[NetBehaviour] Fwd: Blockchain-enabled telemedicine service to be piloted with London patients

Edward Picot julian.lesaux at gmail.com
Tue Jun 5 18:49:13 CEST 2018


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/
>>
>>
>>
>
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