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Healthcare

Apr 07
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Five Takeaways on Open Source, Blockchain and Innovation from HLTH VIVE and HIMSS

By Jim St. Clair, Executive DIrector, Linux Foundation Public Health (LFPH) Blog, Healthcare

The month of March 2022 finally gave us the opportunity to enjoy sunny Florida and partake in the competition of the largest in-person health conferences in two years. In one corner, the scrappy new competitor, HLTH VIVE, having their first ever conference in the Miami Convention Center. In the opposing corner, the champion, HIMSS, which before the pandemic drew a crowd of over 40,000, and managed to draw almost 28,000 (including a shocking 10,000 last minute, in-person registrations) for a week at the massive Orange County Convention Center in Orlando. It was a busy scene for sure – attended by industry professionals, healthcare leaders, government and start-ups. 

These shows cover a huge array of topics, so we were pleased to see that the real-world impact of blockchain and other technologies that support the increasingly decentralized world of medicine were front and center at these events. As we recently highlighted in the post Hyperledger-Powered Solutions Helping to Reshape Healthcare, there has been continuous innovation and investment aimed at breaking down information silos and improving the efficiency and effectiveness of data reporting and sharing. It’s gratifying to see the realization of that work and to gather with colleagues for discussions about what’s been achieved and what comes next.

Read on for five takeaways from the two weeks we spent in Florida getting the latest on open source and blockchain technology in healthcare:

  1. In person is back! It’s worth noting that after two years the in-person experience is finally coming back. It’s hard not to immediately appreciate the value of face-to-face engagement, and reportedly there were only a few health challenges at either event. 
  1. “First rule of blockchain: Never talk about blockchain.” HIMSS hosted two breakfast panels featuring a range of healthcare industry professionals discussing blockchain applications. It was worth noting that these applications didn’t make Anthem or Humana, for example, “blockchain companies,” but instead demonstrated how enterprise blockchain ledgers support existing business processes and improve workflows. This will probably continue in new adoption models. 
  1. Healthcare gets decentralized. While there is plenty of talk about “Web3” in healthcare on the Internet, it’s probably worth noting first how healthcare as an industry is poised to be decentralized, without the first NFT. The shift to remote patient monitoring (RPM), Hospital at Home, and telehealth demonstrate the shift to healthcare moving away from the centralized hospitals and doctor’s offices as the primary means of healthcare services. The Linux Foundation Open Voice Network (OVON) hosted a half-day summit on voice and AI in healthcare, based on other industry trends for voice-controlled devices making major inroads in customer services and delivery. Distributed ledgers, with their auditable and immutable transaction chains, complement voice-only, AI augmented encounters to tie information back to clinical records and support prescriptions and clinical interventions. 
  1. It’s more than privacy; it’s also consent. While healthcare has been heavily regulated for decades, especially concerning medical privacy, there is growing recognition of the need for consent mechanisms, especially in digital health. During the VIVE event, Linux Foundation Public Health (LFPH) presented twice on eConsent mechanisms and the role Hyperledger Indy and W3C Verifiable Credentials can play in enforcing identity and consent as part of health information exchange. 
  1. Future innovations will drive toward scale, speed, and equity. As LFPH member VMWare notes in its takeaways, digital innovation in healthcare is driving the future, and the healthcare industry is living through major market transitions in digital health and patient-centric care models. There is tremendous room for multi-stakeholder collaboration in open source and leveraging blockchain for decentralized healthcare applications, making engagement more patient-centric.

It’s exciting to see how Hyperledger Foundation, LFPH and other Linux Foundation projects are actively involved in so many facets of new innovations in healthcare. Across the entire Linux Foundation, there’s a tremendous amount of work underway that is driving significant improvements in healthcare, demonstrating the power of open source to advance innovation:

  • Hyperledger Foundation hosts a variety of cutting edge solutions to decentralize transactions and integrate with new supply chain models.
  • Linux Foundation Public Health builds, secures, and sustains open source software to improve global health equity and innovation. 
  • The Trust over IP Foundation is almost celebrating its second anniversary and has been pioneering a new model for digital identity that is already being adopted in Canada and the EU. IT’s also laying the groundwork for re-imagining patient identity.
  • LF AI & Data is supporting open source innovation in Artificial Intelligence and Machine Learning (AI/ML), a rapidly growing technology in healthcare.
  • There are numerous initiatives in Cloud Computing, which many public health agencies can leverage for system modernization. 
  • The Linux Foundation is leading the charge in the US mandate on securing software supply chains, and there’s a tremendous opportunity to include LFPH and help to secure medical devices and Internet of Medical Things (IoMT). 

Continue to watch this space for more exciting innovations to improve health outcomes in open source that can be realized in 2022.

Cover image: Piqsels

Mar 29
Love1

Hyperledger-Powered Solutions Helping to Reshape Healthcare

By Hyperledger Blog, Healthcare, Hyperledger Fabric, Hyperledger Firefly

For decades, the healthcare industry has faced the challenge of juggling a huge (and growing) amount of patient, payer, provider and pharmaceutical data with managing accuracy, access, security and privacy. There has been continuous innovation and investment aimed at breaking down information silos and improving the efficiency and effectiveness of data reporting and sharing. Hyperledger technologies power an increasing number of the solutions that are taking on these challenges head on and creating new models for the industry.

Read on for a sampling of these Hyperledger-powered solutions and the ways they are helping to streamline a range of critical healthcare processes. And join the conversation using #HyperledgerHealth on social channels.

