Hyperledger Healthcare Working Group (HLHCWG)

The HLHCWG continues to evolve as it grows in membership, participation, and activities. We are in a transitional process to structure the General Workgroup to serve as a “front door” to better engage and keep prospective new members active in the community, align them with resources, and connect them more directly with our three subgroups.

HLHCWG General Meetings are held regularly and are well-attended. While our EMR Subgroup has been slow to establish a regular meeting cadence, both the Patient/Member Subgroup and the Payer Subgroup are meeting regularly and seeing growth in attendance and an increase in repeat member participation.

Of merit, the Patient/Member Subgroup is in active development on a Fabric-based project, the Human Donor Milk Use Case, collaborating with Rapid Healthcare of Irvine, CA. The subgroup team successfully leveraged that project activity into a HIMSS Asia Pacific Innovations Challenge submission in mid-September 2018.

The Patient/Member Subgroup has encountered technical hurdles as they've spun up their Fabric-based project through Github. While some issues skew more towards a lack of clarity in understanding Hyperledger policy as it relates to project management within the Hyperledger namespace (perhaps limitations of Github itself), the overall process has yet to seem fluid and efficient for both leads and project team members. Our team continues to work in collaboration with Hyperledger Project members to gain a better overall understanding of this process.

The general workgroup (HLHCWG) serves as an entrée for prospective members in the global healthcare community interested in understanding how best to educate themselves and participate in the implementation of blockchain technologies–ostensibly using the Hyperledger Project umbrella of frameworks, tools, and extensive community–in order to create secure and healthcare-compliant enterprise solutions. For more established members, the general workgroup serves as a resource for the notification and publication of relevant community healthcare activities (e.g., healthcare conferences), as well as a means for promoting and encouraging the project engagement and accomplishments of each of its three subgroups.

The general workgroup (HLHCWG) holds a regular meeting on a bi-weekly basis on Friday mornings at 0700 (Pacific Time). As a regular agenda item, HLHCWG Subgroup leads (or their proxy) “roll up” their subgroup activities so as to educate prospective new members on active project opportunities.

Membership and activity across the healthcare-wg listserv(healthcare-wg@lists.hyperledger.org) continue to grow. Listserv membership is currently at 1018 members. Our chat channel, #healthcare-wg (https://chat.hyperledger.org/channel/healthcare-wg), is seeing regular daily exchanges.

Active since June, 2018 and led by Marissa Iannarone, the Patient/Member Subgroup continues to work towards a build effort leveraging Hyperledger tools in the healthcare space. We have meetings every other week and we are active in the healthcare working group mailing list (see #patient-member-subgroup and #DonorMilk for details). We aren't seeing a lot of engagement on Rocket.Chat or on the Wiki, but we continue to work to engage folks on those platforms.

While Hyperledger Global Forum application cited in the June update was not accepted, we continue to move the Human Donor Milk Use Case forward. Enough cannot be said about the incredible contributors to this subgroup, and collaboration with Rapid Healthcare has been a great asset as the project continues to grow and mature. A summary of activities are as follows:

• Applying for and receiving the Labs designation and the HubSpot holds the code - Lab approved on 8/3/2018
• We continue working to build requirements (even rather informally) via the wiki reviewing national guidelines and doing independent research in order to understand the network and how Fabric can be leveraged to solve existing challenges
• Subject Matter Experts (SMEs) have been engaged both on the donor bank and Hospital side in order to ensure that what we are building is meeting actual business needs; we continue actively look for more SMEs
• We completed a HiMSS AsiaPac submission for this PoC and we are waiting to hear back - submitted 9/14/2018

Finally, the subgroup lead was asked to be a moderator for a panel at the Hyperledger Global Forum entitled “Public Chain or Permissioned Ledger - How To Choose?” and is looking forward to representing the subgroup and the HLHCWG at the event.

The Payer Subgroup has been actively working since inception in June 2018 and is being led by Raveesh Dewan from CareFirst BlueCross BlueShield. The group continues to refine the use cases and to ensure the right use cases are being picked for POCs. See the activity at https://lists.hyperledger.org/g/healthcare-wg/search?q=%23payer-subgroup&ct=1.

