Blockchain gives music lessons to healthcare

Peter Nichol
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Blockchain gives music lessons to healthcare

Blockchain smart contracts provide the bridge, intersecting the music and health.

Music shapes culture, entertainment and technology. The passion for music spans industries refreshes ideas and introduces new concepts previously invisible. The music industries maturation into digital contexts and exploration of blockchain technology have uncovered lessons we can apply to healthcare.

Intersecting music and health

The world is growing, and the music industry is shrinking. Economies of scale exist, yet annually miss impacting healthcare for the better. The music and healthcare industries are managing the transition from the physical to digital. How will the music industries keep pace with the trends of instant access and play anywhere? How will the healthcare industry keep pace with the trends of instant access and view anywhere medical information? Blockchain is the answer. Smart contracts provide the bridge.

Musical revenue fragmentation

The music industry is getting a shakeup but continues to lose out in revenue. The end of 2014 marked the first year that the industry derived the same revenue from digital channels (46 percent) as from physical format sales (46 percent). According to the UN, Dept. of Economic and Social Affairs Population Division, there are 7.4 billion people in the world today growing at roughly 80 million a year. It’s disparaging to realize that the global recording music industry was a $40 billion business in 1997 and 2014 the music industry’s global digital revenues barely reached $6.85 billion, according to the International Federation of the Phonographic Industry (IFPI). The IFPI represents the recording industry worldwide, with over 1,300 record companies in over 57 countries are members.

More people are listening to music, and fewer writers and artists are getting paid for their work. Society needs a music industry that rewards people for creating great content. Not a scene where music companies wrestle over ownership rights.

Hitting the music industry with peer-to-peer

The introduction of the bitcoin peer-to-peer electronic cash system by Satoshi Nakamoto (sudo name) in 2008, immediately sparked the interest of the music industry. The wonder started with companies like Murfie, a music marketplace founded in 2011, that accepts bitcoins as payments for music downloads. Bitcoin as a payment method isn’t going to change musicians lives as a new financial standard for payment. However, the application of the blockchain technology to the music industry may change artist lives.

Blockchain has the potential to modernize every industry in the world. We just don’t know exactly how. It was common knowledge that blockchain could impact the music industry, but the full impact on the industry wasn’t articulated clearly to encapsulate the potential for positive change, until last month. In November 2015, Benji Rogers published on Medium, “How the Blockchain and VR can Change the Music Industry.” The article offers a powerful argument in support of the positive impact that blockchain technology (Etherium, Muse, Rootstock) would have on the entertainment industry. In February 2016, Roger published an update that provided substantive support both theoretical and technical on how this could be accomplished in part 2 of his post, highlighting four clear points.

  1. Smart contracts will be the enabler
  2. Blockchain will house a global Fair Trade Global Database of rights
  3. Every song will contain Fair Trade Minimum Viable Data (MVD)
  4. The new format will be called .bc or “dot Blockchain,” a non-replicable wrapper (.bc compliant systems)

Music ownership obfuscation

Will the music industry see the beauty in the blockchain scheme? Blockchain technology applied to your music means that everyone will pay for their use, driving transparency of music ownership. The artist would create a .bc file containing who owns the work and who to pay when used. The music enthusiast using a platform (YouTube, Spotify, SoundCloud, 8Tracks, Tidal, Pandora, Apple) buys and pays for music as they would today. The difference is the behind the scenes a digital ledger tracks ownership of the author and usage rights of the music enthusiast.

Roger suggests, defining the rules governing play at the time of encoding, by the artist and the music rights holders, as part of the song’s Fair Trade Minimum Viable Data. The author, composers, contributors, owners, and usage rights are defined as part of smart contracts enabled by blockchain technologies. The music enthusiast also benefits paying only for what they play, instant payment, and multi-platform accessible. The .bc was envisioned to replace DVD, Blu-Ray and support a new virtual reality (VR) format that has no standardized format or wrapper. This format would contain Minimal Viable Data using the W3C Web standard JSON-LD, illustrated in the dot blockchain concept illustration.

The music industry has struggled with digital rights management (DRM) for years. Blockchain provides a ledger as a means of payment, automatic royalty payment splitter, and simplified licensing using legal enforcement non-ambiguous smart contracts. This concept is more than DRM. Its is DRM+.

