 So good morning, Michael. How are you? Good. How are you today? All righty. Glad to have you on your call. And let's see what I'm going to, I think what I'm going to do is I'm going to make you a co-host. Right off the bat. And then in theory, I can hand over to you or if you'd like, I can just drive your presentation from here. I probably instead of me telling you when to click, it's all I can just run it. Okay. That'll be our backup. Okay. Well, good. Well, we're just at the top of the hour. So let's get started. First off, thanks everyone for joining us today. This is the hyperledger healthcare special interest group. We're thrilled to have Michael Marchand as our guest speaker. But as always, I want to get started with a couple of administrative things. First and foremost, we are recording this. And so just keep that in mind going forward as well. And this is true for all aspects of hyperledger. We do have an anti-trust slide and you see that up on the display. And feel free to read through that. But the upshot of that, of course, is just be a good person. So that's, that's what I will say to that. And there's a URL. If you feel free, if you feel engaged to sort of dig into that, feel free to parse that a little more specifically. We do have, I think a couple of new folks on the call. We usually like to have any new members or people that are visiting, just introduce themselves if you feel comfortable in doing so. So I'll just open it up. Anyone on the call would like to introduce themselves and talk a little bit about their, their background, professional background, and their interest in using hyperledger technologies to solve problems in healthcare. Hi, Jim Mason here. And I've been on this group before, but I'm deferment for a while due to work. But now that you move the time to 10 a.m., it makes it easier to attend. Oh, great to have you, Jim. Yeah. And the focus I have has always been hyperledger earlier on fabric, although the supporting projects as well. And then I really work more in the automotive space, but I did a comparison with sort of our problems around data management, privacy and all that. And it has about a 95% overlap with healthcare as well. So it's always worth tracking what's going on in the healthcare side, because we had the same, most of the same issues, insurance, payments, privacy, all that kind of stuff. So anyway, that's why I'm here. Thanks. Great. Great to have you, Jim. And yeah, I do recognize your name. And, and great to have you on the call again. Thanks for that. Anyone else that's new to the call want to talk a little bit about yourself. Nobody else. Okay. And I suspect we'll have folks getting on the call as the, as we get into the hour here. I do want to say a good morning to Erica beer bower. She's, she's our vice chair for, for the hyperledger sick. Good morning, Erica. How are you? Good morning, Rich. I'm great. How are you? Good. You're out of Colorado, I think. Yes. Denver. And how much snow on the ground? I thought there was, you had snows in the foothills. We got about a foot. It's melting now, but yeah, we, there's still quite a bit of snow on the ground. That is the season. Good. Glad, glad, glad to see on the call. Thanks. Glad to be here. Okay. Anyone else on the call want to say hello. Alrighty. Well, a couple of the things if you are new, or you haven't already participated, we do have a membership directory. So feel free to participate in that. What you'd want to have is your Linux ID to be able to get to this page and edit it directly. It's a great way to sort of connect with other members on, in the special interest group as well. If you ever have questions, we have a, we have a faq and FAQ. And so feel free to walk that if you've got questions. Or as always, you know, you can contact me. We also keep a list, listserv as you probably already know. And, and also chat, which is through rocket chat. And again, that's a great way to keep in touch with members, members sort of in real time. Well, with, oh, and I did want to mention, we do have community announcements. Primarily, we have our hyper electric global form happening. That's happening next early next year in March. That's in Phoenix, Arizona. And we're in the process of trying to put something together for this HCC form, this, this group particularly. And we're working on, on that at the moment. At least several members are trying to, to get speaking engagements queued for this. So their proposals are out. This is our annual global forum. And again, it's going to be centered around hyper ledger specifically. And so all things hyper ledger, which to us should mean all things blockchain technologies. And of course, we have our interest in, in the healthcare space. So feel free to take a look at that. And it'd be great to see you at that Phoenix event early March of next year. And if I'm thinking correctly about a week or so later is the HIMS conference. So it's going to be a busy March for some of us. Okay. Well, I'm thrilled to have Michael Marshaunt from UC Davis Health joining us this morning. I, I think it was actually a HIMS sponsored webinar that I attended where Michael was speaking. I want to say maybe June, July timeframe. And I thought he'd be a great person to join us. For the sake of HCC membership to talk a little bit more about the work that he's doing in the healthcare space as it relates to a broader spectrum of interest, which is health information exchanges. And well, I'll say HL seven. I think you, Michael, you touch on some fire issues. And then we'll talk a little bit about a sort of your view on how blockchain technologies might have influence on some of these sort of day to day technologies that we deal with. As it relate to HIEs and interoperability in general. So first of all, good morning, Michael. Thanks for joining us. Good morning. And feel free. Yeah. And feel free. Do you want to just sort of take over, take over the screen? And I think you should be able to sort of pick it up from here. And again, if we have any technical issues, we have our backup in place. So we're good to go. Are you giving me control rich or am I, I'm asking for control, but it's telling me you're, you're, you're rejecting it. So. Oh, well, that's odd. I do it one more time because it should, I got an okay. Well, here, I'll make you a host and see if that works. Okay. So, so you are officially host at this point. All right. Still not letting me change the view to mice. You know, let's see this. Now let me know if you can see my title slot. Yep. Great. Appreciate it. Well, I'm, I'm appreciate your time this morning and I'm, I'm happy to share my insights and perspective on health information exchange. And where I think blockchain is a, a great technology and a good fit for especially use cases today where we don't do very well with exchange. So by presentation today, we're going to take a look at the, the current state of exchange and