 Hi, my name is Alevtina Dvalitskaya-Kerere, and I'm happy to present to you today fast, secure, and accurate evaluation of prescription drug reimbursement claims using Hyperledger Fabric. This work has been done by a value-based partnership consortium that consists of two insurance companies, CSS, Sanitas, the University of Zuriq, or the University of Geneva, two university hospitals, and Amgen-Switzerland-Arke, pharmaceutical companies in collaboration with SwissCom-Arke as a technology provider. So for the reimbursement of different medications, there exists a sort of pre-approval process that is based on different clinical criteria. So this traditional pre-approval process is paper-based, lacks interoperability and trust, and often time-consuming, costly, and error-prone. So the aforementioned consortium created a blockchain-based system to facilitate using Hyperledger Fabric. The digitalization of the process and as well as its realization using smart contracts on blockchain allows for optimization of this process. And we have tested our system with real-time patient data and also compare it with the traditional paper-based process. On this slide, I would just like to compare the traditional process that currently exists and with our blockchain-based process that we developed. So traditional, just maybe to check, is everything good? Okay. So the traditional cost-demand process consists of the following steps. So first, the patient comes to the medical practitioner and then medical practitioner has to submit a paper-based form that is sent by post to the health insurance where health insurance involves a trusted physician that has to evaluate the form and decide whether a patient is eligible for reimbursement or for prescribed medication. The problem that all this process takes about two to eight weeks because it can also involve back-and-forth exchanges between medical practitioner health insurance and also involve a trusted physician that can take time to evaluate the request. Also, this is the error-prone because we're talking about the paper-based form and also sharing of the patient data and also sending the data over the post which can impose some privacy threats. So in our blockchain-based process, we propose to evaluate those forms automatically and also in a digital manner. So basically, the patient would come to the medical practitioner and then instead of filling the paper-based form, the practitioner will use web interface in order to insert patient data and then the smart contract will evaluate whether the patient is eligible for this treatment for the reimbursement of the treatment. So this lowers the cost because now we don't need to involve trusted physician. It also allows to collect data to collect the outcomes of such process and also no additional visits is required for the prescription by the patient because then the patient can receive from the medical practitioner immediately whether he is eligible for this treatment or not. So as I already mentioned, this work has been done in collaboration with pharmaceutical company with two different entrances in Switzerland and two different university hospitals in Switzerland, in Zurich and in Geneva and in collaboration with the Swisscom that provided the technical solution. So we started from those forms that exist in this usual paper-based process so these are the forms that the medical doctor would need to fill in and then send by post to the insurance company for the patient. So what we did is from those forms and here you see a part of the form and also the description which was by the way happening in different languages because we have some part in the French part of Switzerland there are French language and also in the German there is German used so we had to basically develop the interface for two languages and then to create those rules in order to then implement them in the form of a smart contract. So basically we had the form we had the information on how to interpret the form filled in by the doctor and so we created the rules that then became a part of a smart contract. So from those indications and the questionnaire the doctor would fill on the paper we created those rules and those rules became the logic that was deployed on all the peers of our blockchain network where we had two organizations one for hospitals we had two hospitals testing the system and also two insurance companies and we had also created the front end and web interface for each of the type of the user either hospital or insurance company. So this web interface looks like this and I will demonstrate it to you in the demo so I prepare the video in case of a demo effect but I will just try to to demonstrate to you in real life how a system works so let me just another window so now we see the web interface and I also would like to to show them the logs of our system so now we actually connected to our blockchain network and we can see that there are peers from the hospital organization and the peers from the insurance organization so now we're going to enter the logs of one of the peers as you can see here and basically we can see that this peer joined one channel and we will see that we have the type of the chain is like this so now we go back to our web interface where we see how the system works for the doctor and for the insurance company so for now we can login as one of the doctors so I will login as a doctor from University Hospital of Geneva so here we can see different requests that has already been created by this doctor we can see different patients time of the creation of the request and two different companies that has received those requests we see that some requests were approved and then also there is a reason now we see that in French and also some request has been rejected and again there is an explanation why this happened so now like I'm a doctor I would create another request that corresponds for this medication and I first need to provide the information for the patient information about the patient which is going to be Jane Doe with the insurance number with the data first and some address information now I can choose which insurance company I would like to send this request and the information is already revealed automatically about the insurance company then I have to put information about the patient medical history where I'm selecting those information based on our imaginary example where for example patient has diabetes that is controlled diet doesn't smoke but his cholesterol level is unfortunately quite high and without this medication so we can also list here the information about some medications that the patient received previously because here we are filling in the form for the basic medication and therefore there has to be provided information about the previous treatment of the patient and now in the important part we have to select the indication so basically the doctor would like to prescribe this indication because the patient has specific disease and his cholesterol level is pretty high so now we can either save this request or submit it directly and we are going to submit it and now we see in the list of the requests we see that the information from this doctor about the specific patient is sent and