HXR 2017: Denise Gosnell, Pokitdok: Blockchain: The Now and The Future:
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Transcript of HXR 2017: Denise Gosnell, Pokitdok: Blockchain: The Now and The Future:
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“Controls allow a quarrelsome species ill-suited to organizations larger than tribes to work together on vast projects like manufacturing jumbo jets and running hospitals.”! - Nick Szabo on Smart Contracts, 1997
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History of Blockchain
1985: ECC first suggested
1989: Paxos Consensus
1991: Initial descriptions of cryptographically secured chains of blocks
2008: Satoshi Nakamoto Paper
2014: The first “programmable” blockchain and monetization models beyond bitcoin
2016: DokChain Alliance
1994: Nick Szabo coins “smart contracts”
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Traditional Blockchains
Records Ungoverned Immutable
Consensus Centralized Decentralized
Visibility Closed door Transparent and Auditable
Security Highly Evolved Cryptographically Verifiable
Traditional Systems vs. Blockchains
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Smart Contract a digitally signed, computable agreement (software code) between two or more parties, that relies on a consensus system
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Law Software
Reasoning Contractual + Subjective Boolean Logic
Governance Imprisonment Replication + Cryptography
Predictability Flexible Rigid
Maturity Highly Evolved Few Experiences
Traditional vs. Smart Contracts
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Health Tech Business Goal
The entirety of medical and pharma business services are encompassed:
PrPayment = Pr( $ | ICD,CPT,NPI )
($) Asset Under Consideration
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The Rules
80% of operational rule and rule sets are locked within Store Procedures in SQL databases
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Smart Contracts: Eligibility Request
1979: X12
HL*1**20*1~NM1*PR*2*Premium Gold Insurance Co.*****PI*0123456~HL*2*1*21*1~NM1*1P*1*Back*Has*Your***XX*9876543210~HL*3*2*22*0~TRN*2*89368DC6A14E4E529AA876ED416E8A9F*1453915417NM1*IL*1*A-lot*Lifts****MI*MEM10001~N3*2150 Pleasant Drive~N4*Sunny*CA*900010001~DMG*D8*19820315*M~DTP*291*D8*20141001~EB*B**98****10~EB*A**33*****.20~
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APIs: JSON
{ "member": { "birth_date": "1982-03-15", "first_name": "Lifts", "last_name": "A-Lot", "id": "MEM10001"}, "provider": { "first_name": "Has-Your", "last_name": "Back", "npi": "9876543210"}, "service_types": [ "professional_physician_visit_office", "chiropractic"], "trading_partner_id": "premium_gold_insurance"}
Smart Contracts: Eligibility Request
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function response(address providerWalletAddress, ! address consumerWalletAddress, !
bytes32 activityId) onlyOwner { !
EligibilityResponseEvent(providerWalletAddress, consumerWalletAddress); ! ConsumerWallet consumerWallet = ConsumerWallet(consumerWalletAddress); ! ProviderWallet providerWallet = ProviderWallet(providerWalletAddress); ! consumerWallet.eligibilityUpdate(activityId); !
providerWallet.eligibilityUpdate(consumerWallet); ! } !
} !
Smart Contracts: Solidity Code
Smart Contracts: Eligibility Request
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Reasoning Expressing business logic as computer programs that self-amend
Governance Representing the events which trigger that logic as messages to the respective programs
Predictability We must separate policy from mechanism design
Maturity
Smart Contract Considerations
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Reasoning
Governance Using digital signatures to prove who sent/received
the messages
Predictability Connecting and placing the programs, messages and signatures on a blockchain
Maturity Permission system can be used to restrict the right to create assets
Smart Contract Considerations
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Reasoning
Governance
Predictability The asset(s) function via rule sets based on context
Maturity Rule sets can be greatly simplified if based on behaviors and expected outcomes
Smart Contract Considerations
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Reasoning
Governance
Predictability
Maturity Though early in development, smart contracts will be the most valuable asset of the future systems
Smart Contract Considerations
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Near Term and Future Considerations
• EMRs will be a node on the chain(s)
• Dynamic Underwriting offerings will be created
• Clearinghouses will be disintermediated
• Complete systems will be on chip and fabless