health information exchange. I don't really know what the framework or background of the, of the audience was. So I had, I've got some interest slides to just kind of explain health information exchange as it exists today and some of the standards and frameworks that we're using to do that exchange. And then I go into some of the use cases around things that I'm aware of with blockchain. And then one specific use case that I'm very, I'll call passionate about around patient mediated exchange and how blockchain might be able to not only allow for that capability to happen, but also help with the leveraging of consent, the consent models that are available and some of the other things that blockchain will do that again are limited in the current way. Exchange happens today. So as opposed to, I'm not going to, I'm not going to, I'm not going to read through. I think you have that on the excuse me. I've got a little bit of a cough. My extensive background again, not reading through it all, but the biggest piece for this group is that I'm on the hymns blockchain task force that's chaired by David holding from Microsoft and Heather Flannery from consensus. We have regular meetings and are creating publications to kind of, to help give the health care industry. I'm not going to, I'm not going to read through. I think you have that on the excuse me. I've got a little bit of a cough. So that's thinking about the health care industry, some guidance and some background on blockchain and the technology and really helps shape the hymns. I'll say the hymns opinion or hymns membership around where the best uses of blockchain is and how to move forward with the technology and the organization. I've been in Sacramento for over 25 years. I was with Southern for about 12 in a similar role as the director of integration and that I am here at UC Davis, UC Davis Academic Medical Center. So we have the hospital here in Sacramento, we have a medical school where we're training physicians and clinicians, and we also have a large research arm. So we have a significant amount of R&D work that we do that we're looking at blockchain as possible solutions, especially around research and research consent. Nothing that we're doing today, but part of my responsibility at Davis is to make sure as new technologies, especially technologies that exchange data come into practice that we're familiar with the technology and understand as vendors show up with solutions to how we might implement that with our technologies. Again, I'm just going to go through from a agenda standpoint overview of the current interoperability options in states and standards. One of the hot, this is an industry joke, but the hot topics around exchange and healthcare is fire, which is fast healthcare interoperability resources. So you'll hear a lot of fire-based jokes. It's essentially a move industry-wide to more web, open web API exchange than what's happening today. It's pretty nascent. There's some leading organizations that are doing it, but it's not pervasive as of yet. A majority of the exchange that happens today is with more of the older technologies and exchange standards, but we'll be seeing a large growth of that and I'll talk about that a little bit. And then we'll talk through some of the blockchain pieces that I'm aware of, some of the use cases and give people a good perspective of what I, again, my opinion on where blockchain fits in best. So really what I wanted to do again, just some level setting, health information exchange. For us, there's kind of what I'll look at it as too is there's a noun, there's a health information exchange as a company. So you'll have there's probably 50 or 60 of these throughout the United States. In California, I think we have 20 or so health information exchanges from the San Diego Beacon community, Santa Cruz, Redwood, MedNet, Lanes, LA exchange in Orange County, Manifest MedEx. Essentially, these are organizations that are stood up to connect a community. They create a centralized hub. Everybody feeds into the hub and the hub feeds out to the community. There's also health information exchange, which I call the verb, which is the action of exchange, which is what we do here at Davis. So we're not connected to a noun, we're not connected to a health information exchange company, but we leverage the national networks and standards to connect with physicians and clinicians in our community and exchange north of a million records a month outside of the four walls of our organization. And essentially part of this is just making a decision of how technically competent is your organization? Can you actively pursue deploying those standards or do you need help? How do you create the point-to-point solutions? Or do you need to have a hub that creates those for you and can you support them? From a national exchange standpoint, there's multiple national networks today that we're connected to. eHealth Exchange is a national network that's handled by the Sequoia project. If you're familiar at all with the legislation, the technical legislation 21st century Cures, the Sequoia project has actually been tapped as the coordinating entity for creating a national network of exchange. They currently provide oversight and governance around the eHealth Exchange, which connects the government entity to security VA. It also provides us an access or a port to connect with dignity health and DaVita. Then there's also another national network that was spun up again by providers and caregivers and vendors called Care Equality. It leverages the IHE profile to do exchange for clinical context documents. It's a query and request and respond type network similar to Commonwealth. Essentially, there was a VHS beta paradigm here with these exchange networks. Care Equality was more of the VHS, probably a little more homogenized across the industry. Commonwealth might have been a little bit better model, but it wasn't quite as well adopted, so that's your beta. At this point, all the national networks are moving forward with the Care Equality model and exchange framework. You'll hear Commonwealth talk about them being a Care Equality implementer, same thing with eHealth Exchange. They're a Care Equality implementer, so if you're connected with one of those networks, you're connected across the industry from an exchange standpoint. Then direct is a standard that's been out for a long time. It was part of the meaningful use measures back in 2010. Essentially, it's a secure email protocol that allows clinicians and providers to exchange information using a push methodology as opposed to the query respond. It gives people a little more flexibility of what documents they exchange and how they exchange them. From an organization standpoint, what you have to do is figure out what your needs are. How do you leverage those standards? What do you want to do? That gives you some idea of what standards that you