Blockchain Learning, Proof of Stake, Uncategorized

Why We’re Building Casimir

Note: This started out as an internal document, reconfirming our priorities and values as we watched the First Contagion, the collapse of Luna, in early 2022. Today, we’re watching the Second Contagion and the collapse of  one of the over-leveraged wildcat banks we allude to below. Although we didn’t predict the collapse of FTX, nor are we trying to predict what’s next, we continue to operate by our principles first approach. This approach means working on solutions for our core principles of self custody and peer-to-peer transactions in the Web3 space. It’s why we have never worked with or used FTX before and why our current roadmap remains unchanged. What the FTX collapse has done for us, though, is affirm our approach and hasten our desire to bring about vast improvements to the UI/UX problems that create a barrier to self custody for many users. We hope the following will give insight as to why we’re taking the approach we are and we hope you’ll join us on our journey to making Web3 better, easier, and safer for all.

It’s always a good idea to revisit your priorities and values especially in this time of uncertainty in blockchain, cryptocurrency, Web3, and technology at large. We’ve written before about what the value proposition of blockchain is and why we’re building technology as close to the consensus layer as possible. Fundamentally, the consensus mechanism is what powers a new medium; exchange of value without the need for a third party, peer-to-peer transactions. It’s clear that many of the current issues in the Web3 space today are due to egregious speculative activity and attempted takeovers from centralized entities acting far away from the consensus layer. 

We’ll briefly touch on some recent issues in Web3, the major reasons we think they occurred, and why we’re building Casimir to help fix this.

Bridge Attacks – In February 2022, the DeFi platform Wormhole was exploited for $325 million. Wormhole was a popular VC backed blockchain bridge designed to allow users to access tokens across chains using a single access point. More recently the Binance Smart Chain was exploited for $100M+. While bridges are a potentially convenient solution to the mass of protocols in existence, a single smart contract or hot wallet with $100M+ of deposited tokens is proving to be too attractive of a target for hackers. So far in 2022, over $2B worth of tokens on bridges have been hacked!

Decentralized in Name Only – The first of the warning bells of the impending 2022 cryptocurrency sell-off was the collapse of Terra. There are a range of reasons why Terra collapsed but simply, algorithmic stable coins backed by digital assets have fundamental challenges due to the volatile nature of digital assets. This early breakdown from Staking Rewards names a combination of an overreliance on the yield platform Anchor combined with significant off-chain usage on exchanges being a driving factor in the collapse of Terra. Those externalities, controlled by central entities, effectively subverted the consensus mechanism of the project by operating off-chain where overleveraged risk could not be observed. Additional issues were caused by a concentration of premined tokens in the hands of Terraform Labs who essentially controlled protocol voting and overrode the desires of some in the community to reduce risks. A more recent postmortem in June 2022 showed that the liquidity issues and subsequent depegging of the UST stable coin were caused by Terraform Labs themselves.

The Rise and Fall of CeDeFi – Next to fall, and still unwinding, is the “Centralized Decentralized Finance” (CeDeFi) company Celsius. Companies like Celsius and BlockFi have driven huge growth in Web3 by offering high interest rate yields on your deposited tokens. They act as a bank but don’t do a good job of indicating the potential risk their depositors face nor do they follow the same regulations as traditional banks. Celsius was exposed to Terra and potentially lost $500M there alone. More recent are revelations that Celsius executives cashed out just prior to the collapse and bankruptcy filing.

Last of the “(first) contagion” was the collapse of Three Arrows Capital. Ongoing investigations are looking at whether 3AC took large margin longs on cryptcurrencies through fraudulent activity and then  were subsequently liquidated over the past month of pullbacks. Overall, it sounds pretty bad for 3AC management and they might be going to jail.

