How Blockchain Will Revolutionize Remote Healthcare?

The healthcare industry is one of the world’s biggest industries. This means that it has plenty of opportunities for entrepreneurs, particularly when it comes to software.

Remote healthcare is a significant niche within this sector, however, it comes with its’ own share of challenges as well as opportunities.

Blockchain is one way that savvy entrepreneurs have identified to make a big splash in a very big pool.

In this article, I will explain how blockchain is set to revolutionize remote healthcare.

Contents

The global market for healthcare
Key futuristic trends in the healthcare sector
The cost of healthcare: “The elephant in the room”
When costly healthcare doesn’t improve the quality of life
Enter remote healthcare
The market for remote patient monitoring
The challenges facing remote patient monitoring
Can blockchain have a role in RMP?
A blockchain-in-RMP “Proof of Concept” (PoC) using Ethereum
“TWIST IN THE TALE”: BLOCKCHAIN FOR IOT
Implementing IoT-friendly blockchain in RMP: A PoC

The global market for healthcare

Healthcare is one of the largest industries globally, and one that touches every one of us at one point or other. A few quick points about this industry are:

  • The global market for healthcare was worth $7.724 trillion in 2017, and it’s expected to reach $10.059 trillion in 2022.
  • That’s a CAGR of 5.4%, a significant one for an industry of this size.
  • Several factors are leaving their mark in this sector. A few examples are personalized medicine, increased use of high technology, the entrance of disruptive competitors, the growing demand for more care delivery sites, various new payment models, and new public funding models.
  • The sector is turning more towards high-tech solutions, mergers-and-acquisitions, and bottoms-up innovations.

Read more about this in “2019 global health care outlook”.

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Key futuristic trends in the healthcare sector

Experts have identified a few key trends influencing the healthcare sector. These are as follows:

  • Digital therapeutics and connected care are transforming the entire sector.
  • The demand for skilled health worker is skyrocketing, and everyone in this sector needs to upskill themselves.
  • The industry has a long road ahead for comprehensive tax reforms.
  • Innovation in the healthcare industry is imperative, and there is urgency.
  • Investments from private equity firms are increasing. This will likely drive greater accountability and transparency.
  • The legislative frameworks around healthcare must recognize the importance of healthcare to the less privileged people in the world. At the same time, these frameworks need a pragmatic approach and not an ideological one.

Read more about these trends in “Here are 6 major issues facing healthcare in 2019, according to PwC”.

The cost of healthcare: “The elephant in the room”

A discussion about the healthcare sector is incomplete without touching upon the rising healthcare cost. The following points indicate this challenge well:

  • High medical bills force approximately 4% of Americans to declare bankruptcy.
  • The healthcare industry was valued at $24.7 billion in 1960. At the time of writing, it’s worth $3.5 trillion!
  • In the US alone, healthcare administrative costs have contributed to the overspending of $175 billion in this sector in 2018.
  • Medical care in a hospital in the US for a heart attack could cost over $20,000.
  • In 2017, 1.4 million Americans went abroad for medical treatment, in search of cost savings.

Read more about the rising healthcare cost in “30 staggering healthcare statistics to know in 2019”.

When costly healthcare doesn’t improve the quality of life

  • At the time of writing, 4 out of 10 Americans are obese, while 7 out of 10 are overweight!
  • Medicare in the US covered only 17.2% of Americans in 2017.
  • Avastin, the anti-cancer drug costs 10 times more in the US than in the UK, thus preventing people from receiving adequate treatment.
  • The US will likely have over 40 thousands unfilled posts for physicians by 2030.

This is despite the increased spending. As you can read in “17 statistics on the current state of US healthcare spending, finances”, the cost of inpatient day in hospitals is rising. Health insurance expenses and the spending on prescription drugs are also rising, however, the higher outflow isn’t ushering in a higher quality of life.

