Blockchain Papers

Juan M. Román-Belmonte, Hortensia De la Corte‐Rodríguez, E. Carlos Rodríguez‐Merchán

Although the best-known use of blockchain technology (BCT) is in the field of economics and cryptocurrencies in general, its usefulness is extending to other fields, including the biomedical field. The purpose of this article is to clarify the role that BCT can play in the field of medicine. We have performed a narrative review of the literature on BCT in general and on medicine in particular. The great advantage of BCT in the health arena is that it allows development of a stable and secure data set with which users can interact through transactions of various types. This environment allows the entry and operation of clinical data without compromising other sensitive data. Another important advantage of BCT is that the entire network is decentralized and is maintained by the users themselves; thus, there is no need to rely on organizations for storage. The Blockchain code is open source and can be used, modified and revised by its users. BCT literature is scarce so far. This article describes the basics of this technology and summarizes the various aspects in which BCT could change the paradigm of current medicine. The great potential of BCT, as well as its many applications in the field of health sciences, encompasses the fields of legal medicine, research, electronic medical records, medical data analysis (big data), teaching and the regulation of payment for medical services. If technological advances continue along these lines, it could bring about a revolution in medicine as we know it.

Mark Gaynor, Betsy Tuttle, Allison Roe

In this paper, we present the applications of blockchain technology in healthcare. Furthermore, we evaluate the choice and deployment of Blockchain technology in such applications, review the advantages and disadvantages of such an approach. We review the Estonian system, which is the first blockchain-based health system at the national level, in detail and discuss its ramifications to Turkey. This paper is one of the first papers in this domain and, to the best of authors' knowledge, the first in Turkish.

Katharine Gammon

No abstract is available for this record.

Vaso Rahimzadeh

Clinical research and health information data sharing are but ripples in a growing wave of reimagined applications of distributed ledger technologies beyond the digital marketplace for which they were originally created. This paper explores the use of distributed ledger technologies to facilitate single institutional ethics review of multi-site, collaborative studies in the dataintensive sciences such as genetics and genomics. Immutable record-keeping, automatable protocol amendments and direct connectivity between stakeholders in the research enterprise (e.g., researchers, research ethics committees, institutions, funders and regulators) comprise several of the conceptual and technological advantages of distributed ledger technologies to research ethics review. This novel-use proposal dovetails recent policy reforms to research ethics review across North America that mandate a single ethics review for any study that takes place across more than one research site. Such reforms in the United States, Canada and Australia replace prior institution-by-institution approval mechanisms that contributed to significant research delays and duplicative procedures for collaborative research worldwide. While this paper centers on the Common Rule revision in the United States, the single ethics review mandate is a noteworthy example of regulation evolving in parallel with advances in the dataintensive sciences it governs. The informational exchange capacities of distributed ledger technologies align well with the procedural goals of streamlining the ethics review system under the new Common Rule ahead of its official implementation on January 19, 2020. The ethical, legal and social implications of applying such technologies to ethics review will be explored in this concept paper. Namely, the paper proposes how administrative data from research ethics committees (REC) could be protected and shared responsibly, as well as interinstitutional cooperation negotiated within a centralized network of research ethics committees using the blockchain. Keywords: Blockchain, Data Sharing, Ethics Review, Governance, IRB, Research, Single Mutual Recognition

Amy Maxmen

No abstract is available for this record.

Khalid Mahmood Malik, Hisham Kanaan, Vian Sabeeh, Ghaus M. Malik

To enable the vision of precision medicine, evidence-based medicine is the key element. Understanding the natural history of complex diseases like brain aneurysm and particularly investigating the evidences of its rupture risk factors relies on the existence of semantic-enabled data preparation technology to conduct clinical trials, survival analysis and outcome prediction. For personalized medicine in the field of neurological diseases, it is very important that multiple health organizations coordinate and cooperate to conduct evidence based observational studies. Without the means of automating the process of privacy and semantic-enabled data preparation to conduct observational studies at intra-organizational level would require months to manually prepare the data. Therefore, this paper proposes a semantic and privacy enabled, multi-party data preparation architecture and a four-tiered semantic similarity algorithm. Evaluation shows that proposed algorithm achieves a precision of 79%, high recall at 83% and F-measure of 81%.

