Article | March 4, 2020
The global market for precision medicine is projected to top more than $84.5 billion by 2024. Targeted therapies for rare, genetic diseases, cancer and chronic conditions come with the hope of a cure. Companies such as Roche, Novartis, Spark Therapeutics, Pfizer, Editas and BioMarin are among the pharma players in this space. There seem to be new developments in precision medicine on almost a weekly basis. So what do educational institutions need to do to create fertile ground for gene therapy research to produce the next generation of companies developing these therapies? And what needs to happen to facilitate data sharing, ensure access to genome sequencing and these promising therapies?
Article | March 4, 2020
The COVID-19 virus (C19) pandemic is turning out to be the event of the century. Even World War seems timid in comparison. We are in the 4th month of the virus (in non-China countries) and have gone past the lockdown in many places. Isn’t it time we re-think the approach? What if there is another wave of C19 coming soon? What if C19 is the first of many such events in the future?
Before we get into analysis and solution design, summarizing the C19 quirks:
While a large section of the affected population is asymptomatic, for some it can be lethal
There isn’t clarity on all the ways C19 spreads
It’s known to affect the lungs, heart, and kidneys in patients with weak immunity
It has been hard to identify a definitive pattern of the virus. Some observations in managing the C19 situation are:
With no vaccine in sight, the end of this epidemic looks months or years away
Health care personnel in hospitals need additional protection to treat patients
Lockdowns lead to severe economic hardship and its repeated application can be damaging
Quarantining people has an economic cost, especially in the weaker sections of society
If one takes a step back to re-think about this, we are primarily solving 2 problems:
Minimise deaths: Minimise the death of C19 and non-C19 patients in this period
Maximise economic growth: The GDP output/growth should equal or higher than pre-C19 levels
One needs to achieve the 2 goals in an environment of rising number of C19 cases.
An approach that can be applied to achieve this is:
Data driven health care capacity planning
Build a health repository of all the citizens with details like pre-existing diseases, comorbidity, health status, etc. The repository needs to be updated quarterly to account for patient data changes
This health repository data is combined with the C19 profile (disease susceptibility) and/or other seasonal diseases to determine the healthcare capacity (medicines, doctors, etc.) needed
The healthcare capacity deficit/excess needs to be analysed in categories (beds, equipment, medicine, personnel, etc.) and regions (city, state, etc.) and actions taken accordingly
Regular capacity management will ensure patients aren’t deprived of timely treatment. In addition, such planning helps in the equitable distribution of healthcare across regions and optimising health care costs. Healthcare sector is better prepared to scale-up/down their operations
Based on the analysis citizens can be informed about their probability of needing hospitalisation on contracting C19. Citizens with a higher health risk on C19 infection should be personally trained on prevention and tips to manage the disease on occurrence
The diagram below explains the process
Mechanism to increase hospital capacity without cost escalation
Due to the nature of C19, health personnel are prone to infection and their safety is a big issue. There is also a shortage of hospitable beds available. Even non-C19 patients aren’t getting the required treatment because health personnel seek it as a risk. This resulted in, healthcare costs going up and availability reducing.
To mitigate such issues, hospital layouts may need to be altered (as shown in the diagram below). The altered layout improves hospital capacity and availability of health care personnel. It also reduces the need for the arduous C19 protection procedures. Such procedures reduce the patient treatment capacity and puts a toll on hospital management.
Over a period, the number of recovered C19 persons are going to increase significantly. We need to start tapping into their services to reduce the burden on the system. The hospitals need to be divided into 3 zones. The hospital zoning illustration shown below explains how this could be done. In the diagram, patients are shown in green and health care personnel are in light red.
**Assumption: Infected and recovered C19 patients are immune to the disease. This is not clearly established
Better enforcement of social factors
The other reason for high number of infections in countries like India is a glaring disregard in following C19 rules in public places and the laxity in enforcement. Enforcement covers 2 parts, tracking incidents of violation and penalising the behaviour. Government should use modern mechanisms like crowd sourcing to track incidents and ride on the growing public fear to ensure penalty enforcement succeeds. The C19 pandemic has exposed governance limitations in not just following C19 rules, but also in other areas of public safety like road travel, sanitation, dietary habits, etc.