Avaneer Network

Founded by a consortium that includes Aetna, Anthem, Cigna, Cleveland Clinic, HCSC, IBM, The PNC Financial Services Group, Inc., and Sentara Healthcare, Avaneer Health has built a private, secure, and trusted technical healthcare network where stakeholders can collaborate to streamline and improve the healthcare experience while increasing administrative efficiency. The Avaneer Network leverages Hyperledger Fabric-based blockchain technologies to ensure privacy, security and content-based use of data. Participants connecting to the Avaneer Network have access to a range of solutions for securely transacting and administering healthcare and deploy innovative solutions that streamline processes. The first network participants, all founding members of the consortium, represent 80 million covered lives and 14 million annual patient visits.

IBM Digital Health Pass

IBM Digital Health Pass, built on Hyperledger Fabric, offers a multi-credential verifier that organizations can use to manage and execute their verification policies for COVID-19 and vaccination status in a way that balances the privacy of the individual with the requirements set by the organization and local health authorities. With IBM Digital Health Pass, organizations can verify multiple types of COVID-19 health credentials, such as Good Health Pass, IBM Digital Health Pass, Smart Health Card and EU Digital COVID Certificate. Privacy is central to the solution, where the verifier application minimizes the personal data that is ever displayed to the user through the execution of business rules and it never lets any personal data leave, or be stored in, the verifier app.

KrypC Pharmaceutical Delivery Supply Chain Solution

KrypC’s pharmaceutical supply chain solution uses Hyperledger Fabric to connect pharmaceutical manufacturers and carriers to collaborate on the safe delivery of drugs. The solution focuses on end-to-end traceability to provide an audit trail for the efficacy of drugs by capturing and verifying information such as the manufacturing date, location in transit, and more. With multiple handoffs across handling agents across continents, there is a crucial need for trusted, end-to-end visibility of pharmaceutical shipments, conditions, and documents. With this solution, Kypc leverages blockchain’s inherent ability to trace drug provenance and create an immutable record of the lifecycle of a drug and how it was handled to address the challenges the pharmaceutical industry faces, both in sourcing and distributing drugs.

Synaptic Health Alliance Decentralized Provider Data Directory 

The Synaptic Health Alliance is a coalition of healthcare leaders working to solve their industry’s toughest problems through blockchain technology. Their objective is to create a blockchain-powered platform that enables a culture of innovation, removes friction and solves the shared challenges impacting constituents across health care today.

For their first application, they tackled the challenge of providing healthcare organizations with accurate provider demographic data. Today, healthcare organizations typically collect provider demographic data in separate IT systems maintained by each organization independently. This promotes vast inefficiencies and duplication of efforts (costing roughly $2.1 billion across the industry), while also potentially reducing data quality. 

To solve this, Synaptic created a blockchain-based Decentralized Provider Data Directory leveraging Kaleido and the capabilities of Hyperledger FireFly. Through the power of blockchain, participants are now able to crowdsource provider demographics. Token economics incentivize the creation of accurate data, which can then be used by other providers to update their own records, reducing duplication of effort, streamlining administration, and saving money. 

Ongoing activity in the space is driven by the very active Hyperledger Healthcare Special Interest Group (SIG), which unites healthcare professionals and technologists from around the world in advancing the state of the healthcare industry through the implementation of technology solutions using blockchain technologies in general, and the umbrella of Hyperledger frameworks and toolsets in specific. It includes subgroups focused on patients, payers and healthcare interoperability.

Cover image: Pixabay

Mar 14
Love0

Interoperability in the Open Source community

By Tim Spring, Indicio Blog, Healthcare, Hyperledger Aries, Hyperledger Indy, Identity

Without interoperability, you wouldn’t be able to read this article. Websites, computers, and servers must be able to recognize and share information with each other, and shared standards and protocols allow them to do so, thereby giving us the web. On a smaller scale, companies have their own intranets, and, on the smallest scale, you might have your own private thumb drive for personal documents that can interact with whatever machines you typically work on. 

Interoperability is not a technological given or an inexorable process. It is a choice that needs to be actively made, and it can sometimes take considerable effort to make work. Think of electronic health care records and the years it has taken to make it easier for a patient to access their health data, something originally provisioned in a 2000 Privacy Rule to the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

Crises, however, can accelerate the slog to technological convergence—and that’s precisely what we’ve seen as a result of the global COVID-19 pandemic. In April 2021, a data-sharing provision of the 21st Century Cures Act came into effect: Patients must be able to have direct digital access to eight categories of clinical notes in an electronic health record, notably—given the need for COVID testing—lab test results. 

Cometh the legislation, cometh the tech. Indicio and SITA had already been working on a decentralized, verifiable credential solution to integrate passenger health data with air travel in a privacy-preserving way. Built on Hyperledger Indy and Hyperledger Aries, the technology solved the problem of patient privacy by eliminating the need for a centralizing party to store patient data in order to facilitate verification. 

With the Cures Act provision, there was now no obstacle to passengers in the US accessing their COVID test data directly from a Health Information Exchange in the form of a digital credential. They could use this credential to prove their test status without having to share personal information. In situations where it was important to know which test they had taken and when, they could choose to share this information with a verifier, such as the border control or health agency of the country they were visiting.

This solution is now known as the Cardea Project. Successfully trialed in Aruba, its codebase has been donated to Linux Foundation Public Health as an open source solution for sharing health data through verifiable digital credentials. It has an active community group, led by Indicio and Shatzkin Systems, that is working on expanding its features and, critically, its interoperability.

