 There we go. I think we should be recording. I can't let's see. Can I tell I so I think I can see Well, so what I was saying is well first of all good morning everyone great to have you on the call appreciate it Welcome to the health care special inches group. We were just talking just a little earlier about sort of the stability of the zoom product I at the moment cannot for some reason see participants I could just tell in my participants dialogue that I see six folks on the call But I can't see who you are for some strange reason. Maybe there's some level of security baked into this I honestly don't know but So just offhand if you are just dialing in please just announce yourself. So I know who's on the call I know Alicia's on the call, and I know Jim's on the call Anyone else? This is revisha as well. Oh good. That's I can see them I Can see the list of participants. I don't know why you are not able to go. Yeah, it we were just talking it this the So I run on Linux and so it could well be the Linux client Some for some reason lags, but it always seems to that they have a very tight cycle for releases and they're testing Doesn't seem to be very Specific, but anyway good to have you on the call revision. You're probably the key person that I want to make sure is on the call So Before we sort of jump into things and we'll do we'll do introductions in just a moment I do want to mention that this is a recorded event And as a result we do have a antitrust slide. I want to remind everyone of It's up on the screen right now Please read through it. There's a URL for details specifically about our antitrust policy. Oh look and I can't seem to other we go That's very strange very laggy highlighting anyway And so you please use that URL for any any details the upshot is Please don't share in the IP or anything that otherwise you would consider important valuable to your organization In short just be a good person. So that's our antitrust policy So let's swing back over to introductions and again apologies. I can't see anyone on participants list I just see that there are nine folks on the call And I know Alicia is on the call and Jim's on the call and ravish as well If you are new let me I'll just start by saying if you're new and you would like to introduce yourself, please Please unmute yourself and make an introduction. Tell us a little bit about where you're calling from and and what you do My name is Kent. I work with ravish and the pay us a group. I write the fabric code That sounds like Kent Lau. It is very good. That's one rich I'm you Go good to good catch. I was gonna say yeah, good. I was gonna say good to see you But good to hear hear from you. So that's one. Thanks for and you're calling out of Hong Kong if I recall I am. Yes, it's 10 p.m. Oh very good. Thanks for joining us appreciate it. Thank you Anyone else on the call? I want to make introductions Hi, my name is Padman of butter. I'm also part of the pairs of group I'm based here in the US. I work part of the Atlanta area I'm part of a company called Mocha Technologies. We have Several solutions, you know, getting to the healthcare as well as the broader IT Services and products as well. Nice to be here. Oh very good And I also I just got a note here and chat from Jai car. Jai car. Did you want to introduce yourself? Excellent and I'm having a little bit of a hard time hearing from you, but I I believe several months ago you you presented to the group during the COVID virus sort of focus on special topics Yeah Excellent. It's it's one in the same. Well, good to have you on the call. Thank you so much Anyone else on the call want to introduce yourself Already. Okay. Well as a reminder, and I think I'm I'm I'm guessing and again I just simply cannot see who the participants are on the call today If you are interested in getting involved In the organization and maybe sharing your your information with us. We do have a membership directory And I'll just share that now and it is easy Pretty easy to straightforward to get your name and information up on here And this is a great opportunity to sort of connect with others within the community here What you'll need to do is get yourself an LF ID Linux foundation ID. It's it's free And it's just simply a way to log into the system so you can edit this page And then ideally you would just jump in add a add a new line and and go ahead and add your contact information And again, we've had some really good experiences with people sharing their information for the sake of Sort of one-on-one collaboration and and certainly doing other work As it relates to hyperledger. So so that's available Otherwise Well, let's let's go ahead and get into community announcements Does any anyone have anything that they'd like to share As it relates to black chain technologies in the healthcare space Okay So and I I don't have anything offhand although I will tell you that the linux foundation is Hosting their event and oh gosh, I'd have to dig that information up. But that that's coming up soon I should I'll sort of post this after the fact up on the up on the wiki page here It's not necessarily healthcare related. In fact, I think the agenda didn't I didn't at least didn't see any initial Topics as it relate to healthcare But