Maximise economic growth
The earlier lockdown has strained the economy. Adequate measures need to be taken to get the economy back on track. Some of the areas that need to be addressed are:
One needs to evaluate the development needs of the country in different categories like growth impetus factors (e.g. building roads, electricity capacity increase), social factors (e.g. waste water treatment plants, health care capacity), and environmental factors (e.g. solar energy generation, EV charging stations). Governments need to accelerate funding in such projects so that that large numbers of unemployed people are hired and trained. Besides giving an immediate boost to the ailing economy such projects have a future payback. The governments should not get bogged down by the huge fiscal deficit such measures can create. Such a mechanism to get money out in the economy is far than better measures like QE (Quantitative Easing) or free money transfer into people’s bank accounts
Certain items like smartphone, internet, masks, etc. have become critical (for work, education, critical government announcements). It’s essential to subsidise or reduce taxes so that these items are affordable and accessible to everyone without a financial impact
The government shouldn’t put too many C19 related controls on service offerings (e.g. shops, schools, restaurants, cabs). Putting many controls increases the cost of the service which neither the seller not buyer is willing or able to pay. Where controls are put, the Govt should bear the costs or reduce taxes or figure out a mechanism so that the cost can be absorbed.
An event like the C19 pandemic is a great opportunity to rationalise development imbalances in the country. Government funding should be channelized more to under-developed regions. This drives growth in regions that need it most. It also prevents excess migration that has resulted in uncontrolled and bad urbanisation that has made C19 management hard (guidelines like social distance are impossible to follow)
Post-C19 lockdown, the business environment (need for sanitizers, masks, home furniture) has changed. To make people employable in new flourishing businesses there could be a need to re-skill people. Such an initiative can be taken up by the public/private sector
The number of C19 infected asymptomatic patients is going to keep increasing. Building an economy around them (existing, recovered C19 patients) may not be a far-fetched idea. E.g. jobs for C19 infected daily wage earners, C19 infected taxi drivers to transport C19 patients, etc.
In the last 100 years, mankind has conquered the destructive aspects of many a disease and natural mishap (hurricanes, floods, etc.). Human lives lost in such events has dramatically dropped over the years and our preparedness has never been this good. Nature seems to have caught up with mankind’s big strides in science and technology. C19 has been hard to reign in with no breakthrough yet. The C19 pandemic is here to stay for the near future. The more we accept this reality and change ourselves to live with it amidst us, the faster we can return to a new normal. A quote from Edward Jenner (inventor of Small Pox) seems apt in the situation – “The deviation of man from the state in which he was originally placed by nature seems to have proved to him a prolific source of diseases”.
Article | March 4, 2020
The rapid advancement of technology has inspired hope in the healthcare industry, promising to employ artificial intelligence (AI) and cloud-based data platforms in life-altering ways. Surgery assisting robots and miraculously accurate AI-based cancer diagnosis methods are a few preliminary examples of what the industry can expect. With all these great technological strides being taken, however, compliance can easily be left in the dust. And with COVID-19 pushing the limits of healthcare systems worldwide, it’s too easy for cybersecurity to become a lesser priority.The situation is bleak, with nearly 17,000 patient records being breached every day, according to Entech. Healthcare democratization is essential to fully harnessing the power of AI and other tech advancements on the horizon, which require compliant data distribution and the application of insights gathered from it. Healthcare institutions are struggling to not only meet basic privacy and compliance laws but have difficulty leveraging the large amounts of data that they store in a meaningful way.
FUTURE OF HEALTHCARE
Article | March 4, 2020
Prioritizing health and managing it, has become highly important because our lifestyle is continuously evolving in ways that take a toll on us mentally, physically, and emotionally. However, the major issue for the patients lies in the inaccuracy of treatment due to the lack of complete health records in any hospital. With the recent changes in privacy legislation and data management, patients are even unable to retrieve their own health records.
For example, someone had an accident and was taken to the emergency room. The first thing they will need to do in their condition is to fill the hospital’s form. Then, for the treatment, if the injured person is conscious enough, doctors ask questions like if they are allergic to some medicines or do they suffer from diabetes or any other disease. Besides, what if the individual denies having allergies or diabetes in their half-conscious state? And the previous hospitals where they have already had treatment before have denied sharing the medical details of the person either due to privacy issues or data corruption. Well, it can create a lot of fuzz.
Solely, to improve the health industry without compromising the security of the individuals, blockchain has remained in the discussion. It has the potential to address the operability challenges present in the healthcare industry. But, what is blockchain, what are its underlying fundamentals, why blockchain, and what are its advantages?
Today’s blog will help in understanding every aspect of blockchain and its impact on the healthcare industry. So let’s get started!
What is Blockchain?
Blockchain is a P2P or peer-to-peer distributed or decentralized ledger technology. It stores a chain of data called blocks of information. These blocks are chained together by cryptographic signatures. These signatures are called hash that is stored in the shared ledger and backed by a connected processes network - node. These nodes reserve a copy of the complete chain and get continually updated by synchronization. Though, to include blockchain in the process it’s necessary to hire a developer who has prior experience and knowledge about its architecture and can work with the components efficiently as blockchain is a designed pattern that consists of three major constituents - a distributed network, a shared ledger, and all the digital transactions.
a. Distributed Network
As discussed before, blockchain is built on peer-to-peer networks. While having no central point of storage, it makes the information on the network less vulnerable to being lost or exploited.