To do this, Cardea launched a hackathon for interoperability— dubbed an “Interop-a-thon”— in September 2021. The goal was to get companies using Aries agents to test those agents against a reference implementation of Cardea and each other. Over a half day, SITA, Liquid Avatar, IdRamp, GlobalID, Canadian Credentials Network, and Network Synergies all successfully interoperated. That’s the headline; the story, however, is that it took work to make this happen—it was an exercise in uncovering glitches, unexpected problems, and overcoming them. That’s what made the Interop-a-thon so valuable for all the participants—and that’s why Cardea is holding a second Interop-a-thon on March 17.

This time, in addition to  agent testing, Cardea is going to field “out-of-band” invitations (a critical change coming to Hyperledger Aries at the end of March) and a simple reference implementation of machine readable governance (a way of adding governance rules at the agent level, thereby making governance portable and available offline).

Participants see interop-a-thons as a testing ground for interoperability, and therefore a way to ensure that the products and services they are building have the capacity to scale. This is a critical step toward achieving a network of networks effect. Not surprisingly, the number of participants signed up for the next Interop-a-thon is much greater than the first.

For Cardea, there are more and bigger trials on the way. And with each solution delivered, the scope for expansion becomes greater. If we can successfully implement a system for incorporating health data in travel, what about all the other clinical notes described by the Cures Act? What’s the roadmap to creating a decentralized health record?

This is the perfect challenge for an open source community to solve. And by testing the solution through an interop-a-thon, we can figure out how to make the many function as one.

If you want to learn about interoperability first hand, I highly encourage you to watch the video of their last Interopathon here: https://www.youtube.com/watch?v=KVywPPLhG0U. For more details or to register for the  next event on the 17th of March, go here: https://docs.google.com/forms/d/e/1FAIpQLSdpQmjxnYqohk0SfleulNOJXYsi1bhVhMjeGP5MxBMxCa-9TA/viewform 

Aug 24
Love1

Hyperledger-Powered Healthcare Solutions in Action

By Hyperledger Blog, Healthcare

While always critical, public health and healthcare have taken on added urgency in the last 18 months. Technology is a cornerstone of today’s healthcare, and blockchain adds a vital layer to the increasingly digital infrastructure in this complex market. Blockchain’s growing role ranges from managing new challenges relating to COVID-19 testing and credentials to increasing the efficiency of critical, data-intensive workflows like clinical trials or insurance claims to supporting new models that make it easier for patients to access and share critical healthcare information without sacrificing privacy.

A number of Hyperledger technologies are at work helping drive new approaches to the existing and emerging complexities of healthcare. Read on for a sampling of Hyperledger-powered applications and solutions that are in production across the industry. And join the conversation using #HyperledgerHealth on social channels.

Aruba Health App

Indicio.tech, together with SITA and the Aruba Health Department, created the Aruba Health App to make it easy for visitors to share a trusted traveler credential — based on their health status — privately and securely on their mobile device. Using the Aruba Health App, visitors to the island who have provided required health tests to the Aruba government are issued a unique trusted traveler credential, using blockchain technology. This credential then can be verified by hotels, restaurants, and entertainment venues through the unique QR code on a visitor’s mobile device without sharing any private data. The digital credential also enables the Aruba government to restrict visitors from leaving their hotel rooms until they have received a negative PCR test result. Launched initially as a trial, the Aruba Health App is built using Cardea, an open-source code base that has since been contributed to the Linux Foundation Public Health (LFPH) project. Cardea leverages Hyperledger Indy, Hyperledger Aries and Hyperledger Ursa.

MediConCen

MediConCen built a consortium system powered by Hyperledger Fabric that automates medical insurance claims without using any paper. The blockchain has been in production for two years with over 223,000 blocks written. It is a great production use case showing how blockchain technology can sharpen the efficiency of insurance companies and medical providers, while eliminating the need for reconciliation among the participants. By implementing digital signature using QR codes, the platform is scalable and can include any insurers and any medical providers in the world without concern of the integrity of medical providers and the claim data. This greatly relieves the workload of all parties involved, especially the medical staff with more urgent matters to attend to. It has over 600,000 users, who are connected to over 900 doctors. MediConCen was included in the 2021 “Forbes Asia 100 to Watch” that spotlights notable startups on the rise across the Asia-Pacific region.

U.S. HHS COVID-19 Immutable Testing Results Collections and Analysis

As COVID-19 testing ramped up in 2020, getting accurate and complete data from various testing venues on a timely basis needed for pandemic surveillance and mitigation efforts was a challenge. When the FDA started approving at-home test kits and testing moved beyond the controlled environment of medical labs to work places, colleges and universities, airports, sports venues and, eventually, at-home testing, these challenges grew, creating an urgent need to ensure the completeness, integrity, and accuracy of the reported data and the pandemic mitigation efforts that rely on it. Oracle worked with HHS to address the need for a single source of truth across multiple agencies, data integrity, immutability/tamper-evidence, and privacy/confidentiality of the test results. Using the Oracle Blockchain Platform (OBP), which is based on Hyperledger Fabric, Oracle rapidly deployed a permissioned enterprise-grade blockchain network in Oracle Government Cloud.

The solution is in production for HHS/CDC tracking of COVID-19 testing results reported by non-lab-based testing venues and testing manufacturers. It has received Conditional ATO approval from US Department of Health and Human Services (HHS) (full ATO is in process) and has over 1.5 million testing results on-chain. Learn more here: https://www.youtube.com/watch?v=foVdOfsFAeg.

XATP

Designed for licensed pharmacists in the United States to verify drugs under the Drug Supply Chain Security Act (DSCSA), XATP makes it easy to authenticate and and securely exchange information with trading partners. LedgerDomain, working with industry stakeholders including fellow Hyperledger member UCLA, developed XATP to be a new kind of lightweight Verification Router Service designed to authenticate dispenser identities and streamline verification requests. It allows pharmacists to scan a 2D barcode on any drug in the U.S. to bring essential information on expired, short dated, recalled, and counterfeit drugs. XATP, which leverages Hyperledger Fabric, is currently in production for pharmacy workgroups and is ramping up for deployments at major health centers. 