the status is committed so then almost immediately we see that this request was approved and with the reason why this request was approved so now we can we can login as an insurance company this one and see whether we receive this request so now I am the insurance provider and basically I can see this request that we just submitted that it is approved and as an insurance company I can only see this data without modification and now coming back while still have couple of minutes I would like to get back to our logs of the peer and then we see the previous height of the block of 36 and now we are going to have the height of the block increased by 2 because we basically have 2 blocks and each block has just one transaction each block is generated in 30 seconds and first transaction is just the data sent by the doctor and then the second transaction is actually execution of this logic of ours so now just I would like to end the presentation with this last slide with the results and so the biggest result is that we actually were able to test our framework with the real patient cases of course after the consent was provided by every patient for each case so we test first our system with about 20 cases from insurance companies that was created by insurance providers based on some realistic cases that they had before and also with real patient cases we had 6 patients from 2 different hospitals from 2 different insurance companies and so basically the very important result is that instead of the average process that takes about 11 days in these specific 6 patients we had the results that we received in just a few seconds and basically also this approach allows to also identify and help the correct input errors and gives a great potential for optimization of such decision making process so thank you very much I don't know if we have time for any questions but I would be happy to answer see the question from Brian was the hardest part about making this all work so actually it took us quite a bit of time and I think that the most difficult part was really not on the blockchain side well first I would say there are 2 most difficult tasks so one is creating this logic from description and from the paper based form but not even creating the logic but verifying it with every stakeholder because this is what we had to do we had to when we created those business rules we had to really make sure that they are correct before even implementing that and then we had multiple reviews with people from insurance companies from the doctors and really to make sure that we captured any single every single possible case for different patients that could come and another part was actually web interface and also really making this really trying to make system more easily adoptable and really implementing those forms in a such a way so that it's easy for position so that it captures the missing data but doesn't try to mess with the logic doesn't propose doesn't suggest to add something or to change something that would then influence the give more data and influence the execution of the smart contract and here we will try to yes exactly we will be writing a paper right now and we also we are going to talk with the office of public health in Switzerland in order to get their opinion and hopefully bring this book to the next level and hopefully have it really used by doctors and insurance companies thanks a lot I'm opening the Q&A oh yes that's a great question about the mechanism for ensuring that no private data is shared with unauthorized parties so we actually so the smart contract is running on Swiss compromises however it can also be running all the peers could also be running on site on the insurance companies or on the hospitals what we have implemented in order to ensure the privacy of the patient is that all the patient data is encrypted with the key shared between a doctor that is submitting the data and the insurance company so all the patient all the patient identifiable information all this information about the patient like address and age and date of birth it's encrypted and therefore only the designated insurance company can access can get the information from the ledger about the patient so only about the patients from this insurance company and also as the service providers at Swisscom cannot see any information about patient data so like this we have really point to point encryption between doctor and the insurance company for access to the patient data and no other participant cannot cannot see any information so another question they have a process for deleting editing information the doctors have input it incorrectly so yes so if this is spotted by the web interface so for example if some important information is missing like indication then I can actually share this real quick just to to demonstrate like if I would be the doctor and I would try to create the form so I will start filling the information and then I would try to submit the form that is completely not so first of all I can save if I start filling the form I can save some information but if I try to submit the form then I will receive a notification that will say please fill all the necessary all the necessary fields which are fields such as private information about the patient insurance company and of course the indication so basically already at the stage of filling the information we can spot if there are any information missing also if the doctor made a mistake and maybe forgot to add some information about patient history maybe about the previous indications then and the request is rejected while the doctor can see the reason of the reject and see if maybe there was a mistake or if maybe something happened so another question about multiple blockchain have access to the data it is encrypted so we have just one blockchain one channel where different organizations and different users can either write or acquire the data so first of all the mechanism is that the the insurance company when there is a query to the blockchain so only the data that is written for this insurance company can be accessed by this insurance company this is the mechanism in the query of the of the blockchain code and another part of the question authorized parties share the key to decrypt the data so yeah we have basically we use Diffie Halman in order to have the keys generated for each of the pairs so we have two doctors so it means that each doctor when sending information if information goes to just so information can go to only one of the insurance companies and then the older personal identifiable data is then encrypted with this key so it means that only designated insurance company can decrypt this information while the data such as facts like whether this patient X would have or not have the diabetes or whether some facts from the history they stay unencrypted but because the personal identifiable information is encrypted then this is how we make sure that even the technology provider even the nodes that even the entity that is running the nodes cannot really get or even get cannot get any information about the patient thank you for your questions so I'm just going back to the chat yes I think I'm a little over time so thanks a lot thank you very much