专访 Jason Goldwater：区块链可以解决哪些医疗问题？

The Blockchain Interview with Jason Goldwater

Jason Goldwater

公共管理学硕士，华盛顿全美质量研讨会高级主任

What healthcare problems can blockchain solve?

区块链可以解决哪些医疗问题？

There are three, initially, that it has the potential to solve.

应用伊始，区块链有潜力解决3个方面的问题。

First is access to data. The way that systems have been set up in hospitals or large integrated physician networks is that the data will either reside in a centralized server or now the trend is to reside it in a cloud.

首先是解决数据访问的问题。在医院或大型综合诊疗网络中建立系统的方式中，数据要么存储在集中式服务器中，要么就按当下的趋势上传到云储存。

Blockchain is very different because it is what is known as distributed ledger technology. Essentially translated, that means the data is not all residing in one place. The data is residing in various different locations. Every time a change to the data is made, that change is reflected across all the locations of which the data is stored. If there are going to be threats or hacks to data, it’s easier, to some extent, to hack into a centralized location to find a large amount of patient-generated data, whereas it’s more difficult to be able to get a large amount of patient data when it’s distributed across a large number of networks.

区块链就非常不同，因为它利用了所谓的分布式分类帐本技术。从本质上讲，这意味着数据并不都滞留在一个地方。数据储存在不同的位置，每次对数据进行更改时，该项更改都将反映到存储数据的所有位置上。从某种程度上来说，侵入一个中心化的区域来查找大量数据漏洞进而攻击数据会更容易得多，然而想要从分布式广域网络中获取大量数据漏洞却并不轻松。

The second thing it potentially has the possibility of helping is in the area of interoperability. That’s where most of the attention has come from with respect to blockchain. A lot of individuals are looking at this as possibly a solution to the problems of interoperability over the years, Some have even gone so far as to label it as panacea of sorts. I don’t think it’s that, but I do think it has far-reaching potential to help with interoperability because it allows data to flow in whatever syntax and whatever structure to be stored across locations.

其二，区块链在互操作性方面具有潜能。人们对区块链的关注度大部分源于此。许多人认为这可能是多年来互操作性问题的一个解决方案，有些人甚至把它当做“灵丹妙药”。我不认为真有那么灵验，但我确实认为它在互操作性方面具有深远的潜力，因为它允许数据以任何语法和任何结构在不同位置之间流动。

If a provider, care team member, patient, or a patient’s family needs access to that data, the data can be delivered through the blockchain to whoever is requesting it as long as authorization has been given by the individual of where that data came from. If I’m the patient and you’re a doctor and you need to see my complete patient record to help aid in decision-making for a particular diagnosis, and I grant you access to the blockchain, then you’re able to get all of the data that has been stored. Regardless of how it is structured, you will be able to access all of that data and potentially use it.

如果数据提供方、护理人员、患者或患者家属需要访问该数据，只要数据来源方授权，数据就可以通过区块链传递给任何申请数据的人。如果我是病人，你是医生，你需要查看完整的病历记录来帮助你做出诊断，而我也允许你访问区块链，那么，你就能得到所有的储存数据。不管数据结构如何，你都能够访问所有数据并使用它。

The third biggest potential for blockchain, is that it can help move forward the idea of patient engagement and patient empowerment. The emphasis now is that with the amount of technology that’s around us, we’re generating more data than we ever have before, through wearable technologies and through portals. Even through genomics, with organizations like 23andMe, where you can get an entire genetic profile that you then have and can then send off to whomever you so choose.

区块链的第三大潜力，是它可以帮助推进患者参与和患者授权的理念。现在的重点是，随着越来越多新兴技术的诞生，我们通过可穿戴技术和门户网站创造了前所未有的数据量。甚至通过基因组学，通过诸如23andMe（加尼福利亚一家基因测试公司）这样的组织，你可以得到一个完整的基因档案，然后你可以选择性发送给任何人。

If I’m a patient and I have data that I’m able to view, and you’re a provider and you want to view that data, or you want to examine that data and then work with me on how to improve particular aspects of my health based upon what you’re reading. You could help me interpret what that information means. I would be able to look at that data on a regular basis to be able to see if I’m making improvements. As long as I’m authorizing you to be able to examine the data, then you’re able to look at that and then work with me on aspects of health that need to be improved.

