Blockchains & Healthcare (w/ Dr. Randall)
Speaker 2 GM, and welcome to the EV Mavericks podcast, a show about the decentralized Ethereum Web three ecosystem and brought to you by the Mainnet Dow community. We're thrilled to have you with us. Absolutely none of the following is financial advice. Note that there is an audience discussion thread in the EVM podcast episode three channel. The purpose of this podcast is to explore the intersection of health care and blockchains. I'm Otto here with Fuzzmaster Phil. Thanks for joining us today. Hey, everybody. I'm Phil.
Speaker 4 I've got the pleasure to have the man, the myth, the legend, doctor Dave, sitting next to me right now. Doctor David Randall, he currently serves as resident scholar for the American Research and Policy Institute in Washington, DC. He also serves as a strategic adviser and advisory board member for the Sol dot Care Foundation. It that's a health care blockchain technology. Doctor Randall has extensive experience as a former top insurance regulator, legislative staff member, health care lobbyist, consultant, and executive with not only insurance companies, but also with several provider trade groups in Washington. He has testified before both the US House and Senate committees of Congress on a variety of health policy issues. His research includes study of Medicaid, Medicare entitlements and privatization, health insurance exchanges, health care data analytics, and health care information technology.
He has also published work examining the use of blockchain technology in the health IT and is a frequent guest lecturer at universities around the world. He received his PhD from the Kent State University and a master's degree from the Ohio State University and a BS degree from Case Western Reserve University with honors. Doctor Dave, welcome. I'm Phil. Welcome. Thank you. Thank you.
Speaker 5 Pleasure to be here. How are you today, sir? I'm great. Look forward to, discussing
Speaker 4 these issues. Cool, man. Well, let's get right on it, Dave. If you if you don't mind, would you explain try to explain to me, like, how you got into blockchain?
Speaker 5 Good question. Somewhat by accident. One of my long term friends and colleagues who's currently the CEO of the Self Care
Speaker 5 variety of projects over time, came to me and we basically wrote
Speaker 5 a napkin in a restaurant and a bar, the beginnings of solve care. And, of course, he is absolutely the driving force. But in short, I was drawn to both blockchain and, obviously, Pardeep's vision by the problems that we saw specifically in the health care IT space, that we had encountered
Speaker 5 my research, working with him on a variety of projects within state Medicaid systems as well as within private health insurers about all of the legacy health IT issues that, frankly, are still problematic. We viewed I viewed blockchain as a potential solution to many of the problems that, the health IT space had encountered both in public and private markets. So it wasn't a solution looking for the problem. It was rather, we identified a problem and blockchain, I believe, in terms of its application in the health care space, can present solutions to many of the problems that I've
Speaker 5 peer reviewed research.
Speaker 4 So you believe I mean, well, let me ask you this first. So were you into Bitcoin or Ethereum before Pardeep brought up that conversation?
Speaker 5 Casually. Meaning, I owned a little bit, not a lot. After, I really started delving into it, I became intrigued both with Bitcoin and equally as important with the Ethereum architecture.
Speaker 5 Solve is a an ERC 20 token built on
Speaker 5 it's been developed is principally using Ethereum.
Speaker 4 Cool. So I just wanna bring this back real quick. You said you guys wrote it on a napkin. That's funny because that's where the Fermi the Fermi paradox came from, was on a napkin in a diner. So is there anything else you'd like to say before we start drilling you with questions?
Speaker 5 No. I I I certainly enjoy doing events like this because I learned from the questions. There were several questions that you gave me that, frankly, I really had to think about. So the questions I thought were thoughtful in terms of the scope and, subject matter. So I look forward to having an engaging conversation with your audience.
Speaker 4 Yeah. As do I. I wish we had more folks here, but it is what it is. Right? Yeah. Guess noon on Monday is not a great time.
Speaker 2 Yeah. We'll we'll release it after the recording's edited and stuff, and they'll be able to listen to it at their leisure. 100%.
Speaker 4 Alright. Well, I guess I'll take the first question. So what do you think about Opalus, dude?
Speaker 5 Frankly, when that question was posed prior to this, I only knew, frankly, very little about it. But I did look at it, and, while intriguing, I I'd have to give my opinion that it is not something that would be a fit, in my opinion, within the health IT infrastructure space. I think it has other applications, with
Speaker 4 different employer groups, but I think it
Speaker 5 would be more specific
Speaker 5 types of employers. Now with health care employers being one of the largest employment sectors in
Speaker 5 in The US and, frankly, in many Western democracies, There are certainly applications, but I think in terms of of saying that it would be something that would work with health IT issues per se. I I just I don't I don't see it right now.
