In the early stages of COVID-19, rapid responses in targeted locations were appropriate. However, global systemic crisis considerations grew exponentially in tandem with the virus itself. Despite some jurisdictions starting to emerge from the pandemic, daily case numbers remain worryingly steep.  Information-sharing across institutions and cross-border therefore remain critically important—particularly as most nations are allied in the need to respond to the pandemic collectively to make any long-lasting impact at all.  

Against this backdrop, the World Health Organisation (WHO), IBM, Oracle, China National Health Commission, Johns Hopkins University and others are creating the ‘MiPasa’ platform. This ‘COVID-19 information highway’ will be an enterprise consortium-based platform with analytical tools, built on Hyperledger Fabric.

But even before MiPasa’s creation, Github, reviewing the main areas of activity for health-related blockchain projects in 2017, reported significant activity across healthcare data infrastructure, electronic and patient health records, and healthcare analytics, medical device and IoT security, identity, supply chain, and digital medicine and care delivery.

Whilst further details emerge, this post outlines: 

  1. Key areas in which blockchain can assist pandemic preparedness and response.
  2. Success factors for implementation.

Part 1 – Pandemic preparedness and response

A. Supply chain integrity and provenance

Provenance—the tracking of assets across a supply chain—has emerged as an early application for blockchain in healthcare. [1] An instructive example is the global shortage of personal protective equipment (PPE). This has been one of the biggest challenges globally to date, particularly for frontline healthcare workers. Issues arise in five key areas:

  • Supply and production.
  • (Re)distribution.
  • Quality and genuineness. 
  • Effectiveness. 
  • Scale and speed.

Similar issues also arise with respect to ventilators and other medical supplies.

So how can blockchain assuage these difficulties?

Fundamentally, blockchain involves distributed and immutable data. Data access can be permissioned and tailored where needed, or made publicly available where that is appropriate. This works to make the supply and transaction flows of medical supplies or finance immune to data manipulation, and allows transparency throughout the process. [2]

Case studies are already emerging. By way of example, Alipay, along with the Zhejiang Provincial Health Commission and the province’s Economy and Information Technology Department, has launched a blockchain-based platform that enables users to trace the demand and the supply chains of medical supplies - including PPE.

B. Outbreak tracking

Numerous governments, private enterprises and individuals are sharing COVID-19-related data.  The WHO itself, as well as other data aggregators, are bringing together facts and patterns.

With so many contributors and rapid changes, the timeliness, quality, trustworthiness, auditability and accessibility of that data matters. Blockchain has the potential to assist with a number of these issues, but has a particular advantage when it comes to building an overall picture and tracking changes, trends and even anomalies over time. At a more granular level, patient data management systems can also employ blockchain. 

C. Patient management, service delivery and information

The longitudinal management of patient information, and access to patient information, within a health system, is an ongoing challenge.  In the literature, patient data management systems, including data infrastructure, patient records and analytics, emerge as a critical component of effective patient care. In a patient-centered care model, use of blockchain can grant patients easier access to—and control over—their own medical data. [3] Blockchain-based approaches may have a unique ability to bring cohesion to an otherwise disparate and overly complicated system of delivering data across the healthcare spectrum. [4] 

The opportunity to identify at-risk persons, including via data ‘look-backs’ and big data analytics, is also a feature of good patient data management systems. For example, patients reporting certain symptoms that are only later identified as being pandemic-related, can be contacted for further testing. Importantly, blockchain can enable this to occur without breaching privacy restrictions.

D. Clinical trials and surveillance

For both surveillance and clinical research, blockchain presents an opportunity for clinical research: it may help in structuring more transparent, checkable methodology and help promote clinical trial integrity. [5]   

E. Other key applications and adjacent technologies

A number of other opportunities arise to deploy blockchain technology when preparing and responding to a pandemic. These include payments, donations and insurance.

Blockchain also has a number of adjacent and/or complementary technologies that can assist with pandemic preparedness and response. These include smart contracts, AI / machine learning and cloud solutions. 

Part 2 – Success factors

Critical to the success of any blockchain technology deployment is ensuring the following (overlapping) factors are addressed.

  • Relevance. Blockchain and smart contracts are not the panacea for all pandemic solutions. Certain systems are deservedly centralised.  
  • Fitness for purpose. Any blockchain solution must be developed having close regard to a problem statement and be appropriate to address that problem and its targeted deployment reach. This extends to both its overall framework, as well as to the design of the actual technical infrastructure.  Selections as to private vs public read/write access, as well as additional functionalities such as smart contracts, must be carefully considered.
  • Data protection compliance. Medical data is especially sensitive and can be subject to heightened restrictions relating to collection, use, storage and transmission. Many jurisdictions have offshore transfer restrictions, and some have data localisation requirements, each of which poses hurdles to an unrestricted cross-border flow of data. This issue is probably the most challenging for pandemic responses, but is not insurmountable. In particular, sophisticated permissioning, encryption and data minimization are all hallmarks (and arguably key differentiators) of blockchain technology.
  • Other legal compliance factors. Blockchain solutions need to comply with other legal obligations as they apply to participants and the underlying subject matter. Which particular laws apply will depend on the solution.  However, critically, blockchain can also enable compliance, acting as a regtech tool to deal with medical regulatory and supply chain transparency obligations.  
  • Implementation and scaling. Implementation will mean different things to different solutions, but it must be mapped. Blockchain solutions also typically need scale to achieve their purpose. This generally requires cooperation amongst large stakeholders. Statutory mandates and public / private funding also help.  

Concluding remarks

The COVID-19 pandemic has jolted blockchain from a fringe technology for health care, to the main event.  We have observed blockchain being deployed for supply chain integrity and provenance; outbreak tracking; patient management and service delivery; clinical trials and surveillance; and payments and insurance. 

As always, blockchain is only one of a suite of technologies that add value to pandemic preparedness and response; and it is not a panacea. Health care remains a highly regulated industry and data protection, regulation and compliance remain paramount especially in cross-border flows of data.  

Looking ahead, we see both significant opportunity and appetite to rethink traditional processes. Jurisdictions that are emerging from the COVID-19 crisis are especially well-placed to create strong solutions whilst expertise is fresh and needs remain live.  

As the President of the European Commission recently remarked, ‘we must not hold on to yesterday’s economy as we rebuild’. The same applies to our technology stack.

Dr Jane Thomason is the Chief Inspiration Officer at Fintech.TV. 

Urszula McCormack is Partner at King & Wood Mallesons.

* The authors wish to acknowledge the contributions of Jessica Schmider and Jack Nelson to this post.

 

[1] Kefa Rabah, 'Challenges & opportunities for blockchain powered healthcare systems: A review' [2017] 11(1) Mara Research Journal of Medicine and Health Sciences 45-52.

[2] Asma Khatoon, 'A blockchain-based smart contract system for healthcare management' [2020] 9(1) Electronics, 94

[3] Kefa Rabah, 'Challenges & opportunities for blockchain powered healthcare systems: A review' [2017] 11(1) Mara Research Journal of Medicine and Health Sciences 45-52.

[4] C Brodersen et al, 'Blockchain: Securing a New Health Interoperability Experience'  2016, Accenture LLP.

[5] Mehdi Benchoufi and Philippe Ravaud, 'Blockchain technology for improving clinical research quality' [2017] 18(1) Trials 1-5.