Is Blockchain a panacea for health data? An interview with Carolyn Seet.

You can listen to the interview podcast here.

Welcome everyone. Today, I am very fortunate to interview Carolyn Seet, who's going to actually help explain something, which I often find confusing and that's blockchain, but I will leave the introduction to her.

Interview image CS

Please explain who you are and what you do?

The reason why I got involved with blockchain is mainly because it was new, it was interesting and there was a lot of hype around it and I just wanted to see if they lived up to the expectations or whether people just getting overly excited, like during the dot com boom. I'm generally a curious person. It's just how I managed to enter into this space.

What is your company? What do you on a regular basis?

I’m running a consulting firm, we look into ideas with blockchain, using blockchain for solutions as well. I provide consultancy to companies who need support in terms of growth. In terms of the crypto space, I think a lot of companies are fairly young, so they do need a slightly more experienced hand to help out with operations and getting the right level of governance in place, which is what I'm good at.

I have lots of experience in the whole running of a business: the set up, process improvements and I think it all applies to block chain companies. Certain fundamentals don't change. Good governance, good processes, good people have to be there.

I don't know if you've heard of Simon Sinek’s golden circle which is about understanding what your ‘why’ is. What is your why?

Why I do what I do, is because I want to make the world a better place. I'm tired of corporate greed. I'm tired of lying politicians. I just want things to be done the right way. Principles-based, for the good of everybody. I take on projects, not just to pay the pay the bills, but ultimately I just want to do the right things in the project that I deliver as well, which is why I like helping out the smaller companies, making sure that they get on the right track, givong them the advice so that they make decisions that are aligned with their own values, as well as helping them save money where I can.

In a way, what you're saying is things like blockchain are a way to sort of democratize value or to really bring it out to everybody.

Absolutely. I wouldn't say blockchain is a silver bullet to solve the problems of society, but if done correctly, there're huge opportunities there to make things better. Then again greed will always find a way in. You have scammers coming up, which is another problem that I encounter, and I have to fend off. It's a tricky thing, really.

If you look at the Internet, what the Internet did for small businesses was incredible because suddenly you didn't have to have a big marketing budget. You could really go out and deliver value to your customers and that's really what marketing is nowadays, which I think that benefits everybody. So I think blockchain has that, it can start to do that to a degree, I think.

I think the thing about the blockchain is that it allows for trustless transactions. So it used to be: if I was doing a deal with you and if you don't trust me, you say, Carolyn can you put your monies with a lawyer and I'll put my assets with another lawyer. Then once both sides are satisfied, do the swap. That takes time. There are a lot of costs involved and if you have a good lawyer, great! But if you're unfortunate enough to meet a dodgy one or one with poor security, then you risk losing money. I can see blockchain reducing that sort of time and cost. Again, this depends on how it's being implemented and whether you've got the right mindset to get it done correctly or not.

What is the best collaborative project you've ever worked on and why?

I think the most exciting project or rather the most collaborative project I've worked on was with a bank, which had some data issues within, I would say it's very siloed.

The data was all over the place and without a single view to it. The interesting bit about that project was having to go around finding owners for the project. And then working with them. There were three teams, technologies being split across three different areas and that's a huge opportunity for synergy. For the data use by one team, 50 percent of it can be reused by another team. Instead of creating three different databases, let's sync them up and do extensions for different areas. And here I was, going around getting the different teams, getting the different technology guys to come together to agree to build it. That was an exciting moment because you could see things happening and that was quite magical.

What do you think it was that finally convinced them? How did you go about?

Mainly, different teams needed different things. So, for teams that were into the cost savings, I'll say, look, if you collaborate, I'll give you some of my project funding to support your side of the building that I need as well. So, that you have some funding to build it. Therefore other teams are sold on the idea that if everybody's on the same data set, then we have less reconciliation problems.

If I'm saying I've got 10 trades and you report nine and you go to the Bank of England or to the regulators and they will go hang on, why do they not match? And then we have a problem at the end. It's really understanding what people want or what the concepts are. And managing the timeline. I need to get my project in on the right timeline. So, there was a lot of negotiation going on and a lot of walking around and talking to people and see what they need. I felt I've achieved something and the teams achieved something, so that was nice.

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Can you explain blockchain?

I'm an accountant as a background, amongst my many different qualifications, I did do accountancy for a while and one of the key things about accountancy is the debit and credit events. Because of that you can trace all transactions in the past 20 years, if you still keep them. The thing about blockchain is that it's all encrypted. It's all online, so you have a key for your own transactions, It is distributed. So, in that sense, if one machine goes down, you still have records of it. I guess the thing about blockchain is that it's not a file transfer service. It can store data, but it has got it’s limitations. You can't store heaps of data, but just the  store key information that is useful and it's immutable. Let's say for example if you have land, a blockchain, that parcel of land, you can track it, see where it's gone, who owned it. The person that owns the key can say: I have the land, so it's under my name. If you pledge it to the bank, it’s there on record. So, that's the nice thing about it. You don't have to worry about files being lost.