but that conference is coming up. It's a virtual conference, of course, and it will be happening. I believe in the next month or two Okay, so without any further ado then I'm going to hand over to To ravish. So ravish is and and we've had ravish Talk before about his company jogat or jogat, I think and And today we're going to actually have him Speak on behalf of the payer subgroup. He shares that subgroup they're doing some tremendous work right now and and it's great to hear that That work has just recently been approved for inclusion in the hyperlature labs incubator program Um, and uh, their project is called the modern pharmacy management project. And so uh, so ravish, did you want to take over? I'll stop sharing. Did you want to show your screen or do you want to me? Yeah? Okay, let me let me I will have to share my screen. Okay. Let me stop sharing here Oops, let's see Well, that's my uh, am I sharing right now? Can you see my screen? Uh, I can see your screen. Uh, but when I try to share it says yeah, there we go. Okay Go for it. Cool. Let me share my screen. Give me one second Oh, and I stopped sharing and now I can see participants. So Good morning everyone or good day Oh, I feel so much better now that I can see everyone. So good morning. Well as ravish is getting set up Good morning to jonathan and wendy It's so much nicer to see folks Yes, good morning. Happy friday to everyone. Hi wendy. How are you? And hello jonathan All right, let me share my screen if I can All right, I hope you guys can see see my screen looks great Okay, um rich. Thank you so much for giving us an opportunity to share what we are working on Again, they uh, I just want to qualify. This is as you as we go through the information There are a lot of unanswered questions. Uh, we are just beginning And the idea is to start, um, you know talking about in simple terms and start adding complications or or I would say Features as we go forward I do want to warn everyone that if you ask us, uh, uh There are already unanswered questions. So anyone is, you know, free to jump in You know, talk about it. But at the same time, we would also need if you have any insight do share with us That would be great. Um, obviously, I mean the subject matter expertise is is the most critical You know piece as we start bringing these business models together with, um, you know blockchain solutions and All the times things are not very clear as such. So just, um, you know, let's go through this with an open mind And we are actually looking for any feedback that you have to refine this and this process will continue so, um Let's get started Um, as a pair subgroup, we have a few key, uh attendees, which are regular obviously and then there are a lot of people who join You know come and go. Um, I have mentioned the names who have actively worked on this um presentation as well as Who are working on this, uh lab, uh as rich talked about We meet every friday one p.m. Sorry every other friday one p.m. To uh, two p.m And we are, uh, we are meeting every other friday Um, not the friday when the sig meeting happens. It's the following friday actually So our next meeting is going to be next week july 3rd 2020 and Everyone is free to join. There is No set criteria nothing. I mean, sir Linux foundation open forum all the meetings get recorded and Everyone is free to contribute. There is a wiki page that we have Um, you know just under the I'll I'll go through that towards the end. Uh, just to give you guys a quick overview of that Um So we have uncle jen. He's one of the team members cat law. He's uh, can't you're on the call psb, uh, padman abhatt. Uh, he's on the call as well and myself ravish the one Um No, can't uncle or uh, if you're there if you want to say a quick word Yeah, I want to thank ravish for his leadership and for helping us bring this group together to Uh formulate this use case demo. Thank you Thanks. Can psb or uncle if you guys are on Yeah, I think uh, you know, uh, we are very excited. I think, uh, even with small set of constant members and a lot of, you know In between infusion from I mean infusion of new ideas, you know from others We are having like a constant progress on some of the Ideas we are building on on this Cool, I'll quickly get going. So let's quickly talk about the current state of prescription prescription management and fraud So if you look at across the healthcare system, there is a lot of cost when it comes to prescription In fact, every health pair Is constantly working on how to manage the fraud and how to manage the prescription fraud I'll show you some stats also, uh, as we go through this. This is significant One, I would say public Health crisis also because of the behavioral issues that we get A lot of people try to game the system if they are addicted they will go, you know, multiple doctor shopping You know, same prescription being filled multiple times um, you know And and fraud can happen from various directions. It can happen from a member perspective It can happen from a Provider perspective. It can happen from a, you know, a pharmacy perspective So, I mean, there are all sorts of examples if you find automatic refilling if I am a pharmacist pharmacy and I see your prescription is 90 days and there is a Refill