Intersecting music and health

Blockchain technology can improve transparency of ownership for music as well as health records. Music industry’s song ownership challenge parallels the healthcare industry’s problem with medical health record ownership. The U.S. life and health insurance industry reached $877.9 billion in 2014 according to statista.com. How much more transparency in your personal medical records have you seen in 2014 compared to 2015. I’ll share my experience between 2014 and 2015; I saw zero positive impact towards better visibly into my medical records. Personal health records continue to be as fragmented between providers and physicians as song ownership and royalty payments of the music industry. Platform scale, interoperability, and privacy are surmountable challenges. How do we transfer trust, when patients have no faith in the system? Payments don’t reflect treatment provided. We can’t blame patients for their lack of confidence when even experts have trouble explaining the circus we call today’s “healthcare system.”

Blockchain has the potential to give patients, like you and I hope, and restore trust in healthcare. Transparency and ownership of our medical health records are the beginning. New healthcare platforms will emerge returning medical record ownership back into the hands of the patient.

Blockchain applications for healthcare

Peter Nichol
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Blockchain applications for healthcare

Blockchain opportunities are changing healthcare globally – innovative leaders see the change. There are many blockchain applications for healthcare. The exponential growth of blockchain applications can benefit population health, medical records, and patient-generated data. Healthcare startups have already discovered how to leverage blockchain technology for healthcare.

The first industry to visibility take advantage of blockchain was financial services. Financial services had the courage to believe in the potential of blockchain technologies and grew a three tier model:

  1. Applications and solutions (brokerages, exchanges, soft wallets, hard wallets, investments, merchants, compliance, trading platforms, capital markets, microtransactions, money services, banks, ATMs, payroll and insurance, payments, trade finance)
  2. Middleware and services (services, software development, general APIs, special APIs, platforms, smart contracts)
  3. Infrastructure and base protocols (public, special, payment, miners)
    Healthcare is late to the show but also hasn’t missed the show. Blockchain opportunities are changing healthcare globally – blockchain is fitting into a new world.

Population health management

Health information exchanges (HIE) and all-payer claim databases (APCD) have become obsolete with blockchain. It doesn’t make sense to trust organizations to verify member’s trustworthiness when it’s not required with blockchain. Eliminating this prehistoric middleman increases data security and removes the cost, time, and resources required to prove that a party is doing what they say they’ll do. New models that share medical records are emerging.

In 2007, the government of Estonia joined forces with Guardtime, a leader in cybersecurity using blockchain’s Keyless Signature Infrastructure (KSI), to provide authentication on a massive scale. Their combined challenges were to verify the integrity of data-at-rest on a global scale. Estonia is among the few if not the only digital societies which have 100% of their medical health records online. Spending time and resources verifying members’ trustworthiness (e.g., HIE, all-payer claims database, local EMRs) no longer makes savvy business sense. Blockchain will leap frog population health by providing trust where none exists for continuous access to patient records by directly linking information to clinical and financial outcomes. Population health just got smarter.

Healthcare mobile communications and notifications

Tierion can collect data from web and mobile apps, record information in the blockchain and slingshot data to other systems by using REST API or HTML form submissions. Already have an existing mobile application? Leveraging REST APIs can extend functionality and provide a “safe” way to amplify your corporate innovation footprint. In October 2015, Philips Healthcare’s announced a joint blockchain project with Tierion. Tierion supports over 400 applications such as Google Sheets, Gmail, and Slack and also assisted the Department of Economic and Community Development of Connecticut surveying 200 top technology companies. Tierion can also handle medical, financial, and legal records through their blockchain integration and infrastructure platform.

PGHD meets wearables

Patient-generated health data (PGHD) has tremendous potential, but to-date hasn’t delivered the promised value. Mainly, because this data never makes it to the patient.

Under Armour HealthBox, Bragi Dash, Hexoskin smart shirt, OMSignal OMbra all generate industry excitement while playing safely on the fringe of patient transformation. Wearable tech is exciting, hip, and a great conversation starter. Value alignment is found at the intersection of wearable tech and integration of medical records. FHIR APIs, needed to connect the patients to EMRs, won’t be mainstream in 2016. The major EHRs vendors aren’t going to publish a complete service definition for FHIR profiles to share with software companies. Access to data is preventing adoption, not technology or even patient behavior. No data – no insight.

In 2011 at the World Economic Forum, personal data was declared a new asset class. Healthbank, based in Switzerland, is a global digital health innovator taking a radically transparent approach to health system transactions. Their approach is a new way of sharing data and uses personal data that is secured. A next logical step for healthbank would be to incorporate blockchain technology. The healthbank mantra is “my data, my choice, my healthbank.” Blockchain applications place personal and patient information into the hands of the individual. Doctor visits, sleep patterns, heart rate, glucose, and other IoT devices can all be polled and then stored using the healthbank blockchain. This innovative blockchain company is attending conferences and telling their story in Finland, Barcelona, and Brazil – the world is watching. Also, Noser Health (Germany) and Netcetera (Switzerland) have recently joined healthbank as partners to mature its global health data transaction platform.