The unifying thread of these major collapses was the concentration of digital assets and their control into single points of failure. Even worse, the users themselves were in the dark, unaware of what was occurring with little visibility into the behind-the-scenes actions of those companies. What the latest round of speculative growth in Web3 was built around was, in short, unsustainable, over-leveraged, unregulated, wildcat banking, totally divorced from the core ideas of a decentralized currency. This mentality has unfortunately not changed since the beginning of the year and more liquidity crises are not out of the question.

Unfortunately, all of these problems were intentionally created (not the fallout of course); many players in the Web3 ecosystem today are attempting to rebuild traditional business models around SaaS and fee extractional models by creating layers of complexity that separate users from the core Web3 value proposition: Peer-to Peer-transactions.

While the 2022 drawback in Web3 did a lot to refocus the industry on its core principles, there are still growing centralization and regulatory concerns:

Ethereum Merge – Ethereum 2.0 staking is currently heavily concentrated among major cryptocurrency exchanges and the Lido Pool. So far, just two centralized staking providers, Coinbase and Lido, have mined almost 50% of Ethereum blocks post merge. Control of cryptocurrencies by “banks” (Coinbase, Kraken, BlockFi, FTX, etc) presents a threat to the uncensorable features of the Ethereum blockchain. With control of the Ethereum blockchain and operating under U.S. regulatory policies, these entities must implement any and all controls as required by law. What this means is that cryptocurrencies would effectively become fiat currencies – implemented by decree from the state.

If we are to avoid this scenario we must help create a truly decentralized ecosystem where a few centralized entities can’t control the Consensus mechanism of a Web3 protocol. We need native Web3 solutions – peer to peer, decentralized solutions and tools that empower the users, not centralized market makers. We’re building Casimir to do just that.

Decentralization – Probably the most overused and watered down word in the space is “decentralized.” Nearly everything in blockchain/web3 is called decentralized, whether or not it actually is. The unfortunate reality is that blockchains are decentralized in name only. A recent study by Trail of Bits for DARPA concludes blockchains are fairly centralized. They report that the pooled mining for Bitcoin gives a Nakamoto coefficient of 4 to Bitcoin and Proof of Stake protocols aren’t much better. I won’t get into criticism of the overall piece by Trail of Bits, particularly the misassociation of pools and protocol control for Bitcoin, but the Nakamoto Coefficient for Proof of Stake is worth analyzing. Chris Remus of Chainflow has written extensively on Staking Decentralization and currently maintains a live Nakamoto Coefficient tracker that predates the Trail of Bits report. The Nakamoto coefficient is a measure of decentralization and, by definition, the number of nodes needed to control the Consensus mechanism of the protocol. The lower the number, the less decentralized. At the time of this writing, some major protocols have very low Nakamoto Coefficients, of note Polygon is at 3.

The goal of Proof of Stake protocols should be to get the highest Nakamoto Coefficient number possible, which would make it very difficult to manipulate the protocol since it would require simultaneous compromisation of hundreds of nodes. For example, Cosmos has an active set of validators of 150, around the world. Compromising all of them would be likely impossible, however the Nakamoto Coefficient of Cosmos, is only 7, meaning that to control the Consensus mechanism of Cosmos would only take a compromise of the top 7 Cosmos validators. A tough job to be sure, but a lot easier than the 150 total active validators in the Cosmos ecosystem.

What this means in practice is that the allocation of staked tokens should be spread across all validators as equally as possible, not continually concentrated in a few of the already heavily staked validators.

So why are the Nakamoto coefficients so low? Let’s talk about the User Experience

The Crypto Experience

User experience

The Web3 user experience today… sucks. You’re forced to either leave significant returns on the table and surrender control of your assets to a major exchange; or, endure the inconvenience of manually staking across multiple protocols, wallets, platforms, and websites. It’s harder to know what’s going on and it becomes easier to get scammed through faulty or malicious smart contracts. 