Unlike the traditional client-server model that has a centralized storage point or controlling party, all the information in the blockchain network is constantly recorded and transferred to the participants of the network that are also known as nodes or peers. These peers also own several identical copies of the information. That’s why blockchain is seen as a huge improvement to centralized models and is considered the future of data storage and ownership.
b. Shared Ledger
Each authorized participant in the network records the transactions into the shared ledger. If they want to add any transaction, it is important to run algorithms that evaluate and verify the transactions. If the majority of members agree to the transaction’s validity, a new transaction gets added to the shared ledger. The changes done in the shared ledger is reflected in minutes or even seconds in the copies of the blockchain. Once the transaction is added, there’s no way to modify or delete it. Also, as the copy is shared in the form of a ledger to each member, no single member can alter data.
c. Digital Transaction
Transactions are information i.e. data transmission to one block. During the process of data transmission, each node acts as a central point to generate and digitally sign the transaction. As the nodes connect each other in the network, each of them has to verify the transaction independently for its conflicts, validity, and compliance. Only after the transaction passes the verification, the information is added into the shared ledger. The major element that makes digital transactions successful is cryptographic hashing that encrypts the data for security.
Why Blockchain technology in healthcare?
It has happened so often that the patient remains unable to gather all of their previous medical records in one format from one place swiftly or sometimes cannot even collect the required information at all. Unfortunately, in most cases, the information of critical patients remains scattered across several different institutions of healthcare that too in different formats. Besides, the data management systems along with the security regulations also vary in different institutions making it difficult to trace and fix mistakes.
But, what can blockchain do?
A blockchain is a system used for storing and sharing information with security and transparency. Every block in the chain is an independent unit of its own and a dependent link among the collective chain that creates a network controlled by participants rather than a third party.
As blockchains are managed by network nodes instead of central authority, they are decentralized that prevents one entity from having complete control over the network. With the incorporation of blockchain, the need for a central administrator will be removed by cryptography. Healthcare providers will be able to promote data management processes beyond perception. It will help in collecting, analyzing, sharing, and securing medical records. It will provide the access to healthcare workers for retrieving health records with the cryptographic keys provided by patients from anywhere without creating any privacy or security problems.
Advantages of Healthcare Blockchain
Although applications of blockchain in the healthcare industry are inceptive, some early solutions have shown the possibility of reduced healthcare costs, improved access to information among different stakeholders, and streamlining the entire business process. So, keeping aside the buzz, let’s see the real advantages of blockchain in healthcare.
1. Master Patient Indexes
The master patient index helps in the identification of patients across separate administrative systems. It is often created within the EHR or electronic health record system. As these EHRs have different vendors, there are several irregularities of MPIs. In many cases, the data of a patient between these healthcare systems become mismatched. However, with the nature of decentralization in Blockchain, it possesses the ability to solve the issue. In the blockchain-based MPIs, the data will be hashed to the ledger and content will remain unique as only the authorized nodes of the data can make changes to the hashes while all parties with access can only check the related information.
2. Single, elongated patient records
Blockchain technology is potent to transform health care by placing patients at the center of the system while increasing the security and privacy of health records. It provides a new model for health information exchange by forming electronic elongated patient records secured and efficient. Additionally, the fact that the data is copied among all the nodes of the blockchain network creates an atmosphere of clarity and transparency that enables healthcare providers and patients to know how their data is handled by whom, how, and when. It can also help healthcare from potential frauds, data losses, or security attacks.
3. Supply Chain Management
Supply chain management in healthcare is a challenging aspect. With scattered settings for ordering drugs, medical supplies, and critical resources, there’s an inherent risk of compromising the supply chain that might impact patient safety. Indulgence of blockchain technology in the transactions can tap into the complete process of medicine or drug products movement. As all the transactions will be recorded onto the shared ledger with every block recording and maintaining every transaction, it will become easy to verify the vendor, distributor, and origin of the drug within a matter of seconds. It will also enable healthcare physicians and officials to check the authenticity of the supplier’s credentials.
4. Claims Justification
Currently, the insurance claim processes face difficulties like lack of transparency i.e. most customers don’t even know how insurance works; human errors and inefficiencies i.e. insurances are full of confusion along with human errors that create inefficiencies that lead to the increased cost to customers; higher frauds in claims. But, blockchain technology can simplify and enhance recordkeeping, payment processing, claims registration, contract management, and closure with its immutable ledger.
Interoperability is the capability of distinct healthcare information technology to interpret, exchange, and use data. Due to the privacy issues, the alphanumeric code to identify a patient has been revoked that caused problems in gathering the required record of the patient. Enforcing measurement standards for industry-wide interoperability is also a challenge in interoperability. With blockchain in healthcare interoperability, data can be shared in real-time on the trusted network and provides access to the patient’s record in a secured manner. Moreover, with the pri