Stanislaw P. Stawicki, MichaelS Firstenberg, Thomas J. Papadimos

No abstract is available for this record.

Kenneth Colon

Over the past decade, there have been many innovations in new payment and care delivery models and technology, from telemedicine to artificial intelligence (AI) to blockchain. These innovations, however, must be used in tandem to drive real change. We review each of these innovations and propose a model for how they can be combined to be greater than the sum of their parts. In doing so, we can create a global, decentralized health system that truly puts patient care at the center, while supporting and further enabling the clinicians who make this care possible, to deliver higher quality care at a fraction of the cost. Keywords: Artificial Intelligence, Behavioral Health, Blockchain, Collaborative Care, Decentralization,Direct Primary Care, Ethereum, Integration, Payment Models, Telemedicine, Virtual Assistants

Ming Chao Wong, Kwang Chien Yee, Christian Nøhr

Blockchain technology is often considered as the fourth industrial revolution that will change the world. The enthusiasm of the transformative nature of blockchain technology has infiltrated healthcare. Blockchain is often seen as the much needed and perfect technology for healthcare, addressing the difficult and complex issues of security and inter-operability. More importantly, the "value" and trust-based system can deliver automated action and response via its smart contract mechanism. Healthcare, however, is a complex system. Health information technology (HIT) so far, has not delivered its promise of transforming healthcare due to its complex socio-technical and context sensitive interaction. The introduction of blockchain technology will need to consider a whole range of socio-technical issues in order to improve the quality and safety of patient care. This paper presents a discussion on these socio-technical issues. More importantly, this paper argues that in order to achieve the best outcome from blockchain technology, there is a need to consider a clinical transformation from "information" to "value " and trust. This paper argues that urgent research is needed to address these socio-technical issues in order to facilitate best outcomes for blockchain in healthcare. These socio-technical issues must then be further evaluated by means of working prototypes in the medical domain in coming years.

Yu Zhuang, Lincoln Sheets, Zon‐Yin Shae, Jeffrey J. P. Tsai · 5 authors

"Blockchain" is a distributed ledger technology originally applied in the financial sector. This technology ensures the integrity of transactions without third-party validation. Its functions of decentralized transaction validation, data provenance, data sharing, and data integration are a good fit for the needs of health information exchange and clinical trials. We investigated the current workflow of Health Information Exchange and clinical trials; conducted design thinking processes with clinicians, trial managers, informaticians, and blockchain professionals; and implemented a private blockchain model to tackle known issues. We used coded Smart Contract regulations to simulate several scenarios in healthcare processes. This proof-of-concept work provides a feasible simulation for potential solutions to monitor clinical trials across different census regions persistently. Various levels of data access privileges have been designed to utilize a suite of customized Smart Contract settings. These settings emulate the workflow protocols for the monitoring entities, trial sponsors, clinical sponsors and participating subjects. Keywords: Blockchain, Smart Contract, Health Information Exchange, Clinical Trial, Persistent Monitoring.

Athina-Styliani Kleinaki, Petros Mytis-Gkometh, George Drosatos, Pavlos S. Efraimidis · 5 authors

Biomedical research and clinical decision depend increasingly on scientific evidence realized by a number of authoritative databases, mostly public and continually enriched via peer scientific contributions. Given the dynamic nature of biomedical evidence data and their usage in the sensitive domain of biomedical science, it is important to ensure retrieved data integrity and non-repudiation. In this work, we present a blockchain-based notarization service that uses smart digital contracts to seal a biomedical database query and the respective results. The goal is to ensure that retrieved data cannot be modified after retrieval and that the database cannot validly deny that the particular data has been provided as a result of a specific query. Biomedical evidence data versioning is also supported. The feasibility of the proposed notarization approach is demonstrated using a real blockchain infrastructure and is tested on two different biomedical evidence databases: a publicly available medical risk factor reference repository and on the PubMed database of biomedical literature references and abstracts.