The subgroup meets on a regular basis every Tuesday from 3:00 PM to 4:00 PM EST.

The subgroup started with exploring current problems in the payer industry that can leverage blockchain solutions. The group started having discussion around scoping the activities and decided on two specific deliverables:

• A white paper focused on the challenges with healthcare payers using Hyperledger: this paper will review valid use cases, pick a few use cases and demonstrate how Hyperledger can help
• Creating a POC based on one of the use cases identified in the white paper

We started discussions around various use cases and a number of meetings were dedicated to following use cases:

• Authorizations
• Provider Data Management
• Value Based Care

The subgroup did get a chance to invite various SMEs from the industry to understand the business processes. Thanks to Tony Little, who shared a use case that Optum is focused on addressing the Provider Data issues in the payer industry. Thanks to Richard Cole, Steven Elliott, Chris Cole who shared other use cases that have great potential.

As we discussed these use cases, it became clear that we need to have a decision framework to establish the validity of a use case for blockchain use. Subgroup members decided to come up with a decision framework white paper. The team is activity working through that as of now. While the subgroup team is starting at a general level, it will be later customized for application in the payer industry. Thanks to Jeff Stollman for walking us through the initial decision flow he came up with.

The best part of this subgroup is that everyone is contributing actively.

Active since June, 2018 and led by Robert Chu, the EHR subgroup has kicked off its activity with its two first meetings. The EHR subgroup has agreed to structure its work in three phases:

• Describe the EHR blockchain use case
• Define a reference architecture for EHR blockchain systems
• Provide a framework and process for open-source code contribution with the reference architecture

The subgroup will hold calls every two weeks. Calls are recorded and recordings are made available to the subgroup. External subject matter experts to the group will be invited to provide a perspective on particular aspects.

Upcoming activities planned by the general workgroup include:

• A revision of the HLHCWG Charter: the original charter was drafted in 10/2016, and does not include a number of sections that have since been added to the charter draft. A planned review of the HLHCWG mission statement/scope is also anticipated
• The establishment of regular speaker presentations from across the healthcare community to provide “real world” experiences in the design, implementation and establishment of a Hyperledger Project solution within their enterprise context.
• A redesign of the HLHCWG Wiki in order to:
  • Provide a more meaningful “front door” experience for new members to quickly discover HLHCWG resources and subgroups
  • For established members, serve as a dashboard of activities and accomplishments
  • Better separate (and highlight) our subgroups (where the real action is) from general WG coordinating activities/governance

The Patient/Member Subgroup will continue to to work on the donor milk use case through next quarter, finalizing the PoC, and then looking at expanding to additional use cases. This work will include building/refining requirements and building the code base.

Activities planned for the next quarter include:

• Continue working on a white paper on the General Decision Framework and Decision Framework for Payer Industry (target for completion in Q4-2018)

Future plans:

• Start working on a white paper around Challenges with HealthCare Payers and HyperLedger/Blockchain (target for completion in Q1-2019)
• Apply and select a use case for POC and execute a POC
• Presentation of the Decision Framework and POC at various events as we progress

We will soon be looking for members who can help with the coding of the POC.

For the next quarter, the subgroup plans to deliver a 10-15 page document describing the following for its EHR blockchain use case:

• Benefits of storing/indexing EMRs in blockchain
• Impacts for the healthcare ecosystem: patient, providers, care centers, pharmas, payers, authorities, changes in data governance
• Incentives, impact on the current patient data economy, use of tokens
• Benefits/challenges vs privacy compliance: HIPAA, GDPR
• Impact on government regulation
• Challenges: EMR fragmentation, standards, interoperability, availability/access to EMRs, Master Patient Index, size of data in transactions
• Use of standards: HL7
• User interface considerations
• Timing for deployment

This is a very diverse membership with global representation (including, but not limited to, member participation from England, Canada, and India). The majority of membership represents corporate healthcare entities, though we do regularly see regular (and perhaps increasingly so) participation from smaller healthcare startups.

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