Blockchain Technology - Common Use-Cases
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Blockchain technology has many potential use cases in healthcare, but also faces challenges regarding interoperability, security, and performance. While blockchain investments peaked in 2017-2018, many projects have failed due to a lack of real use cases. For healthcare, appropriate uses of blockchain may include payments and supply chain applications that do not require storing sensitive medical data on the blockchain. Overall, blockchain remains an emerging technology that could play a role in healthcare if standards, security, and technical limitations are properly addressed.
Blockchain Technology - Common Use-Cases
- 1. Blockchain Technology - Common Use-Cases Massimiliano Masi massimiliano.masi@tiani-spirit.com, http://www.mascanc.net IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018
- 2. Take away message Take away message Interoperability is a key to establish sustainable health IT services Interoperability is not achieved by only using standards Many blockchain projects do not tackle interoperability, enabling vendor lock-in Cryptography of blockchain is tamperproof, but IT Security is still vulnerable In this presentation I’ll try to show Status of blockchain investments The need of interoperability Common mistakes of blockchain projects Good use cases Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 2/22
- 3. Some stats How many Initial Coin Offering related to healthcare? Coinschedule1, 912 ICOs, Raising 21.548.685.716 USD, 1.5% healthcare, raising 322.682.651 USD ICOBench2, 4724 ICOs, 230 is healthcare-related (4.8%) ICOWatchList3, 3.8% healthcare-related Warning: Those numbers are only ICOs!!! 1 https://www.coinschedule.com/stats.html 2 https://icobench.com/stats 3 https://icowatchlist.com/statistics/categories Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 3/22
- 4. ICO Investments are dropping4 4 https://www.icodata.io/stats/2018 Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 4/22
- 5. Trough of Disillusionment? According with Hype Cycle of Emerging Technologies, 2018, Blockchain is entering in the Trough of Disillusionment. Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 5/22
- 6. Good news Lack of ICO investments is a good sign :-) (Technologically speaking) We are moving from the Hype: reduce the high quantity of scam which is out today The technology remains, and it’s probably here to stay Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 6/22
- 7. Using standards Using standards is not enough “standards alone are not enough to guarantee interoperability” (G. Lewis) “The nice thing about standards is that you have so many to choose from” (A. Tanenbaum) HL7V2 vs FHIR, OpenEHR vs HL7, etc. Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 7/22
- 8. Interoperability Interoperability Levels (Himss) Foundational (at the level of message exchange), Structural (the format of data exchange), Semantical (at the level of the information exchanged). Enterprise Architecture comes to the rescue Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 8/22
- 9. The problem with a unique solution The vendor lock-in effect happens when a customer is de- pendent on a vendor for products, and it is unable to use another vendor without substantial switching costs and risks5. By defining concepts, rules, and building blocks, Enterprise Architectures (e.g., TOGAF, IHE), enables components continuum 5 Source: Wikipedia Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 9/22
- 10. Concepts Reference Architecture is the generic architecture providing guidelines and options for developing specific architectures and solution implementations. Here it refers to the set of all available profiles used to build a solution architecture. Solution Architecture describes the specific business operations/activities and the ways in which information systems and technology support them. It typically applies to a single project/organization. Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 10/22
- 11. Concepts / 2 Actor is a functional component of the healthcare, or energy, organization. Transaction is a standards-based specification of the interactions between IHE Actors. Profile is a high-level functional unit composed of related IHE Transactions, with the capacity to address specific IT infrastructure requirements for a single case. Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 11/22
- 12. Relevant Blockchain Ideas Blockchain? Blockchain Is a distributed, decentralised and immutable ledger, where a program can be executed on a transaction receipt Defined as the longest path from the genesis block, i.e., the root of the blockchain tree, to a leaf Blockchain acts as a consistent transaction history one which all nodes eventually agree On each transaction some code can be executed in different ways (Chaincode, SmartContracts) Smart Contrat inherits the definition of the 50’s: a signed agreement made by multiple stakeholders, in electronic form Ethereum makes this programmable Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 12/22
- 13. Relevant Blockchain Ideas Blockchain is slow: storing unstructured data in blockchain is a guarantee of poor performance (depending on the blockchain deployment private blockchains (trust amongst node) run more efficient consensus strategy (or don’t need one at all) Storing data in the blockchain is a bad idea Apart from storage costs, without a freely given informed consent you cannot disclose medical data Data in the blockchain is publicly accessible. Encryption does not help. NIST, BSI, and ENISA update the list of useable algorithms often (every five years, in average). Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 13/22
- 14. The problem of smart contracts Ethereum writes a smart contract ”in stone” If there is a bug in a smart contract, it can’t be corrected, today Security Audits are useless, since they are checked using today’s security knowledge Moving smart contract version in Ethereum is still hard work The problem of updating smart contracts Smart Contracts can also be updated in Hyperledger But if few people can update a smart contract potentially holding economic value, we inherit the IT security problem of who is entitled to change it? (Authorisation) Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 14/22
- 15. The problem of consensus Satoshi Nakamoto reused existing literature and scientific work (Haber et al.6, Schneier et al7, Vishnamurty et al8, Szabo 9, Dwork et al.10) Nowadays many consensus algorithm exists, many of them without a formal proof of their correctness (e.g., the Delegated Proof of Stake). Again on performance The time of the doctor is precious. Time spent waiting for a transaction to be processed in the blockchain is time taken away from the patient treatment. 6 S. Haber, and W.S. Stornetta, How to timestamp a digital document 7 B. Schneier, J. Kelsey, Cryptographic support for Secure Logs on Untrusted Machines, in Proceedings of the 7th USENIX 8 V. Vishnamurty et al., Karma: A secure economic framework for peer-to-peer resource sharing, 2003 9 N. Szabo, Formalizing and securing relationships on public networks, 1997 10 C. Dwork, and M. Naor, Pricing via Processing or Combatting Junk Mail, Crypto 92 Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 15/22
- 16. Is off-chain storage good? Some DLT projects utilise pointers to data stored on off-chain infrastructure. FHIR resource identifiers stored in the blockchain to guarantee a property (e.g.. data integrity, patient-centric access) Is blockchain suitable for off-chain? What is the benefit of having a distributed consensus, over a centralized, efficient and redundant database using advanced signatures? How to keep in sync the off-chain infrastructure with the chain? Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 16/22
- 17. Is blockchain anonymous? All the transactions in the blockchain are public by definition It is relatively trivial to track all the transactions belonging to a public key Wallets change user address often to avoid such tracking Wallets and clients poses severe IT Security issues: key preservation, password, social attacks Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 17/22
- 18. ”Good” Use Cases All about monetisation and payments: cryptocurrencies can facilitate the payments. ERC-20 and (decentralised) exchanges can easy eventual differences on curriencies All that does not require storing healthcare information or well established trust chains (e.g., supply chain, anti-counterfeiting) Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 18/22
- 19. Conclusions I spent most of the talk dissecting what blockchain is ”not”, or not fit-for-purpose Good example of using blockchain are really hard to find, in the healthcare sector 26,000 blockchain projects launched in 2016, 92 percent are now dead1112 Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 19/22
- 20. Conclusions Out from the noise Recall first slide: according with Gartner the Hype is over, technology is getting stable, and Blockchain can play a crucial role in eHealth Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 20/22
- 21. Input from Attendees / Discussion Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 21/22
- 22. Thank You Masi et al.: DLT - Use Cases CC Massimiliano Masi IHE ASIAPAC SUMMIT, Brisbane (AU), November 5, 2018 22/22