What Web3 Looks Like Today

The easiest way to manage multiple digital tokens and assets is through centralized exchanges like Coinbase, which leave a lot to be desired. You give up custody of your tokens and if you’re staking, you’re missing out on potential rewards that Coinbase scoops up in the form of third party fees. If you’re more adventurous, you may have multiple wallets and multiple staking websites you use. You have the benefits of self custody but are forced to go through the process of managing the wide range of websites and wallets you have to interact with the various protocols. It becomes confusing to manage and monitor all of your stuff and there aren’t any good solutions today that help you compile everything.

What’s more, current Web3 non-custodial products, like MetaMask, fall far short of protecting users from scams or interacting with bad smart contracts. Because cryptocurrencies are so difficult to interact with and understand, even seasoned pros get manipulated and hacked.

How MetaMask Responds to UI Criticism

Let’s look at how this poor user experience even affects the Consensus mechanisms of PoS protocols. One of the easiest ways to stake in the Cosmos Ecosystem is using Keplr, a mobile/web wallet that allows you to stake to any of the Tendermint based protocols. However, users trying to stake with Keplr aren’t given much to work with. 

The Staking Page for Cosmos

A new Staker has no way of deciding who to stake to. There are no easy ways of determining whether an above listed validator is reliable or participating in the governance of a protocol. Users have no real reason to choose a validator outside of the top ten, because there are no tools to sort and research each individual validator. So, people end up picking validators from the top of the list due to the appearance of quality. We can see this effect in the Nakamoto Coefficient of Cosmos today, which is 7. What’s more, two of the top five Validators for Cosmos are cryptocurrency exchanges. In Proof of Stake today, cryptocurrency exchanges have an outsized impact on the consensus mechanism of proof of stake protocols.

So, we’re left where we started. Exchanges offer the best user experience and are gaining control over Proof of Stake protocols. Since exchanges are likely to be regulated more like banks in the future, we are looking at a future where Proof of Stake is controlled by banks. What this means is that they control consensus. They can censor accounts, users, or transactions that they don’t like or are told to by the government. That’s a fundamental threat to the idea of decentralization and Web3 as a whole – an uncensorable digital currency.

Our conclusion is that a poor user experience is driving centralization and will continue to lead to major single point of failures like Celsius unless we create tools that allow users to take full advantage of the protocols they use.

How we’re building Casimir

First, we reexamined how Web3 is being built today. It’s been often stated that Web3 is “going to be just like the internet”. It’s certainly true that there may be some parallels in growth trajectory and societal impact; however, for many projects in the space today, “just like the internet” means being built using today’s internet: AWS/Google Cloud, numerous HTML websites, and centralized SaaS powerhouses. With Casimir, we want to break the paradigm of today’s Web3 and reexamine how users interact with and use blockchains, digital value, and Web3 overall.

We are getting off the Web 2.0 rails and building something new, a native Web3 experience that prioritizes decentralization, user experience, and user control. We’re building the first true Web3 portal, capable of integrating with any wallet, any blockchain, and any token, allowing users to easily navigate Web3 and interact with the protocols directly, not through a centralized exchange or a variety of unconnected websites.

How We’re Designing Casimir

Improving the User Experience through Decentralization

We’re starting bottom up. Unlike current UIs, designed with traditional Web2 architectures, we’re starting at the Consensus and Infrastructure layers of Web3. These layers of decentralized node infrastructure providers hold fully indexed blockchain databases, provide APIs for querying, a network of worldwide decentralized nodes for consistent uptime, and build blocks of transactions as they are added to the blockchain. Today, most users are forced through third parties to access blockchains, which introduces extra costs for transactions and token management. By accessing these nodes directly, users are assured of uptime, uncensorable and low cost transactions, and minimized fees taken by the normal third party intermediaries. Also, with the right tools, users can access on-chain analytics and other information that these nodes carry. This information can protect users by providing transparency to the entities they’re interacting with as well as information about smart contracts and other on-chain data. Today there simply aren’t good enough tools to make on-chain information available and usable to the everyday user.

