Academic-Industry Stakeholder Closing Workshop Report
The Wellcome Trust Blockchain for Healthcare academic-industry stakeholder closing workshop was held on 28 November 2019 at the University of Birmingham. The workshop brought together a select group of key individuals involved in building blockchain applications for healthcare from the UK and USA, together with leading academics and from several disciplines including law, computer science, bioinformatics and medical ethics and clinicians, in order to share, reflect upon and critically discuss the provisional findings arising from the project. The workshop presented findings on research into the legal, ethical, technical and governance challenges pertaining to the regulation of healthcare through blockchain. The workshop commenced with an introductory session led by Prof Karen Yeung, the project Principal Investigator, who provided an overview of the project research aims, objectives and questions by way of context.
The workshop proceeded with a presentation of research mapping the development of blockchain for healthcare usescases and applications by project Research Associate Immaculate Motsi-Omoijiade, who also led discussions on the legal, ethical and governance considerations around the use of blockchain in healthcare. Presenting on the technological challenges and business opportunities, state of the art and future trajectories was project Research Associate and technical lead, Dr Alex Kharlamov. Dr Kharlamov was joined by Jim Nasr who provided industry technical insight into blockchain deployment in the context of healthcare.
The workshop concluded with some critical reflections on the current state of the healthcare blockchain industry by John Bass followed by critical insight, core findings and provisional answers to project research questions by Prof Karen Yeung. With active expert participation and feedback from leading academics and blockchain for healthcare industry stakeholders, the workshop served a vital contribution to the refinement and revision of the project's research findings and upcoming publications.
a) Blockchain has established a presence in healthcare, but the industry is very much in its infancy. The early promises of blockchain-enabled electronic patient records have not come to fruition, as developers have discovered that these are fraught with difficulties, many of which are not of a technical nature. Hence most of the current activity is focused on the B2B sector, with a focus on finding use cases that will deliver real value to the sector.
b) There is ambiguity and lack of clarity in the terminology surrounding blockchain. Participants noted that there is no consensus around what is meant when we refer to 'blockchain' in healthcare. Often the term is used to refer to permissioned, distributed ledgers: yet these bear very little resemblance to the open, permissionless blockchain that rests on Satoshi Nakamoto's White paper, and which provides the foundational architecture for Bitcoin.
c) As the majority of blockchain for healthcare applications are permissioned blockchains, the legal challenges that are commonly associated with public permissionless blockchains where roles, responsibilities and liability are difficult to ascertain, including questions around jurisdiction and the challenges presented by pseudonymity, are unlikely to apply in the same way. However, there are real opportunities for blockchain to facilitate regulatory compliance in healthcare, for example, in tracking pharmaceutical supply chains and tracing and monitoring the credentials of healthcare professionals and providing an auditable record throughout.
d) The 'internal governance' dimensions of distributed ledger systems have yet to be fully grasped, given the industry's youth and the early stage of development. Similarly, the development of appropriate incentive structures will be critical, grounded in 'token economics' is likely to be critical to the success and sustainability of any blockchain for healthcare solutions.
Dr Abdullah Albeyatti - Medical Chain
John Bass - Hashed Health
Prof Alastair Denniston - University Hospitals Birmingham
Helen Disney - Unblocked
Madeleine Forster - Chatham House
Dr David Galindo - University of Birmingham
Dr Alexandra Giannopoulou - University of Amsterdam
Prof Andrew Howes - University of Birmingham
Ashley Kerr - Mills & Reeve
Matt Lucas - IBM
Dr Federica Lucivero - University of Oxford
Dr Maureen Mapp - University of Birmingham
Chris Miller - Guardtime
Jim Nasr - Certara
Dr Natalie Pankova - Metadvice
Vincent Racine - Guardtime
Dr Melek Somai - Medical College of Wisconsin
Dr Alex Szolnoki - Babylon
Dr Chen Zhu - University of Birmingham
Katarzyna Ziolkowska - University of Warsaw