Speaker 4 Okay. Would that be something that someone like myself who owns their own business self employed, is that something that I would look at, or is that something more technical that like a web dev? I
Speaker 5 based upon my reading of the protocol that it's something that's quite ready for prime time. It it appears to be to be more experimental, more pilot oriented, but I think it has potential. I don't wanna be totally dismissive of of the platform. But, yeah, I think small businesses could potentially utilize the platform.
Speaker 2 Okay? Yeah. For those that listeners that don't know, Opalis is a a digital employment cooperative. So they offer, you know, employment benefits like health care, dental, disability, retirement, stuff like that, kinda just giving that independent worker the the flexibility while maintaining that that corporate structure of of benefits. So for those who don't know.
Speaker 4 Yes. It it seems like it's a great idea, in my opinion. You know, I I think
Speaker 2 maybe further maturity down the road. You know?
Speaker 5 Yeah. And Yeah. Yeah. I think, to be fair, I I think it's something that definitely needs to mature. The the the final thought that I'll make about it based upon my reading is that I could potentially see insurers that are providing benefits or for that matter, even specialty benefits such as disability coverage, that that could be a potential efficiency
Speaker 5 in terms of using what they state it would be, meaning a unified benefit service that could arguably be better than, what's in the current marketplace.
Speaker 4 Yeah. Because I'll I'll say for one, I absolutely hate hate insurance companies and health care. It's it's always been a hassle for me. So anything You and everybody else. Yeah. No doubt. Right? Right. Alright. Otto, you got the next one?
Speaker 2 Yeah. So, doctor Dave, what are the risks, associated with doing health care on the blockchain?
Speaker 5 Well, frankly, most of the risks from my perspective are regulatory regulatory compliance. And very specifically, one of the obstacles that I've seen that a question that
Speaker 4 continually comes up in terms of both my experience with
Speaker 5 self care plus other projects that I'm currently involved in is data privacy. And the I I I hate to phrase it in this way, but the lack of understanding in terms of how a permissioned based blockchain,
Speaker 5 infrastructure would actually do a much better draw job, excuse me, of data privacy than current legacy IT systems. Meaning that by using a blockchain, you can give very specific permissions, through a tokenized environment in terms of who, how, and when health data, personal health information PHIs could be shared among providers or family members, as an example. So legacy systems are frankly not capable, at any scale in terms of providing those types of specific permissions to share personal health information. So that, I think, is one of the largest challenges. The other secondary challenge is that the lack of understanding of how a blockchain works and its confusion or linkage to cryptocurrency is another obstacle within legacy IT systems or, for that matter, those that administer them.
I mean, those walls, I think, are starting to come down in terms of sort of separating the two, meaning the technology from the currency and, a lot of the headway that, at least, I've seen is is really more of a focus on technology rather than, tokenization.
Speaker 4 So back to your first part of that statement. You're saying that it could potentially be programmed into the smart contract on on who sees what, when they see what? Yes. It it it it can be. Yes. I yeah. Okay.
Speaker 5 Solve Solve has developed it.
Speaker 4 Okay. And, oh, by the way, everybody, doctor Dave, like I said in the beginning, he is on the advisory board for Solve. This is not a Solve podcast. This is a general health care and IT related podcast. But I do imagine that we'll be hearing Solve here and there. But he's not trying to get you guys to buy Solve or anything like that. This is all, educational. Correct? Absolutely. Good. Alright, Dave. So how do we remain HIPAA compliant?
Speaker 5 Well, again, to go to, any smart contract
Speaker 5 with health applications on a blockchain, they have to be permission based, meaning they have to be programmable,
Speaker 4 which obviously smart contract
Speaker 5 is, to allow those that are permitted under the law to see personal health information. That is one of the, I think, key features of being HIPAA compliant or for that matter, improving on current compliance standards directly related to to
Speaker 5 I mean, there's not a month or week that goes by that you don't hear about some health data breach on some legacy system. I'm not saying that if everybody adopted blockchain that that would never happen, but I in my
Speaker 4 opinion, that would be
Speaker 5 a lot less frequent occurrence if you used a smart contract that would be very specifically permission based in terms of how, when, and who sees personal health information.
Speaker 2 Yeah. Yeah. That kinda sounds like a a whole new niche for, those who write contracts and and have knowledge and kind of, you know, a foot in both camps there. Yeah.
Speaker 4 That's what I was thinking. This could be a great employment opportune not solved, but just anybody that wants to build a protocol around this stuff.
Speaker 5 Yeah. I mean, with again, to be both intellectually honest and disclosure, Solvent obviously isn't the only platform doing this right now. Every major, IT firm, IBM, is delving into this now. So it's it's it's coming, and there are literally thousands of potential applications within both public and private
Speaker 4 health systems, whether
Speaker 5 that's insurance or or something that's
Speaker 5 based in terms of how this could work. So, it's in my opinion, it's definitely the future in terms of dealing with the problems I've I've outlined in my
Speaker 4 published work about the
Speaker 4 health IT systems. Okay.
