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Using Telehealth as a Model for Blockchain HIT Adoption

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Abstract

Telemedicine and blockchain technology share a core philosophy of empowering the individual. Blockchain solutions that focus on empowering patients and enhancing the workflows for the providers who treat them continue to make big headlines, as does enterprise investment and adoption of telehealth. Both models focus on direct-to-consumer health services, with a personalized care experience designed from the ground up to save time and money for everyone involved. The typical binding factor between the telehealth and HIT (health information technology) blockchain adoption is a patient centric, value-based care model. Therefore, it is as no coincidence that value-based care is at the center of the fastest growing (and operational) part of HIT blockchain adoption. For this reason, telehealth can demonstrate adoption synergies than most other lines of business in healthcare cannot.
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Using Telehealth as a Model for Blockchain HIT Adoption
Brennan Bennett
Editor’s note: This month, Telehealth and Medicine Today brings to its readers the
second in a series authored by Brennan Bennett on telehealth and blockchain
technology. In this article, the focus is on their shared core philosophy of
empowering the individual.
Telemedicine and blockchain technology share a core philosophy of empowering the
individual. Blockchain solutions that focus on empowering patients and enhancing
the workflows for the providers who treat them continue to make big headlines, as
does enterprise investment and adoption of telehealth. Both models focus on direct-
to-consumer health services, with a personalized care experience designed from the
ground up to save time and money for everyone involved. The typical binding factor
between the telehealth and HIT (health information technology) blockchain adoption
is a patient centric, value-based care model. Therefore, it is as no coincidence that
value-based care is at the center of the fastest growing (and operational) part of HIT
blockchain adoption. For this reason, telehealth can demonstrate adoption synergies
than most other lines of business in healthcare cannot.
Telehealth is used to empower consumers to make better healthcare choices, have
higher access care, and lower medical costs by getting help when they need it
instead of waiting until it’s necessary. Blockchain technology can improve existing
technological applications of telemedicine by providing more quality assurance in the
data retained each visit. Additionally, blockchain can build incentive structures based
on its ability to facilitate an economy of scale (i.e., producing more services at a
lower cost). The only thing missing from combining high data integrity with a scalable
solution for producing more services at a lower cost is a mechanism for
incentivization- enter crypto-currencies, also known as tokens.
Bitcoin and Tokens
Following the birth of Bitcoin, other alternative currencies, or tokens, arose as people
developed blockchain solutions to be less about binary transactions and more about
the quality of interaction. To accomplish this, tokens had to take on various kinds of
rights that enabled various kinds of actions, or reactions, to be made. These “rights”
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have evolved from only being able to make payments on the network (i.e., payment
rights tokens), to innovative functionalities like being rewarded for making a human
decision (i.e., contribution rights tokens). Contribution in healthcare is akin to chain of
custody of a patient’s healthcare data as multiple healthcare professionals review
diagnosis, test results, treatment and ultimately discharge plan.
As healthcare systems continue to face roadblocks in the exchange of healthcare
data, blockchain technology seemingly offers several solutions for the protection and
management of patient information. One of many blockchain startup companies,
Patientory, enables patients to secure their own data utilizing blockchain technology.
Patientory is not a standalone blockchain EMR (emergency medical record) solution,
but it does take a step in the right direction by enabling healthcare consumers to use
their personal health data as a resource to securely socialize with multiple health
teams and other patients experiencing similar health issues.
Following the footsteps of Patientory is Healthcoin, which utilizes blockchain
technology to reduce the effects of diabetes. Another offshoot, Dentacoin, utilizes
blockchain based applications to facilitate global dental care. Ultimately, programs
like Patientory and Dentacoin are still in their beginning stages and remain a work in
progress. The proverbial kinks in the chain-system require repair and whether
cryptocurrencies or smart contracts provide a cure-all solution to an evolving health
care industry remains to be seen.