Peng Zhang, Douglas C. Schmidt, Jules White, Gunther Lenz

No abstract is available for this record.

Polina Mamoshina, Lucy O. Ojomoko, Yury Yanovich, Alex Ostrovski · 12 authors

// Polina Mamoshina 1,2 , Lucy Ojomoko 1 , Yury Yanovich 3 , Alex Ostrovski 3 , Alex Botezatu 3 , Pavel Prikhodko 3 , Eugene Izumchenko 4 , Alexander Aliper 1 , Konstantin Romantsov 1 , Alexander Zhebrak 1 , Iraneus Obioma Ogu 5 and Alex Zhavoronkov 1,6 1 Pharmaceutical Artificial Intelligence Department, Insilico Medicine, Inc., Emerging Technology Centers, Johns Hopkins University at Eastern, Baltimore, Maryland, USA 2 Department of Computer Science, University of Oxford, Oxford, United Kingdom 3 The Bitfury Group, Amsterdam, Netherlands 4 Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA 5 Africa Blockchain Artificial Intelligence for Healthcare Initiative, Insilico Medicine, Inc, Abuja, Nigeria 6 The Biogerontology Research Foundation, London, United Kingdom Correspondence to: Alex Zhavoronkov, email: // Keywords : artificial intelligence; deep learning; data management; blockchain; digital health Received : October 19, 2017 Accepted : November 02, 2017 Published : November 09, 2017 Abstract The increased availability of data and recent advancements in artificial intelligence present the unprecedented opportunities in healthcare and major challenges for the patients, developers, providers and regulators. The novel deep learning and transfer learning techniques are turning any data about the person into medical data transforming simple facial pictures and videos into powerful sources of data for predictive analytics. Presently, the patients do not have control over the access privileges to their medical records and remain unaware of the true value of the data they have. In this paper, we provide an overview of the next-generation artificial intelligence and blockchain technologies and present innovative solutions that may be used to accelerate the biomedical research and enable patients with new tools to control and profit from their personal data as well with the incentives to undergo constant health monitoring. We introduce new concepts to appraise and evaluate personal records, including the combination-, time- and relationship-value of the data. We also present a roadmap for a blockchain-enabled decentralized personal health data ecosystem to enable novel approaches for drug discovery, biomarker development, and preventative healthcare. A secure and transparent distributed personal data marketplace utilizing blockchain and deep learning technologies may be able to resolve the challenges faced by the regulators and return the control over personal data including medical records back to the individuals.

Mehdi Benchoufi, Philippe Ravaud

Reproducibility, data sharing, personal data privacy concerns and patient enrolment in clinical trials are huge medical challenges for contemporary clinical research. A new technology, Blockchain, may be a key to addressing these challenges and should draw the attention of the whole clinical research community.Blockchain brings the Internet to its definitive decentralisation goal. The core principle of Blockchain is that any service relying on trusted third parties can be built in a transparent, decentralised, secure "trustless" manner at the top of the Blockchain (in fact, there is trust, but it is hardcoded in the Blockchain protocol via a complex cryptographic algorithm). Therefore, users have a high degree of control over and autonomy and trust of the data and its integrity. Blockchain allows for reaching a substantial level of historicity and inviolability of data for the whole document flow in a clinical trial. Hence, it ensures traceability, prevents a posteriori reconstruction and allows for securely automating the clinical trial through what are called Smart Contracts. At the same time, the technology ensures fine-grained control of the data, its security and its shareable parameters, for a single patient or group of patients or clinical trial stakeholders.In this commentary article, we explore the core functionalities of Blockchain applied to clinical trials and we illustrate concretely its general principle in the context of consent to a trial protocol. Trying to figure out the potential impact of Blockchain implementations in the setting of clinical trials will shed new light on how modern clinical trial methods could evolve and benefit from Blockchain technologies in order to tackle the aforementioned challenges.