Speaker 2 Doctor Dave, do you have any advice on how a DAO should determine what level of contribution should qualify for health benefits. Should it mimic the 80% standard?
Speaker 5 Well, I my my opinion on that is that given the nature of health care and obviously since
Speaker 4 published work has been looking
Speaker 5 at US health care systems and
Speaker 5 programs like Medicaid
Speaker 4 very specifically and obviously Medicare as
Speaker 5 well. I do not think that DALs are quite ready for prime time
Speaker 5 their implementation within a lot of these systems because
Speaker 5 regulation, number one, the control that must be exercised by states that administer state Medicaid systems, and also very specifically
Speaker 4 with health insurers that are regulated principally at
Speaker 5 the state level about them seeding any control and very specifically, the authority with state Medicaid systems rest with the state Medicaid director by federal law. So and a a decentralized autonomous organization, frankly, in a global sense probably wouldn't work. Now there are applications, and I know this is part of your other questions that you'll pose to me. There are applications that Dallas would potentially be, appropriate within niche areas within health care finance or administration. So but, as far as the, principal way that health care is delivered in The United States either through, the two principal entitlement programs, Medicaid and Medicare, or through health insurance. There are regulatory impediments in terms of having what I would call a overreaching DAO that would, in essence, provide autonomous regulation. It just it wouldn't it wouldn't fly.
Speaker 4 So that's a bummer. Right. No doubt. Hey. I I wanted to say, if anybody in the audience that's listening right now, feel free to wave your hands so I can bring you up on stage. You could ask doctor Dave some questions. It does not have to be limited to the topic we're currently talking talking about. I mean, he's got extensive experiences in economics and lobbying and DC, etcetera. So feel free to wave your hand, and I'll bring you on stage. And that brings me to my next question. Do you see any kind of integration between the DSI movement and health care where DAs could be help fund slash manufacturer, cheaper medicine, more available, etcetera.
Speaker 5 Absolutely. So, that,
Speaker 4 I think, is a perfect example of a
Speaker 5 DAO when you look at, the
Speaker 4 in terms of implementing clinical
Speaker 5 trials, at different phases within the process where
Speaker 4 a a DAO could be used to help
Speaker 5 to manage those processes somewhat better. And I know for a fact that many of the large pharmaceutical manufacturers, specifically in The US, are looking at this type of structure to, implement not only clinical trials, but administration through, a PBM structure
Speaker 5 what's the best word I can use here?
Speaker 5 I think, is the operative word here, in terms of how a DAO could be used within the PBM space, plus, obviously What does what does p? What
Speaker 5 mean? Professional benefit
Speaker 5 pharmacy benefit manager. Excuse me.
Speaker 2 Are there any scaling benefits to doing health care on on chain versus off chain?
Speaker 5 That is a question, frankly, that is that I am not able to answer because there's really limited data. Oh, okay. When when when I when I think of both on chain versus off chain, meaning, a public blockchain, I'll call that on chain. Off chain would be, in my view, a private blockchain. Private
Speaker 4 blockchains would have their obvious benefit
Speaker 5 within the health care
Speaker 4 space, specifically to deal with any
Speaker 5 privacy issues. Sensitive clinical data, as an example, to allay any fears in terms of having that data not, get out of, what I would call a closed loop system, that would be off chain, that would truly be permission based and not be able to be seen on any, public ledger.
Speaker 2 Okay. So would something like, the chain of custody and the pharmaceuticals, would that be something that would fall under that off chain privatized blockchain?
Speaker 5 Good question. I I think something like that would would lend itself to on chain, meaning you want verification through
Speaker 4 multiple sources on a distributed
Speaker 5 ledger about where these drugs or components of drugs, where they're coming from. So absolutely. In fact, I there there are numerous pharmacy manufacturers that are using the blockchain for that very purpose. I
Speaker 4 know for a fact Pfizer is. Really? Yes. That kinda took me by surprise.
Speaker 5 For the very reason that, your colleague mentioned that, you know, they wanna know where and they want verification, you know, where are the components coming from, and can they be verified? Certainly, any any manufacturing process, you know, having a verified distributed ledger, provides benefit. I mean, the shipping industry is,
Speaker 5 probably one of the best examples where, IBM has developed, in essence, chain of custody
Speaker 4 Yeah. We've seen that, in what? I I believe olive oil, certain different types of wine companies are now adopting different NFT labels or whatever you want to call it. Yeah. Diamond Mandarin. Yeah. I've seen that. Right. So that's that's pretty interesting that it's moving in that
Speaker 5 direction. I I I think that's a perfect immediate application that, you know, that current legacy systems can't handle that a blockchain can. So
Speaker 4 What are your views on proof of stake versus proof of work? This is a big topic right now, by the way, because the flipping is coming.
