How smart contracts are shaping the healthcare industry

Captions as YouTube publishes them, usually machine-generated, so names such as Daml and Canton can be misheard.

1. 0:01

   hey i'm corey from digital asset i'm senior product manager for healthcare at DEA working on dam al driven health care solutions dama liz lives in the blockchain world and so along with that phrase comes a lot of baggage about what blockchain is how it works and what it can do for industries like healthcare but i want to back away from what is blockchain and how it works for a minute

2. 0:26

   and just conceptually think about what technology like Gamal can do for the industry and what we think it can do and what we're very excited about is how Gamal can help integrate with existing systems to create synchronized multi-party workflows for the healthcare industry now that's a pretty loaded statement to them let me unpack that just a little bit what's a multi party workflow it's a phrase we use a lot of DEA and and Ford Amal and it can seem confusing but healthcare is full of what

3. 0:57

   we call multi party work for those it's simply there are multiple enterprises who are providing care to a patient the patient's a party themselves so there's the patient and there's the healthcare facility the physicians who are providing the care there's often an insurance company whether that's private commercial insurance company here in the United States or governmental insurer like there is around the world or in case of the United States Medicare

4. 1:23

   Medicaid for example there may be a pharmaceutical company involved who is manufacturing a medication that the patient takes and the delivery of healthcare is allah these entities talking to each other about what care was delivered what the bill looks like when they'll be paid for example and if anybody's experienced health care in the US you know it's it starts and stops there's a lot of breaks in the workflows where there may be faxes being sent to other parties who have to review the

5. 1:54

   documentation get back with a phone call and it could be days sometimes weeks or even months before a business process completes where care has been successfully delivered where payments been made where all the records are updated etc and so there is no solo workflow in healthcare it's always multiple part and that multiple that multi-party workflow has what we call friction it's

6. 2:18

   not easy to communicate all the information that needs to flow in order for these processes to complete quickly and seamlessly and that's where demo comes in so what is damn old a mole is a tool chain it's it's a language and technological tools to allow enterprises to write the business flows the business logic of a multi-party workflow and when deployed on a on a database or a blocked chain it enforces the rules of that business logic so that the parties can

7. 2:51

   trust that the business workflow they're working on will behave the way they expect it to and so that instead of just trusting that other party we can now trust the technology in a new way to to get better synchronized workflows to ultimately deliver better care for the patient and so in blockchain and healthcare there's a lot of talk of let's put something on the blockchain let's put medical records on the blockchain let's put clinical research on the blockchain especially in

8. 3:23

   the context of kovat 19 there's a lot of talk about that but what that obfuscates what that and doesn't make clear is how that works and so I wanted to take this first blog in this first video to talk about how Daniel integrates in with existing data systems to allow enterprises to to build valuable multi-party technology to meet their business needs and to support the best interest of the patient and so what we're gonna do is think about how Dan'l helps you break down data silos and

9. 3:53

   drive data interoperability burning topic in healthcare as always through Daniel integrated messaging so you see that blockchain technology specifically demo doesn't replace existing data systems it's not like we're gonna replace a whole sale the claims adjudication systems or the electronic medical record systems when we talk about putting something on the blockchain what we're really talking about is independent enterprise is

10. 4:18

    interacting with each other through smart contracts through damn old business workflows to increase that interoperability to have it that that workflow be secure in that it's going to behave in the expected manner parties can't cheat each other on through damn well smart contracts and that the outcomes will be well understood and transparent to all the involved parties and that's what a de Mille smart contract fundamentally does but how it does it is through integration and integration with

11. 4:51

    existing data systems through one of the many healthcare messaging specifications that we have and so when we can tie these messaging specifications to smart contracts we get a lot of business value and so there's no shortage of messaging there we go no shortage of messaging specifications in healthcare perhaps the most well known is is X 12 which is a messaging specification or at least a standard for how we communicate about medical claims and payment there's

12. 5:28

    clinical data messaging formats like hl7 or the new fire the fast health interoperability resource there's code sets to describe clinical information about the patient diagnosis procedures sno-med hickspicks codes etc and then when we buy things in health care like supplies we often communicate in an EDI specified messaging system the problem with the status quo or the current

13. 5:55

    system now is not that we have these messaging specifications these ensure that multiple parties are communicating in the same language the problem is we send off a message and we send it off into a black box a hospital will send a medical claim through their Clearing House to an insurance company with the insurance company or the Clearing House is doing with that information with that message is completely opaque to the hospital we've come to learn that Oh

