This article was published in the “Blue Book of Blockchain Applications: Research Report on the Development of Blockchain Applications in China (2019)”

Core points: The medical and health ecological field covers a wide range and is highly specialized. With the help of high technologies such as the Internet and artificial intelligence, smart medical care and telemedicine have achieved new development. However, chronic diseases in the medical and health field still exist, such as information islands, doctor-patient relationship, and difficulty in claim settlement.

As an underlying technology, blockchain technology focuses on the benign guidance and reshaping of the medical and health ecology. At present, the blockchain has begun beneficial attempts in various fields of the medical ecology. The medical industry is related to the national economy and people’s livelihood, and the top-level design and policy orientation of the government are very important.

The medical industry is related to life safety. Of course, its industry reform needs time to settle and baptize, and then the replacement of supporting industries. Medical informatization originated from the HIS system entering the hospital informatization management process, in order to change the manual billing mode, realize the informatization management within the department, and then establish an Internet-based information system to coordinate daily activities between departments. In order to strengthen epidemic management and improve emergency response capabilities, under the promotion of the government, a regional health information system and public health platform have been established to strengthen public health management.

In recent years, the scale of the medical informatization hardware market and software market have shown a steady growth rate. Under the situation of accelerated social aging and rapid development of new technologies, the market demand for medical informatization is also growing rapidly. Treatment from individuals to families Demands and health management needs, information sharing and balanced development from hospitals to regions, the satisfaction of these needs requires the application of new technologies.

In order to balance the distribution of medical resources and reduce medical costs, under the promotion of policies, Internet hospitals, medical consortiums and other organizations have gradually been promoted; at the same time, favorable policies and positive market responses have promoted enterprises in intelligent imaging, online diagnosis and treatment, and medical services. In the field of pharmaceutical e-commerce and other fields, the progress is relatively slow, and the coverage capacity is partial. In the future, the informatization development of the medical industry will focus on the medical service process, realize the intelligentization of medical services, and at the same time promote pharmacies, insurance institutions and other related The efficiency of the organization, the balance of regional medical resources, the breaking of the phenomenon of information islands within a controllable range, and the formation of an ecological chain of the medical industry based on Internet applications.

With the rise of information technologies such as the Internet, Internet of Things, big data, cloud computing, and artificial intelligence, the degree of integration with medical care has continued to deepen, boosting the development of smart medical care. Since 2009, a series of policies (as shown in Table 1) have been issued by the State Council, the former National Health and Family Planning Commission, the State Food and Drug Administration, and the Ministry of Industry and Information Technology to promote the healthy development of the medical industry. Rise to a national strategy.

In 2018, the General Office of the State Council issued the “Opinions on Promoting the Development of “Internet + Medical Health”, marking the beginning of the country’s explicit support for the development of “Internet + medical and health”. In the same year, the National Health and Health Commission issued the management measures for Internet hospitals, diagnosis and treatment, and telemedicine services, which is conducive to strengthening the access and supervision of new forms of Internet medical services and regulating the development of new forms of business.

Blockchain technology was born in 2009. With Bitcoin, it became known to the public. Blockchain is known as the next-generation Internet technology. As early as 2016, the State Council issued the “Thirteenth Five-Year Plan for National Informatization” for the first time. Set blockchain as a strategic development direction. The exploration and integration of blockchain technology and medical treatment is gradually deepening.

1. The current problems in the medical industry and the combination of blockchain and the medical industry

From the perspective of medical policy, in recent years, the government has continued to issue documents to support medical reform and the development of medical informatization, which has helped the informatization development of the medical industry. However, under the premise of a favorable environment, the development of informatization in the medical industry still has the following Problems to be solved urgently:

1. There is a lack of access standards for medical information products, and the regulatory system for information products is vague. After years of development and reform, some medical informatization products have developed to a mature stage. From the perspective of hospital internal management, informatization products such as HIS system, drug inventory and management, and infusion mechanism are relatively mature, and their operation modes are relatively simple. Can meet daily needs.