Speaker 5 You know, full disclosure, I I own Bitcoin. I own Ethereum. Both have their benefits. But from my perspective, in terms of scalability of the type of applications that could be used in a, health IT infrastructure
Speaker 5 from a scaling solution. And I think all the published academic based literature, I think,
Speaker 5 prove that out. Now, you know, once we get there, we shall see. That, I think, is probably one of the biggest challenges. You know? How do you scale a system that, you know, most health large health IT systems, you know, they're processing, you know, hundreds of millions of transactions in a day, millions in some cases and
Speaker 5 So as an example, you know, you've got sixty percent of the population in The US that get their health care either from Medicaid or Medicare. So there are very large health IT systems that I'm fairly familiar with with both those programs that you've got literally hundreds of millions of transactions, pieces of data that are flowing. One dataset, it's a health claims dataset that I'm currently working on doing different predictive analytics with those datasets. I've got over 2,000,000,000 data points that I'm using. So the question becomes, you know, can a blockchain at scale be able to process and automate a sophisticated algorithm that my colleagues and I have built to place that on a blockchain. I'm skeptical right now, but I think eventually that is an application. And one of my published pieces of work really speak to that issue in terms of scalability. It's possible, but we're not there yet.
Speaker 4 Great answer, Dave. Great answer, doc. We got two speakers coming. Let's go, b broad first.
Speaker 3 muted. Hey. Sorry. I lost, audio. Let me see if I can figure this out. I'll be back.
Speaker 4 Okay. Alright. That's a cool name.
Speaker 0 Welcome. Hey, guys. Can you hear me? Yeah. We
Speaker 0 Oh, hi. I joined slightly late. I'm a fairly inactive EBM holder. Nice to meet you all. I just by my background, I'm a doctor from The United Kingdom practicing medicine, but also involved in various kind of public health COVID related IT projects, you know, for 50,000,000 plus people. And so I'm super interested in this space, and it's great that you put this talk on. Thanks for organizing it. I you kind of moved on since I've raised my virtual hand, but I I think what I was gonna sort of muse on was the potential for zero knowledge proofs and l twos, like what Polygon are doing with with Nightfall, etcetera, to solve some of the problems that hashtag fuzz master was was alluding to.
And I just wondered what you thought about, you know, the potential in the in the far future for us to be able to actually put, you know, fairly privileged information on l twos off the main chain and be able to, you know, verify stuff secretly and therefore be able to, you know, do all kinds of cool cool stuff without breaking privacy in the public sphere, but while allowing the blockchain to compute over sensitive information. Because that seems to me like, you know, where the future needs to go. If they're
Speaker 5 on. Yeah. No. I couldn't agree with you more, but, you know, we're not there yet. So I'm familiar with your health system. Obviously, not as familiar with as as with The US system, but my my caution, in terms of getting to the state of nirvana that you outlined, and I think it's possible, is that these processes must be done incrementally. They have to be done on a trial basis to deal with the many regulatory constraints that I've generally outlined here and to make regulators and
Speaker 4 participants within these systems
Speaker 5 comfortable. So this is going to have to be done on an incremental basis. So many of the projects that I'm currently involved in, specifically with health data, analyzing health data, the clients that we have worked with in the past, they always want to test and verify. There's I and I I'm speaking from experience that that is the only way we'll get to this state of of of, I would call, perfection that you've outlined
Speaker 5 of being able to share data, access data in usable, real time, use, over time by using the blockchain and, in essence, ditching legacy health IT systems. So we're not there yet. And I think, again, to reiterate, this is going to have to be an incremental process.
Speaker 4 Thanks. Thank you. What do you see as the timeline, Dave?
Speaker 5 Based upon what I'm seeing with the projects I'm involved in, honestly, we're five, ten years away from what I would call scalable blockchain solutions being used within these legacy systems.
Speaker 4 I'll I'll give you a a prime example
Speaker 5 of something that I'm working on right now, and it's an obscure part of both Medicare and Medicaid. It's called nonemergency medical transport. I I published an article in one of the journals I regularly write for and I'm an editor of about this issue of it's commonly referred to as NEMT, that the implementation of it currently in a lot of states, specifically with state Medicaid systems, it's done with maps with pins. So that is the impediment you're facing. You've got these archaic, horribly inefficient systems that are currently being used where you have siloed data processes that are not interoperable that would be very reluctant to make the leap to the next technology advancement
Speaker 5 their efficiency. And, most importantly, from my perspective, interoperability. So it will take time. It will take pilot projects. It will take a lot more data analytics to understand, how these systems could work together on a distributed ledger. And, frankly, that's some of the work that I'm currently engaged in now with both public and private health systems.