Patient-owned

Once patient-generated data is owned by the patient from wearables to physician and clinical visits; a dramatic shift will occur.Trust is difficult to find in today’s global economy. The “cloud” is considered safe, well up until the point that your personal information is going to reside there. Blockchain technology can authenticate access to medical information, quickly and securely.

Innovative leaders can see the change. It’s happening now; the patient experience is evolving.

Why experts are slowing the emergence of digital health

Peter Nichol
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Why experts are slowing the emergence of digital health

Article originally published on CIO.com.

Digital transformation visions crumble from a lack expertise. Don’t let yours be one of them.

Digital health is the convergence of the Digital and Genomic Revolutions specifically health, healthcare, living and society. Personal empowerment is the heartbeat of digital health making our lives better by managing, tracking and improving wellness for a healthier tomorrow. The realization of this healthier and seamlessly connected future will require orchestration between the physical and digital world. This orchestration will be conducted by digital experts.

What does it take to be an industry expert? Is it pure raw intelligence or is there a subtler side to expertise? In some instances, experts that are required to transform organizations and tap into top-line innovation growth, may be the same experts preventing adoption of your organization’s digital capabilities. There is a lack of expertise when it comes to digital transformations and applying digital technology to dramatically improve performance of an enterprise in all aspects of human society. 

There is something sacred about the word “expert.” This role can’t be given; it can’t be won; and it isn’t issued with a promotion – it’s earned.

Two types of expertise

There are fundamentally two types of expertise: Routine and adaptive. Routine experts often assume that their current knowledge and their problem definitions are correct. Adaptive experts have the ability to apply knowledge to novel problems or atypical business challenges and reshape problem definitions.

Routine expertise

Digital transformation visions crumble because of a lack of experts or the wrong kind.  

Giyoo Hatano of Dokkyo University and Kayoko Inagaki of Chiba University” studied aspects of cognitive development in the 1980’s. The updated translation is that digital transformation is impossible when companies are made up of only routine experts.

Routine experts are unable to think beyond their models built on procedural knowledge. Routine experts rely on similar experiences from their past when building a solution framework.  When problems arise that are atypical and do not fit historical problems, they get stuck. For example, the problem may require a new model such as introducing digital disruption. 

Digital disruption occurs when new technology affects existing business models and how products and services create value. Those regarded as routine experts would apply the same models they have used for the last twenty years and find they do not work. This illustrates the real problem preventing digital disruption, attempting to solve new problems with procedural expertise.

That’s not to say routine experts are not effective. Procedural skills are used to efficiently solve everyday problems in stable environments. Unfortunately, stable does not describe the digital environment that influences business today.

Adaptive expertise

Another type of expert is the adaptive (or conceptual) expert. These experts not only retain procedural skills, the base of routine expertise, but they also understand the reasoning behind the skills they demonstrate. They internalize the need for invention and they have the desire to understand the meaning behind these procedural skills. Routine expertise has a pattern that is prevalent in every industry. The test is to be able to describe ‘why’ something works, not ‘how.’ The combination of the past knowledge and the reason why it works enables adaptive experts to grasp the full domain of information surrounding the skill. Taking this past knowledge, adaptive experts will then identify even more efficient methods of performing the skill.

Bottom of Form

In 1983 Gentner and Stevens introduced the concept of mental models, in their book of the same name. Mental Models help us visualize the theory with a series of short studies. They explain that individuals can run mental simulations and make predictions on conceptual outcomes. We can logically infer that conceptual experts step beyond the cultural limits procedural experts experience and are able to explore problems more deeply than with simple trial-and-error. The desire to learn unlocks new thinking, removes conventional mental barriers, exposing raw talent.

Consider the following exercise:

 “Two men played five games of checkers. Each won three games. How is this possible?”

Clearly, if the two men are playing against each other this problem is impossible to solve. Adaptive experts will already assume information is missing, constraints are flawed, and their problem is larger than what is being suggested.

After a few minutes most routine experts will realize the two men were not playing against each other and that the problem was indeed solvable. This example of restricted problem spaces, demonstrates how individuals build restricted definitions of problems. When you look at companies that are digitally innovative and companies that are not, the primary differentiating factor is the talent; each company defined the problem differently.