Why do you think blockchain is important and is it over hyped?

I think when it first kicked off, there was a lot of hype. I was trying to sift the hype from the reality, it was an interesting time last year. A lot of people go into it for the cryptocurrency space. And that to me is just one aspect of blockchain because blockchain is a technology that one can do many things with, not just cryptocurrencies. I think it's name has been a bit tarnished with cryptocurrency. I wouldn't call them scams, but some of them have turned out to be very poor investments while some have turned out to be wonderful investments.

Blockchain and cryptocurrency should be split up. So in terms of blockchain as a technology, that's a lot to do there. There are improvements that can be made. I've been talking to technologists, CTOs, and their view is that we might not want to adopt it yet. We want to wait and see for the bigger organisations. I think there're things moving forward. There are marketplaces for technology being created, so it's not just technology. I think there's a lot of opportunities there, if it's done in the right way.

How can blockchain be used to facilitate the sharing of patient data or individual data?

I think one of the things I can see being very useful is, for example, when a child is born, they have all the checks, they have the tests being done. To me some things might be personal. If someone's got a genetic issue or a health issue, and they don't want it to be known, that's something that is a bit of an iffy thing whether you want to blockchain that. But things like flu checks, for example, vaccinations. I think those would be handy to be blockchained. I've moved countries and one of the pain points is having medical records in different countries having different needs for vaccinations. And I have to go back through my doctor and say what was my son vaccinated with? When was that done? And just tracking that is a pain. If that could be a blockchain, I can just say, okay, so here's the records of all the checks. Oh, he missed one because when you go through the whole ledger, something's missing. That might be really useful. Or even treatments. So if I'm going through a particular series of treatment and maybe I've got dementia or Alzheimer's, I can't remember when my treatment was and if all those are recorded in blockchain and it's on distributed ledger, it doesn't matter which hospital I go to, it can be checked.

If I give someone permission through a blockchain to use my data, look at my data. Can I revoke that or are they always going to have permission?

There are ways around that. It depends on how it's been set up. Revoking it might be tricky because they've already got access to it. So what you could do, I guess is to re encrypt it. That again, depends on how the technology was set up. I mean ideally, revoking would be the way you want to go.

Because you could see saying, okay, you can have my data for a limited time for a study, but then not anymore. That seems to be the question with sharing and reuse of data.

I think that's the problem that some companies have been trying to solve is, yes, I give you access. The question is, can I take the access back eventually. There's also questions around if you've paid for it, is there an expiry date? if there's expiry date, that can be built into the blockchain. So, at some point in time, it just locks itself. it wouldn't delete itself because, remember it's immutable, so it's there forever.

What are some of the most common misconceptions about blockchain that you've run across?

That it’s  a silver bullet for everything. We can lock in everything. No, you can't. There’s  a limitation. There is a size limitation. There's a computing limitation and again, you don't want everything to be on a blockchain. I think the thing that is very important is, it's a ledger. It's not a file transfer protocol system. You want to use it to track things and events and you don't want history to change. I think in terms of personal identification, that might be a good one. I have people challenge me saying, look what happens if I get hacked or somebody does something to me, at least on my blockchain it's immutable. I can't reverse that. There's no central authority. So, there's all these things that people do need to think about where they say they want to blockchain some things, especially sensitive data.

Is blockchain a big advancement?

I think we're still at the early stages. We're probably towards the end of the beginning of the whole blockchain evolution. It's just like when the dot come came out, everybody said, oh, you know, pets.com, everything dot com, and then they realised that they have operational problems that don't go away just because they've got dot com at the end of it. There are problems basically with new technology, which eventually there'll be a shakeup and then the stronger ones will survive, and those will pave the way for future blockchain technology and become business as usual, eventually.

The question is the application of it. Sometimes I've seen the application based on all business models and that to me is, yes, so you're just putting a new technology for all models. However, that's a lot of opportunities for rethinking the way things should work. And that's where I see the excitement.

It's a way to enable new business models. I think the thing that comes to mind is the idea that, which is where I really became interested in this topic as well, is the opportunity for patients to own their data.

Absolutely. Yes. Instead of having hospitals owning it, a patient can own and carry that around with him or her wherever they go.

Where do you think the biggest impact of blockchain will be in life sciences and healthcare?

As you mentioned, decentralisation of patient records would be a good place to start with. However, there are privacy issues that still need to be thought about. Again, it depends on the level of file sizes. Some patients' records files are really big if they have been in and out of hospitals, but I think in terms of a ledger, in terms of blockchain, again, it's tracking for treatments. I wouldn't want to put my diagnosis on my record. I would be happy to put down my treatments on the blockchain. Just so that I don't have to keep referring to my old records. I don't have say, oh, hang on, I took this medicine three years ago, but I can't remember what that was. Because right now my doctor, (I have different doctors who host my information because I've been around the world). It'd be nice to, if you say, at this age I was in for treatment and this was the antibiotics I was given, and then I completed them or not. And you know, it goes from there.