Other types of tokens have enhanced their functionality by adding their own coding
to the core design. Ethereum for example, implements smart contracts. Smart
contracts are self-executing and auto-enforced digital agreements without necessity
of a middle-man. Some contractual arrangements involve financial terms and when
met, the data-oriented contract releases units or "ether." Patientory and Healthcoin
incorporate Ethereum's technology, but have developed their own token to run on
the Ethereum blockchain specifically for their respective ecosystem. For example,
when using Patientory, a doctor can use the network’s native token, PTOY, to get a
retrieve a patient’s medical history. Dentacoin's smart contract design is slightly
different; fill out a survey and in return the amount earned pays for further care at a
partnered dental clinic.
A Direct-to-Consumer Philosophy
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Blockchain technology and smart contracts in a sense remove the third-party,
empowering more of the direct to consumer philosophy, just like telehealth.
Medicine's metamorphosis through integration of modern technologies naturally
causes a paradigm shift in clinical practices, and often a divide among professional
opinion follows the change. Using cryptocurrencies in healthcare is not immune, as
believers opt to reside in either camp. Standardization of any process creates
interest groups, and as always, there are advantages and disadvantages to
adoption.
Frequent access to telehealth services allows early detection of disease and hence
lowers the medical cost for patients, doctors, and insurance companies.
Nonetheless, the efforts to reduce the administrative costs of healthcare are major
motivating factors behind the application of telemedicine. For this reason, Blockchain
may also provide a glimpse of how future virtual care communities rooted in
telemedicine can be self-sustaining by ensuring transparency in addition to
redefining trust. Point Nurse has developed a blockchain based member-owner
community that gives healthcare professionals an entrepreneurial channel to do what
they do best- help people. Their reward, “…credit toward future ownership of the
community including a share of any profits.” Essentially, healthcare professionals
such as LPNs, RNs and even med techs are empowered to build themselves as a
brand and connect with patients seeking home health services either in their
community or via telehealth.
Blockchain adoption still has a long, long way to go to achieve adoption in the
healthcare sector. Telehealth can demonstrate quite clearly how healthcare
technology can evolve faster when focused on direct to consumer value based care.
Understanding how could lead those developing major HIT blockchain use cases to
refine their focuses, even in administrative workflows.
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Brennan Bennett is the Founder and Managing Editor of Blockchain Healthcare Review, a
publication covering technical innovations in blockchain technology and how it is reshaping
the future of health data governance. He is an experienced HIT strategy consultant with a
background in the Fortune 100 space. Additionally, Brennan holds a M.S. in Biomedical
Informatics from RutgersThe State University of New Jersey.
Department: Blockchain
Tags: Blockchain, Bitcoin, token, telemedicine, Ethereum, Patientory, Dentacoin,
Healthcoin, EMR, security
... Les solutions actuelles d'e-santé se heurtentà un obstacle de taille : la centralisation, qui augmente la possibilité d'un point de défaillance unique et qui est sujetteà des attaques contre la fiabilité et la disponibilité [50]. La décentralisation améliore la robustesse globale des systèmes de santé actuels, garantissant que les données médicales sont protégées contre les attaques malveillantes ou les pertes de données accidentelles [9]. Par ailleurs, nous considérons les défis de recherche suivants : ...
... Current e-health solutions face a significant impediment in centralization, increasing the possibility of a single point of failure and prone to attacks against reliability and availability [50]. The decentralization improves the overall robustness of current healthcare systems, ensuring that medical data are protected from malicious attacks or accidental data loss [9]. Hence, we consider the following research challenges: ...
... Moreover, we also assume the security of the broadcast encryption scheme as well as asymmetric encryption one; both can be similarly formalized as Equation 6. 9. Moreover, at least one trusted party is required for handling the homomorphic encryption and decrypt the query results; for simplicity, we assumed this is the same user as the query engine; however, this trusted user can be any other node. ...