Health and healthcare updates from Hyperledger Global Forum

At Hyperledger Global Forum, there was a range of business, technical and demo sessions focused on health and healthcare developments and deployments, including:

Covid Vaccine Beneficiary Identification using Verifiable Credentials – Punit Kumar & Hitarshi Buch, Wipro Technologies

Blockchain-based Decision-support and Longitudinal Data Storage, with Illustration for Diabetes Type 2 Management – Alevtina Dubovitskaya, HSLU (Lucerne University of Applied Sciences and Arts)

Bringing Trust and Privacy-Preserving Smart Contracts to Clinical Trials in Healthcare – Andrew Weiss, UMBC (in partnership with Softhread) & Bruno Vavala, Intel

Fast, Secure, and Accurate Evaluation of Prescription Drug Reimbursement Claims using Hyperledger Fabric – Alevtina Dubovitskaya, Swisscom AG

Blockchain in COVID-19 Fight – US HHS Testing Results Reporting Using Distributed Ledger – Mark Rakhmilevich & Bala Vellanki, Oracle 

Ongoing activity in the space is driven by the very active Hyperledger Healthcare Special Interest Group (SIG), which unites healthcare professionals and technologists from around the world in advancing the state of the healthcare industry through the implementation of technology solutions using blockchain technologies in general, and the umbrella of Hyperledger frameworks and toolsets in specific. It includes subgroups focused on patients, payers and healthcare interoperability.

Cover image: Piqsels

Mar 11
Love0

Combing IoT and DLT to Ensure the Safety of the World’s Vaccine Supply Chains

By everis UK Blockchain for Banking Practice, Emma Landriault & Dario Cerchiaro Blog, Healthcare, Hyperledger Fabric

In March 2020, the world was devastated by a global pandemic that fundamentally restructured the way we live and do business. Now, a year to date later, we are lucky to be at the point where multiple vaccines have been approved and administered to the public. Alas, vaccinating the global population against COVID-19 has proved to be one of the biggest challenges humanity has ever faced, both with unique distribution and logistical challenges. 

To date, as per March 10th, there have currently been ~93.6 million vaccine doses administered in the US and 23.7 million administered in the UK1.

At the moment, there are multiple different COVID-19 vaccines that have been authorized and recommended, with others in advanced stages of development. While they have all been developed with the same goal in mind, there are substantial differences between the jabs from their composition and reported effectiveness, to their price and ease of conservation, and distribution obligations. For instance, some vaccines are incredibly time and temperature-sensitive, requiring a life of 5-8 days only with temperatures as low as -75C, whereas others can be maintained stable for 30 days at a temperature between 2C and 8C. Needless to say, the logistics and operations of selling, storing, shipping, and administering each of these vaccines is incredibly time-consuming and overwhelmingly manual, only increasing the burden when one administrator must manage large purchase order quantities of two or more different Covid-19 vaccines.

With particular reference to the distribution of the vaccine, a few challenges must be noted. Namely

  • Demand Forecasting – What is the total quantity required for shipment 
  • Supply Chain Management – How it should be sent to purchases and distributed once arrived to host countries
  • Quality Assurance – How and by whom it should be administered, and with what specific procedure to ensure appropriate provision
  • Monitor and Mitigation – How people who have received the vaccine should be monitored, particularly where potential collateral effects may rise 

With these vaccines quickly coming to market, it is no surprise that governments and enterprises around the world are exploring solutions, such as vaccine credentials or digital immunization certificates, that can streamline the rollout of vaccines. Many of these solutions leverage combined emerging technologies such as artificial intelligence, machine learning, Internet of Things, and distributed ledger or blockchain technologies

The Powerful Combination of Internet of Things (IoT) and Distributed Ledger Technologies (DLT)

 The combination of IoT and blockchain, in particular, opens the door for new systems that inherently reduce inefficiencies and increase transparency for all involved parties. Take a supply chain for example: the accessibility and geolocation functionality of IoT, paired with the accounting of blockchain and DLTs has created new systems that foster supply chain accountability and integrity unlike any before seen solutions. The coupling of these technologies allow an asset to be tracked from the moment the raw materials are mined and among every step of the supply chain until it is with the end consumer. Without leveraging various device intercommunication capabilities and a strong audit system such as the one perpetuated by DLT, this would be virtually impossible (without large-scale human intervention).

An example of combined IoT, Cloud, and Hyperledger Fabric Solution Architecture(2)

Everis and NTT Data have developed such a tool that combines IoT and Hyperledger Fabric, allowing users to track any type of virtualized asset such as bulk or trade item products, additives, packaging materials, logistic units, and more, from any device. The solution utilizes Hyperledger Fabric to ensure that corresponding transactions are stored and accounted for when reviewing the movement of the assets. This ensures data security, transparency, and an indisputable audit trail, while allowing for automation (via smart contracts), simplification due to a shared truth (ledger), increased security, and certification capabilities.  

Future Applications of Blockchain/DLT in Covid-19 Vaccinations

As both Covid-19 vaccines and DLT+ IoT technology solutions remain in their infancy, only early implementations have been seen – as such, we can expect to see a variety of future applications that have not yet been pushed to production. This may include implementations to alleviate key pains including negotiations, logistics, and fraud prevention.

