1. Introduction to Blockchain
Tony Trenkle, CHIO
IBM Global Healthcare and Life Sciences
May, 25, 2017

2. Blockchain is not the thing. It’s the thing that enables the thing.
Mark Buitenhek Global Head of Transactions Services ING

3. Shared ledger between a set of entities that faithfully records a series of transactions Combined with… A smart contract platform for embedding scripts that run across the network and can add new entries to that ledger.

4. Inefficient, expensive, vulnerable
Problem - Difficult to monitor asset ownership and transfers in a trusted business network
Ledger
Incident
Ledger
Party A’s Records
Ledger
Counter-party Bank records
records API-integrations
Party C’s Records Auditor records
Ledger
Party B Records
Ledger
Ledger
© 2016 IBM Corporation 15
© 2016 IBM Corporation 15
Inefficient, expensive, vulnerable

5. Solution – shared, replicated, permissioned ledger
Party A’s Records
Counter-party Bank records
Ledger
Ledger
Ledger
records Ledger
Ledger
Party C’s Records Auditor records
Ledger
Ledger
Ledger
Ledger
Party B’s Records
Ledger
Participants have multiple shared ledgers
NOTE : Participants same as before
© 2016 IBM Corporation 15
© 2016 IBM Corporation 15
Consensus, provenance, immutability, finality

6. Bring Technology and New Business Models & Processes Together
Blockchain can be the center of technology that drives Value, Efficiency and Trust in business transformations
HCLS Pain Points
Technology Enablers
Transformations in every part of business
Interoperability, accessibility, and data integrity
Privacy and Security
Healthcare delivery models and cost
Fraud and abuse
Process complexity
Customer engagement
Procurement and contracting
Regulation
Revenue leakage
Improving operations & lowering costs
Creating new products & business models
Driving engagement & customer experience
Bring Technology and New Business Models & Processes Together
Measure the Outcomes
Develop Business & Digital Strategy
© 2017 IBM Corporation

7. Blockchain is NOT Suited for high-performance (milestone) transactions
Suited for low-value, high-volume transactions
For use cases involving only one participant
A replicated database replacement
A messaging solution
A transaction processing replacement

9. Blockchain for Business
Shared Ledger
Append-only distributed system of record shared across business network
Smart Contract
Business terms embedded in transaction database & executed with transactions
Privacy
Ensuring appropriate visibility; transactions are secure, authenticated & verifiable
Consensus
All parties agree to network verified transaction
IBM has an easy to access, proven and incremental engagement model giving customers the confidence to get started NOW
Shared Ledger:
Shared ledger – single source of truth
Digital assets – record depository
Smart Contract:
Smart contracts – business logic
Privacy:
Secure – tamper proof (extra security)
Audit-able – prove identity & ownership
Confidential – permission control
Consensus:
Permissioned – participants identity
Consensus – modular protocol
Blockchain
Benefits:
Saves Time
Business transactions
automated and conducted in near real-time
Removes Cost
Business networks can eliminate intermediaries and scale easily
Reduces Risk
Business transactions become verifiable and auditable
Increases Trust
Through shared processes and recordkeeping
© IBM 2016 9

11. Top Friction Areas
Top frictions that Trailblazers expect to reduce using blockchains
Source: IBM Institute for Business Value Analysis ; EIU survey healthcare executives - 63% providers 37% payers, 16 countries

16. Potential Linkage of Blockchain/EHR
Drew Ivan ONC /Nist Blockchain Challenge August 2016
Potential Linkage of Blockchain/EHR
Figure 4. Architecture and data flow for the EHR with built-in blockchain client (option 1).
1.Upon completing an encounter, the EHR saves data locally, prepares a C-CDA version of the encounter data, and transfers it to the built-in blockchain client.
2.The built-in blockchain client encrypts the document using the patient’s public key and connects to the blockchain to transmit the document.
3.The C-CDA document, along with metadata about the document’s source and subject, is committed as a transaction to the blockchain. The nodes of the blockchain network use a consensus algorithm to determine the transaction’s validity, and when a quorum of nodes agrees to the change, it is permanently committed to the public ledger.
4.The blockchain stores all documents for all patients.
5.The PHR client is able to connect to the blockchain and download all documents for the patient. The documents are decrypted using the patient’s private key.
6.The patient is able to view the documents and share them with other providers.

21. Rethinking Clinical Trials Management
Sponsor (Pharma/CRO)
Regulator
Protocol
C RF DCF (Data
clarification Form)
Site’s Case Report Form (CRF paper)
Regulator
üAuditability and use for fraud detection
üStandardize electronic Case Report Forms creation
üProvenance of patient data through the chain of exchange, transformation and results üeCRF data can be checked in blockchain by any authorized participants Site or Pharma or FDA üUn- alterable record of protocols, eCRFs and protocol amendments
üTraceability of protocol design elements to data collection
© IBM Corporation
© IBM Corporation
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25. Discussion Questions
What do you see as the major policy inhibitors to beginning to implement Blockchain in your or any healthcare organization?
One of the major building blocks for Blockchain is the creation of an ecosystem like we have done with other major technology/business advances.
How best drive the growth of a healthcare blockchain ecosystem. What role should the government play? Do we need additional regulations, standards, or legislation?
What role can HIMSS play?
What do you see as the major friction points that can potentially be helped by Blockchain?

26. Contact Information
Tony Trenkle, CHIO IBM Global Healthcare and Life Sciences