There are 3 key areas we’re focusing on as we design Casimir: Usability, Security, and Transparency.

Usability: Similar to a Mint or Personal Capital, it will be a place where users can aggregate their digital currencies and assets, for an easy place to manage what they have across the various protocols they use. Many Web3 users have multiple wallets and assets from a variety of protocols, so a single location for them to better manage and view their assets is much needed without it being a single point of failure for any stakeholder.  With our multi-chain approach and Multiwallet Connect we can effectively be an interoperability solution without the bridge.

Casimir will do more than just a Mint, however, it will allow users to interact with their chosen protocols, accessing mints and air-drops, Stake and manage their digital currencies across protocols beyond ethereum, and access specialized tooling that helps protect users. We’ll build and continue to add features like this that help users use Web3.

Our business model isn’t built around trading or exchange fees. Unlike an exchange, we’re not front running trades or building in hidden custodial fees. Our base product will always be free to use and we’ll make money by offering a premium subscriber product as well as through our infrastructure services. We believe you’ll not only have a better user experience, but you’ll actually save money as well.

Security: Unlike most centralized exchanges and custodians, we will never take custody of user’s wallets or tokens. This means we are able to leverage existing on-chain security to protect users at a much higher level. It also means we will never be worried about liquidity or will be trading a user’s tokens on the backend. Although Casimir will be a single site, it won’t be a single point of failure. The code is open source and we will never take custody of user’s digital tokens or NFTs. If Casimir goes away tomorrow, no funds will disappear and users will still have access to all of their tokens.

Unlike traditional Web2, we’re not building around user account management, user analytics, and productizing the user. We’ll never ask for a user’s email address and build an internal profile because not only does this create a security vulnerability for our users, it’s also unnecessary. Our users will always be able to login through their wallet which means they will always control their login credentials.

As part of our usability effort we’re building a smart contract analyzer for users to know what their interaction with a smart contract will *actually* do and monitor the smart contracts they’ve given permissions to and control permissions on old contracts. Because we are working at the protocol level, we are able to provide users with real time information and on chain analytics to help users make the best decisions with their digital assets.

Transparency: As the name indicates, every on chain action on a public blockchain is publicly accessible. Every wallet, every transaction. This transparency is unique in financial systems where the books of banks or governments are not available to everyday users. Today, many Web3 financial providers continue to hide behind their proprietary systems and their financial solvency is only available to the select. What’s worse is that these companies (in the US at least) often skirt regulation loopholes to avoid the same auditory requirements banks have. 

In a world where Bitcoin was launched in the face of a banking crisis, with a desire to bring about a new and transparent financial system to the world, the actions of many major players in the space today are in direct opposition to the values of Web3.

Casimir will help change this. We leverage our fully indexed chains to provide transparency analytics to our users. While block explorers and address balances are always available to those who know how and where to look, we’re making it easier for users to interact with and use Web3 indexed information. We’ll allow users to easily sort data, see large and identified wallets, track large transactions, and match wallets with organizations so that proof of reserves can be ensured.

We’re here to create a better Web3 user experience. For us that means enabling users to better use the decentralized capabilities of the space, not to trade better in the crypto casino. We’ve got a long way ahead of us, both to build something better but also to help users learn the importance of self-custody and what decentralization truly means.  

Over the next few months we’ll present some of the specific technology developments we’re working on to help achieve our goals including non-custodial Ethereum Staking, cross-chain wallet integrations, and a cross-chain single sign on. You can follow our progress on github and join us on Discord. We’re striving to create an open ecosystem that empowers the user and we hope you’ll join us.


COVID-19 is Forcing Medical Supply Chains to Change… And that’s a Good Thing: Part I

By Connor Smith

Without question, the dedication and tireless work ethic exhibited by medical first responders has been nothing short of heroic throughout these trying times. Unfortunately, despite (and partially due to) the valiant efforts on the ground, the healthcare sector is one of the most negatively financially impacted industries by the pandemic. A recent report by the American Hospital Association estimates the total financial impact of COVID-19 on the U.S healthcare system from March 2020-June 2020 to be $202.6 Billion. While a significant amount of this financial strain stems from treating patients infected with the virus and forgone revenue from elective procedures, many problems brought on by the virus could have been mitigated with more efficient and resilient U.S medical supply chains.