required every month. I might fill your prescription and not you may not come and pick it up, right? And I can build the build the Pair for that Very difficult to catch some of these issues. Um, you know, uh, in that sense Phantom prescriptions, uh, you know, there is there is no prescription. It is being forged The the key is member who who on behalf of him these transaction or her these transactions are going on And the member may not even be aware if you are a pharmacy And you fill my prescription without me knowing it until as I log into my pair Claims system and see that claim which, you know, rarely happens I'm sure you all have health care in in in us and how many times have you logged in and validated? Well, you know what my prescription projects are absolutely accurate. It doesn't happen And you only log in when you have an issue your bill is not being paid Other than that as long as I am not being charged, you know, I don't care that's unfortunately that's how the system works today And there is a huge market for diverting legal prescriptions Meaning I have health insurance. I go, you know, get these inexpensive medications covered by my my My plan but then then I sell it for for financial gains You know at a at a lower cost than what we will get in the market. I mean, there is there's such a big, you know fraud happening in that In an area as well And these are just simple examples that we can understand There are a number of other ways these can happen But the key is when that happens and when pair dollars go out it always gets logged against a particular member So the idea is going to be how can we Structure a system wherein some of these things Can be looked at in in a way wherein I can record what is going on I can manage the consent If somebody is filling a prescription on my behalf for me, I should know it Whether I go there or I should know it So some of those things we have tried to systematically address with our use case And again, this is a complicated You know Scenario so we have not covered everything we will slowly add layers to it as we progress Just to give you a scale of When we say prescription drugs, what is the marketplace? Annually filled prescription in united states exceeds three billion dollar If the fraud is just one percent, we are talking about three billion dollars Three hundred billion dollars of approximate annual prescription drugs. Just imagine one percent fraud itself is three billion dollars I am confident it's much more than one percent So just giving you a scale of what we are dealing with here So these are some interesting facts. I just wanted to share But just a quick big breakdown of prescription drug fraud by type, you know, 13 percent identity theft Someone may steal my identity go get a prescription filled pain medication, you know opioids I mean, there are so many such things right forced prescription 11 percent 9 percent duplicate Meaning I can get the same prescription filled at two different pharmacies. For example I my doctor gave me a pain medication and I am addicted. I go fill it one pharmacy call the doctor Can you send it to this other pharmacy that I need to go and pick I may not be able to go to the one that you regularly send that's called, you know Ability to to get this filled, you know from various now pair does not know until the claim comes in That's another after after the after the process that has happened So whenever these frauds are happening in healthcare pair is actually You know, it is very difficult to catch in the beginning So pair is always reacting to it and the dollar gone out is not the dollar coming in Hi, can I request if you're not talking put yourself on mute, please Thank you Um, and then there is 64 percent of drug seeking behavior addictions I mean, this is this is just an example of what we are dealing with when we talk about the pharmacy You know or the prescription fraud And there is a link at the bottom from bcbs. You can go, you know, check that out as well Prescription drug fraud by region And this is something I just wanted to share You know interesting you will see the southern Part of the of the us has 48 percent of this The reason being is some of the laws To own a pharmacy and you know for a pharmacy technician and all those are a little You know, I don't want to say Uh, simpler or linear But it is easy to get that and hence you see the concentration, you know as much as 40 percent from the south itself You know in the I know about florida. I mean it is like two or three weeks process to get that So just something to be aware of What kind of issues that we are dealing with when we talk about the pharmacy management And and thinking about leveraging blockchain. What you're about to impact is the industry That is dealing with 300 million dollars drugs a year Significant impact can be created there As I shared all the solutions Pildate are analysis based after the fact You know, especially in healthcare If you go visit a doctor and doctor sends a claim Where knows after you have availed the services Through by virtue of you know that claim coming in now. There is a very good possibility some may Your physician does a prior approval for certain things or your eligibility checks before you come in but those