Roger Boodoo, MD, is a radiologist and clinical informatics fellow actively seeking opportunities where blockchain technology might be applied to challenges in healthcare.
The following article is an exclusive contribution to CoinDesk's 2017 in Review.
Let's start with the problematic scenario.
A medical researcher stands behind the podium at a prestigious healthcare conference and proclaims that the "Kill Cancer Blockchain" will revolutionize the clinical trials process. The audience erupts with enthusiasm and begins to believe in this new "blockchain" concept.
Most of the healthcare conference attendees are unfamiliar with the nuances of blockchain. Little do they know, the researcher holds 100,000 "Kill Cancer" tokens and other cryptos in a cold storage wallet.
Disruption, come hither
Sure, that future may be exaggerated, but it's one that might be worth considering.
In the fall of 2016, the Office of the National Coordinator for Health Information Technology (ONC), a division within the U.S. Department of Health and Human Services, challenged industry, academia and developers to a blockchain contest.
The ONC solicited white papers on subjects including patient-reported outcomes, interoperability, healthcare finance and clinical research. Over 70 white papers entered the competition and the contest helped to springboard healthcare into the world of blockchain. Furthermore, the Healthcare Information and Management Systems Society (HIMSS) 2017 annual conference, attended by over 40,000, held a full day Blockchain in Healthcare workshop which sold out.
In 2016, Distributed Health, a healthcare-specific blockchain conference, spawned as well as others, and they grew and gained momentum in 2017.
And this is likely to continue as entrepreneurial concepts are finding fertile ground at the intersection of healthcare and blockchain. However, changing the course of a slowly moving, highly regulated, behemoth takes time.
Medical claims and billing with a built-in fraud prevention blockchain, supply chain management to help prevent phony medications, medical devices with IoT integration, the verification of provider credentials across state lines, private and secure health information exchange with an immutable audit trail, all could cut overall medical cost and improve efficiency.
These are just a few use-cases that blockchain will transform. And many have not been thought of yet, but they are coming…
Unsurprisingly, a plethora of startups are grasping at the opportunity.
For example, Health Nexus from SimplyVital Health is a healthcare-grade blockchain with protocol-level governance and validated HIPAA-compliant miners. The protocol is a fork from ethereum and the smart contracts and apps require Health Cash, the Health Nexus token, to run.
Other healthcare companies or researchers can build apps on Health Nexus blockchain for free. Moreover, many other startups are building on ethereum and initiating their own ICOs. The tokens or coins are then listed on exchanges and made available for traders, investors and speculators.
Conflicts of interest
Indeed, a tsunami of blockchain-related literature and presentations touting the revolution of healthcare is coming and the ensuing conflicts of interest statements will inherently become opaque and cryptic.
Digital cryptocurrencies have seen an astronomic increase in monetary valuation. As this valuation may be rooted in the successes of the blockchain, should presenters of blockchain-based research and applications disclose cryptocurrency holdings and their amounts?
The International Committee of Medical Journal Editors’ Uniform Disclosure Form for Potential Conflicts of Interest is the de-facto standard, and it is used by many academic journals to include the likes of the New England Journal of Medicine, The Lancet, Radiology and the British Medical Journal.
The purpose of this form is to provide conference attendees and readers of manuscripts with information about the author's other interests that could influence how they receive and understand the work. This form does not address cryptocurrencies specifically but does state that all monies received that can be relevant should be disclosed. It continues to state that it is best to disclose than not to, if there is any question about a conflict of interest.
Cryptocurrencies fall into the "other" category. The goal is to provide transparency to allow the objective consumption of the presented material.
Yet, as blockchain efforts expand, we face the question of cryptocurrency holdings as a potential conflict of interest to investigators looking to further its role in healthcare.
This problem is multifaceted, based not only on the financial ties between cryptocurrency and the successes and failures of blockchain, its platforms and applications, but the inherent anonymity of the investment. Like most ethical concepts, this consideration came about through retrospective analysis of past projects and the implications on future blockchain-based research, presentations and publications.
The challenge is the analysis and difference of opinion on the question of whether the new champions of blockchain in healthcare should disclose the holding of cryptocurrencies in their personal digital wallets or in any form of fund, and should they disclose the amount?
Technologies such as immunotherapy, artificial intelligence and CRISPR will also likely change healthcare, but they will follow the convention rules regarding conflicts of interest, meaning authors and presenters will disclose associations with commercial entities or financial support before peer-reviewed publications or professional speaking engagements.
Most traditional financial assets and associations are easily traceable through tax records and statements, which result in a feeling of greater responsibility to disclose. However, the inherent secrecy and anonymity of cryptocurrency raise questions about traceability and disclosure in general.
Conclusion and solution
It's a worthy question, and one I'm thinking about as I weight the benefits of the technology.
I am actively brainstorming healthcare related use cases, beginning to build proofs-of-concept and submitting abstracts to medical societies. I am promoting the use of blockchain, yet it is not clear if I must disclose these potential conflicts.
I believe cryptocurrency holdings should be considered for disclosure when presenting research and potential applications of blockchain technologies in healthcare in any form. These disclosures are not meant to question a person's integrity or hinder progress, but instead to allow for the consumption of information in an unbiased manner.
A conflict of interest later discovered can lead to a retracted journal article or a discredited presenter.
Regardless, if professional societies require presenters to disclose coins of interest or not, I encourage transparency.
Radical transparency can only help to further the adoption of blockchain applications in the healthcare settings, and healthcare hungers for disruption. If the "Kill Cancer" tokens are coming, then there may be many buyers, and with a cause like that, who wouldn't want to be among them?
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