如果我是一个拥有可查看数据的病人，你是一个想查看数据的数据提供方，或者说你想和我一起查看数据，然后和我达成合作，你根据查看到的内容来改善我的健康状况。你可以帮我解释数据信息的医学含义，我则可以定期查看这些数据，以判断自己的健康是否在改进。只要我授权你检查数据，你就能看到数据，然后帮我一起改善健康方面的问题。

Every time that data changes, the blockchain changes. Since I’ve authorized you to have access to that blockchain, you’re viewing that data as it’s changing. You can then view and see exactly what changes are being made in my health as a result of activities that I’m doing.

每次数据发生变化，区块链就会随之改变。因为我已经授权你访问区块链，你可以看到数据的波动。然后，你可以查看并确切地分析出，我所从事的哪些活动导致了这些变化。

Profit and legislative mandate drive much of what happens in healthcare. Who would benefit financially to move forward with blockchain？

盈利和立法授权驱动着医疗保健的发展。谁会在经济上受益于区块链呢？

Where blockchain can assist in value-based care is that if you have a distributed ledger where data is going to be shared across a number of areas, you are authorizing the blockchain to receive the data, and you’re working with your provider to be able to look at that data on a regular and continual basis, the provider can understand what needs to be done in order to improve the outcomes of your health and what processes need to be taking place. That, in turn, then meets the value threshold for reimbursement. As such, by doing that, they’re able to continually examine and understand a patient’s health in a way that they may not have been able to before. Because it usually relied upon a patient coming in, or in some cases having a virtual visit, and they would diagnose and look at the patient then and be able to prescribe the appropriate treatment protocols.

如果你有一个分布式账本用以数据的跨域共享，区块链可以提供基于价值的护理，你授权区块链接收数据，你和你的数据提供方协作，定期并持续地查看数据，数据提供方就可以知道为了改善您的健康需要做什么，以及需要进行哪些过程。这就满足了偿付的价值门槛。因此，通过这种前所未有的新方法，他们可以不断检查和了解病人的健康状况，因为它通常依赖于病人的到来，在某些情况下通过虚拟访问，自动诊断并观察病人就能够开出适当的治疗方案。

With blockchain, you’re taking a large amount of data, personally available data that patients are generating, and being able to look at that on a regular and continual basis to drive better outcomes of care, which then in turn drives value. That’s the first thing.

有了区块链，你就拥有了大量的数据——病人产生的个人可用数据，并且能够在定期和持续的基础上观察这些数据以达到更好的护理结果，然后反过来驱动价值，这是其一。

The second thing is the market dynamics are changing. Twenty-some odd years ago, it was a pretty basic concept. A patient would come in, they would say, "This is wrong with me," or they would come in for a regular checkup. They would be diagnosed and the provider then would recommend the appropriate medications, treatment protocols, whatever it may be. The only data that was generated at that point was the data that was generated during the encounter.

其次，市场动态正在发生变化。二十多年前，这还是一个相当基础的概念。病人进来会说：“我哪哪有问题”，或者他们来做常规体检。他们会接受诊断，然后医生推荐合适的药物，治疗方案等等，以至于在特定阶段（生病或体检期间）才生成了唯一的数据。

That is not the case any more. The data is being generated everywhere. There is more data available for a patient than there has ever been. It’s not just the data that would come from wearables, portals, and smartphones, it’s also the data that’s available on social media sites, where patients write very eloquently about their health. It’s available through validated instruments that they have filled out over the course of their care. It’s available through sites like PatientsLikeMe that store an abundance of patient-generated data. 

现在，数据的生成已经摆脱了传统模式，数据随处而生。一个病人产生的数据比以往任何时候都多，不仅仅是可穿戴设备、门户网站和智能手机上的数据，还有社交媒体网站上的数据。在这些网站上，病人们滔滔不绝地讲述自己的健康状况，可以通过他们在护理过程中使用的精确仪器获得数据。上到诸如PatientsLikeMe等网站，可以获取存储其中的大量患者数据。

Blockchain allows the data to be distributed across a variety of locations, but the benefit of that is that the patient and the provider both have access to it. I have to authorize you to look at that, and every time that data changes, every time on a daily basis, if things begin to change — my heart rate changes, my blood pressure changes, my mood changes, I’m not exercising as much, I’m not taking the medications I need to be — that data is updated and sent to the provider on a regular basis.

