Alan,
I'm sceptical about it too. For one thing paying for medical care is
still private medicine, even if the payment in question is made via a
new type of e-currency. But it's also unclear from the article exactly
how much the blockchain will be involved in medical record-keeping - is
the patient's medical record in its entirety actually going to be
inscribed on the blockchain, or is the blockchain just going to act as a
ledger of how many times the record was accessed and updated, and by
whom? I suspect the latter, because the former would probably make for
painfully slow response-times; but I've looked at the Medicalchain
website and their 'Whitepaper', and I'm still not clear.
They seem to be trying to position their blockchain-authenticated
version of the medical record as an alternative to the prevailing
'paternalistic' model, where although patients are nominally entitled to
full access to their own records and a right to veto other people
accessing them, in practice those records are kept and updated by other
people (the GP, the hospitals, out-of-hours services etc.) and other
people (notably the Department of Health) access them willy-nilly
without any patient consent. Medicalchain that under their model, the
patients will have complete control over their own notes, and nobody
else will be able to access them (or update them) without the patient's
consent.
Concerns about other people accessing your medical notes without your
knowledge or consent are legitimate. About four years ago NHS England
launched a project called Care.Data which basically siphoned off an
immense amount of data from the patient notes held in doctors'
surgeries, linked it to data held about the same patients in hospitals,
'anonymised' it, and then offered offered it to other agencies for
'research purposes'. The other agencies might include people like
insurance companies, from whom NHS England hope to make considerable
amounts of money in the shape of fees for granting access to the data.
And the data wasn't as 'anonymised' as NHS England claimed, because it
soon emerged that if a patient had something like a rare disease or a
rare blood group, he/she could be quite easily identified from the data
being offered. Originally NHS England were going to run this whole
scheme without letting anybody know about it; then, at the last moment,
they decided to pass the responsibility for letting people know about it
to GPs, who were completely unprepared; then the Information
Commissioner's Office found out what was going on, and told NHS England
they'd got to take responsibility for informing people about the scheme
themselves; then the papers got hold of it; and within a couple of
months the scheme was closed down. But not before it had been
demonstrated how blithely the Dept of Health is prepared to ignore
patient confidentiality if it suits its own purposes. And even though
Care.Data has been stopped, there are still numerous data-extractions
from the various 'silos' of electronic patient records taking place
every day, for one reason or another, usually without the patients
knowing anything about them - a lot of them, it must be said, for
entirely creditable purposes like research into diabetes and cancer.
But I'm not sure that patients having control of their own notes is the
answer. Most patients don't like having adverse information about
themselves placed on record. There are enough cases of people with
diabetes who refuse to acknowledge that they're really diabetic, or
people who used to smoke who adamantly deny that they ever touched a
cigarette, not to mention people who drink well over the recommended
limits but insist that they stay well inside them, etc. But the real
problem comes if you're dealing with people with a history of drug
abuse, violent behaviour, child abuse, psychosis and so forth. Actually
you need to share the medical record between patients and their
clinicians in some way, so that patients have access to their records
and can query inaccuracies, but on the other hand grant permission to
the clinician to record accurate information, even if that information
is something they'd prefer not to be on there.
But leaving the ethics of the system on one side, most of these things
come down to questions of how efficiently the software works in
practice. How quick and easy-to-use will this blockchain system be for
patients and doctors? How easily will its architecture allow it to
communicate with other computer systems, or to take on board things like
scanned documents or blood test results, or to produce things like
prescriptions or requests for x-rays? At this stage it all remains to be
seen.
Edward
On 03/06/18 19:56, Alan Sondheim wrote:
Hi, read about this as well as the comments which are somewhat
skeptical - I'm curious what your opinion is?
Thanks, Alan
On Sun, 3 Jun 2018, Edward Picot via NetBehaviour wrote:
A new telemedicine platform utilising blockchain technology will be
trialled
with patients in south-west London next month...
https://www.digitalhealth.net/2018/05/blockchain-enabled-telemedicine-servi
ce-to-by-piloted-with-groves-medical-patients/
New CD:- LIMIT:
http://www.publiceyesore.com/catalog.php?pg=3&pit=138
email archive http://sondheim.rupamsunyata.org/
web http://www.alansondheim.org / cell 718-813-3285
current text http://www.alansondheim.org/vk.txt
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