Enter remote healthcare

As I have explained the key trends in the healthcare sector, connected care is increasingly important. Remote healthcare, or “Remote Patient Monitoring” as we often call it can help in transforming the healthcare sector. It has the following benefits:

  • The transition from an episodic care model: We often visit the doctor when we have a health issue to address. That’s episodic care. On the other hand, a holistic model will look to prevent issues and improve the quality of life. Remote healthcare can help with this transition.
  • Use smart devices to ease the workload of health professionals: Most of us now have smart devices like smartphones and wearable devices. These can measure a lot of our health parameters. You save your time, moreover, the health professionals can save time too.
  • Communicate our health status better: Again, thanks to the age of the Internet, smart devices monitoring our health parameters can communicate these to the health professionals.
  • Making patients more responsible: With the tools modern technology offers, you can be proactive about managing your health. Maintain a healthy body weight, and prevent that heart ailment!

Read more about these benefits in “Remote health care is the future of medicine”.

The market for remote patient monitoring

Remote patient monitoring is an evolving niche. The potentials are for everyone to see, as the following facts indicate:

  • The US remote patient monitoring in 2008 was worth $60 million in 2008.
  • It grew to $175 million in 2015.
  • By 2022, the remote patient monitoring market in the US will likely be over $535 million.

Read “North America’s remote patient monitoring market in 2008, 2015, and 2022, by country (in million U.S. dollars)” for more details.

The challenges facing remote patient monitoring

Remote patient monitoring (RPM) faces certain challenges that constrain its’ growth. These are as follows:

  • Traditional healthcare systems don’t support RPM well: Traditional healthcare systems are geared towards episodic care, whereas RPM intends to also focus on preventive care. Take the example of “Electronic Health Records” (EHRs). By their very design, they support episodic care. There are also legal angles to including RPM data in EHRs. Healthcare industry stakeholders need to first finalize their approach and then transform existing systems to support RPM. Read more about this in “On the challenges of remote patient monitoring”.
  • RPM device adoption needs to improve: We have wearable devices for many healthcare-related use cases now, however, the devices aren’t sufficiently usable for continuous use. Continuous use of the device for an extended period is important for RPM to deliver value.
  • Assurance about accurate data: This hardly needs an explanation! Fancy devices streaming inaccurate data won’t do any good to RPM.
  • Timely and relevant data transmission to health services providers: Secured transmission of accurate data to health services providers at the right time is an important success factor for RPM. It’s not easy to achieve!

Read more about these challenges in “Three challenges to remote patient monitoring”.

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Can blockchain have a role in RMP?

Blockchain can help in ensuring the accuracy of data recorded by RMP devices and facilitating secure and timely transfer of this data. To understand how, we need to understand how blockchain works, which is as follows:

  • Blockchain is a distributed network that’s also decentralized. Computers in this network are called “nodes”, and a public blockchain network is open to anyone.
  • Every node has equal authority and each has the complete record of transactions in the blockchain. This makes each node a complete ledger of all transactions. Thus the name “Distributed Ledger Technology” (DLT).
  • No hacker can destroy the network by compromising one computer since the other nodes will maintain the network.
  • Digital signatures, modern cryptographic hash functions, and rigorous consensus algorithm protect the data against tampering.

I have explained these features earlier in “How to build your own blockchain using Node.js”. These security features protect data against tampering.

Furthermore, blockchain networks like Ethereum use smart contracts, which work as follows:

  • These are tamper-proof, open-source, transparent, and autonomous pieces of code that transfer cryptographic assets based on predefined conditions.
  • Their execution results are irreversible. I have explained smart contracts earlier in “Blockchain software development using the Ethereum network”.

Smart contracts can ensure secure and automated transmission of RMP device data to healthcare providers.