区块链允许数据分布在不同位置，好处是患者和数据提供方都可以访问数据。我授权你查阅数据，每次数据变化以及每天的波动，如果情况有所改变——我的心率、血压、情绪的变化，我锻炼少了，我不按时服药了……数据都将更新和定期反馈给数据提供方。

If the provider understands that they’re going to get that data on a regular basis and that it will aid in the decision-making, that they can put that data into an EHR and send that data around to provide access to that patient’s care, and understand that that data is then available to not only aid in decision-making, but to provide the impetus for better decisions — because the value based market is demanding that — then certainly that’s going to be an impetus to push towards better interoperability and better use of the data.

如果数据提供方知道他们会得到定期的数据，这将有助于决策。他们可以把数据转换为电子健康档案，并将数据发送至周边以提供对患者数据的访问，如此一来，这些数据不仅可以帮助制定决策，而且可以为更好的决策提供动力。因为基于价值的市场有这样的需求——那么，这势必成为推动良好互操作性的动力，人们也能更好地利用数据。

Does blockchain provide enough scalability for them to be able to increase the amount of data they can have for a patient? Does it provide the ability to exchange data across partners that could access that where they could either add to the blockchain or they could use the blockchain to help provide care for the patient? 

区块链是否提供了足够的伸缩性，以存储患者增加的数据量呢？它是否提供了在合作伙伴之间交换数据的能力：这些合作伙伴可以访问并添加内容到区块链，又或利用区块链为病人提供护理吗？

Now let’s start to look at the access security issues with respect to blockchain. That’s always going to be a paramount issue. The real thrust right now is for patients to have access to data. It’s the patients’ data. They should have access to it and they should be able to engage in a shared conversation with their provider using the data to understand their care better and for the provider to work with them on what needs to be improved. Understand how blockchain can improve access security between the provider getting data and the patient getting data and how that dynamic would change. How that dynamic would improve outcomes, enhance patient care, and enhance patient engagement, which is another part of this value-based dynamic.

现在，让我们来看看区块链的安全访问问题。这一向是非常重要的问题。现在真正的推动力是让病人能够获得数据。对于病人自己的数据，他们应该能够访问它，并与数据提供方进行共享对话，利用数据来掌握现有的治疗并一起进行完善。我们要了解区块链如何提升数据提供方和患者获取数据的访问安全性，以及动态的变向——这种动态如何改善数据结果，改进病患护理，提高患者参与度，这是基于价值动态的另一部分。

They really should also look at their data and their data privacy. How is their data stored? How is their data encrypted? How is their data protected? Is it vulnerable? Does it have the potential to be accessed and hacked? Is there a potential for a breach? No technology will solve that completely, but blockchain provides a greater ability to be able to protect data because it’s not stored in a centralized location. It’s stored in a peer-to-peer network.

人们真的应该关注自己的数据和数据隐私。他们的数据是如何存储的？他们的数据如何加密？如何保护他们的数据？数据是否易受攻击？它们有可能被访问和攻击吗？是否存在潜在漏洞……没有技术可以完全解决这个问题，但是区块链提供了更大的能力来保护数据，因为数据并不存储在一个集中的位置上，它存储在点对点网络中。

The EHR on the blockchain can be access control manager. Who gets access to the data? What data flows into it? Does that significantly improve what they already have? If it does, then it’s a solution worth considering, because it can scale upwards in the ability of for them to not only gather more data, provide more data to the patient, and be able to exchange more data. It not only addresses better access security between the provider and the patient, but it may also improve privacy overall. Rather than the data being in a centralized location — whether it’s a cloud storage system or whether it’s in a centralized server — a distributed ledger provides a better mechanism by which data privacy can be maintained.

区块链上的电子健康病历可以成为访问控制管理器。谁可以访问数据？哪些数据流入其中？是否显著改善现有状况？如果是这样，那么这是一个值得考虑的解决方案，因为它可以扩大他们的能力，不仅可以收集更多数据，向病人提供更多数据，还能够交换更多数据。它不仅解决了数据提供者和患者之间的访问安全性问题，而且有望全面提高隐私性，因为分布式分类帐提供了一种更好的维护数据隐私的机制。

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本文来源于数据观，编译/黄玉叶，编辑/方茶云，转载请注来源。