14. 6:20

    will he ear back in a certain amount of time they'll do something like that they'll respond in this format but the process that the other party is going through to process that information and to return an answer it's completely opaque and so it's like we're passing slips of paper over the transom or underneath the door to another party who's doing something with it and then they'll get back to us if we integrate these messaging specifications in today

15. 6:45

    MO then we have transparency into what the other party is doing when they're doing it or when they ought to be doing it and what the expected response can look like because we're now sharing a piece of business logic it's not like I'm doing my homework on my side passing it over to you who does it on your side and then passing a message back we can integrate these messaging specifications into demo smart contracts and so that the smart contracts themselves can

16. 7:10

    understand these messages so we can create or solve for disparate workflows and code sets to prevent quality or just for workflows prevent quality improvement and and we can undo that we can actually unify clinical workflows and financial workflows we can break down those data silos to achieve data liquidity which helps all the enterprises involved in healthcare operate better now it might be helpful to to talk about a concrete example of this and for that I want to talk about

17. 7:47

    fire so fire is the the new clinical query API and framework for querying information inside electronic medical records unlike older wearing specifications like hl7 health level seven and fires if you want to learn more about fire you can go to hl7 org have great resources on the open standard of fire what sets fire apart from previous iterations of how you query clinical data inside electronic medical record is that previous attempts were all very

18. 8:19

    document focused they still carry that that notion that a medical record is a file folder full of papers and so when you queried it you could get documents back even an electronic format XML format or others but what's different about fire is that you can query health resources it really views the totality of information inside electronic medical record system as queryable data resources that can be extracted transferred and integrated very easily

19. 8:50

    into other applications something you can't do with a document if you've ever received a PDF integrating the information in that PDF into other programs takes a lot of manual labor fire overcomes that burden fire enables us to very selectively pull clinical data resources outside of electronic medical records and integrate them into other kinds of applications that could be a consumer facing health application

20. 9:14

    like a Fitbit application or it could be a commercial financial application around healthcare payment one workflow that fire is often talked about being involved in is something called prior authorization so Austin insurance companies will demand to authorize a treatment before it takes place this is especially common for very expensive radiological tests MRIs for example where if a physician deems it necessary they need to communicate with the insurance company and the insurance

21. 9:45

    company has to authorize it before it is available for payment from the insurance company and so the patient is left waiting the physician has to communicate not just that they want to do the MRI but some sort of medical justification for that and so that often involves clinical data today's work or flow around prior authorization and the vast majority of cases is still via phone and fax machine where clinical documentation can be faxed to the insurance company

22. 10:09

    for their review and you can wait sometimes days sometimes weeks for a response before the test can be conducted for example the scan or radiological test and this can be you know very trying for patients who understandably simply want the healthcare their physicians indicating that they need one of the barriers there though is how we make that information that clinical information more liquid such that it can be easily shared with the insurance company and the insurance company can very quickly return an

23. 10:41

    answer on an authorization request and so the way we think about that and amyl is that the demo smart contract actually contains the authorization logic used by a commercial insurer for example to determine whether or not a test is off or not we integrate that damos smart contract in with the fire api such that we can translate outcomes from the fire api into demo types so we can make the demo smart contract speak the same

24. 11:13

    language as the electronic mecha record through fire and such that workflows can be become automated in the sense that a physician can hold the relevant information outside of electronic medical record share it immediately with a smart contract which is jointly uh governed by both the insurance company in the physician and receive a determination of whether or not the treatment is authorized and then proceed

25. 11:38

    to deliver care to the patients by bringing in not only fire which is an amazing resource for querying discrete pieces of clinical information but integrating that into smart contracts we can truly create synchronized workflows between large enterprises involved in healthcare and avoid the need for things like paper-based workflows time delays phone calls breakages in the workflow

26. 12:04

    where the data has to be resent or refax and ultimately it's a smoother better experience for healthcare in general and that's just one example of how we can take messaging specifications and integrate them into smart contracts and in this blog series as well as this video series i'm going to be exploring a wide variety of use cases in healthcare and i want to invite you to follow along

27. 12:30

    and to let us know your own ideas for how we can best used amal an open-source tool chain for building multi-party workflows how we can make this open source technology work for healthcare so that we can all do better thanks