For products involving the core links of medical services, such as regional electronic medical record systems and auxiliary diagnosis systems, the development is still in its infancy. These products lack complete and rigorous access standards, and most intelligent auxiliary diagnosis systems have not yet been approved by the Food and Drug Administration. Direct obstacles to product market promotion. Especially the information products with artificial intelligence and blockchain as the core technology are more obvious. When the technology itself has not yet reached the mature stage, its application in the medical industry will be difficult, and it is naturally difficult to form a clear supervision. system.

2. The concepts of artificial intelligence, cloud computing, and smart medical care are hot, but the phenomenon of industry homogeneity is serious. Around 2016, Internet + medical enterprises gradually began to develop. In April 2018, the State Council issued the “Opinions on Promoting the Development of “Internet + Medical Health”. The document’s encouragement of Internet + medical care has promoted the promotion and pilot of smart medical care. The concept heats up quickly.

Judging from the current results, the homogenization of smart medical products in the market is serious. Online medical companies such as Chunyu Doctor, Ping An Good Doctor, and Good Doctor Online are mainly engaged in appointment registration and online consultation. AI medical imaging Enterprises such as Huiyi Huiying and Airdoc use artificial intelligence technology for image-assisted analysis and diagnosis. The diseases covered by them are mostly pulmonary nodules and sugar net screening. However, the research and development of AI medicine is still in the experimental stage. The process of intelligentization still needs longer time and tests.

3. Industry barriers are high, and the phenomenon of information islands between hospitals is serious. The medical industry has the additional attributes of high technology. Enterprises or organizations engaged in smart medical production and research and development need to have a basic understanding of the medical industry. The closer to the core medical service, the higher the requirements for practitioners’ ability and quality, which is also the development of the smart medical industry. One of the major reasons for the slowness.

In addition, medical data involves patient privacy and security. Hospitals have high confidentiality requirements for data content in order to comply with legal and ethical principles. Based on this, it is difficult to achieve data interconnection between hospitals, resulting in cumbersome medical procedures and repeated inspections for patients. At the same time, it is also difficult for enterprises to obtain clinical data from hospitals for experimentation and training. This is also the reason for the serious homogeneity of medical information products. It takes a lot of time and labor costs to cooperate and communicate between enterprises and hospitals. Most of the experimental data of enterprises come from a single hospital or a relatively market-oriented institution, covering a relatively large amount of data storage. high field.

In recent years, blockchain technology has received a lot of attention globally. Governments of various countries are actively making efforts in the field of blockchain in an attempt to seize the commanding heights of the next industrial innovation. my country encourages the exploration and study of the combination of blockchain technology and practical application scenarios to serve the real economy. Among them, medical + blockchain is one of the important application scenarios.

The medical and health ecology covers a wide range of fields, involving patients, doctors, hospitals, medical examination centers, pharmaceutical companies, insurance and the government, and the relationship between them is intricate. Starting from the core pain points, that is, around the medical needs of patients, the domestic medical and health system has three major links – providers of medical services, providers of medical products, and payers of medical services (medical security system). Among them, the providers of medical services mainly include various medical service institutions at all levels; the providers of medical products include pharmaceutical companies, medical device companies, etc.; Insurance business, etc.

Blockchain technology is the underlying technology with significant features such as decentralization, distributed accounting, and non-tampering. It may be combined with every link in the medical ecology and has a wide range of application scenarios. The main combination points are shown in Table 2. :

Internet medical care, including health education, medical information inquiry, electronic health records, disease risk assessment, online disease consultation, electronic prescription, remote consultation, and remote treatment and rehabilitation and other forms of health care using the Internet as a carrier and technical means Serve.

If it is said that Internet + medical treatment can allow patients and doctors to have contact with doctors across the limitations of space, it can improve the situation of insufficient medical care. Then blockchain + medical treatment can make the development of the medical and health ecology more benign, ease the relationship between doctors and patients, and maybe it will not bring short-term profits, but it will allow all parties in medical and health to return to their respective positions and reshape medical and health. Value Chain.