want to implement. Is it position to physician, position to patient, ensure how will the data be consumed? Is it discreet or not discreet? Part of the reason I'm going through this is really that's the same sort of mindset as you look at a blockchain use case of who's the consumer? How will they consume the information? Blockchain as a technology is very good at a federated data model where you have multiple endpoints with data sets that are somewhat shared across that entire federation. Understanding how a consumer, let's just say a patient, how would a patient plug into a blockchain consortium or what would be their leverage point or their fulcrum point to get access to or the ability to provide consent to data. When you're looking at blockchain solutions, you're looking at who are the people that are going to administrate it? Who are going to be contributing to those records? Who's going to provide access to the chain? What types of data do you store on chain? What I've done here is just kind of giving you a sense of what standards apply for these particular use cases today, whether it's provider to provider, consumer or insurer and which ones are supported throughout the industry. From an HL7 standpoint, so HL7 is the standards body that has defined most of the standards relating to exchange today. Essentially, pipes are limited ASCII techs where the HL7 organization went through, they identified trigger events and things that essentially as you go through an activity in electronic health record, what information do you want to exchange and how you'll exchange it. They created a specification that identifies segments, fields, essentially the data elements that will go in based on the event that occurred in the software. From ADT, so what you're seeing on the screen as an ADT is a patient demographic transaction. It means admit discharge or transfer, so that's a function in the hospital. If a patient's admitted, then you have a transaction which is AO1. The message that you see at the bottom of screen or the format, essentially as you're looking at the MSH segment, that's the message header, it'll tell you what the transaction and transaction types are as you see in the little circle. This is ADT AO1. That's the event type and that lets the consuming side of the transaction know what date is coming, what event occurred and understands the standards and segments that are applied. This is the pervasive, the currently, the current and most pervasive way version 2, so here V2 HL7. That's most of the exchange happening within organizations today in healthcare. So if I'm trying to send patient demographic information, order information, result information between systems inside my organization or even outside of my organization, this is probably the most pervasive standard that we have today. I have a V2 interface that I implemented at Sutter in the 90s that's probably still running today. So part of this transition and from an industry standpoint to more federated data sets, requests and response and some of the more web API standards are things that are starting to be adopted, but it's going to be a long time before this version and standard is retired. Version 3, version 3 was an effort to remodel the transaction sets kind of back in the 90s. The one that adopted it the most heavily was our pharmacy modules. So if you hear about share scripts, which is the national organization that handles electronic prescribing, they implemented a v3 standard for that prescribing methodology. So if a provider creates a prescription, sends it off to a pharmacy, the messaging standard that's leveraged through that is usually v3. It has heavy adoption in Europe, not a lot of adoption here in the States, again, mostly because of some of the care models and some of the infrastructure and things in place. Part of meaningful use was to facilitate document exchange. So you'll see clinical document architecture or a CCD, a continuity of care document, and essentially that's the document that gives you a full range of information for a particular transaction set. So if you have a history and physical or a discharge summary or a particular document that gets created in the EHR from a care interaction, the old standard didn't quite provide enough framework to capture all that. So this standard supports a newer way of exchange, a more full exchange that allows providers to give us a more of a summary of care as opposed to a specific item of care, like a radiology result or prescription or an order or patient demographic information. And most of the exchange that happens between organizations today across those national networks is a CCD document that has problems, meds, allergies, advanced directives, and some clinical notes embedded in those transaction sets. These are all, you know, XML based transactions that you'll see the tagging so you can human readable format that you'll see in that exchange frame. And again, just to give you another opportunity to kind of see how what the setup in the markup is for these transaction sets. It's pretty straightforward. It was really kind of the first move by HL7 to a more of a web standard, as opposed to, excuse me, as opposed to a de facto or custom standard that they created. So from an industry standpoint, you're here, you hear a lot of talk about AI and NLP and machine learning. I think that the conceptually the amount of data and healthcare that get created in an exchange, we have what I call a very much a redundant data strategy. We take the same information, copy it across for multiple organizations and systems. So the idea of federation again, a consortium is really something that needs to be looked at because we are copying and we don't, we essentially don't know what the source of truth is anymore. So with this a significant amount of data increase and everything being electronic, leveraging these tools can help provide a little more insight to clinicians to overlay some of these technologies over the significant data sets. We're starting to see some inroads mostly in research today, but I think that as those research use cases bear some fruit, you'll see some of those AI and NLP capabilities being wrapped into your EHR technology and helping the clinician who's in front of the patient sort through the mountains of data that might be in a patient chart and provide some better insight into that large data set during a care transaction. The FIRE standard, again part of the concept with FIRE is that it's unlocking the data. So historically the EHR vendors have had their data in their database and it's been very difficult to get out. A lot of the regulations have essentially required the vendors to make web APIs available. FIRE is the standard that HL7 has created that it gives people some framework around what those transactions and transaction sets look like. Obviously blockchain, there's getting more and more of a footprint in