  • Supply Chain Integrity and Validity of Origin: Analysts project that Covid-19 vaccines will be the highest demand counterfeit drug on the black market for 20213. Track and trace DLT networks with blockchain-based authenticity certificates could allow purchasers to ensure the origin of the vaccination and track the journey throughout an often global fragmented supply chain. We believe that leveraging IoT and a mature enterprise blockchain such as Hyperledger Fabric would create an accountability and tracking flow to benefit all parties, virtually removing the possibility of receiving fraudulent or counterfeit drugs. In this case, Hyperledger Fabric’s architecture and IoT could benefit the proposed solution as outlined below.
 Hyperledger Fabric(4)IoT
FlexibilityThe programmability of Hyperledger Fabric allows for the flexibility required to digitize complex supply chain operations. For example, trust assumptions for chaincodes are separated from trust assumptions for ordering, ensuring that ordering services can be provided by one set of nodes and tolerate some failure or misbehaviour, depending on the lenience in the business case at hand. It also allows for separate channels per company or shipment, and that endorses may be different for each chaincode, allowing for customization while maintaining privacy and security. In this use case, this is particularly relevant as the system design can be built to ensure end-to-end tracking where any (movement) data is logged or payments are made leaving no room for the entry of malicious actors. IoT allows for multiple types of devices to communicate with one another achieved thanks to different IoT protocols such as Bluetooth, ZigBee, MQTT or CoAP. This ensures that sensors or equipment, from the time of production through to delivery, can communicate with devices of key stakeholders throughout the entire process, from the time of production through to delivery,  adding a layer of reassurance for all parties. There is no room for counterfeit drugs to enter the value chain if tracking is end-to-end.
ConfidentialityThere is a possibility to add confidentiality requirements to chaincodes, so that content and state of transactions can only be updated if requirements are met. This ensures that the strictest of confidentiality is ensured across the supply chain. Confidentiality is often embedded in the design of IoT systems. In this use case, it would be key to ensure that the security and authentication measures only permit participants who have defined roles in the system which require the logging of data. As such, end purchasers can review the roles of all parties involved throughout the entire production and shipping process. 
ConsensusThe modular architecture allows for pluggable consensus, which provides an added level of customization. The endorsement policies can include checking the certificate details, roles of the requester, or executing chain code. This allows for originating companies to build a consensus mechanism that suits only their operational process and can remove any possibilities for counterfeit drugs to enter the value chain. It also retains a level of programmability and flexibility, which may be required to build a solution across multi-national vaccine supply chains.With specific solution design and consented user permissions, there is no room for disruption across IoT devices or networks.

Cargo Storage Space: With temperature and time-sensitive lifecycles, the vaccines must be shipped in specific conditions. By tracking cargo ship storage space and corresponding vaccinations through asset tracking DLT networks, logistical burdens can be minimized. 

Smart Contracts for Negotiations: To date, many governments around the world have found themselves susceptible to private battles with vaccination companies. With high global demand and few verified suppliers, private companies hold essentially all bargaining power. As seen in Canada, Italy, and other countries, this allows the companies to delay sending vaccinations even after payments have been made and force better conditions including import tax payment delays, among other critical legal disputes5. By leveraging a smart contract in the negotiation process, any room for intermediation is removed as they will be self-executing with previously agreed upon terms. 

Ultimately, it is clear that there is a strong cause to leverage IoT and DLT technologies to ameliorate the current Covid-19 vaccination system, from logistics to temperature monitoring and negotiations. Though there are currently only a few systems in production, we can assume that the efficiencies brought forth perpetuate more use cases in the future. 

  1. https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/
  2. https://developer.ibm.com/patterns/develop-an-iot-asset-tracking-app-using-blockchain/
  3. https://www.afro.who.int/news/fighting-fake-immunization-travel-certificates-frontier-technologies
  4. https://hyperledger-fabric.readthedocs.io/en/release-1.3/arch-deep-dive.html
  5. https://www.ctvnews.ca/health/coronavirus/negotiating-contracts-for-vaccines-in-development-needed-flexibility-anand-1.5218491

Cover image by torstensimon from Pixabay.

Feb 12
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Working Together on What “Good” Looks Like

By Brian Behlendorf Blog, Healthcare, Hyperledger Aries, Hyperledger Indy

On Tuesday, the Good Health Pass Collaborative (GHPC) launched. This initiative is intended to define, in the context of test results and vaccination records for opening up borders for travel and commerce, a high bar for implementations of identity and credentialing systems to meet with regards to privacy, ethics and portability. They will also work with the implementers of such systems to converge towards common standards and governance.       

A set of Linux Foundation organizations – TrustOverIP, Hyperledger, Linux Foundation Public Health, and its Covid Credentials Initiative – have engaged as supporting organizations and were part of the announcement. We did this based on very encouraging signs during formation discussions that GHPC would not only help bring many of the organizations emerging into the self-sovereign identity space into alignment on platforms and standards we have long championed, but would also give us an external reference point for our position on the importance of privacy in the design and implementation of such systems.

Hyperledger has been home to the pioneering digital identity ledger Indy and agent toolkit Aries, which form the basis of so many production privacy-preserving digital identity systems and, now, are serving as the basis for many of these emerging health pass solutions. The TrustOverIP Foundation led the formal recognition of the need and role for governance organizations in the digital identity landscape – showing how we can get both optionality and interoperability when we weave global identity and credentialing systems together in a decentralized way. 

The Covid Credentials Initiative, starting way back in March 2020, recognized the potential for credentials of all sorts in the fight against this and future pandemics, and have pulled together an amazing community of technologists and entrepreneurs working together on this. Now, as part of Linux Foundation Public Health, we are working to bring together a set of software projects that can implement credential systems and help accelerate adoption of these globally, centered on the needs of public health authorities.