Zon‐Yin Shae, Jeffrey J. P. Tsai

This paper proposes a blockchain platform architecture for clinical trial and precision medicine and discusses various design aspects and provides some insights in the technology requirements and challenges. We identify 4 new system architecture components that are required to be built on top of traditional blockchain and discuss their technology challenges in our blockchain platform: (a) a new blockchain based general distributed and parallel computing paradigm component to devise and study parallel computing methodology for big data analytics, (b) blockchain application data management component for data integrity, big data integration, and integrating disparity of medical related data, (c) verifiable anonymous identity management component for identity privacy for both person and Internet of Things (IoT) devices and secure data access to make possible of the patient centric medicine, and (d) trust data sharing management component to enable a trust medical data ecosystem for collaborative research.

Mehdi Benchoufi, Raphaël Porcher, Philippe Ravaud

<ns4:p>Clinical trial consent for protocols and their revisions should be transparent for patients and traceable for stakeholders. Our goal is to implement a process allowing the collection of patients’ informed consent, which is bound to protocol revisions, storing and tracking the consent in a secure, unfalsifiable and publicly verifiable way, and enabling the sharing of this information in real time. For that, we will built a consent workflow using a rising technology called Blockchain. This is a distributed technology that brings a built-in layer of transparency and traceability. From a more general and prospective point of view, we believe Blockchain technology brings a paradigmatical shift to the entire clinical research field. We designed a Proof-of-Concept protocol consisting of time-stamping each step of the patient’s consent collection using Blockchain; thus archiving and historicising the consent through cryptographic validation in a securely unfalsifiable and transparent way. For each revision of the protocol, consent was sought again. We obtained a single document, in a standard open format, that accounted for the whole consent collection process: timestamped consent status with regards to each version of the protocol. This document cannot be corrupted, and can be checked on any dedicated public website. It should be considered as a robust proof of data. However, in a live clinical trial, the authentication system should be strengthened in order to remove the need for third parties, here the trial stakeholders, and give participative control to the peer-to-peer users. In the future, we think that the complex data flow of a clinical trial can be tracked using Blockchain, that a blockchain core functionality, named Smart Contract, could help prevent clinical trial events not to happen in the right chronological order: for example including patients before they consented or analysing case report forms data before freezing the database. Globally, we think Blockchain will help with reliability, security, and transparency, and could be a consistent step towards reproducibility.</ns4:p>

V. S. Dhillon, David Metcalf, Max Hooper

Evidence-based clinical sciences are currently suffering from a paralyzing reproducibility crisis. From clinical psychiology to cancer biology, recent metaresearch indicates a rise in researchers failing to replicate studies published by their peers. This problem is not just limited to benchwork that happens in a lab; it also plagues translational research where the transformation from bench to bedside happens. Treatments, tests, and technologies are converted from simple lab experiments to government-approved devices and assays that affect hundreds of lives. Therefore, replicability is crucial to converting scientific breakthroughs into pragmatic remedies.

Ariel Ekblaw

No abstract is available for this record.

Thomas F Heston

Blockchain technology is a system of creating an immutable, secure, distributed database of transactions. Blockchains were initially created to provide a distributed ledger of financial transactions that did not rely upon a central bank, credit company, or other financial institution. The technological breakthrough, however, has been extended to transactions involving legal matters, medical records, insurance billing, and smart contracts. One primary way that blockchain technology is important to healthcare professionals in that it can revolutionize medical database interoperability. This greater interoperability can help improve access to medical records, imaging archives, prescription databases. Given that a patient’s medical history is a primary cornerstone of good medicine, blockchain technology has the potential to dramatically improve medical care.