While the magnitude of a global pandemic is something few could have properly anticipated, COVID-19 introduced few truly new problems for U.S medical supply chains. Instead, it exacerbated problems and inefficiencies that have plagued the industry for years which have never been properly addressed. Yes, over 70% of active pharmaceutical ingredients that supply the U.S healthcare market are imported and constrained as a result of the pandemic and unprecedented global surges in demand for PPE created massive shortages in basic medical equipment for U.S frontline responders. However, siloed data, lack of automation & interoperability, and a reactionary approach to purchasing contributed to upwards of $25 Billion in wasted supply chain spending each year long before the pandemic. In fact, analysts project that 2020 will be the first year in which supply chain costs surpass those of labor as the largest cost component of delivering medical care by providers.

Some are optimistic that a COVID-19 vaccine will be ready by the end of 2020, but this is far from guaranteed and it could be a year or more before one becomes readily available. Consequently, the U.S healthcare system must face a stark reality that it may continue to lose upwards of $20 Billion per month for the foreseeable future. Major operational improvements must be made to its supply chains in order to help offset these costs.

The status quo for medical supply chain management is no longer tolerable and inefficiencies that were previously ignored must be corrected. Medical supply chains need to be reinvented over the coming months if the U.S healthcare system is to survive the pandemic and thrive into the future. This is the first of a three part series in which I will explore 6 different ways that U.S medical supply chains will look in the post-pandemic era and the technologies and external forces that will enable them. So without further ado, let’s dive into the future of U.S medical supply chain management!

1. Automation & Digitization

While this may sound obvious, over 80% of clinicians and hospital leaders still rely on manual processes for managing inventory. Consequently, health systems struggle to know what supplies they currently own, where they are located, if they have expired, and a myriad of other problems. Unfortunately, patients pay the largest price for these manual, inefficient systems. One survey found that 40% of clinicians postponed a patient’s treatment and 23% know of adverse events occurring to patients because of inadequate inventory. Considering that some industries are well into the ‘Supply Chain 4.0’ era, the first seismic shift for medical supply chain & inventory management will be to go entirely digital and implement technologies already used in more mature supply chains like retail.

Regulatory pressures from the FDA’s medical device unique device identifier (UDI) requirements and the Drug Supply Chain Security Act have already begun forcing some of this change and major compliance requirements are going into effect over the coming months. Digitizing medical supply chains will not only significantly reduce errors and inefficiencies arising from human error and manual entry, but also enable the use of technologies like AI and blockchain that can elicit even greater cost savings. For example, firms in other industries have seen cost savings of 32% across an entire operation by implementing AI based inventory management systems. Such implementations can be used to improve inventory management by enabling features like predictive forecasting and optimizing surplus inventory levels that should be maintained at all times. Other heavily regulated industries, like food, are experimenting with blockchain for product traceability applications in supply chains and estimate they can reduce costs of compliance by 30% within a few years. 

Certainly, there is much foundational work that must be done before medical supply chains can integrate these more advanced solutions. Implementing RFID chips to enable real-time asset tracking, achieving basic systems interoperability through data standardization, and switching to cloud-based healthcare inventory management software are among the baby steps that must first be taken. However, given the lack of digital infrastructure currently in place in many medical supply chains, there is an opportunity to ‘leapfrog’ legacy supply chain technology and implement cutting edge solutions to realize even greater cost savings immediately. Forward looking medical supply chain management teams will be looking to implement such solutions to ensure their supply chains remain resilient and future proof to future disruptions or pandemics.