Thesis
Full-text available
Avec la longévité et le taux croissant de personnes âgées, il est vital de permettre aux personnes âgées d'avoir une meilleure qualité de vie avec des coûts réduits en utilisant la santé en ligne. Le manque de fiabilité des données, l'incertitude des règles médicales, les problèmes de sécurité et la personnalisation posent de nombreux défis pour la création d'un système de santé en ligne intelligent et sûr; dans cette thèse, nous abordons les défis mentionnés. Tout d'abord, nous avons proposé un cadre de télésoins auto-adaptatif. Ce cadre fournit un télémonitorage basé sur l'IdO avec une sélection intelligente d'actions de détection pour fournir une image holistique des patients avec un minimum d'intrusions. Deuxièmement, nous avons proposé un cadre sécurisé pour traiter les questions de robustesse et de respect de la vie privée dans les réseaux IdO. Le cadre proposé est basé sur la technologie de la chaîne de blocs et du stockage distribué pour garantir l'intégrité et la disponibilité dans un réseau décentralisé. Le cadre proposé permet de préserver la confidentialité des données grâce à l'IA, ce qui permet à l'IA de crypter les données sans y donner accès. Troisièmement, nous avons proposé un cadre sûr et robuste pour le partage des données dans le domaine de la santé en ligne, ou plus généralement dans les réseaux IdO. Le cadre proposé utilise des algorithmes cryptographiques pour assurer un partage sécurisé des données sans révéler aucune donnée personnelle et en évitant les redondances.
... The decentralization feature increases the overall robustness of existing healthcare systems, and thus Electronic Health Records (EHRs) of the patient are preserved against adversarial attacks or accidental data loss [2,[13][14][15]. Moreover, the consensus protocols ensure the agreement on the current state of the blockchain ledger to establish trust among telehealth and telemedicine participants [10]. ...
... Smart contracts have been extensively practiced in existing systems that are proposed to digitize healthcare services [21]. More specifically, the existing studies have mainly focused on securing patients' EHR [16,10,22], traceability of COVID-19 outbreak [23][24][25], drugs supply chain management [26,18,27,28], and digitization of telemedicine industry [29,30,14]. An Ethereum-based telemedicine solution presented in [31] has preserved the integrity of EHR by storing IPFS hashes of EHR in the decentralized network. ...
... This increases the system cost that can profoundly influence the effectiveness of a patient's treatment. Blockchain technology assures that the complete and trustworthy medical history of a patient can be maintained and tracked by the authorized users through immutable records of transactions and medical records [79][80][81]14]. However, the lack of awareness, immaturity of the technology, and unavailability of security and privacy standards prevent telehealth participants to unlock the full potential of blockchain technology [82]. ...
Article
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Objective: Telehealth and telemedicine systems aim to deliver remote healthcare services to mitigate the spread of COVID-9. Also, they can help to manage scarce healthcare resources to control the massive burden of COVID-19 patients in hospitals. However, a large portion of today's telehealth and telemedicine systems are centralized and fall short of providing necessary information security and privacy, operational transparency, health records immutability, and traceability to detect frauds related to patients' insurance claims and physician credentials. Methods: The current study has explored the potential opportunities and adaptability challenges for blockchain technology in telehealth and telemedicine sector. It has explored the key role that blockchain technology can play to provide necessary information security and privacy, operational transparency, health records immutability, and traceability to detect frauds related to patients' insurance claims and physician credentials. Results: Blockchain technology can improve telehealth and telemedicine services by offering remote healthcare services in a manner that is decentralized, tamper-proof, transparent, traceable, reliable, trustful, and secure. It enables health professionals to accurately identify frauds related to physician educational credentials and medical testing kits commonly used for home-based diagnosis. Conclusions: Wide deployment of blockchain in telehealth and telemedicine technology is still in its infancy. Several challenges and research problems need to be resolved to enable the widespread adoption of blockchain technology in telehealth and telemedicine systems.
... The decentralization feature increases the overall robustness of existing healthcare systems, and thus Electronic Health Records (EHRs) of the patient are preserved against adversarial attacks or accidental data loss [2,13,14,15]. Moreover, the consensus protocols ensure the agreement on the current state of the blockchain ledger to establish trust among telehealth and telemedicine participants [10]. ...
... Smart contracts have been extensively practiced in existing systems that are proposed to digitize healthcare services [20]. More specifically, the existing studies have mainly focused on securing EHR of patients [10,16], traceability of COVID-19 patients [21,22], end-to-end drugs traceability [18,23], and automation of telemedicine industry [14,24,25]. To the best of our knowledge, none of the existing studies have explored the role of blockchain technology in telehealth and telemedicine systems. ...