Arjun Singh, Arun Pratap Srivastava, Pushpa Choudhary, Harikesh Pandey · 5 authors

The fourth industrial revolution, which will alter the globe, is commonly referred to as Blockchain technology. Blockchain technology provides a decentralized, distributed, and central authority-free environment. Since Bitcoin launched Blockchain, research has been continuing on non-financial use cases to extend their applicability. Healthcare is an industry with a significant influence on the Blockchain. Healthcare has penetrated the enthusiasm for the changing nature of Blockchain technology. Blockchain is frequently viewed as the most necessary and optimal healthcare technology to handle sophisticated and complex security and interoperability concerns. More significantly, the “value” and trust-based system’s smart contract mechanism can offer automatic action and reaction. Healthcare, on the other hand, is a complex system. In this paper, we introduce the blockchain and its properties, as well as the significance of the blockchain in healthcare. It also provides blockchain administration, adjudication of claims, interoperability, and application. While in several situations, we observed blockchain technology, the use of blockchain in health care was highly addressed in this paper and the reason why blockchain should be utilized. We introduce the advantages of blockchain as well. Furthermore, we examined the difficulties and prospects for the future and how they may be implemented in more healthcare industries. The paper also discusses the current level of Blockchain application development for healthcare and its limits and topics for further research. This paper aims to demonstrate how Blockchain technologies may be utilized in healthcare and what problems this technology may face in the future and what the Blockchain’s prospects are.

Ariel Ekblaw, Asaf Azaria

No abstract is available for this record.

Vintech Solutions, Siddhartha Vadlamudi

Artificial intelligence (AI) delivers numerous chances to add to the prosperity of people and the stability of economies and society, yet besides, it adds up a variety of novel moral, legal, social, and innovative difficulties. Trustworthy AI (TAI) bases on the possibility that trust builds the establishment of various societies, economies, and sustainable turn of events, and that people, organizations, and societies can along these lines just at any point understand the maximum capacity of AI, if trust can be set up in its development, deployment, and use. The risks of unintended and negative outcomes related to AI are proportionately high, particularly at scale. Most AI is really artificial narrow intelligence, intended to achieve a specific task on previously curated information from a certain source. Since most AI models expand on correlations, predictions could fail to sum up to various populations or settings and might fuel existing disparities and biases. As the AI industry is amazingly imbalanced, and experts are as of now overpowered by other digital devices, there could be a little capacity to catch blunders. With this article, we aim to present the idea of TAI and its five essential standards (1) usefulness, (2) non-maleficence, (3) autonomy, (4) justice, and (5) logic. We further draw on these five standards to build up a data-driven analysis for TAI and present its application by portraying productive paths for future research, especially as to the distributed ledger technology-based acknowledgment of TAI.

Chris Berg, Sinclair Davidson, Jason Potts

Are there differences between the sale of an unopened Super Mario Bros. computer game and of the digital collage of 5,000 images? Viewed from the perspective of the doctrine of exhaustion, we can easily conclude that the two transfers have significant differences. The auction of the tangible data carrier of the Super Mario’s 1986 edition (for $660,000) 1 fits well into the doctrine. The auction of the NFT (non-fungible token) representing Beeple’s “Everdays: the First 5000 Days” (for an equivalent of an astounding $69.3 million) 2 seems to be hype with a snowball effect rather than a modern encapsulation of digital exhaustion. Some commentators, 3 including the present author in collaboration with Alexandra Giannapoulou, João Pedro Quintais, and Balázs Bodó, 4 have thoroughly introduced the incompatibility of the NFT mania with the existing copyright status quo, and so – in connection with the present book’s topic – the sale of tokenized information, which is capable of representing information related to digital artworks, is practically excluded from the scope of the exhaustion of the right of distribution. At the same time, NFTs de facto offer a “code-based digital ecosystem that has practical consequences for the copyright-relevant fields of creativeness.” 5 The sale and resale of NFTs is possible; an exchange of information and title to “own” and “trade” information related to copyrightable subject matter is technologically guaranteed. In line with that, a quasi-exhaustion regime has also emerged. As such, the NFT mania can practically evidence the need for and modern technology’s capability of offering digital marketplaces for artworks as well.