eligibility check is not You know expense that has happened But you may go there or may not go there after eligibility check. But if you go there Pair knows after the fact that event happened Now if it is a fraud or if it is a genuine event, they don't know till they go through, you know Heavy analytics to find out the behavior and issues and sometimes with the provider or with the The the pharmacy so on and so forth and you can you can search through there are so many You know, I would say Legal cases around, you know starting from all sorts of organizations intentionally and an intentional issues and errors And and and the fines are hefty on that So just wanted to set a perspective what we are dealing with Before I go to the use case any questions Any anything anyone wants to add this is more of a participative conversation. So Anything anyone wants to add about You know what we discovered I think the same Unless you go for a real-time system With a unique medical record and Mark healthcare card This problem cannot be solved Yeah, jacker you're right What we are about to talk is the real Real-time system as well Because there is if you look at the healthcare industry today Uh, I don't know about the all the other countries, but definitely united states There is no real point a real-time touch point between a pair provider and a member These three are very critical to managing members health as well as You know any any such fraud detection and all and especially member being the center of this Because all these transactions are tagged based on a member Right, so we will talk about that You know in in how we are crafting the solution Any other suggestions questions Mod card also So let me just quickly cover the current state You know, uh, as it happens in a patient or a member would visit a physician, you know, right? Physician usually ask you a question Where do you want me to send your prescription and you you give them a full filler? You know a particular pharmacy a cs cvs wall wall greens wall more whatever That you go to regularly right, um You go there, uh, and you Sometimes find out either the medication is not there or Let's say you are not in the city and you want to go, uh, you know grab your prescription somewhere else Usually the process is you will call back the physician office And you will request, you know, can you send my prescription to another place and this can happen also in You know for uh, you know Someone who's trying to gain the system and wants to uh, you know get this prescription filled multiple times also I got the prescription from cvs. I intentionally call the physician office. Can you forward it to the other one? I'm not there You know at this location or something right physician office sends the prescription to another location, right? Full filler the second full filler gets the prescription and they may fulfill your prescription So, you know, when I'm trying to gain the system for multiple prescription of same prescription from the same physician being filled multiple times There is a possibility to do that right um and then you know, obviously full filler gives me the prescription both both the both the Uh pharmacies will file a claim depending upon how sophisticated the payer system is they may catch it They may not not catch it. You don't know. I mean the dollars are out the door now And usually what happens is this can this can continue. I mean there is a possibility I am I am genuinely need I need these prescriptions today I I may go to multiple full fillers Every time I change the full filler. I will have to call my physician office to get it redirected or recent to another pharmacy So this is this is what goes on in current system today um Now if you if you consider this this whole step three four and five wherein I have to call make a call to the doctor. Doctor has to send it again or doctor office has to send it again to another pharmacy It's usually a dissatisfying if I'm a genuine You know member who is trying to get the prescriptions, but at the same time It's a it's a blessing for the someone who is trying to gain the system and getting the prescription filled multiple times Right, so this is where this whole fraud You know can can pop up. It can happen from pharmacy also. It can happen from a member also all sorts of You know possibilities of frauds are there So this is where We stand today now. Let me shift from a perspective Instead of medications. This is let's say a vision prescription wherein I want to get some glasses in that scenario this whole idea of member wanting to change full filler is not because Um, I I I want to game the system. It may be because of convenience. I went to one shop. I did not get the Uh, you know the the glasses that I want. I didn't like all the options. Let me go to another one This happens today if you wear glasses, I am pretty certain There is a possibility that you want to you want to have the flexibility What and when ends up Happening is I go to this shop. I set my prescription there I'm going to be there and I may choose to make a compromise. Okay, fine. I I don't want to bother going somewhere else Let me pick what whatever is there But imagine if you had the flexibility to go to any full filler without your prior decision