区块链赋能大健康

区块链赋能大健康
Blockchain Empowers the Health Undertaking
香港国际新经济研究院高级研究员付饶
Senior Research Fellow of Hong Kong New Economics International Institute

随着老龄化社会到来，就诊人数逐年增加，重复检查却时有发生，诊疗效率不高情况明显。由于医患互相不信任，暴力伤医和劣质医院竞价排名高等现象突出。医疗机构或患者骗保现象屡禁不止，医院和保险机构的沟通机制也亟待提升。而区块链的分布式、不可篡改、可追溯等特性能够帮助解决这些痛点。
As we are entering the aging society, more patients are visiting hospitals and clinics. Duplicated physical examinations occur from time to time, with low diagnosis and treatment efficiency. The distrust between doctors and patient leads to violence towards doctors. What’s worse, the paid listing of low-quality hospitals is getting prominent. The insurance fraud conducted by hospitals or patients is not new in China and the communication mechanism between hospitals and insurance institute is desperately needed to be improved. The attributes of decentralization, temper-resistance and traceability put the blockchain in the right position in dealing with these pain spots.
提高诊疗效率方面，IBM Watson与美国食品与药物管理局 (FDA) 签署了一项为期两年的协议, 以探索区块链技术在安全共享病人数据方面的应用。上链的数据来自医疗记录、临床试验、基因检测和移动设备等资源。肯尼亚国家公立医院搭建了区块链平台, 可从中查看患者病史、医疗资源的使用情况，以及医务人员管理等数据。某小医疗点的护士可以在其他大型医院里获取相关医生的建议而为患者进行治疗。2017年8月中旬, 中国的阿里健康与常州天宁区卫生计生委合作“医联体+区块链”试点项目。该市卫生计生委把各个医疗机构产生的数据信息登入区块链,确保每个数据提供方的每条数据都可信并不可篡改,通过数据共享互惠机制避免形成医院数据“孤岛”, 形成利益共生环,还可精准定位医疗敏感数据的全程流转情况等。
To raise the efficiency of diagnoses and treatments, IBM Watson and the Food and Drug Administration signed a two-year agreement to explore the application of blockchain technology in securely sharing patients’ data. The data updated to the blockchain comes from medical recorders, clinic trials, gene detection, mobile devices and so on. Kenya’s National Public Hospital built a blockchain platform, where people could check the data including the patient’s medical history, the use of medical resources and the management of medical staff. In this way, the recommendations from doctors of bigger hospitals will be made available for nurses from a small medical aid post to treat patients. In mid-October, 2017, Ali Health and the Health and Family Planning Commission in Tianning district Changzhou co-initiated the “Health Alliance + Blockchain” trial. This Health and Family Panning Commission registered the data from several medical institutions on the blockchain, to make sure every data file from every data provider is credible and temper-resistant. By using the data sharing and reciprocity mechanism, we can prevent the hospital’s data from becoming an “islet”, thus creating the interests symbiotic system, accurately positioning the transfer of sensitive medical data and so on.
人工智能和医疗数据上链相结合也是区块链赋能大健康的研究热点。或许在不久的将来, 我们可以用可穿戴设备、健康管理App、智能家居等智能软硬件, 实时上传个人的体征数据, 获得人工智能医生给出的健康管理建议和诊疗意见, 非常方便地获得医生、医院、保险公司、基因检测公司和健康管理机构提供的各项专业服务。
The combination of AI and medical data update is another research hotspot in using the blockchain to power the Health Undertaking. Maybe in the near future, we can use smart soft and hardware like wearable devices, health management apps, and the smart home to update our personal sign data and receive the health management and treatment suggestions from the smart doctor. It will be much easier to access different services provided by doctors, hospitals, insurance agents, gene detection companies and health management institutions.
解决医患关系方面，患者端，如果区块链的数据库精确高效地记录下患者每一个生命体征、所有曾用药物、每次就医信息、疾病、手术和其他信息, 可大大减少医疗机构的运作时间、成本和风险, 同时实现精准策略制定、高效资源利用、靶向产品对接有效市场等, 提升患者的就医体验。医药端，从医疗教育开始到医生整个职业生涯，将医生的相关重要信息上链，建立医学生信用体系、医生从业信用体系；药品生产流通过程溯源上链，以供鉴别真伪。相信以上种种措施将极大缓解目前的医患互相不信任的问题。
To defuse the medical conflicts, at the patient end, if the blockchain database accurately and efficiently records every vital sign of the patient, all used drugs, medical information of every treatment, diseases, surgery and other information, the operation time, costs and risks of medical institutionswill be greatly reduced, and at the same time we can achieve precise strategy planning, efficient resource utilization, targeted products and effective market coordination, etc., to enhance the patient’s medical experience. At the medical industry end, from the beginning of medical education to the doctor’s entire career, the doctor’s relevant information will be updated to the blockchain and a credit system for medical students and a credit system for doctor’s practices will be established; the process of drug production and circulation will be updated through source tracing for authenticity. I believe that the above measures will greatly alleviate the current mistrust between doctors and patients.
在医院与保险机构沟通方面。如果患者的电子病历、电子处方以不可篡改的形式记录上链，患者的身体数据是由前述可穿戴设备、智能家居等设备自动上传，相信将大大缩短保险理赔的真实性，提升效率，恢复信任。
In the communication between hospitals and insurance companies, if the patient’s electronic medical records and electronic prescriptions are recorded in a non-tamperable form and the patient’s physical data is automatically uploaded by the aforementioned wearable devices, the smart home and other devices. It is believed that the insurance indemnity process will be greatly shortened, the authenticity and efficiency will be improved, and the trust will be restoredaccordingly.
医疗区块链落地难
It’s Hard for the Medical Blockchain to Land
虽然如前所述医疗+区块链有广泛应用及光明前景，但目前落地项目寥寥。究其原因，有数据安全性、技术挑战、政策风险等。笔者认为，在区块链赋能大健康的过程中，有几个核心原则需要注意。其一是数据安全性优先。患者本人需拥有数据的处置权，应由患者决定数据是否披露、披露程度，数据的使用方有义务保证数据不被泄露。其二是应有数据的管理标准或框架，如“谁使用，谁付出成本；谁产生数据，谁获得收益”，以供相关产业链的良性循环。其三是区块链与人工智能、虚拟现实等其他技术相结合。健康问题维度众多，种种矛盾和痛点并非区块链一种技术可以解决。但解决相关问题需求迫切，唯有多管齐下，方能尽快促进健康产业健康发展。
Although the medical + blockchain has a wide range of applications and bright prospects as mentioned above, the current landing project is rare. The reasons include data security, technical challenges, and policy risks. The author believes that there are several core principles to be aware of in the process of blockchain empowerment. Firstly, we should put data security top on our agenda. The patient himself/herself must be offered the right to dispose of the data. It is the patient who should decide whether the data is disclosed and to what extent, and the user of the data is obliged to ensure that the data won’’t be leaked. Secondly, the management standard or framework of the data should be established, such as “who uses, who pays the cost, who generates the data, who gets the profit”, so that a virtuous circle can be established in relevant industry chain. Thirdly, we should combine blockchain with other technologies such as AI and VR. Health-related problems are multi-dimensional, and with various contradictions and pain points, blockchain technology isn’t able to solve them alone. However, there is an urgent need to solve related problems. Only by taking multi-pronged approaches can we promote the healthy development of the health industry as quickly as possible.