healthcare of organizations that are doing blockchain use cases. A lot around pharmacy supply chain and directory services. At least those are the ones that I've run into that people are actually doing and I'll talk about that a little bit. And then patient mitigated or mediated exchange, again looking for something where a patient has access and control and I think this again is where blockchain can come in if we have the right framework and the right UI that a patient can engage and manage the access to their record, provide consent to different organizations and different use cases for their information. And again the use case I have at the end will kind of walk through at least my vision of what that might look like. So this is a graph that just talks to you about the different standards. So I've talked about B2 HL7, that's your kind of PO line there, the adoption and as we move forward there are less and less of those being implemented. You've got the CDA, the purple line there. That's really again kind of tied in with meaningful use and the significant adoption curve essentially to get the meaningful use dollars that were farmed out in the healthcare industry. V3 similar. And then as you can see the timeline moving forward you see those HL7 fire integration. So the projection is these web APIs are really going to become the pervasive exchange standard within healthcare. Again hype cycle, I think you've probably seen the Gartner hype cycle. I just share this because this is from 2017 specifically around different technologies. If you look kind of on the down slope of the curve as we head to the trough of disillusionment blockchain is kind of falling into that and I think that there's after all the hype I was at a HIM session two years ago and it was standing room only for a room of 400 about just kind of general concepts in healthcare around blockchain and healthcare. I think that there's some disillusionment as solutions have come to the industry or have come to market and been presented to different organizations. There's a lot more skepticism about what the value proposition is for an organization like UC Davis to implement a blockchain solution without a consortia. Is there where is the value in having a blockchain solution to secure my devices in a particular in my organization as opposed to leveraging again that federated dataset. So you'll see more of that. I'll talk about that in a minute. Just a little bit more about the fire, the fast healthcare and availability resource. It really is the hot fire that's happening in healthcare. I apologize for all the puns. I hear them all and I just get stuck in my head. But just to give you a little more information on that, there's also something called smart on fire which is essentially an out of the box app that leverages the technology. So you'll hear about smart on fire applications where people have built application functionality on top of the web APIs that provide additional decision support or UI to pulling data out of the EHR and making it available to clinicians whether that be a physician growth chart or something else that's a lot more or call it cool technology or cool view of the datasets that the historical EHR vendors haven't provided. One of the cool use cases is Apple health kit. So if you have a little heart on your phone, if you're familiar with health kit, health kit leverage the fire standards and actually our Apple leverage the fire standards and actually has allowed us to plug our EHR into your phone. Excuse me. So by leveraging that standard, we actually have been able to download our medical records and provide patients with the ability to actually pull in their allergies, their medications, their immunizations, their lab results and handle them on their phone and actually share them. So if you haven't done that or if your organization hasn't supported that supporting that standard, that's one of the ways that we're doing the exchange. Now, one of the things that's missing here is consumer education. So now that I have this information on my phone, what's my security risk? What can I do with it? How does that help if I have an emergency and I'm in a different state? How do I provide access to this information to another provider? So there's still a lot of education to be done to consumers on what the value of having this information on your phone. Everybody just wants their data. This is a pretty easy way from a UC Davis standpoint or from a provider standpoint of giving consumers access to their data, putting it on their phone. And personally, I think that most of the transactions that we have or the interactions we have with patients and consumers will move towards mobile if it hasn't moved already. And the more that you can facilitate a need of that transaction set, the better off your organization or the better set you are for success. So one of the other pieces with the new TEFCA and 21st Century Cures regulations or what types of data sets that you might say, well, what information can I pull out of an EHR with a fire transaction set? This list gives you a pretty good overview of the types of information that's going to be available through those fire APIs. Some as you can see on the Providence one is a little bit of a future piece. It's not available today. It's at least with the EHR technology that we're using. But it gives you a sense of what kind of information can you pull, what kind of transaction can you pull out of your EHR? One of the things, so one of the, I'll call it white spaces in healthcare is the interoperability between payer and provider. Buyer is attempting to try to solve some of that with what's called the DaVinci project. So it's a number of insurers that have come together to help define the transaction sets and standards for insurers communicating with providers. So for data quality in exchange for our ATO or medical home model, there's a lot of exchange of data for quality measures that help improve the contract rates or the reimbursement for providers that shows that they're managing their patient population. Today, most of that happened through fixed CSV files and uploads and downloads. There's not a lot of real-time transaction sets between the health insurers and the providers for these things. So this organization is trying to move towards a more real-time exchange framework for not only quality measures, but authorizations that another problem spot for healthcare organizations is when does a patient need authorization based on their health plan, based on what they've been contracted for with our organization versus different organization. There's a lot of layers to that onion that make authorizations a lot more difficult and the transaction's quite not as standard. Some things need additional clinical data, some things just need a provider, some things just need the insurance company to sign off on. So the DaVinci project is really kind of