Growing digital innovation initiatives requires adaptive expertise to create a highly metacognitive organizational environment that promotes content knowledge, domain knowledge, and experimentation. Adaptive expertise is defined in the mind and fueled by the attitude that drives it.

The next time a team is assembled to deliver the next dermable (a type wearable that goes on your skin and can stand out like a tattoo, or blend into the color of your skin), swallowable, or nanobot, rethink who’s an expert.

Divergent thinking is essential for digital health creativity.

Healthcare’s Two Biggest Problems Going Into 2016: No Sugar Added

Peter Nichol
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Healthcare’s Two Biggest Problems Going Into 2016: No Sugar Added

Healthcare’s natural evolution from a fee-for-service to value-based outcome models will remain out of reach, until interoperability and payment reform are removed as barriers to provide patient care.

 

Interoperability

Overall, it’s widely accepted that the Health Information Technology for Economic and Clinical Health (HITECH) Act, as a policy was a success. It’s not surprising when the percentage of US Hospitals using digital records skyrocketed from 9.4% to 75.5% between 2008 and 2014, according to a recent brief by the Office of the National Coordinator for Health Information Technology. However, as we include the patient experience into the definition of success, perspectives change. For example, you have a simple annual checkup at your primary care physician locally, and then a week later you travel to a neighboring town and end up in the hospital. The hospital doesn’t have any record of your recent visit a week ago, no access to labs, and won’t even know to ask unless you mention it. Is it an effective meaningful use application? The primary challenge continues to be that providers and payers are not accountable for interoperability under HITECH. The result is a fragmented national healthcare that only hurts the patients we’re trying to help. HITECH was a significant investment with a staggering $35 billion committed for the program, according to Robert A. Sunshine, Acting Director Congressional Budget Office (CBO) in his response to Charles B. Rangel, U.S. House of Representatives, Chairman for the Committee on Ways and Means. The program initially committed to savings from Medicaid and Medicare of $12.0 billion between 2011 – 2019. Have the US consumers and patients realized that savings? Why of course not, there is limited interoperability when making clinical decisions with existing EMR technologies.

 

Interoperability is a monumental challenge that is rarely discussed nationally, and this critical issue needs to be confronted before costs are driven down opening access and allowing providers to explore models for improved quality in patient care.

 

Payment Reform

The method healthcare providers are paid must be changed from a fee-for-service payment system. Without heavy healthcare payment reform, the realization of better access to higher quality care at lower costs, will not happen. Payers won’t do it. Providers won’t do it. We as patients must spearhead this change. Otherwise, we’ll be passing the burden to the next generation.

 

The Center for Healthcare Quality and Payment Reform identified ten major barriers of healthcare payment reform 1. Continued use of fee-for-service payment models, 2. Expecting providers to be responsible for costs they cannot control, 3. Physical compensation based on volume not value, 4. Lack of data for setting payment amounts, 5. Lack of patient engagement, 6. Inadequate measures 7. Lack of alignment among payers, 8. Negative impacts on hospitals (inefficiencies), 9. Policies favoring large provider organizations, and 10. Lack of neutral convening and coordination mechanisms. These issues are complex and will require payers, providers and patients all working together for a healthier tomorrow. This realization will be nearly impossible without payment reform considering we have a payment system incented not to keep patients healthy and a dis-coordinated delivery system at the patient level.

 

In an effort to push down costs, consumers are demanding price transparency. Will healthcare transparency reduce costs? It sounds like it should. Price transparency protects consumers from unfair pricing, and helps to determine the true product evaluation, while building consumer trust. Empowering consumers with price allows, consumers make decisions based on cost and quality information, before care is obtained not after. Better decisions do save money. West Health Policy Institute’s latest analysis indicated, that price transparency could cut $100 billion over 10 years from health spending. However, there can be adverse effects of price transparency, and according to the Health Care Cost Institute, in markets where pricing is very transparent, pricing narrows and the average cost rises. As employers force consumers toward contribution models, selections become difficult and price transparency may not be the single solution. Price transparency creates behavior changes in employees and also in employers.

 

We can only hope the behavior changes in employers soon start to favor the employee.

 

 

References

HTA. (2015). Using The PCAT Formula During Conversational Hypnosis To Solve Problems (online image). Retrieved November 15, 2015, from http://hypnosistrainingacademy.com/using-the-pcat-formula-to-help-people-solve-problems-during-conversational-hypnosis/

 

Peter Nichol, empowers organizations to think different for different results. You can follow Peter on Twitter or on his blog. Peter can be reached at pnichol [dot] spamarrest.com.

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