Speaker 4 So by siloed data, you mean stuff that's kept on a private server?
Speaker 5 Not only that, but, as an example, with Medicaid, there are literally, in a lot of states, twenty, thirty, 40 different
Speaker 4 independent systems that
Speaker 5 process claims that monitor utilization. And, frankly, a lot of times, they don't talk to one another. And as a result of that lack of interoperability, it presents a ripe environment for
Speaker 4 fraud, waste, and abuse,
Speaker 5 that frankly goes undetected until some whistleblower calls, some hotline and turns in their former employer. That's something I'm currently working on right now that I've published about about the use of predictive modeling, predictive analytics to root out fraud, waste, and abuse within any with any
Speaker 5 And that, in my opinion, that is a processee that could be placed in the blockchain that could be done in real time if these systems were able to talk talk to each other. And that's the beauty of a distributed letter, ledger in terms of having permission based, access to data to run, predictive models as an example.
Speaker 2 circle back oh, I'm sorry. Just to circle back to your maps and pins analogy. So I assume there's just loads of undigitized data as well that has just not been introduced into the the twenty first century, it sounds like.
Speaker 5 It it varies by state. Some states are a lot more sophisticated than others. Medicare, given the fact that it's principally it's administered by a central authority in Washington, Centers for Medicare and Medicaid Services.
Speaker 5 And with fiscal intermediaries within different regions of the country. So there's a lot more control per se versus you've got 50 state Medicaid systems each with their own, IT infrastructure, each with their own very specific processes that deal with claims and benefit administration that are very, diverse and desperate,
Speaker 4 in terms of their implementation. Awesome. We got Ben Meadows up here. What's up, Ben? Hey, Ben. Hey,
Ben guys. So I am driving, so apologies. You know, a little
Ben Just joined it. Had a couple interesting thoughts. So on the five to ten year timeline, it's kinda interesting. I was chatting, with a group out west about that the other day, and I said five years. And and literally, a former rocket scientist at NASA corrected me. She said she said, five years is for us. You know? It's it's for the early adopters to start using blockchain technology in a limited capacity, you know, that has real world use cases and that has some visibility. It's ten years easy before a 65 year old doctor or my parents or grandparents are using it. So I thought that was interesting. I think we're all so early on. Sometimes, our time frames are probably a little bit more compressed than it'll really end up being. So just something interesting. On the idea of blockchain, so I had this discussion.
I'd love to hear your thoughts, doctor Dave, on, we were talking about medical data. I was talking to some of the, Deloitte Blockchain division about this, and they they had this idea that, you know, medical data, you know, they were worried about it from a dystopian standpoint that essentially sold Bound NFTs or tokens would be one of the first use cases for soul bound tokens was medical data that it would be locked to you. And, you know, on one hand, that's great. It would be locked down to a single identity. On the other hand, there's a lot of potential for misuse there. And I've got another thought, but I what what do you think about that in terms of the potential for misuse, you know, for some of
Speaker 5 this? You you hit the nail on the head both in terms of your assessment of the implementation timeline that I'm seeing firsthand based upon my experience with these legacy systems, but also the great reluctance to, for these administrators of these systems to jump into something that's brand brand new. And and with that, I will give you an analogy based upon my experience in government that I think still holds true today, unfortunately, that no one ever got fired by hiring IBM. Meaning, given how state contract procurement works, these large legacy vendors have very distinct advantages in terms of how, these contracts are let, how they're administered, and that in many cases, innovation lags because of these archaic laws. I've seen that firsthand, and I think your ten year assessment that you, I think, very correctly identified is correct. It's it's going to take time.
It it it will need to be incremental, meaning you're gonna have to pick out different processes that really aren't working and experiment and and validate the use of the technology first
Ben So you mentioned nobody ever got fired for choosing IBM. And it's funny. I was talking to an IBM product manager about this, a senior one. She's getting ready to retire. I was up in New York last month, and and we were sitting down having lunch. And she was one of the early, you know, middle managers at IBM that they asked to investigate the blockchain. And I brought this up, this idea of medical data and the reluctance of some people, you know, to understand how it could be chat about this. And her response was
Speaker 4 Would you mind repeating the last thirty or fifteen seconds?
Speaker 2 You're cutting out just a little bit, man. Just the last half of your
Ben question. About that. Is that is that better now?
Ben Okay. Sorry. Must have been driving through a bad spot. So this IBM product manager, we were chatting about blockchain. She was one of the early people that IBM asked to investigate blockchain technology five, ten years ago. And we I brought up this idea of medical, data and the blockchain to her and talked about, you know, some of these guys at Deloitte and their concerns about it. And her response was, oh, yeah. IBM's already on this. We're gonna sell it as a private blockchain. We're gonna sell it as higher security, you know, than a public distributed ledger. We're gonna we're gonna sell it as a centralized ledger, you know, maybe that's running on 24 bit encryption instead of one twenty eight or two fifty six. And we've already got our plans in place to push this product down the road.