On Thursday’s GHPC webinar, Charlie Walton from Mastercard said GHPC is “in the business of describing what good looks like.” We will be working with GHPC to bring our own communities’ views of not just what good looks like, but how we’re already working together to standardize and implement this work. Furthermore we’ll see if our processes can directly support GHPC’s efforts to harmonize this domain.

We recognize there are quite a few of these initiatives now, reflecting just how broadly this issue is felt across society. We can play – we must play – a key role in channeling all this market activity and good-faith sharing of expertise into applications directly in people’s hands, so we can get back to travel and re-opening workplaces and schools in a safe and equitable way. Our key levers to move the world are open source software and open public engagement, and we will double-down on those tools to have a unique and substantive impact.

Look for more on this soon within our communities. We’re incredibly excited to be a part of this global effort.

Jan 11
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Blockchain technology for healthcare data management

By Alevtina Dubovitskaya and Volkmar Beck, Swisscom Blog, Healthcare, Hyperledger Fabric

The accelerating digitization of the healthcare sector has led to the creation of large volumes of sensitive data stored online. Swiss eHealth strategy promotes the adoption of the electronic patient record to allow registered patients and authorized healthcare professionals to access medical data anytime and anywhere. To achieve this, a reliable, compliant, and privacy-preserving solution is required to support definition, maintenance, and enforcement of fine-grained authorizations (consents). Convergence of distributed ledger technology and intelligent data management approaches provides a unique opportunity to bring trust, transparency, auditability, and optimization of medical data management and other healthcare processes. 

Recent research works and numerous PoC implementations actively demonstrate the value of blockchain technology for connecting health care stakeholders in order to help maintain a complete history of patient’s health care data, ensure traceability of the data exchange and automate claims and reimbursement processing. Transparent and auditable prescription monitoring may help to avoid incompatibility of the prescribed medications and can provide incentives for writing fewer prescriptions for certain medications such as opioids. In the pharmaceutical supply chain, blockchain can bring traceability to the tracking of pharmaceutical goods, from verification of the producer, to the transportation and storage conditions and control over drugs returned to the pharmaceutical company. Applying blockchain technology in biomedical research may facilitate new ways for patients to contribute with their healthcare data while ensuring privacy and security and  may  speed-up participant recruitment and collection of large and integrated heterogeneous data. When building such heterogeneous datasets, ensuring authenticity of the data and their sources is essential in order to make informed unbiased decisions and get valuable insights from the data. 

What are the important aspects and potential hurdles that deserve attention from practitioners when employing blockchain in the healthcare settings? While domain-specific requirements to the system functionality vary depending on the application, desirable properties of a resilient healthcare infrastructure for management of the sensitive data distributed among multiple sources are: data and process interoperability, privacy, security, and compliance. For instance, in the case of connecting healthcare stakeholders to facilitate management of patients’ history, some of the most important requirements are ensuring patients’ rights to access and share their sensitive data but also to erase their personal data. To achieve these, the system must ensure interoperability (i.e., must have the ability to exchange and interpret the data) and must be privacy-preserving (i.e, the patients must be able to have full control over the sharing/access revocation/erasure of their data). 

Data erasure (i.e., the possibility to erase the data) itself is not an “out-of-the box property” of the blockchain technology. It is challenging to comply with the right of data erasure when using immutable ledger. However, different approaches exist to address this issue including off-chain management of sensitive data, privacy-preserving techniques (such as encryption, zero-knowledge proofs (ZKP), secure multi-party computations (MPC), and data pseudonymization and anonymization. If anonymized data are released, a reliable infrastructure is required to support a trustworthy collaborative environment and to verify that the data were not altered. 

The choice of the appropriate approach depends on the underlying blockchain technology, the number of participants in the network and the sensitivity and volume of the data, among others. Moreover, patient control over his identifiable data and his actions (for instance, providing consent or authorizations) has to be efficiently verifiable and compatible with access to the data in an emergency situation such as when the patient is unconscious.

Hyperledger Fabric is a permissioned blockchain technology framework that has been actively employed in the implementations of blockchain-based systems for healthcare data management. To ensure privacy of data subjects, Fabric mainly relies (i) on multiple channels support, which make it possible to limit the access to the data to certain participants of the consortia, and (ii) on private collections where sensitive data can be exchanged peer-to-peer and stored in the private databases, yet accessible from chaincode on authorized peers and hashed to verify authenticity. Storing only hash on-chain is also used to provide verifiability of vast amounts of anonymized data for data-driven research and applications. In this case, contrary to limiting the access to the data, it is of a high importance to set up a reliable multi-cloud environment and collaborative framework – a step forward towards attaining interoperability. 

Blockchain infrastructure offered by Swisscom provides support for multi-cloud environments. Multiple non-endorsing peers provided by Swisscom are now dedicated to support verifiability of public COVID-19 related data, as a part of the multi-party, multi-source verifiable data sharing platform MiPasa. To address the scale of the problem, the types of data, languages, time-zones and jurisdictions,- many vendors joined forces to strengthen and support this blockchain-based shared infrastructure to unlock the potential of the data and deliver integrated, trusted, and verifiable insights across multiple industries around the globe. 

Sep 22
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Answering the FDA’s call: LedgerDomain’s Hyperledger Fabric-based BRUINchain improves tracking and tracing of prescription drugs

By Hyperledger Blog, Healthcare, Hyperledger Fabric

Four billion prescriptions were dispensed at US pharmacies in 2019, and even conservative estimates suggest that over 100 million prescriptions may be incorrectly dispensed. To address this problem, healthcare leaders are actively working to put new tools into the hands of pharmacists to ensure the right drugs reach the right people.