... This increases the system cost that can profoundly influence the effectiveness of a patient's treatment. Blockchain technology assures that the complete and trustworthy medical history of a patient can be maintained and tracked by the authorized users through immutable records of transactions and medical records [14,58,59,60]. However, the lack of awareness, immaturity of the technology, and unavailability of standards prevent telehealth participants to unlock the full potential of blockchain technology. ...
Preprint
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div> Objectives: Telehealth and telemedicine systems aim to deliver remote healthcare services to mitigate the spread of COVID‐19. Also, they can help to manage scarce healthcare resources to control the massive burden of COVID-19 patients in hospitals. However, a large portion of today's telehealth and telemedicine systems are centralized and fall short of providing necessary information security and privacy, operational transparency, health records immutability, and traceability to detect frauds related to patients' insurance claims and physician credentials. Methods: The current study has explored the potential opportunities and adaptability challenges for blockchain technology in telehealth and telemedicine sector. It has explored the key role that blockchain technology can play to provide necessary information security and privacy, operational transparency, health records immutability, and traceability to detect frauds related to patients' insurance claims and physician credentials. Results: Blockchain technology can improve telehealth and telemedicine services by offering remote healthcare services in a manner that is decentralized, tamper-proof, transparent, traceable, reliable, trustful, and secure. It enables health professionals to accurately identify frauds related to physician educational credentials and medical testing kits commonly used for home-based diagnosis. Conclusions: Wide deployment of blockchain in telehealth and telemedicine technology is still in its infancy. Several challenges and research problems need to be resolved to enable the widespread adoption of blockchain technology in telehealth and telemedicine systems. </div
... An efficient broadcast encryption solution using n-mulinear maps has been proposed in [3]. The proposed broadcast encryption scheme consists of no header, and the size of private keys is O((log t) 2 ). ...
... The first two forms can be formalized using Eqs. (2) and (3); while the last one is, in fact, the access control requirement. ...
Chapter
IoT technology is rapidly growing in all fields of modern industries. Billions of IoT devices contribute to facilitating life in various contexts. A centralized system can hardly handle the extensive volume of IoT networks. Blockchain technology provides an immutable decentralized platform for communication in IoT applications. However, blockchain does not provide a solution for the confidentiality of data, which can be vital in many IoT applications. To this end, in this paper, we define the security concerns of data sharing in the IoT application. On that basis, we propose a secure data-sharing framework based on blockchain. In this framework, broadcast encryption is used to provide confidentiality of data with minimum data overhead. Moreover, with homomorphic encryption, the proposed framework enables secure data queries without leaking any information about the data. In the security analysis of the proposed framework, we have formally proved that this framework meets the security requirements. Moreover, the proposed framework is evaluated in the teleconsultation use case. The evaluation results show the proposed framework’s strength in providing a secure and robust framework for data-sharing in the context of e-health.KeywordsIoTBlockchainSecureBroadcast encryptionHomomorphic encryption
... Health for all India's mission is experiencing a major roadblock due to the lack of availability of an adequate number of doctors and nurses, especially in the underprivileged areas of the country due to the misdistribution of resources [1]. In India, the most recent data shows a doctor-to-patient ratio of about 0.62:1000 people, which is far much lower than the recommended 1:1,000 as per World Health Organization (WHO) [2,3]. COVID-19 persistent spread worsens the situation further by creating an acute shortage of health care professionals, especially qualified doctors [4]. ...
Article
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... Smart contracts have been commonly practiced in existing systems that are proposed to digitize healthcare services. More precisely, existing studies have concentrated primarily on ensuring the EHR of patients [11,30], COVID-19 patient traceability [51,52], end-to-end traceability of drugs [53][54][55], and the automation of the telemedicine industry [56,57]. Disintegrated systems suffer from a lack of appropriate means to exchange data and build information silos for participating organizations. ...