walking through those use cases and helping facilitate on the FHIR API standards those exchange frameworks to help move from a batch, antiquated batch exchange process that we're in today to a more real-time web API based exchange framework. This just gives you a sense of who's involved right now. It's very payer and vendor heavy. If you look kind of at the bottom, you've got Cedars, you've got Sutter Health, and a couple other organizations we've just signed up to be a partner to develop some of those standards with our HealthNet partner. We're also an Epic shop, so Epic is moving along those guidelines and we use inter-systems as our middleware. They're also a sponsor here, so we're in the right place with the technology to try to advance some of this at our organization. So now I'm just going to talk a little bit about blockchain. Again, most of you probably know a lot more than I do. I'm talking to you from the frame or the lens that I come out at it from just to give you a sense of what I'm familiar with through my work at HIMS, and again my opinions on kind of where blockchain is going to fit and I don't think you need an overview of what blockchain is. Here's the blockchain hype cycle. So now blockchain on the previous hype cycle in 2017 was one dot on the Gartner block that kind of showed us moving into the trough of disillusionment. Now if you look, we've got a whole Gartner hype cycle for blockchain and the different iterations of blockchain. Blockchain and healthcare is moving up to the top. You got smart contracts, you got blockchain insurance, so again you can tell that Gartner's got a whole hype cycle dedicated to blockchain and blockchain technologies. The technology is here to stay and it's got a footprint. Now it's kind of especially in healthcare is what are the right use cases? How do you leverage the technology and really to bring the value of consortia to a community so that you can see that value? Because right now in the vendors that have come and talked to me about implementing blockchain solutions, they've come to me with point solutions and it's hard for me to reconcile whether that's a better way than what we have today. If there's a consortia or there's five or six organizations in my community that are willing to leverage a shared data model, then that might be value especially around provider credentialing and some other use cases that I'm familiar with. Healthcare related blockchain projects, again this is a slide that I pulled off online for this presentation just to give you a sense of who's out there that's doing blockchain related projects. Some of the use cases, so in this deck I've linked you to the HIM website. We've got digital identity management which is essentially for me the use cases are provider directory use cases. So Synaptic Health is a provider, a payer provider kind of consortium that's pulling together a human and a number of organizations to look at how to put provider directory information on blockchain. Hashtag Health has a similar model, their pro-credit solution and Simblock. Those are organizations that are again, I think digital identity is the tag that HIMS has given to it. For me these companies are providing provider directory solutions. So if you think about this in the Sacramento market, we have a group of providers that are independent that get credentialed at EADOR organization. To credential a provider to provide care at our health organization, we've got to confirm their license, we've got to track their DEA number, we've got to get their NPI, we've got to get insurance information and all of us in Sacramento have to do that same piece of work for credentialing a provider at organization. These models actually take that and make that data federated so that if I confirm a license, I can put that confirmation on chain, I can make it available to the community and that way another organization doesn't have to go through the two-week wait to get that licensing information. They can see that it's on chain, that it's verified. I'm still working through in my own head what the compliance or risk is on leveraging data on chain that's been provided by another organization. I think we still got some ways to go from a regulation standpoint because if I allow a provider to practice medicine in my organization based on information from somebody else and they're not actually licensed because something got messed up, what's my liability there? So I think that there's some good value, I think that these are a good use case because it is the same information. Still think that there's some things to work out in the legal and compliance area. Clinical research, access and modernization, again I think this is providing consent and consent management, putting information out there that allows researchers to share information across large data sets and large enterprises. I included some of the companies or projects that I'm from or that were again on the HIMS website for you to take a look at but that gives you a sense that pharmaceutical supply chain is one area where I see some traction in leveraging blockchain and blockchain technology. And then standard supply chain, you've got essentially data, I mean I think you're familiar with Walmart putting lettuce in their supply chain on blockchain to manage it or to track it from field to the store. So I think supply chain is a use case, again in talking with the people here at UC Davis we haven't seen any vendors show up. We do buy a lot of our supplies or pharmaceuticals from kind of resellers or wholesalers. So we're not getting it from the manufacturer traditionally. So again it's not something that we've seen but again this gives you a sense of that. And then financial records, payment processing, you got change health care and TIPCO. Essentially just looking at how payments and payment processing happens in the industry in some use cases where people are doing it. Again it's not something that I've seen or are familiar with here. This slide just gives you a sense of the 50 plus blockchain real world use cases. Again some of them are in health care, some of them are in different areas. This is what I thought was interesting that came across my Twitter feed was a blockchain for emergency response. So we've got in California here, we've had a lot of fires recently, people displaced by the fires. And so is there a way to leverage the blockchain solution for some of the things that are going to be needed in an emergency and letting people know and verifying that. So this was an interesting use case. Again that came across my feed but I thought based on what's happening in California this is something that would be very important to somebody that's in one of those areas that's been affected by the fires. So then this is where we get into Mike's version of what I think patients mediated exchange and self-sovereign identity might be a really good place for blockchain