Part of that effort is the Drug Supply Chain Security Act (DSCSA), an ongoing, decade-long effort to track and trace prescription drugs in the United States. The DSCSA is intended to enhance the FDA’s ability to help protect consumers from drugs that may be counterfeit, stolen, contaminated, or otherwise harmful. The vision is to have an interoperable system in place by 2023 that will allow for drug tracing, product verification, and prompt detection and response protocols to handle all suspect medications. To get the system in place, the FDA turned to the public in 2019 and asked for new, cutting-edge approaches to improve the prescription pipeline.

LedgerDomain, an enterprise-grade blockchain solutions provider known for its work on developing the next generation of healthcare and pharmaceutical supply chains, was one of the companies that responded to the FDA’s request. LedgerDomain’s proposal of a blockchain-based solution in collaboration with UCLA and the pharmaceutical company Biogen was selected by the FDA as part of its pilot project program. 

LedgerDomain’s pilot centered on the development and live testing of BRUINchain, a blockchain-based system that meets DSCSA standards for pharmaceutical dispensers all within a shared-permission yet private ecosystem. While the pharmaceutical supply chain has numerous stakeholders, BRUINChain, which is built on Hyperledger Fabric, establishes one version of the truth for the pipeline that is immutable and invaluable.

The team tested BRUINchain within UCLA Health’s network of 500 pharmacists and technicians, focused on tracking the drug Spinraza, the first medication approved to treat children and adults with a rare and often fatal genetic disease called spinal muscular atrophy. The results exceeded UCLA Health and LedgerDomain’s expectations. The BRUINchain app’s barcode scanning functionality on iPhones was 100 percent effective, and the Hyperledger Fabric-based system was able to track every dose of Spinraza at UCLA Health, down to which refrigerator each dose was stored in across the campus. Even before the pilot ended, the team was adding new functionality and products as the network of pharmacists grew more reliant on the BRUINchain system. 

Hyperledger teamed up with LedgerDomain on a detailed case study on the BRUINchain pilot, including deployment details and results, projected cost and time saving and next steps based on the solution’s success to date.

Read the full case study here.

Jan 29
Love5

Five Healthcare Projects Powered by Hyperledger You May Not Know About

By Hyperledger Blog, Healthcare

The New Year brings about various resolutions for millions across the globe. For many, that means putting more focus on their physical and mental health. Blockchain’s ability to revolutionize healthcare is undeniable. When applied to healthcare, blockchain is a shared platform that decentralizes health data without compromising the security of sensitive information. For example, patients can potentially use their own signatures, combined with a hospital signature, to unlock data to provide secure access to medical information for use in treatment. Patients could have full control of their medical information, selecting the information they want shared and viewed by providers or doctors. This model lifts the costly burden of maintaining patient’s medical histories away from hospitals. Also, counterfeit medicine is a big issue pharma companies face in their everyday operations since there are many stakeholders involved in the supply chain. Recall of drugs and avoiding counterfeit drugs from entering into legit marketplaces will help in reducing the losses and improving service delivery to the end customer. Blockchain could be used to maintain the entire supply chain in healthcare.

Below is a list of some interesting healthcare applications powered by Hyperledger technology you may or may not have known about:

Axuall – Axuall is a digital network for verifying identity, credentials, and authenticity in real-time using the Sorvin Network and Hyperledger Indy. The Axuall network is currently in pilot with Hyr Medical and their 650+ physician network in addition to two other health systems. Physicians’ time is better spent practicing medicine than filling out redundant, repetitive credentialing paperwork consisting of unchanging information. Using Axuall’s digital credentialing network, physicians will be able to present fully compliant credential sets to participating healthcare systems and medical groups they are affiliated with or applying to. Utilizing the cryptographic constructs from Hyperledger Indy, healthcare organizations will be able to verify the validity of a physician’s credentials – spanning medical education, training, licensing, board certification, work history, competency evaluations, sanctions, and adverse events – ensuring compliance with industry standards, regulatory mandates, and health system bylaws. 

KitChain – LedgerDomain joined forces with other industry leaders like Pfizer, IQVIA, UPS, Merck, UCLA Health, GSK, Thermo Fisher, and Biogen to build out a pilot on Hyperledger Fabric called KitChain. Scoped and developed over the course of two years, KitChain aims to demonstrate a robust collaborative model for managing the pharmaceutical clinical supply chain, creating an immutable record for shipment and event tracking without the need to resort to paperwork and manual transcription. KitChain has two major components: a frontend mobile application and a backend blockchain server. The backend was implemented in Golang and used Hyperledger Fabric, the LedgerDomain Selvedge blockchain app platform, and LedgerDomain’s DocuSeal framework, encompassing smart contracts and application logic. As such, the pilot has a fully functioning highly secure blockchain backend.