2. Medical blockchain market layout

According to statistics, as of July 2018, there were a total of 60 medical + blockchain related projects at home and abroad. Many countries are trying to start to apply blockchain technology to improve the problems in the medical field, and China is very active in the application practice of medical blockchain projects. Although enterprises are practitioners of medical blockchain projects, medical data is an important national resource, and medical informatization construction promotes the medical field. Therefore, the government also plays a pivotal role.

According to IBM, 56% of the world’s medical institutions will invest in blockchain technology by 2020. At present, many global Internet giants are following the trend and actively promoting the medical application of blockchain. Foreign technology giants such as Philips Medical, Gem Medical, Google and IBM are actively exploring the medical application of blockchain technology.

Many start-up companies are also actively deploying. For example, Chang Healthcare in the United States has launched the first enterprise-level medical blockchain solution for transparent claims settlement scenarios; SimplyVital Health in the United States has built a blockchain system that integrates with the existing health care system. Help patients coordinate the whole process of medical treatment and provide accurate data evidence; South Korea’s MediBloc has built a blockchain-based personal medical information platform to provide doctors and patients with new medical information management methods.

Other startups include Chronicled, which manages drug supply chains, Robomed Network, which creates smart contracts to reduce medical costs, PaTIentory, which launches medical smart contracts and token payments, PokitDok, which develops APIs in healthcare, and blockchain in partnership with US state governments. Hashed Healthcare, a medical pilot, and doc.ai, a digital health startup, to name a few.

In China, large Internet companies have layouts. Tencent proposed a “prescription chain” as early as 2018. This project is an attempt by Tencent and Liuzhou, Guangxi, to realize the first ‘out-of-hospital prescription circulation’ service in China based on WeChat registration, payment and other functions. Because the circulation of prescriptions involves multiple links such as health and family planning commissions, hospitals, and pharmaceutical companies, blockchain technology is used to ensure that prescriptions cannot be tampered with.

The medical consortium + blockchain pilot project between Ali Health and Changzhou is also attracting attention. In August 2017, Ali Health joined hands with Changzhou Medical Consortium to help the medical business data interconnection. It is reported that this technology was first used in Changzhou Wujin Hospital and Zhenglu Township Health Center have landed, and will be gradually extended to all tertiary hospitals and primary hospitals in Changzhou Tianning District Medical Association to form a rapid deployment information network. Domestic blockchain companies have also made efforts to deploy medical blockchain.

3. Medical + blockchain case

Tsinghua University, People’s Venture Capital, and Zhongguancun Blockchain Alliance have researched companies such as Tianhe Guoyun, Zhuhai Medical Alliance, Chongqing Medical Alliance Health, and Token Technology for medical blockchain projects. There are mainly the following exploration modes.

Case 1: Blockchain Electronic Medical Record

Medical Chain Alliance Information Technology Co., Ltd. (hereinafter referred to as “Medical Chain Alliance”) was established in 2015. It is one of the earliest groups in China dedicated to introducing blockchain technology into the medical service industry, solving development bottlenecks for the industry and realizing the goal of medical reform. Explore possible paths. The Medical Chain Alliance gathers top domestic talents in the blockchain field and senior practitioners in the medical service field. With advanced core technology and complete business qualifications, it provides new impetus for the development of medical care.

In the medical and health ecology, there are not only regulatory agencies such as the National Health and Family Planning Commission and social security, but also major players such as hospitals, patients, and pharmacies, as well as service agencies such as logistics and insurance. Among them, electronic medical records are the core and most basic data shared. The blockchain electronic medical record system is through a platform, without touching the existing interest pattern, the relevant parties only bear the cost of accessing the system, and can obtain more benefits.

The medical alliance model is promoted through a top-down approach. For social security institutions, verifying the identity of patients can effectively prevent patients from defrauding insurance through hospitals. For the Health and Family Planning Commission, allowing hospitals to access the system can obtain more medical records, which is of great help in monitoring the physical health of the local population and preventing diseases. For hospitals, through this system, insurance policies can be quickly reviewed and the financial pressure of hospitals can be relieved.

