare. And I think we run we can grab it or we can all be on planes to Boston or Austin or the Bay Area to do these conferences in the future.

[01:06:31] So it’s ours to grab and I’m glad to see this many people in the room interested in doing it. So thank you all and please continue to mingle.

[01:06:49] You’ve been listening to the Hashed podcast preceded by Hashed Health find more content like this at come to our next meet up and join our growing community of blockchain professionals and learn more about hash health dot com. Thanks for listening. We’ll see you next time.

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