MELLODDY Project – This drug discovery project uses Amazon Web Services technologies to execute Machine Learning algorithms from academic partners on a large scale. The data never leaves the owner’s infrastructure and only non-sensitive models are exchanged. A central dispatcher allows each partner to share a common model to be consolidated collectively. To provide full traceability of the operations, the platform is based on a private blockchain and uses Substra, a software framework for orchestrating distributed machine learning tasks in a secure way. Substra is based on Hyperledger Fabric. MELLODDY is designed to prevent the leaking of proprietary information from one data set to another or through one model to another while at the same time boosting the predictive performance and applicability domain of the models by leveraging all available data. The MELLODDY consortium consists of 17 partners: 

  • 10 pharmaceutical companies: Amgen, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, GSK, Janssen Pharmaceutica NV, Merck KgaA, Novartis, and Institut de Recherches Servier 
  • Two academic universities: KU Leuven, Budapesti Muszaki es Gazdasagtudomanyi Egyetem
  • Four subject matter experts: Owkin, Substra Foundation, Loodse, Iktos
  • One large AI computing company: NVIDIA

MyClinic.com – Medicalchain was one of the first healthcare blockchain companies to join the Hyperledger community, signing on as a member in 2017. The company’s ethos is to empower patients to have access to their medical records. Providing patients with direct access to their data unlocks the barriers we face in healthcare today such as patient choice and interoperability issues. A doctor-led team based in the UK, Medicalchain trialled the first telemedicine consultation using blockchain technology.  The company’s first blockchain-based product to market, MyClinic.com, makes it easy to schedule appointments, review medical reports and request further investigations or assistance using an Android and iOS app. Now the company is set to focus on scalability with the view to onboarding clinics and patients locally, nationally and internationally.

Verified.Me – SecureKey launched its innovative and in-demand network to Canadian consumers in early 2019. Verified.Me is a blockchain-based digital identity network built upon Hyperledger Fabric 1.2 that enables consumers to stay in control of their information by choosing when to share information and with whom, reducing unnecessary oversharing of personal information. Sun Life Financial has signed on as an early adopter and the first North American (health) insurer, making it easier for their clients to do business with the company.  Dynacare, one of Canada’s largest and most respected providers of health and wellness solutions, has joined the Verified.Me network. Dynacare’s participation will make it easier for Canadians to verify their identities as well as gain safer and faster access to their health information.

Curious about blockchain and advances in healthcare? Contribute to the conversation by joining the Hyperledger Healthcare Special Interest Group (HC-SIG). Open to anyone, the SIG was created to offer healthcare professionals and technologists a forum to discuss the implementation of technology solutions using blockchain technologies in general like Hyperledger frameworks and toolsets in specific.

Cover image: Pixnio free images

Jan 28
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How Hyperledger Besu Will Help Solve the Pharmaceutical Waste Problem in the U.S.

By Adoriasoft Blog, Healthcare, Hyperledger Besu

The problem of surplus medication is getting increasingly serious. Each year, tons of prescription drugs remain unused in clinics, assisted living facilities, and at individual patients’ homes. Often, the law demands that any unused medications be destroyed, which results in a whole complex set of problems. 

On the one hand, about $2 billion worth of prescription drugs are wasted every year. On the other hand, one in every three Americans cannot afford their prescribed medications due to the high cost or absence of medical insurance. At the same time, there is no unified procedure for using surplus medications and making them available to those who need it. 

Another issue to consider in this context is the cost of unused drug disposal, which can be around $1.25 per pound. The rules require that unused drugs be disposed of through incineration that creates additional environmental concerns. 

The obvious solution to this complex problem is establishing a mechanism for returning the unused medications and offering them to patients who need them. In fact, the drug donation and reuse programs have been researched for more than twenty years, but only 38 states have passed laws on drug reuse as of now. 

At the same time, the implementation of these laws gives hope that the multi-faceted problem of surplus drugs can be resolved. However, to achieve true effectiveness and prevent misuse, such programs need to take into account many practical aspects: 

– Control over the donated drugs’ quality and expiration. Of course, to be accepted, drugs must be unexpired and their packaging must be intact. 

– Motivation for pharmacies to act as drug acceptance facilities. Participation in the drug donation program has its costs, which pharmacies are not too eager to bear. 

– Motivation for clinics and patients to donate unused drugs. The law prohibits selling medications, thus, their owners should be motivated in a different way. 

– Data security. Medication-related data is highly sensitive and needs special protection from unauthorized access. 

How technology can help 

Our experience with blockchain and distributed applications proves that these technologies can become the core of an effective and secure platform for unused drug donation and redistribution. It resolves the problems of data security and traceability and can help to automate a number of processes. 

Together with the Save Pharmaceutical project, Adoriasoft is now building a blockchain-based platform to join drug donors (clinics, assisted living facilities, individual persons), drug repositories (pharmacies), and patients. The solution will be a multi-functional product allowing donors to donate the medications they do not need, and pharmacies to approve or reject the donations and, ultimately, to provide them to patients. 

We are using Hyperledger Besu as the base technology for this project. By choosing Hyperledger Besu, we plan to leverage the benefits of the protocol to enable transaction processing. Furthermore, we see Hyperledger Besu as a platform for building a permissioned enterprise-scale network to serve the drug repository system. 

In view of the high sensitivity of healthcare data that is going to be exchanged in the network, the transactions will be processed via smart contracts executed on Hyperledger Besu. Only the parties directly involved in the transaction will have access to its details. 

At the same time, blockchain provides the means of controlling the entire transaction flow from the drug donation by the owner to its final assignment to the patient. The platform will include a mechanism of monitoring the pharmacy income from reselling the donated drugs and distributing it among the other participants. 

Since the law explicitly prohibits donors from demanding payment for the drugs they donate, there should be other methods of motivating them to participate in the program. The state laws establish a tax deduction for drug donation, but our product can include an additional compensation in the form of a tradable digital token. 

The tokens issued on the blockchain can be used towards a discount on the platform or exchanged for other assets. The same tokens can be issued to pharmacies, too, to attract them to the program. 

Blockchain-based drug repository networks are going to be a true quantum leap in the healthcare industry, on the one hand, bringing significant cost savings, and, on the other hand, making medications accessible to patients who were otherwise unable to purchase them. We are proud to be a part of a project of such a social impact and to make the knowledge accumulated by the Hyperledger community serve this noble cause.

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