to fit in and a blockchain solution. You know I think of it as a longitudinal health record tracking trace because right now you don't really know. For me as a health care provider I don't know all the places that a patient has received care and I can't always confirm their identity. And one of the things I'm showing here in the slide is how many identities a patient may even have from their insurance company to their physician, pharmacy if they've changed insurances they might have different providers and pharmacies. And then when you look through that how many different identity or identification numbers do they have? You've got driver's license, you've got social security. Every company that you engage with provides you with a customer number so you've got an insurance number for each insurance company. Each physician probably gives you a medical record number. You might have a different number at the pharmacy. So again it just kind of gives you a sense of when you talk about managing identity and knowing who somebody is from encounter to encounter it's very difficult to as much as the industry has tried to do that with algorithms and matching algorithms and and sophisticated making them even more and more sophisticated it's still not a hundred percent. So if you looked at this and said well what if Paul and his family could create their own identity leveraging self-sovereign identity and that could be consumed by a blockchain and then provided to the healthcare providers and organizations as their true identity. You know the concept of digital twins or digital identities is fairly commonplace or at least in the things that I interact with. You know I've got a I might have a gamer tag for any time I do games versus my social media presence so the concept of having blockchain and a self-sovereign identity for my health identity seems like a relatively straightforward and consumer-friendly idea here right. So if I have an identity chain and I can have that consumed by the organization is what you're seeing on the screen is the green block just says okay I've created an identity there's an identity chain and as I interact with these different organizations one through four they consume that identity and so now there's a very true and real knowledge that I am the true customer is who they are and there's an ability to know where I've had care right so so that way I can in this particular example I can leverage the existing exchange framework that I talked about before care quality e-health exchange the commonwealth network and that way any time that there's an exchange I've got a patient match and now I can leverage those existing frameworks to change that clinical data and based on what I understand is that heavy long large data sets aren't very isn't the right use case for blockchain right I'm not going to put an entire encounter one of those v2 transactions or those ccd documents on chain but I could put some summary piece of information from subset of that hash that put that on chain that gives me the breadcrumb back to that full information so you know that's kind of the first layer of the idea and then the second layer of the idea is that we now move forward and have what I call the encounter chain so now not only are the organizations consuming my identity but now as I have each transaction I put that breadcrumb on chain so in the in in essence what I'm providing is the ability to track and trace across the longitudinal my longitudinal health record where I've had care essentially I don't I don't know that I always remember where I've been there might be interactions where I have it so I'm relying on a consortium to be writing those things on chain but at least I've provided the infrastructure to say here's my identity here's where I've had care and then maybe leveraging again those existing frameworks again to pull that longitudinal record back together so at the end what you've got is you've got the ability to take all that information all those different encounters and then pull it back together in a fairly straightforward and again I've got a patient portally UI on the right but that frame or what that looks like is really up to the solution providers and what they want and what consumers want and how flexible your technology is and this is just again David Holdings somebody I've worked with a lot he wrote an article that kind of the article I link at the bottom really summarizes some of the ideas that I just had about or shared about the the encounter chain and kind of taking taking the the longitudinal record and leveraging blockchain for more of an identity and track and trace model and essentially this is just a blockchain representation of that common data set and what that common data set that's shared or that's kept at each organization independently so as you can see organization a b and c they've got private data and they've got common data well instead of all of them storing that common data you move to the right and you've actually put the common data on chain and made that available from a community resource standpoint so in the presentation you'll see a lot of links that I'll take you out the different information or where I've pulled some of this this thing and again a lot of this is is information that I've gathered from my experience and from working with really smart people on that hymns blockchain task force so at this point I'm happy to answer any questions if there's any anybody has anything hi jim mason um i'm the guy from the automotive world and this is exactly as you walk through it why I pay attention to health care because minus differences the differences in regulation are believe they're not small not large and the differences data formats are obvious but minus that everything else you walk through um i'm actually working on all the same stuff in what we call the mobility space so we have all the same problems pretty much technically to deal with for sure um what I can tell you is looking at this thing more on the technical side is that hey you talked about the trough of disillusionment so I'll I'll get everybody right to the bottom of trough there's not going to be one network for any of this um and we've discovered that in the mobility space so one of the major challenges of course is interoperability between networks and so we've started focusing on that in the mobility um mapping if you will that we have to upfront support multiple blockchains for things like identity um in your case encounters all that stuff um the other thing that sticks out that's big um which is an issue that's not fully resolved the way it needs to be to be effective there's really three types of information for transaction when you quote put it on the network that includes a blockchain number one you pointed out you have the transaction identity you know if if I took um if I ordered a prescription there's a transaction for that in