A blockchain-in-RMP “Proof of Concept” (PoC) using Ethereum

Let’s now describe a PoC that uses Ethereum smart contracts for secure automated RMP. A group of researchers from Fordham Center for Cybersecurity, Fordham University, New York has collaborated with the US-based National Center for Biotechnology Information for this PoC. Following is a summary of the PoC:

  • RMP uses the “Internet of Things” (IoT) technology in the wearable devices extensively.
  • The research team addressed the use of IoT devices collecting and disseminating the RMP data.
  • Their particular concern was with the security concerns about recording patient data and transmitting that.
  • RMP devices collect “Protected Health Information” (PHI) extensively. These are sensitive information and regulations such HIPAA protect these.
  • IoT devices communicate over the Internet, and the security of PHI transmission over the Internet is of utmost concern.
  • The research team created a private permissioned blockchain using the Ethereum blockchain protocol.
  • In this system, the IoT devices invoke smart contracts and logs all events on the blockchain.
  • The smart contracts support real-time patient monitoring, moreover, they would send notifications to patients and healthcare providers. This will facilitate medical intervention when required.
  • Every intervention gets recorded in the blockchain.
  • The permissioned, private blockchain with its’ encryption and other security features address the HIPAA compliance.

Read more about this PoC in “Healthcare blockchain system using smart contracts for secure automated remote patient monitoring”.

“Twist in the tale”: Blockchain for IoT

Here we have a “twist in the tale”, since public blockchains as know them don’t work too well with IoT. Note the following points to understand this better:

  • Public blockchains like Ethereum are decentralized, secure, and stable.
  • Consensus algorithms like “Proof of Work” (POW) make them very secure since hackers simply can’t manage the computing power required to hack these networks. Read more about POW in “Proof of work vs proof of stake comparison”.
  • The more nodes join these networks, the more secure they are. Ironically, this high security limits the scalability of these networks! I have explained this in “How to scale an Ethereum Dapp”.
  • Now, consider millions of patients in an RMP programme, each using a multitude of wearable IoT devices.
  • If we use blockchain to secure data from these millions of IoT devices, the network won’t scale well. Transaction throughput will be very low, therefore, the RMP will not be viable.
  • Blockchain-crypto communities are working on this scalability challenge with respect to IoT devices. For example, “Tangle” technology uses “Directed Acyclic Graph” (DAG) to provide security like a blockchain. There is no POW and “crypto mining” here, therefore, it’s a highly scalable network. Read about “Tangle” and their cryptocurrency IOTA in “What is the Tangle? Complete guide to IOTA’s Directed Acyclic Graph (DAG)”.

Another research team has addressed this scalability aspect concerning IoT devices used in RMP. We will now review this.

Implementing IoT-friendly blockchain in RMP: A PoC

This research team at Cornell University has conducted a valuable PoC on implementing IoT-friendly blockchain-like technology in RMP. The researchers are Gautam Srivastava, Ashutosh Dhar Dwivedi, and Rajani Singh. The following is a summary of their PoC:

  • They are using a POW-based protocol called GHOSTDAG. Here, it uses DAG, which eliminates the scalability and transaction throughout challenges.
  • The researchers further go on to create two blockchains, one of which is public whereas the other one is private.
  • A system on the private blockchain uses smart contracts to analyze patient health data. As private blockchains are permissioned, sensitive patient health data gets adequate protection.
  • Upon analyzing patent health data, smart contracts issue alerts beyond certain thresholds. The application then makes that health observation available to relevant stakeholders via the public blockchain.

This way, the PoC addressed the accuracy and privacy of patient health data, moreover, it also took care of the scalability and transaction throughput. Read more about this PoC in “Automated remote patient monitoring: Data sharing and privacy using blockchain”.

Planning to use blockchain for remote healthcare?

As you can see, blockchain has immense potential in remote healthcare. However, it’s a new technology, and solutions addressing remote healthcare use cases are still evolving. If you are planning to use blockchain for remote healthcare, you need healthcare industry expertise at your disposal.

Additionally, blockchain skills are at a premium, and DAG is a niche even within the blockchain technology landscape. You need quality software architects, blockchain developers, and project managers with blockchain experience. You might need professional help. Our guide “How to Find The Best Software Development Company?” can help you in engaging the right blockchain consulting, design, and development partner.

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