For insurance institutions, under the condition of personal authorization, it is possible to quickly query the past real medical records and quickly calculate the actuarial premium. For patients, since the hospitals in the system can trust each other, the cost of repeated examinations can be reduced. When other institutions use patient medical records, they need to notify in advance and obtain patient authorization, and the call situation is tracked through the blockchain system, which also ensures the ownership of patient information.

The profitability of the platform does not depend on hospitals and patients, but is achieved by providing value-added services to ecological stakeholders. The project is trying to be implemented in Zhuhai and other places, but due to the relatively complex integration of institutions, hospitals are not very willing to connect their own electronic medical records to other systems, and they have to bear a great risk of information leakage. The promotion of the system faces certain difficulties.

Case 2: Blockchain + Health Certificate

Hunan Tianhe Guoyun Technology Co., Ltd. (hereinafter referred to as Tianhe Guoyun) was established in 2015 and is committed to building an open, equal, respectful and creative blockchain ecosystem. Tianhe Guoyun has built four blockchain basic service platforms, including blockchain-based certificate storage services, blockchain security services, distributed computing and storage services, and DAPP services. Its application in the medical field is mainly reflected in the application of blockchain + health certificate.

Blockchain + health certificate mainly provides a systematic health certificate integration process solution, which is oriented to hospitals, medical examination institutions, inspectors, relevant regulatory departments, enterprises and merchants.

At present, the health certificate is issued by a medical examination institution, and the industrial and commercial administration department uses the health certificate for industrial and commercial registration. Usually, the food and drug administration department is responsible for verifying whether the health certificate is legal and valid, and the food hygiene production and distribution are responsible for the management of employee certificates. and operating a business. Based on blockchain technology, these departments or personnel can store and confirm rights based on blockchain technology, realize content distribution according to the business nature and scope of power of different subjects, ensure the validity of electronic certificates, solve social costs, and achieve advantages in the following aspects:

1. Solve the problem of information barriers and mutual trust between medical information and other users;

2. Simplify the process of obtaining certificates for hospitals, save labor costs and improve operational efficiency;

3. Help enterprises or merchants achieve centralized management of employee health certificates;

4. Simplify the procedures for the application and use of health certificates to achieve the policy goal of “only let the masses run once”;

5. Online confirmation of rights is conducive to the supervision department’s verification and inspection at any time.

Due to the short implementation time of the project, further communication with the government and the recognition of the health certificate by local enterprises are still needed in the implementation of the process.

Case 3: Doctor time (disease-based medication feedback community)

Chongqing Medical Alliance Health Management Co., Ltd. was founded in October 2015. It was jointly established by 18 experts from tertiary hospitals in Chongqing. It is a new type of health management company that leads the development of “passive medical treatment” to “active health management”.

This project is used in the fourth phase of medicine. The main service targets are doctors and patients. Relying on the original specific community, people with the same disease often gather in the online community to discuss their conditions. Patients often share and related factors that may affect their response to the medications they are taking. A strong sticky relationship has been established between patients, helping each other and sharing medication feedback. However, due to time constraints, doctors can only understand patient feedback through face-to-face consultation, which is inefficient, small in sample size, and poor in data tracking, making it difficult to use for scientific research support.

On the basis of the original community, through the intervention of blockchain technology, doctors and patients can have more connections. Patients can upload medication feedback regularly, and doctors review the patient’s medical records. On the one hand, the patient’s medication status can be paid attention to and reviewed by doctors. on scientific research results.

At the same time, the feedback data of doctors and patients interacting with each other is encrypted and time stamped to ensure the reliability and authenticity of the data. The data report formed after sorting has huge implications for insurance institutions and drug research and development institutions. The reference value can also be used for commercial purposes, and data contributors (doctors and patients) can also be rewarded accordingly.