And you know get that done there itself That flexibility today does not exist in even in vision You know prescription because if I have to go to another one I call my my You know, uh I doctor they have to release a prior out. They have pulled on you so that another full filler can pull the prior out as well This happens and I think these vision Players are trying to get away from this prior out But nonetheless, it has not happened yet systems are still looking for the authorizations and You know, uh, basically the flexibility to go from one full filler to another full filler by virtue of not trying to Tying yourself to the physician or the eye doctor that can you send my prescription there so I can go get my My prescription or my medication in another location That flexibility is is tied to making salt physician today You cannot just walk into another full filler and get this taken care of today So that's the current state The the previous one is more on medications This one is more, you know customer convenience of can I pick my glasses from another location? I see another, you know, um, I I wear shop right next to it. I want to go there. But guess what my prescription is here How do I handle that you will have to make a call to your eye doctor to get the prescriptions into the other one as well That's what goes on today in current state Let me just take a pause and digest this information any questions so far This is kent. I just want to add to ravisha's point that This prescription can be for more than ocular glasses. So for example with a prescription It's typically typically common that a pharmacy may not have the required Let's say there were three items on the prescription. You may have one and three and not have number two then What do you do so the prescription can either be filled with one and three Or then can be released back to the patient So we need somehow not only to endorse what has been dispensed but also to actually Uh Reconciled what is owing to the patient? Thanks. Yep. Yep. Cool. Any other questions? Hey ravisha's Erica How are you? Good, uh, I just had I had a couple questions going back to the medication part. Um So Where is there data on actual like pharmacy fraud? Because I know that pharmacists are usually pharmacies are usually pretty good about putting the medication back once it's dispensed If the patient doesn't pick it up and as well as keeping a pretty strict inventory among controlled substances So I was just wondering if that was I was surprised to hear that's actually an issue Um in the united states at least, uh, I just I've worked in the pharmacy so much I've never heard of of data on that so I was curious about that Um, and then I also wanted to make a comment on the pharmacy shopping It's definitely a problem. It used to be a way bigger problem. It still is a problem Um, but there are there are some safe guards safeguards in place, especially if you're billing the same payer. Um There are you know, the systems have gotten a little more sophisticated to kind of detect if someone's Filling like opioid prescriptions in one day the payers kind of will reject them Even if it's coming from different pharmacies. So I just wanted to I just wanted to make a comment those songs Sure. Sure. Sure. So, um, erica the I I'll probably send you some links, uh, maybe when You know after the call as well There is some data that that talks about and actually there is a there is a link that talks about all the you know lawsuits against various pharmacies or or providers or Or so on and so forth Some of this is on the pharmacy side is not intentional as well It can happen unintentionally also So it's not just, you know, uh, that pharmacy is trying to do something intentionally and second thing is You are absolutely right. The payer system has gotten sophisticated But then there are still coordination of benefits when you have multiple insurances covering multiple things That become that is still a big issue today Because then you are going cross pairs So that's that's another um, you know issue that comes comes and the other important thing I want want everyone to realize is a lot of large pairs Do not have uh or work with another You know pharmacy benefit manager So for example, you know, there is a there is a company a which is healthcare pair There is a company b which is the pharmacy management, uh benefits manager management company Their systems before they reconcile is is is is another, uh, I mean that's another big Uh undertaking as well. So there are some of these things some of these issues that are cross You know organizations if you will if I have all the data with me at the same time, you know, and I'm managing everything That's one thing. So there are complications still existing despite the pair systems have um, uh, you know become sophisticated challenges are still there Yeah, I agree. Um, a lot of the I definitely agree with what you're saying There's there's until we get all on the same page with like you said a single point of real time Connection between the pair provider and the patient. It's always going to be an issue Hi, this is kent again, uh, could I just uh add one more point to erica's point of view is that uh, if the patient takes a prescription to the