And, you know, of course, I asked, you know, what advantages they have, and, you know, their argument was they're IBM. Of course, you know, government and health care providers would buy this. So I I think you hit the nail on the head, doc, with the nobody ever got fired for IBM. What what do you think about that? I mean, on one hand, I'm like, no. That's never gonna work. You know? How are you gonna get interoperability? Linux is on most servers. You know? And at the same time, almost everybody from a user facing standpoint, they're all using Windows. They got no problem going with something proprietary in a big old school brand. So what's your thoughts on that?
Speaker 5 I I could give chapter and verse about my direct experiences dealing with IBM executives over time, and I'll leave that for a private conversation. The next podcast. They they they you you absolutely nailed it. They have very distinct advantages. However, they also have some disadvantages in my opinion. That, as an example, within state Medicaid systems, they have what I would term to be a negative reputation of overpromising and underdelivering. So there is, I think, an appetite both at the federal and state level to look at innovation outside of these large consultancies and large, entrenched IT service providers like IBM. Yes. They're all, of course, gravitating towards it. I've met a lot of the folks over the last few years that are associated with those companies, but in my opinion, they're sort of behind the curve in terms of innovation from what I have directly seen.
They they they will get market share, obviously, because of their size, scope, and their natural advantages within the government space, or for that matter, even with private insurers that they currently
Speaker 5 But I think there's going to be, a lot of companies that are currently innovating that will give them a run for their money. So they will absolutely, in my opinion, rely on their legacy product lines and tweak them to, include some form of the blockchain. But the final thought that I'll give on them is that that doesn't deal with the core issues that are associated with these legacy IT systems. That, in my opinion, blockchain specific companies can solve.
Speaker 4 Those were some really good questions, Ben. Thank you.
Speaker 4 Do you have anything more to ask?
Ben Yes. No. No. That was that was all I thought on the on the ten minutes I've been listening, but, thanks for thanks for letting me ask.
Speaker 4 Oh, no. We appreciate you tuning in, man. Absolutely. Alright. Who's who's next? Anybody got questions for doctor Dave?
Speaker 2 Yeah. Did you wanna come back up, b broad?
Speaker 4 Oh, there he is. Got him.
Speaker 2 He must still be having Audio issues. Audio issue.
Speaker 0 No worries. I've I've got another one if if that's okay. Yeah. Absolutely, dude. I was just gonna say so, I mean, one of the challenges and I think barriers in The UK for us is that you have all of these legacy IT companies that you were talking about and the sort of incentives for them to move to a sort of a more open, trusted interoperability layer, which is, I guess, kind of the way that we would use the blockchain for a lot of the challenges that we want to solve, the incentives aren't there. So what you end up hitting is a lot of barriers and a lot of poo pooing of the blockchain in general. And I just wondered if that's the kind of thing that you experience in The U. S. As well, where you have these large companies who own or manage a vast amount of U.
S. Health care data, who just don't want to give that data up and don't want to put it in a space where where it can be shared and used because it threatens their own competitiveness going forward.
Speaker 5 Absolutely. I'll give you a very specific example in terms of a multibillion dollar failure. I think any rational person would call it a failure in terms of what happened at the Veterans Administration with their EHR rollout
Speaker 5 vendors that I won't name, in terms of their documented failures, of of interoperability that, frankly, the client desperately needed. And, you know, they they, frankly, were an impediment because of their architecture and how they went about their centralization of EHR data that, frankly, made it
Speaker 4 interoperable. Excuse me.
Speaker 5 And I think, you know, there are a lot of other examples just like that with these large IT vendors like IBM, that, you know, they wanna maintain control to preserve their business interests,
Speaker 5 product lines. And given their, I would call, stranglehold on the procurement process, specifically
Speaker 5 federal and state government, they are an impediment. But, you know, I think in terms of how do you get around that impediment is, by having individuals, companies test and pilot some of these ideas. I know that's probably a lot harder in The UK given the centralized nature of the, National Health Service. But in The US, you've got a number of states that are starting to experiment within their state
Speaker 5 looking at different blockchain applications with different processes within state Medicaid and to look at different benefit programs to implement the type of interoperability that I think is sadly needed.
Speaker 4 Did that answer your question, Kutta?