At present, the platform is open to specific patients and is being piloted in more than 20 hospitals. Project data is continuing to grow. This project cuts, strengthens and records the original interaction between patients and doctors from the original single disease community, does not require the integration of complex relationships and the intervention of regulatory agencies, and has great impact on both parties and third-party agencies. The value of the project is a relatively lightweight practice model, and the operation model and commercial value of the project are worth looking forward to.

Case 4: Traceability of discarded medical devices

Token Technology relies on the technical experience of Internet products and combines the characteristics of blockchain to explore the application of scenarios. Its application in the medical field is mainly reflected in the traceability of discarded medical equipment. The main business of this case is also a hot issue in the current medical industry. ——The CCTV 315 Gala revealed that medical waste is made into various daily necessities and toys, and its source and flow are required to be seriously investigated and dealt with.

The scope of traceability includes hospitals that use medical devices, logistics companies that transport waste medical devices, and environmental treatment companies that incinerate waste medical devices. Different from the traditional paper recording method in the past, this mode performs identity authentication and limited authorization on the subject of each link on the blockchain platform, and records the specific behavior of the medical device transaction in each link, such as the confirmation of the identity information of the transaction subject, Verify the type and weight of medical devices processed, trace the transaction process, etc., to ensure the traceability of information on discarded medical devices.

Based on the use of blockchain technology, the company has jointly built a system with technologies such as the Internet of Things and artificial intelligence. In the future, 5G technology will be introduced. This model has been piloted in a tertiary hospital in Fuzhou. Due to the ethical, economic, and regulatory issues involved, there are many stakeholders involved. The normal operation of the model needs to be led by the local government, coordinated with local health and health commissions, environmental protection departments, etc., to promote the application from top to bottom. Relatively speaking, this method has certain advantages:

1. The maintenance cost of this project is relatively low. It only needs to store certificates and operate daily to obtain information such as the quantity and type of discarded medical devices. It does not involve the core data of the hospital, and there is no risk of data leakage for the hospital;

2. Dispose of discarded medical equipment in accordance with the law and reasonably, and avoid disputes and adverse effects caused by illegal disposal of discarded medical waste in hospitals;

3. Optimize the environment of the medical waste treatment industry to prevent waste from being illegally used by unscrupulous manufacturers and thus posing a threat to public health.

Case 5: Internet Mutual Aid Program

The concept of mutual insurance is not new. Mutual insurance emphasizes the “mutual assistance and sharing” model of serious illness protection, such as Easy Funding, Water Drop Mutual Assistance, Dawning Funding, and Rock Mutual Assistance. These projects all introduce blockchain technology to show that the sponsor is more capable The flow of letters and donations is more transparent.

Mutual insurance is an innovative insurance product jointly developed by Ant Financial and Xinmei Life Insurance. It was launched on October 16, 2018. Later, it was interviewed by the regulatory authorities due to suspected violations. Bao” changed its name to “Mutual Treasure”, Xinmei Life Insurance withdrew, and Mutual Treasure became an Internet-based mutual aid plan. As of April 2019, more than 40 million users have registered.

Mutual treasure products only need 0 yuan to join, everyone helps each other, and each person shares a small amount of funds to obtain insurance protection of 100,000 to 300,000 yuan (40-50 years old protection amount is 100,000). It should be noted that Mutual Treasure does not have the attributes of commercial critical illness insurance. Users pay a few yuan to more than a dozen yuan per month, and the upper limit of the per capita share of the cost is capped at 188 yuan, and Ant Financial is responsible for the excess cost.

In terms of insurance age, mutual insurance can only be insured until the age of 59, and it faces the risk of ending the project at any time. If there are less than 3.3 million members, it will be terminated. High transparency is achieved through blockchain technology to ensure that there will be no fraudulent insurance and delinquency. At present, the project is still in the experimental stage, bringing a new wind to the mutual insurance market, but it remains to be tested whether this approach of bypassing the insurance law, making no commitments and assuming the risks entirely by the insured members is feasible.

In practice, the medical + blockchain project belongs to the exploratory stage that has just started, and there are not many real implementations. Although some companies have already deployed the medical + blockchain field, the scope is small, the coverage is not large, and the business model The idea is innovative but difficult to implement or it belongs to the project verification stage. The large-scale application of the project requires the mutual running-in and a certain degree of compromise between institutional innovation, enterprise innovation and ecological service system.