2. Rep-less Medical Device Sales Models

Manufacturers of implantable medical devices have traditionally used an in-person sales model for distribution. These sales reps form close relationships with clinicians and are oftentimes even present in the OR during the surgery. While this model has been the standard practice for decades, it also increases the cost of delivering care tremendously. For example, in orthopedics, it’s estimated that the sales process for implantable devices accounts for 35-50% of the cost of sales. Moreover, this sales process makes it nearly impossible for device manufacturers to track their field inventory and providers to manage their consignment inventory, resulting in further cost increases of up to 25%.

The pandemic has not only made these inefficiencies no longer bearable for providers, but it has hindered the ability of manufacturers to even sell their products. Whether through self-selected or provider mandated deferral, there have been 50% fewer patients receiving care compared to normal, and elective surgeries for implantable devices like knee replacements have dropped by 99%. Moreover, nearly 50% of orthopedic sales reps have been forced to use exclusively digital means to support physicians or have been unable to provide support at all. 

It is reasonable to suspect that providers will continue to limit who is allowed into a hospital at least until a vaccine is readily available, if not longer, and patients can only forgo necessary care for so long. Hence, providers and manufacturers alike will be required to implement technologies that make rep-less sales models attainable. One key technological enabler of this transition will be integrated data environments of supply chain, medical IoT, and EHR data. Integrating supply chain data with EHR data had already been a top priority for many providers entering 2020. Such environments will serve as the cornerstone for other tools like video conferencing software and payment processing tools that can enable a rep-less sales model and save providers  millions of dollars per year

In Conclusion
I hope you enjoyed the first part of my series on the future of U.S medical supply chains! I will be back next week with two more insights regarding what the future of these complex systems will look like. If you are interested in learning more or ways your medical supply chain could be improved, feel free to contact us at Consensus Networks, where our HealthNet technology is being used to reinvent medical supply chains for the post-pandemic era. Until next week!


Consensus Networks Will Support NuCypher

Consensus Networks is excited to announce its continued support of NuCypher through mainnet launch later this year. Consensus Networks has actively supported the network since the beginning of its incentivized testnet challenge which launched earlier this year called “Come and Stake It”. 

“We are big believers in NuCypher’s mission and see a major need for the work they are doing in enabling privacy preserving applications and providing a secure compute platform.” Said Consensus Networks’ COO, Connor Smith. “We will look to continue not only supporting the network by operating Ursula Nodes on our infrastructure, but are actively building out tools to help developers and organizations connect their applications to NuCypher and leverage the network to build the next generation of privacy preserved dApps. We have had an absolute blast participating in all four phases of their incentivized testnet and cannot wait to help bring the power of the NuCypher network to the rest of the world.”

NuCypher aims to provide the cryptographic infrastructure for privacy-preserving applications by allowing users to manage secrets across dynamic environments, conditionally grant and revoke access to sensitive data to any number of recipients, and use a secure computation platform to process encrypted data while preserving the confidentiality of the inputs and outputs. It is a proxy re-encryption network designed to provide cryptographic access controls for dApps and protocols by functioning as a decentralized key management service (KMS). If you have any questions about how to integrate NuCypher with your application or if it is the right fit for what you and your team is building, contact our team today!

About Consensus Networks.

Consensus Networks is an Indiana based LLC that designs, builds, and manages dedicated infrastructure for blockchain technology. Founded in 2016 with the goal of providing direct, high-speed, low-latency network connections, Consensus enables clients to create, disseminate, and store information securely and efficiently. Consensus Networks uses advanced cryptographic techniques and smartly architected network designs to ensure maximum security and network uptime. 