Speaker 0 Yeah. Yeah, I think it did. Actually, just to say, we have sort of the worst of both worlds in The UK because although we have a centralized health care system, our health care technology is actually kind of federated over geographical reasons. So you have this messy, complex system where you have a never ending array of different vendors and different solutions doing different things, trying to talk to a relatively small population when you compare us to The U. K. But yes, agree agree with with what you're saying. It's gonna be interesting, isn't it, that that change is gonna have to be driven from the kind of ground up and and is really kind of the real benefits to the to the patients and to individuals and and and the companies will just have to get used to it. You can imagine that taking quite a while to
Speaker 5 Yeah. And and again, you know, I I can't stress this enough in terms of what I've seen and how these processes within
Speaker 4 government specifically
Speaker 5 operate and function. This is going to have to be, an incremental, arguably slower process than anybody would like, that you're gonna have to, in essence, pick it apart one processee, one program at a time in terms of implementing the benefits of a distributed ledger programmable technology
Speaker 5 to show that it does work, that it's better than what's out there. And, frankly, it's gonna have to be very well documented as well in terms of how, these processes will drive efficiencies for the benefit of of the,
Speaker 4 end user. Coup d'etat, as a doctor, not like doctor Dave, but like an actual physical doctor, do you see health care on the blockchain potentially being a solution to all these problems?
Speaker 0 I mean, I come from a very different perspective, because as Doctor. Davis pointed out, we you know, our socialized health care system has very, very different challenges. But in in short, I mean, absolutely, yes, for all kinds of for all kinds of reasons. I've worked on so I about half my work is clinical. The other half of my work is really in the digital realm. So I've worked on Bluetooth based contact tracing applications with Google and Apple. I've worked on what we call in Europe COVID status certification, COVID passports using vaccination data, recovery data, and a variety of other systems which basically involve messaging layers between different parts of health care systems, which, you know, might be some distance apart. And, I mean, I think on everything from from clinical trials to people being able to get a accurate copy of their health care record and take it with them to being able to conduct massive and fair data analytics inquiries using using the blockchain.
There are just use cases falling out all over the place, and it's it's an exciting space to be in, especially as we see as I was referring to earlier, especially as we see stocks and snarks appear all over the place, and we have the tools to be able to kind of experiment this stuff with this stuff without being, you know, math PhDs. Because at the moment, it's really in that kind of experimental realm, isn't it? But once we've got the tools to to be able to imagine and to build products, I think there'll be a massive, you know, storm of innovation, which is doctor David said will take ages to kind of pick apart and work out, you know, really whether the right direction to go is and how we do this in a in a safe way.
Because the moment, you know, the moment that Kudithar's medical record leaks out onto the blockchain, it's, you know, it's game over for ten years. We'll have to we'll have to start again. So
Speaker 5 yeah. Right. Interesting. Per perfect perfect example of some of the pitfalls. But, again, I I think your examples that you gave are perfect in terms of looking at this from, an incremental, perspective. Meaning, you know, you've gotta look at processes that are frankly broken, that are screaming for some type of innovation or something new to make them more efficient and more user friendly. You know, there are countless examples, here in The US with
Speaker 5 private. And some of my published work, really, I I try to outline different use cases within some of these systems as to how, a distributed ledger could improve efficiency.
Speaker 0 Yeah. I'll be sure to to to give some of that. Really, I I jumped into this. I'd only figured out that you were doing this right right at the last minute, but I'll I'll be definitely doing some some investigating, and
Speaker 4 it'd be good to catch up offline as it were
Speaker 0 about some of that stuff. One of the things that that I thought maybe blockchain was really actually gonna be useful was was the process of COVID nineteen vaccinations. And I think there were actually some some some real products that were made that were kind of blockchain tailored. I remember vaguely that some guys tried to build a kind of COVID nineteen vaccination system using IOTA and the Tangle. But I in the end, I don't I'm not sure that any of that stuff really took off. You would probably know better than I with doctor Dave. In Europe, we have this massive federated system where if you want to go from France to England and you want to prove that you've been vaccinated, then what happens at the moment is that the government signs a message and gives you a QR code that enables you to travel.
And it's it's obvious how you could actually blockchainify some of that stuff and get rid of all of that that that centralness and and and do this in a kind of peer to peer way. Yeah.
Speaker 2 It sounds like they could also oh, I'm sorry. I was gonna say, it sounds like they could also fraud proof a lot of those systems as well with blockchain.
Speaker 5 Yes. Absolutely. So, I'll I'll also note, and if Fuzzmaster Phil could do this, I I I I'll I'll
Speaker 5 me. I will go ahead and send him links on Google Scholar, a number of the publications I've just referenced.
Speaker 4 Great conversation so far, fellas. Are you is everybody enjoying it? Well, I can't really tell. But
Speaker 4 Yeah. B broad. You ready?
Speaker 3 Third time's the charm?
Speaker 4 Third time's the charm. Good.