pharmacy Little times if the pharmacy does not have that medication The pharmacist will actually order in The medicine and then go on to dispense and label and prepare the correct medication But if for whatever reason the patient Takes that prescription away then a pharmacist not only has done all the work necessary but also has Gone out of his way to bring in the medication Out of pocket and then the patient walks away then You know, they are with real time. You can actually compensate All the relevant stakeholders and actors for what they've done appropriately Yeah, I agree. It's really inefficient. Um, I've done that a million times like filled a prescription or ordered something really expensive And then I just sits there because the patient ended up getting it somewhere else or whatever It's certainly inefficient, but it does eventually get returned and You know the the patient, you know, if anything the pharmacy is really the one who suffers in that case Yeah, that's what I mean. So in a in a way the pharmacy has the worst of both ends thank you I think that uh Honoring the prescription has to be linked with that medical record so unless That is not there that we cannot How that is the account all these I think jikar the definitely you can Link the prescription with the medical record. The problem is the medical record is at a provider place pair does not have You know medical record, you know a lot of times right and at the same time I mean pair is is Uh is paying your bills for the pharmacy, which is again not connected to the provider system. So it's not as straightforward, you know To tie all these things together and all the efforts that we're talking about in the patient subgroup and all Is creating that fluidity with the medical record as well But nonetheless, I mean the question is going to be pharmacy or pharmacist should see Only what is relevant to them and medical record may have other things in place as well It just depends how and I mean there are a lot of Laws that have to be kind of tweaked before you know all that fluidity happens so just just just You know You're kind of How the systems work in that sense. That's right that medical record has to be suckered should not be able to take this It has to be suckered and that he when that from the card you can update that Of this And So it's a few jobs. Let us see and the structured data Working across through blockchain. It's a very huge work. There's a lot of yeah I think joker the the patient subgroup is actually working on that medical Uh, uh, I think uh, uh, can't correct me if I'm wrong. Is that sharing of medical records or just the clinical trials? No, so Just to update you What we've done with the patient subgroup is that we've put some of the patient data on the blockchain but in order to Pseudo anonymize or anonymize the patient. We are thinking about putting a Hyperledger Ares in the sort of wallet for the distributed ID in front of the fabric chain in order to Have patient there anonymize pseudonymize and also have the Data on the fabric chain as well Yeah, so I think uh, you know bottom line is going to be there will be multiple pieces that come together to solve each of you know various problems Our focus in these u.s. Cases are how do we manage this particular flow as we are talking about efficiently to avoid some of these I would say mishaps frauds, you know privacy some of these things So let's go to the blockchain viewpoint. I mean the previous viewpoint for what is the current state and the way it is happening today Let's talk about in if we implement a blockchain uh solution. What would it look like? So here the patient goes to a physician physician will send out the prescription Somewhere in the in the network It is not going to go to a particular pharmacy or a particular eyewear doctor or or You know, I wear full filler and all it will just go right on the chain Uh, what will happen is member will go to whichever choice of pharmacy or I would say I wear You know shop and try to request for fulfillment Full filler will request the consent the real time By the member by virtue of either, you know, a message coming to their phone or something like that But before the data for the prescription is pulled By this full filler It's going to request You know ravish give me a consent so I can pull your information from the chain for Fulfilling the request in this case. I don't need to go call back the physician I just need to approve Yes, this particular organization is asking Um or requesting the access to my you know prescription. Let me grant that request Or I would say consent to it Full filler gets the consent This is recorded as well. You know, I've got the consent. I got pulled out the prescription Full filler pulls the prescription out fills the prescription or I would say service the prescription in Whether completely or partially as can't mention there is just an area that you know out of three I only have two let me fulfill two one is still pending whatever fulfillment was done by the pharmacist Can be recorded there In context of that particular prescription So there is a there's a prescription one what I've done with the prescription one You know great And once the endorsement is done, this is what has been fulfilled