the hl7 framework or the fire framework I guess and you'd say okay that transaction has an id type an id and it also on the blockchain would have a proof so all of that stuff the on the blockchain but you're right the actual private data about who I am and all that other stuff is flowing as your diagram showed through the private data network the way you laid it out but there's a third part to this which is tougher and that's the fact that there's a whole another data layer of large data not small data and so it's not just about who I am as a patient and that kind of stuff but you've now got the associated my case in radiology I've got the images and all that other stuff and I have to have links to that whether it's a third party service I'm getting it from or as you pointed out earlier in these distributed networks we're trying to share the stuff across not maybe not the whole network but at least maybe from the provider to the insurance company and so on whoever's involved whoever needs it so there's a lot of complexity around getting this right on the implementation side and the biggest thing I guess at this point is challenging the happy assumptions that a lot of the larger players have that like look I'll own this no one entity is going to own any part of it actually it's all going to come down to standards and interoperability you know from our point of view both on health care and on mobility as well yeah and and I mean you make a good point and it's something that that I'm not again very educated on but when you talk about not everything's going to be on one chain or one solution stack is what's the capability or ability of organizations that are on different ones so let's just if you look at the patient model right and I've got mediated exchange and I deal with different organizations with different solutions what what's the capability or possibility at some point in the future that you can at least reference or have a cross-reference between hyper ledger and ethereum and whatever or is somebody working on that interoperability today and I again I'm not aware of it so the argument is there are there are organizations in other domains that do exactly that so there's things like in the security space you have something called symbol sign-on that under the coverage uses something called perforables perforals we actually put a mapping of different in a sense service effect across a security realm or domain and and you're providing that translation so that there is a the idea that there's a central directory of types and if you have it you can't do exchange without that thing that concept so it's either everybody has to agree that we all say oh no we're all going to pick that identity has this one format or you need a directory service where you register the different types and as you say map them and so I can't I'm not smart enough to tell you which one's going to win but I suspect it's always going to be the what I call the directory service model and you know with that directory service you'll wind up in a sense mapping these types automatically but there's really nobody writing anything about that at this point for sure everybody still has the happy model as these providers that I'm the guy that wins the war and it also comes down to the platforms because in your case probably I'm going to assume that a big chunk of this is intended to be operating in a cloud environment as opposed to an on-premise environment is my suspicion and but when you look at the cloud environments we have the same problem so none of this is all going to run an aws or azure any of that it's all going to come down to using something like the kubernetes orchestration framework at a higher layer to integrate multiple physical networks as well so there's lots of integration architecture problems that need to get resolved to make this real across a broad space and there's not there hasn't been a lot of I guess focus on that at this point and for what it's worth but it's worth paying attention to yeah I mean I I think that there's at least again from my perspective is the the where where we need to start in healthcare is that we need to find the highly engaged patient sets that are pushing the envelope on access to data and those sorts of things and so what you find are people with significant disease states there's a fairly well known patient his name is his his I'll call it performing name for lack of a better term is e-patient Dave and essentially he had a condition that was not a widely known or treated condition a number of years ago went online and created a community and essentially has been stomping for patient access to patient records for a long time and you find that with cancer patients and in particular disease states where you have a very vocal a small number of people but are very vocal wanting access and wanting the ability to control their data and have access to their data and those are the communities that are really going to push the the the market to make that available and then understanding how the the remainder of those the consumer side comes behind I think that's where it gets into you know who which one's first is the market going to create a solution or the consumer is going to push for a solution and then and it's hard to know what that is but I think if we don't make it interoperable on the back side it's just going to be a failure like Microsoft Health Vault or or Google Health or whatever so yeah very much so and so that's a correct thing the only other thing I'll throw in there is yes regulation is good but it's also bad in the example of ccpa right so what that does is definitely slows down big time it doesn't prevent but it does slow down and increase the cost of getting patient outcome data that's shared for an event of whatever the type is so you know if it's a certain type of cancer or something you're interested in it's not that you can't in a sense get that data on outcomes shared quickly to say oh look you know Jim different than Michael had a different treatment path and look at the results for the people that followed Jim's path it's you know is a lot better outcomes even at this point that kind of information you're right important to share as quick as possible and yet the all the what I call the privacy and identity problems regular regulations around that certainly slow that up so it doesn't mean that there isn't a solution to it it just means that the unfortunately the time for e-patient Dave to get that stuff in many different communities is not as quick as it should be much like saying that I want access to a drug that's not FDA approved yet same issue you know that kind of thing so that's a challenge for sure yep no I appreciate the conversation anything else anybody else have any other questions or anything I can answer and again I'm as I told Rich is I'm pretty much an open book so if there's any time or anything that you have