Top Three Takeaways From Blockchain and Digital Transformation in Health in 2020

By Connor Smith

Healthcare is frequently mentioned on the shortlist of industries that are expected to be transformed by blockchain technology. Supporters of this assertion have a range of reasons for arguing that blockchain can improve healthcare but most tend to revolve around improving health data security, immutable claims tracking, physician credentialing, or putting patients at the center of care by taking charge of their own data. However, there are many who argue that healthcare is not ready for blockchain or that many of its theorized use cases could be better addressed using other technologies. There are good arguments to be made on both sides and, when considering the complexity of healthcare and nascency of blockchain, it can be difficult to discern what projects are ‘hype’ and which can actually drive meaningful impact. 

We at Consensus Networks are bullish on the potential of blockchain in healthcare, but we also pride ourselves on taking a pragmatic view of projects to realistically assess what is feasible and what is not. This past week, we were fortunate enough to attend the inaugural Blockchain and Digital Transformation in Health in 2020 summit in Austin, TX, where our CEO Nathan Miller presented on the work we have been doing with HealthNet and developing highly secure information architectures in a regulatory environment. The Conference was hosted by the Austin Blockchain Collective in conjunction with the Dell Medical School at University of Texas Austin. There were presentations from industry and academia alike accompanied by an open discourse about the state of blockchain in healthcare, what is actually feasible, and identifying a path forward for the technology as healthcare starts its digital transformation. It was an absolutely great event with high quality information and a pragmatic assessment of the state of the industry, and we’re here to share our top three takeaways with you from the event!

1). Blockchain EMRs are not ready….. At least not yet in the U.S

Throughout the short lifespan of blockchain projects in healthcare, there have been several attempts at a blockchain-based electronic medical record (EMR) that is owned by a patient and shared with providers as needed, the most popular of which is probably Medicalchain. Medical records hold a wealth of information about an individual, containing everything from a person’s medical history to their demographic, identity, and insurance information. However, to date, medical records have been largely owned and controlled by the health systems they reside within. Aside from issues of data sovereignty and controlling who has access to that information, having isolated data silos has a decidedly negative impact on patient outcomes, especially in the U.S. Competing EMR systems are incapable of communicating well with one another. Thus, if a patient goes to multiple providers that all have different EMR systems, the data for those visits will likely never be aggregated into a single, cohesive file and instead remain as isolated fragments. This makes it nearly impossible for a provider to know what care has been administered to a patient previously and leads to billions of dollars being wasted in redundant testing, unnecessary procedures, or in the worst scenarios patient death from improper care.

A blockchain-based EMR would enable the patient to own his or her own medical record, which they would likely hold in some form of mobile application. A patient could then control who has access to their record and have the guarantee a provider is seeing her most up-to-date record as any changes would be reflected in that copy immediately. All transactions would be immutably recorded on a blockchain, and once the visit was finished the patient could revoke the physicians access. Conceptually, such a notion sounds appealing. However, one of the biggest takeaways from the conference was that such a future is far off in the U.S and requires a societal shift and fundamental rethinking of data ownership to get there.

Dr. Aman Quadri, CEO of AMSYS Blockchain and AMCHART, was one of the speakers in attendance at the event. The product he is building, AMCHART, is a blockchain-based EMR that is currently undergoing testing in India, and even he was skeptical of its prospects in the U.S. Dr. Quadri said that the reason they have started seeing AMCHART adoption in India is because people there already have a mindset of data ownership. They take responsibility over their data so a platform like AMCHART extends their current capabilities in a way that is beneficial. Dr. Quadri said that for AMCHART to have impact in the U.S it would require patients and health systems alike to change how they view and approach handling data before their could be a marked increase in value to patient care. He said that American patients have been conditioned for decades to blindly trust their data with medical providers, so shifting that view will be no easy task.

2.) Use Cases Are Emerging Around Care Coordination, Identity, and Data Sharing

The projects being spearheaded by the talented Dell Medical School faculty, visiting academics, and industry representatives in attendance covered a wide range of applications in healthcare, spanning both population health and the clinical setting. While the individual problems these solutions address vary, the common thread amongst most of them was that they centered around care coordination, identity, and data sharing applications. The consensus seemed to be that blockchain could help lay the foundation for a web of trusted access to data with the patient at the center of care.