That's really interesting because what I've seen in a lot of registry type work, one of the challenging things that people face is that, how do you keep track of when patients start and stop medications and even why they started and stopped medications. Once you get a medication out on the market, that becomes a real challenge because that's what you really want to know after it hits the market is how are people using it? What's happening in the real world? But that would mean they'd have to be conscious and go in to enter something to say I stopped this medication today or something like that.

Yeah, in terms of personally taking it. Yeah. It would be a very in-house thing. Apps can do that. People have apps to track what they do during the day for one thing or the other For example, if it's not what they've been eating, but what they'd been dispensed perhaps, for future research, I suppose. Everybody's taking this drug during this time. I have proof to say, on my blockchain, I have taken the drugs and so if you want to run a test, here I am. That's one way.

The other thing, as well as certain medical records, the disposable sorts. So, for example, if, let's say, I'm going for a particular treatment and I need to get records from different places, so just only for that one particular treatment, it'd be handy to be able to have that on a single space. Instead of having to go to take printouts from different places and having a big pile and carrying them around with different doctors. So that's one option. But again, at the end of it, it will not be destroyed, but it should be able to be deactivated, the keys can be taken off so that no one can access that again.

And this will track the timing of it. If you've been to three hospitals, instead of you being the one looking through different records and trying to place a timeline, if you have it on track, you can say, oh, on this day he went to this hospital and he had this treatment. On that date he had this treatment. Maybe not so much details, but just a general idea. Again, it's a ledger, so you can track and say yes, this has been done. He's gone through nine of the 10 treatments, the 10th one that's missing. Then you can find out more if it's really missing or maybe he needs to top it up, for example.

What do you think needs to happen before we can achieve wide scale adoption in the use of blockchain?

I think that technology is still quite young, so there's still a lot more to be done to test the robustness of it. Also, the speed of the blockchain, for example, bitcoin can take between 10 seconds to two minutes to confirm. If it's something that's urgent, like paying a bill or something, you don't want that sort of timing. I think in terms of security and timing there is still work to be done. Again, developers are just coming online so once it matures a little bit more then you will see a lot more widespread adoption.

For example, if my blockchain is in Europe and I travel to the US, would there be a delay in getting that record?

It wouldn't be delayed, but I think if you are in Europe then you have to face things like GDPR. So, that's another question, because it's online, it's there permanently and GDPR has rules around deletion and removals. So how do you handle that? that's another question. The GDPR space is a huge thing. Again, it's another one of my topics I was looking at last year as part of this whole banking/watching thing.

It's an interesting thing because when you think about the GDPR, which is protecting privacy, yet people are pushing blockchain technology, they're pushing open data and those kind of things are against each other to a degree and there's a tension there between them. Right?

Exactly. I think that needs to be resolved before we have a widespread adoption because what you don't want is a push on technology and you know, a year down the road you get it through GDPR, you're fined 20 million euros or something.

Just even the fear of that, what I've seen already is very, very limiting, and actually what you see with GDPR already is, some people take a very protective stance that's overdone. So, that can limit things, you know, so it's all good in development, but there's this, again, the hype or the misunderstanding or convenience.

I think blockchain creates more privacy if it's done correctly. So again, it goes back to how people see things. And how do they define it? So I think we'll see a lot more regulation coming up soon, maybe towards later part of this year or even early next year. So, hopefully there'll be some more guidelines around the GDPR, so then we can make a decision then, but I think that means there's nothing stopping the technologies from going forward and come up with ideas. Again, there are always B2B opportunities, if they are conscious around privacy of individuals.

Is there anything you want to bring up or make a point on that I haven't really touched on yet?

I think the key thing I just want people to realise is that cryptocurrencies and blockchain are two very different things. One is pretty much to act as a lubricant, which is cryptocurrencies. There are opportunities there, there are stable coins coming out and I think is interesting space to think about, but do not confuse it with blockchain technology.  Do keep that in mind. I think there's a lot of misunderstanding out there right now where people, when you say blockchain, they go oh, cryptocurrency. Oh, that's so dodgy. Oh, that's wonderful, I've made so much money. They’re different things. Just keep that in mind, and just bare in mind that I think both have the opportunity to make a huge difference if used correctly.

 

Scott Wagers

"The Consortium Whisperer" Physician and researcher who has spent the last 12 years engaged in developing biomedical R&D consortia, as well as designing and supporting the delivery of consortium based projects.

No matter who you are, you can, and you should innovate through consortia. They are the only way to make a big difference to the future of medicine. Want to find out how? Get in touch.