a question about health care related or exchange feel free to reach out but I'm always open to chat hey hey Michael this is Erica great presentation I really learned a lot is UC Davis Health actually participating in any consortia around blockchain or any research use cases currently not not that I'm aware of today there's some there's some research folks here at UC Davis that are looking at some blockchain solutions but there's nothing we're doing today on block on chain and I can dig around some more but it's but I interact with the director for our research arm fairly regularly and there's some graduate students that are doing some conceptual things but there's nothing that I'm familiar with from a solution stack standpoint that we're looking at okay thank you but if you want to send me a note I can I can connect you with our folks the right people here and they can they can give you the real answer I'm peripherally involved on the research side mostly because I have access to all the epic data or the clinical data but I'm not day to day involved on the research side okay great yeah I was just asking I'm I work on the health utility network with IBM so I was just wondering if you if anyone had approached you guys with regard to that but I'll send you an offline yeah just send me a note offline I believe IBM is participating we have a think tank spinning up here in Sacramento called Aggie square and I believe IBM is a big partner in that and that would be the place to possibly have that as an entree so but yes hit me you send me a note offline and we can connect that I can get you with the right people thank you any other questions otherwise I'll turn this back to you rich yeah excellent uh yeah any any other questions as we uh we're coming up to the top of the hour but uh I mean outstanding uh outstanding presentation I mean you know really amazing given particularly that uh what we're looking at is sort of this interesting sort of integration of blockchain technologies into existing healthcare state and it's it's you know we often sometimes forget that new technologies have to integrate into existing technologies and frameworks and backends and so it's really interesting to sort of get a sense from from your perspective at UC Davis health where the notion of blockchain technologies is interesting but you know to your point uh it you know it just it's not quite there yet uh but there are you know there's there's some you know the rattling of chains and so it's it'll be interesting to see how things progress going for yeah and and again I I think that the conceptually is that if I have a vendor show up again whoever it is if they have a built-in consortium if they've already sold or or can show up in Sacramento and say hey we have these four business partners and they want to share this information would you like to do that maybe maybe it's a consideration but if it's just a point solution for me it's hard to see a value internally so right and I think you know to me the takeaway and this is something that uh I think you know both yourself and I mean I know David Holdings also sort of driven this point and this is something that I think we all want to sort of take away from is that you know the value of blockchain technologies is very sort of specific it's a specific tool in a very large toolbox and uh and then you know the examples that you presented uh really sort of emphasize that which is there is common data that ought to be shared uh and blockchain uh particularly blockchain uh DLT is a great way to make that happen but you don't dump everything onto uh a new DLT and so you really have to think about you know making use of the technology to the to the best of its strengths and so that to me is the compelling aspect of you know much of the much of the the threat of of discussion here regarding the the technology suite here yeah for sure I mean that that's one of the basic tenants we talked about early on is that that the footprint of the data on chain has got to be pretty lightweight and and at the end of the day for me the concept of track and trace really uh hit home with the idea that you know my biggest problem in my day-to-day job is who had who they who a person is and where they've had care and if I have both of those information if I have that information and I lock it in 90 percent of the data 95 percent of the data that I want to get from another organization or somebody wants to exchange with me I can probably do with with existing with today's existing frameworks there's not anything right now that I'm aware of that's a 100 accurate on that because not everybody's connected and that's another piece right you know if you're not connected chain or not you're not going to get that that information so yeah yeah yeah exactly I mean uh you know islands of information and the idea is to try to find a way to sort of homogenize that or you know I think the the the reference that you made was you want longitudinal access to data which I think is you know the the proper way to look at it going forward particularly in health care okay well again thanks michael a great presentation um and then as far as uh the hdc community goes we will be meeting again in two weeks and for people that are newer to the to the organization uh the the health care sig meets every two weeks so our next schedule general meeting will be on november 15th 7 o'clock a.m that's pacific time and I think we're going to be hosting a general meeting which is just a sort of a status from our hc sig subgroups and some of our ad hoc teams and so we'll we'll sort of bring everybody back up to speed with some of the work that's been being done in the in the in the sig specifically uh any comments or questions before we sign off is the timing of the meeting always going to be the same every friday every other friday correct every other friday right yeah as long as the timing stays the same that's great thank you yeah exactly yeah seven seven o'clock in the morning that reaches all the way across so that we can get uh folks on the east coast and then I think we have a couple of folks that join us from india periodically as well all righty well thanks everyone thanks again michael a great presentation and oh by the way for folks that are interested the mics presentation is available you can sort of see it here and so feel free to make use of it as well i'll be posting the video and that'll go up to membership a little bit later on today and so anyone that's interested feel free to make use of that going forward as well I didn't know I was being videoed rich I didn't find that waiver oh boy surprise surprise excellent well thanks I'm sorry go say say again mike you were doing an audio recording I didn't know you were doing a video recording oh okay it worked great and perfectly all right well thanks everyone and we'll see you in two weeks have a great weekend thank you bye thank you