Dr. Timothy Mercer, a faculty member at Dell Medical School and practicing physician, is exploring ways in which blockchain could be applied to help address homelessness in Austin. His research found that one of the biggest problems for the homeless population in Austin is a lack of any legal form to prove their identity. As a result, they frequently go through the process of proving who they are, which can take weeks to months to complete and delay physicians from providing critical care to the homeless. If the documents are lost or stolen, the process must start all over again. As a result, the average age of death the chronically homeless is 52-56, nearly 20 years less than the global average. Dr. Mercer is exploring ways blockchain and digital identities could be used to ease this burden and accelerate the time to care for homeless persons in Austin. This way, the myriad of stakeholders involved in caring for homeless persons would be able to verify an individual through a  web or mobile application and administer care to the patient. The homeless care ecosystem involves many different organizations, all of which must properly authenticate the individual before they can legally administer care. Utilizing a blockchain-based identity application, the different caregivers would be able to verify the individual’s identity through digital documents linked to the patient’s digital identity and legally provide the care he or she needs. This ultimately would place the homeless person at the center of the care and alleviate the inefficiencies pervasive in the current continuum of care for this patient population.

Image Adapted From Change Healthcare

Another interesting application that was highlighted at the event was Tribe Health Solutions use of blockchain in a medical imaging management solution designed for patients. Through the use of blockchain technology and the interplanetary file system (IPFS), they created a platform where patients can store medical imaging data on a distributed file system and then grant necessary providers access when needed. After care is administered, the patient can revoke access to the image and ensure that only trusted providers can access it. This solution aims to help patients overcome many of the problems associated with receiving care for skeletal or muscular injuries. In such tears or breaks, patients oftentimes seek out multiple opinions and are forced to either manage a physical copy of the medical image themselves or wait days to weeks for the file to be transferred to the provider. This not only delays the time it takes for these patients to receive the care they need and start the recovery process but in the worst case scenarios can lead to a worsening of the condition. Putting the patient in charge of the imaging data, allows her to determine who can view the image and when – ultimately reducing the time it takes to receive treatment.

3.) Blockchain Projects Must Start Small in Healthcare and Involve Many Stakeholders

Image Adapted from AdvaMed

Lastly, perhaps the most prevailing takeaway from the conference was that blockchain projects looking to tackle problems in healthcare need to start small and involve as many stakeholders as possible from the onset. Healthcare is a highly complex industry where ‘moving fast’ and ‘breaking things’ can have significant ramifications on patients, especially when considering that the industry is only now beginning its digital transformation. Dr. Anjum Khurshid of the Dell Medical School at University of Texas Austin and a director of the Austin Blockchain Collective is leading research on a patient credentialing platform called MediLinker. When pressed about the ability to extend the platform into an EMR type technology that could exchange clinical data, Dr. Khurshid cautioned that it’s more important to start small and clinically validate each stage of the product. In an industry that handles high fidelity information and typically averse to new technologies like healthcare, Dr. Khurshid said its important to demonstrate the value of the technology and make it more approachable. He said that the problems in the current healthcare system are so vast that even simple solutions can have a massive impact and that it is imperative to validate the benefit of the technology to patients, providers, and payers alike at each step. Any new, truly innovative and sweeping changes that are to take place in healthcare from blockchain will require all of these parties to work together and identify applications that can drive meaningful value for everyone involved. Healthcare is changing rapidly and only by taking small incremental steps will blockchain be able to integrate with the complex, multi-stakeholder ecosystem that is healthcare.

That’s all for this week! We at Consensus Networks are grateful to have been able to attend this conference and excited about the work going on in Austin to advance the industry forward. We are continuing forward with the development and commercialization of our population health data sharing network, HealthNet as well as smart tools for analyzing health data. If you are interested in learning more about HealthNet or have an idea for a new digital healthcare application you’d like to build, contact one of our experts here today!