Chapter
Full-text available
Presently, Internet of Things (IoT) and wearables have become advanced technologies that intend to ease life and aid people in every aspect of life. They find use in smart healthcare where several wearables and IoT devices are used to monitor the health status of the patients. At the same time, Alzheimer’s disease (AD) is a dynamic, permanent, and neuro-degenerative illness that mainly affects elder people and it progressively degrades the efficiency of the brain, thereby affects memories, learning, and behaviors. The advent of machine learning algorithms has led to the design of IoT and wearables-enabled automated AD diagnosis and classification model. In this view, this chapter introduces an effective IoT and wearables-enabled AD detection and classification model using stacked sparse autoencoder (ADC-SSAE). The proposed ADC-SSAE model enables the wearables to collect patient data and medical examination takes place on the captured data. In addition, the region of interest extraction and bilateral filtering based preprocessing take place to raise the image quality. Besides, local texton XOR patterns (LTxXORP) model is applied as a feature extractor to derive a useful set of features from the preprocessed data. At last, SSAE model is utilized as a classification model to determine the proper class labels of the applied input data. An extensive range of simulations was performed to highlight the better outcome of the ADC-SSAE model. The experimental values obtained by the ADC-SSAE model have ensured the efficacy of the ADC-SSAE model over the compared methods.
Chapter
Blockchain has three main features—decentralization, immutability, and encryption—that can cover multiple fields of use in the healthcare industry. Telemedicine, a relatively new field, stems from telecommunications’ contribution to healthcare services’ remote delivery. This area has observed many benefits of Blockchain technology. However, innovative techniques for secured and authenticated data transfers still need to be put forward in this new digitization era. Healthcare professions use the opportunities provided by the Blockchain technology (BCT) in accessing the patient’s information in a decentralized format. Though the decentralization aspect improves the overall robustness of current healthcare systems, trust and traceability are the key action points that need to be focused on. BCT paired with smart contracts automates operations and services of telehealth and telemedicine in an efficient and trustful way. Several case studies and models have been discussed and proposed, demonstrating the practicality of secured data transfers using BCT in the telehealth and telemedicine domain. BCT has hopefully assisted in the safe sharing of data information, from cryptographic record keeping of a person’s information to easy access and access everywhere. Telemedicine has had significant security issues, but Blockchain’s ability to develop and maintain a secure network when exchanging data has allowed easy information flow. This chapter presents various models and frameworks proposed in the state-of-the-art and discusses their implications for patient engagement and empowerment. These models are discussed in terms of their performance and cost in providing secured and private data sharing. Cost, lack of awareness on how to implement it, and lack of standardization are obstacles preventing Blockchain’s adoption in telemedicine. The COVID-19 pandemic has boosted telehealth and telemedicine technology uptake, where BCT could be a prevailing solution. The interest in providing hospital care in the patient’s home is also growing, an approach where multiple investors are pouring money into companies working on remote monitoring of different health and telemedicine parameters. There is currently limited research on Blockchain applications for telemedicine, but more research is available every day. Blockchain is now one of the most active fields of software science, and by restoring authority over medical records and health data to the patient, it will shift the hierarchy of healthcare.
Article
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Purpose: Blockchain technology is one of the emerging Information Communication and Computation (ICCT) underlying technologies of the 21st century with potential applications in primary, secondary, tertiary, and quaternary industry sectors. In this paper, we have identified and analyzed some of the potential fields of the healthcare industry that can get benefit by means of using blockchain technology principles. Based on a systematic review on the development of blockchain technology and its application in healthcare sector to improve the quality of healthcare services, this paper identifies some of the application areas in the healthcare industry including Healthcare Security & Authentication aspects, Clinical Trials & Precision Medicine, Personalizing the Healthcare Services, Healthcare Data Management, Strengthening Public Health Surveillance, e-Healthcare to Customers, Healthcare Administration & Medicine Management, Telehealth & Telemedicine, Managing Medical Imaging, Developing Smart Healthcare System, and Healthcare Information System. The purpose also includes the analysis of the current implementation challenges of blockchain technology in healthcare industry services. Methodology: The study is descriptive and exploratory in nature. The related information is collected from various secondary sources for review. The secondary sources include published literature from various scholarly journals searched through Google scholar by means of identified keywords. Results/Findings: Based on a systematic review, we have identified the current status of the use of blockchain in several areas of healthcare sector, desired status called ideal status, and the research gap of use of blockchain technology in various application areas of the healthcare industry along with identification of various possible research agendas for future research. Originality/Value: It is found that blockchain technology facilitates for the improvement of quality services in the healthcare sector and various research agendas are proposed to carry out further research for patient satisfaction and comfortability. Type of the Paper: Review based research analysis.
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