Novel Technologies and its effects in Healthcare Industry
However, I think the problem that we see in our limitation and response to covid is because of information asymmetry and lack of liquidity in transferring that data from one data silo to another. And blockchain can and should solve many of it. Unfortunately, I don't think it has the attention as AI or cyber security has in daily media. So, I hope that through interviews I will be able to increase the awareness of the use of distributed ledger technology to create an ecosystem that would be attacker resistant, censorship resistant, and collusion resistant through blockchain technologies.
All industries are unique and require cross-disciplinary advice. Moreover, the specialty of the healthcare industry is that it deals with sensitive information. The information is private and needs to be protected, which also means high quality and high fidelity. It's not only with the healthcare industry but also with the financial industry. It also has to be worked in a trusted environment where we can trust the information, and one needs to keep it secure. I think the difference between healthcare and any other industry vertical is that it's an unbalanced ecosystem.
In other words, there are healthcare winners, economic winners that are shareholders. They are making more and more money the more and more the world is getting sicker from covid or sicker period. Then there are other stakeholders who are big losers, primarily patients and professionals. The reason is the business model. It is exclusionary and extractive and has not been built in a decentralized, distributive way. Healthcare has become imbalanced, and that's why it is different from any other industry. Therefore, it is neither sustainable nor surprising that companies like Apple and Google are leaving healthcare. And it is just too difficult because, in their current economic and business model, they don't see it as an excellent way to make money.
Holocratizing of healthcare
The solutions have embraced the "holacratizing" of healthcare with Universal Health Income (UHI). Well, the concept, holacracy, is to work in a team, unlike hierarchy. In contrast, democracy is hierarchy unless it is direct democracy, like in ancient Greece. But democracy, in general, is a hierarchy. Holacracy, on the other hand, is multiple teams that work together, and it promotes synergy. So, it's more horizontal than vertical. And this allows not only agility but also the ability to exchange information quickly. Moreover, I believe that because healthcare has so many different stakeholders and because, as I mentioned earlier, we suffer from data silos and lack of data movement between the various actors. Holacratizing, it would make that transfer of information more seamless.
The idea of universal health income is a fancy way of saying that I would be paid for my healthy behaviors. Presently, I'm not getting paid for it. For example, I can give my genomic data to a company or give my wearable data to a company, and they would make money on it, and I won't. So, beyond it not being fair, it is also not sustainable. Because then why would I do it? What is my incentive to do it? So, both holacracy, which is more participatory, and the idea of being paid through my activities represent decentralized or distributed ways of availing wealth to large societies.
Blockchain can be termed as a “time-chain”
After consulting multiple private and public companies, startups, healthcare organizations, and the United Nations Center for Trade Facilitation and Electronic Business (UN/CEFACT), I realize the essential difference is their perspective of social organization. The United Nations or state governments versus individual consumers or startup and early growth companies are very different. The definition of quality and cost is very different with the need for change and the urgency for change. This causes the topics we discussed or the area of interest to be almost diametrically opposed. So, someplace like the UN will talk about data through the perspective of security, privacy, standardization, laws, and regulation as a government or a large community. Whereas a consumer or small startup community with a solution in mind, wants to talk about information as ownership. Not security or privacy of the data, but sovereignty or ownership of the data. How can I build an economic model that can incentivizes me to be part of the company? I think it may be two sides of the same coin, where it is essential to talk about privacy and security, which is what a large organization or government talks about. But it is also crucial to talk about ownership and financial and social inclusion, which is what startups are interested in.
What I'm trying to show them is that there is a new way to do business. People ask me, "Dr. Cahana, what is definition of blockchain?" So, my definition of blockchain is: a software solution that allows us to trade in different ways. So, I am not a fan of calling it blockchain because it speaks to how the data is saved in blocks and connected in a chain which makes it very secure. I like to think of it as a “time chain”. So, when you know something that you can go back to, it starts the first chain. You can read it and understand it. It is an excellent way to record everything. It not only creates trust but obviously, it is required to put the people in the middle to say that is auditable and true.
In essence, blockchain is a peer-to-peer network. In a way, it is a way to automate and improve or optimize the system. That's the top-down vision. But bottom-up vision gives more control, and there are fewer fees because you don't have to pay for that. That means you have more money in your pocket. For me, bitcoin is MOIP, money over internet protocol. It is programmable money that doesn't need all the fees you pay to the central bank when you want to remit or send money to your family in a different part of the country. And in healthcare, it is less about MOIP; it is about DOIP, data over internet protocol. So, that's the kind I look at this.
Approaches for health services
Many people think the future of healthcare in developing markets is about access and affordability; in developed markets, they talk more about longevity and technology. I think people should be interested in changing their role as producers, not consumers in healthcare. Presently, we are health service consumers. It means that consuming more tests, surgeries, and pills leads to more expense. This is not sustainable, even if it would make a lot of people happy. Therefore, we need to transform ourselves from being health consumers to health producers.
How do I produce health? So, one way of doing it is using Fitbit, using all kinds of data and translating that into actionable information. One way with blockchain also is that you can produce wealth. It's that if you tie those health behaviors to rewards, you can make money. And so, people would get paid for wearing masks and getting the vaccination; it would solve everything very quickly. Hence, the problem of the current approach is that we look at healthcare as something we're passive, hopeless, helpless, or sick, and we consume. And instead, we should look at health that's not something done in a hospital, which is treatment, but health is done in-home, that is active, positive and increases not only being well but also wealth. After the pandemic scene, people understand that healthcare is not working.