Speaker 3 Great. Doctor Dave, thanks for doing this. Very interesting. I joined a little bit late, but I have heard a cup you and a couple of other folks touch on clinical trials. I don't know if you've seen Vibe Bio that was, announced a few weeks back, and it looks like they're making a play at clinical trials. But I'm curious to you, you know, or some iterations, what does a decentralized clinical trial look like, in five, ten years?
Speaker 5 Good question. That is Somewhat out of my lane, in terms of, what I've looked at with a distributed lever ledger application, but I'll I'll give you my best thought. I think that from an administrative standpoint, having a DAO be the hub, so to speak, of administration of a of a clinical trial to have, in essence, verifiable proof of the trial, that would be, I think, a a absolutely
Speaker 5 application of a DAO on a blockchain. And then what we had discussed earlier, same being the case with manufacturing processes within the pharmaceutical industry. So as with any of this that we've discussed, this
Speaker 5 going to have to be done on a small scale to begin with before you start looking at large scale trials or for that matter processes like the development of COVID nineteen vaccines. So I guess this dovetails to our earlier discussion that, again, incrementalism is the
Speaker 5 of the day in terms of how blockchain can be utilized to deal with many of the administrative
Speaker 4 inefficiencies within
Speaker 4 Yeah. That friction is absolutely absurd, and I I I truly believe that with
Speaker 3 it all the time right now. Yeah.
Speaker 4 Yeah, dude. It sucks. And thank god there's people like doctor Dave that are out there on the front lines trying to get this stuff done for us. Because I'll tell you what.
Speaker 3 And that that makes sense to approach it iteratively via administrative stuff first. Because that's the most human of all the elements, I think. Right? And so to get us out of the way.
Speaker 4 you. Yeah. No. Thank you for coming up on stage. We'll give you a a
Speaker 0 I can kinda give you an imaginative example of a a a clinical trial stuff because it it has come up in The UK and a couple of things. So right at the beginning of COVID, a few guys decided, and this is one of the advantages of having a centralized health care system, that they would do a massive trial to work out what the benefits of various standard over the counter drugs would be for COVID. And they enrolled it's not like the kind of clinical trials that some of us might imagine with a pharma company that wants to try one drug and see what it is like compared to a placebo. This was like a dynamic thing with hundreds of hospitals involved, giving them all kinds of different medications that we knew, you know, could modify the immune system in a certain way.
And it's one of the reasons that we now know that prednisolone, standard over the counter steroid, can be used to make COVID less severe in a certain cohort of patients. But when you're dealing with a population that is that vast and that dynamic, and you've got all these different health care systems, you need a place that you can store that data and verify that all of that data is correct and follow that proof right from enrollment all the way to the end of the trial. And so I can see easily why a system built, you know, over a blockchain would would be able to offer really, you know, profound advantages over the status quo, which is probably a few Excel spreadsheets coupled together, you know, in the mad rush.
Speaker 4 Yeah. I I I agree. Yeah. Yep. Well, guys, we're coming up on an hour and ten minutes. Is there anybody else in the audience that has any questions? I'm gonna take that as a no. Would you guys like to have doctor Dave on again? Drop a drop a post in the the EVM podcast thread because there's still more stuff we could talk to him about. Like I said, we haven't even finished the show notes, but I I'm trying to keep these things to about an hour, hour and a half the most. So we could have a two part if y'all want. Just Yeah.
Speaker 4 Incremental. The word of the day. That's right. Alright. Well, this is hashtag Fuzzmaster Phil, and I am, gonna go ahead and end this right now.
Speaker 2 Yeah. Thanks to everybody for coming up on stage. Yeah. Ben, for sure. Thank you.
Speaker 4 Yeah. And and thank you very much for coming up stage and actually answering some really good questions. I think this was a very solid conversation, and we can move forward with this too if you guys would like to see doctor Dave again.
Speaker 5 Okay. Happy to do it.
Speaker 4 Alright. Make sure you guys like and tweet and blah blah blah blah blah. I'm not gonna tell you to smash the subscribe button or anything like that because we don't even have a YouTube. But, yeah, again, thanks guys for coming. Thank you, doctor Dave. Thank you for Kuta Ta, b Broad. Obviously, Otto, thank you. And we'll see you guys. For sure. This
Speaker 4 Yeah. It was great, man. We'll see you guys on the next the next pod. I'll get this stuff uploaded, and we'll go from there. Oh, thanks, Ben, to
Speaker 2 Maybe maybe we'll see you sorry. Go
Speaker 4 ahead. Oh, I was gonna say thanks, Ben, for your very insightful questions. I mean, those were high high caliber. Yeah.
Speaker 2 And while driving. We appreciate the
Speaker 4 commitment. Driving. Alright, gentlemen. Ladies, everybody, you have a great day, and keep an eye on that EVM podcast thread because we'll have another one coming up soon. Right? Thank you. Thanks, guys. Mhmm. Bye.