At present, one of the main problems encountered in the implementation of blockchain in the medical field is that, unlike medical data sharing in every state in the United States, the problem of information islands in medical big data in my country is difficult to solve in the near future. Because the software and hardware systems of each hospital are provided by different system providers, even without considering the hospital’s own interests, it is a huge project to realize the information exchange of multiple hospitals.

Secondly, the National Health and Health Commission and the Medical Administration Bureau stipulate that the ownership of electronic medical record information belongs to the patient and no institution has the right to use it without authorization, and the hospital is unwilling to take the corresponding responsibility. It is difficult to turn medical and health data into a commercial organization for management and operation. But in the medical sector as well as other government departments (such as environmental protection, industry and commerce) and other fields, blockchain may play its technical advantages.

The medical and health industry is related to the national economy and people’s livelihood. Therefore, the development of medical blockchain projects cannot be separated from the promotion of the leading government departments. The development of the project can help promote the healthy development of the medical and health industry, and allow the competent departments to achieve disease management and disease prevention in their jurisdictions. The realization of administrative functions such as reducing the waste of medical resources is more conducive to the success of the project.

But at present, the main subjects of medical + blockchain are enterprises. The innovation ability and execution ability of these enterprises are commendable, but if the project is not profitable for a long time, it is still questionable whether it can stick to it. On the other hand, due to the lack of in-depth understanding of medical institutions or the lack of contact with medical institutions for a long time, the degree of integration needs to be strengthened. Third, the promotion role of the competent authority is also indispensable, and the joint force of policies and the market can ensure the implementation of technology.

Although blockchain technology has been developed for 10 years, the integration and implementation of blockchain technology and industry is underway. Although it has great potential, it has not yet formed large-scale commercial use. Especially in the medical and health field, there are high requirements for security, reliability, scalability and privacy, and the efficiency, high energy consumption, supervision and other issues of blockchain technology are also being further solved.

4. Development Trend and Suggestions of Medical Blockchain

1. The government should play a leading and promoting role in subdivided fields with national economy and people’s livelihood, such as the establishment of personal electronic medical records and drug supervision systems, through supervision, promotion by industry associations, setting standards, and promoting in the form of alliance chains or private chains. Enterprises promote the informatization construction of medical institutions in an open source and open manner, provide a basis for the realization of credible and exchangeable medical data, and promote the realization of blockchain electronic medical records.

2. The exploration of blockchain technology in the medical field is still in the early stage. To do a good job in the medical blockchain project, one must have a deep understanding of the medical industry and find the pain points of the medical industry, and the other is the use of blockchain technology and multi-party participation. , which enables multiple parties to establish cooperative relations and achieve win-win results. The third is to start with non-mainstream business. The focus of these non-mainstream businesses and non-medical institutions can help medical institutions reduce personnel costs and improve efficiency, and are willing to accept medical institutions. On the basis of the demonstration effect, it has been affirmed by the competent administrative department, and a wider range of promotion is being carried out.

3. The combination and comprehensive application of technologies such as 5G, Internet of Things, blockchain and artificial intelligence can achieve results in smart medical care. Artificial intelligence and big data provide the possibility of data integration, while the blockchain ensures the reliable transmission of identity throughout the process and the establishment of a credit mechanism, enabling multi-departmental collaboration and cross-departmental data transmission to be more secure and effective. , low-cost operating mechanism.

5G is a new engine of the digital economy. Due to the high speed, high reliability, and low latency of 5G, it can ensure the certainty, continuity and security of medical information. The blockchain technology can allow objects to establish multiple networking nodes, and at the same time, multi-channel signal transmission, establish relevant connections with the surrounding environment, and achieve real-time and stable multi-point transmission of signals. The comprehensive application of the above technologies can amplify the effect of technical performance and have a significant impact on the medical and health field.

Responsible editor: ct

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