fully or partially It gets written back to the chain What is going to happen is if this member tries to refill this prescription anywhere other location The the prescription will come as fulfilled by some other pharmacy Partially or fully whichever be the case even though the member gives consent to that second pharmacy as well Which means in a given context that prescription will be fulfilled only by Only by a single, um, you know, uh pharmacy if if the If the prescription was fully filled or partially filled it will be accordingly endorsed And there is a possibility I may want to revoke the consent You know after this transaction So every time I I should be consenting every time or consenting whenever I'm trying to fill Which is again will lead to a real-time notification to me Somebody is pulling my prescription information and they need my permission to do that This addresses Number of use cases does this address all the use cases absolutely not This is just the initial purposes of how we can create the flexibility. So imagine in the same scenario Um, this has happened to be a I wear, um use case I can really go to any shop I want I go there consent They don't have what I need revoke the consent go to another one And if one fulfilled the other one cannot fulfill that prescription anymore right and again in in this whole process what we are trying to do is avoid Number of fraud use cases refilling the same prescription and things like that also um, a real-time information to me as a member or a patient somebody trying to pull my record out and They need my consent to do that Which means I am I'm always dealing with the real-time information if you will And as I said earlier member has to be a key player in catching some of these things because these transactions whether it is prescription or a physician visit or Hospital visits are all going to be tagged by a member and sent to the pair If member is not able to validate some of these things or if member becomes a critical element to Provide consent at real-time We can avoid some of these mishaps that happen Then it may not be from member but an identity theft and and I can restrict that second on from behavioral perspective, you know The same prescription is going to be only filled once now and coordinated across any number of pharmacies So these are just a few highlights how we can look at it differently and leverage the blockchain Again, it's a very simple view as I said earlier. You're Erica. You you've been in this There are a lot of you know, peripheral use cases the same thing happens on the DME side as well Where in the medical equipments? You know get get sent to the members home and all all sorts of use cases exist You just pick one which is pharmacy and and kind of a viewpoint wherein it makes it simple to understand What we are talking about from from blockchain standpoint I'll just take a pause Take any questions or or can a psb or anyone anything to add Another thing you can integrate is a cyber physical system. So many iot devices and including variables That is that is perceived for a particular disease that can monitor the consumption of that And that update in the medical record So that that misuse can be that will reduce But yeah that That's a possibility But you have always on such system is If you take some time, there is a lot of collaborative report is needed Yeah In healthcare Any such change because of the nature of the business And so many different, you know constituent types who are in in the flow It takes time to change healthcare. It is not as easy as it is thought through Even if I have this perfectly working fine and and rock and roll Changing or adopting that into the healthcare system. It is not easy And I will not be surprised if making this happen requires some tweaking to the laws It is absolute. I will not be absolutely surprised But any the things are moving that Yep, yep Yeah, I have another question about the partial fill. Um, I was just curious where the need in the market for You know, um showing the partial fill is because I know as a pharmacist we have a pretty good way of Showing that those prescriptions were filled on that prescription. Um, even if there's one left over Uh, it's not like the patient can just take that and go get the other ones filled that are on there Um, so I'm just wondering where that need comes from or what the market needs for that is Perhaps I can take that question so I think Uh, you'll realize that if you fill half the prescription then you're never going to let go of that prescription Whatever happens the patient has to come back to you to get the other half or whatever is remaining Now that's very inefficient for the patient. The patient's always complaining. They never want to wait They don't care about the cost. They want it right now. So imagine there were two pharmacists next door to each other Pharmacist a can never fill half and they give the prescription to pharmacist b Right Because you need to keep the original copy or the laws or the reimbursements It depends on the on the level of control of the prescription Yeah, but you follow my point there. This is the actual paper paper copy versus digital copy and then Yeah, we make right so a digital copy is created when we write the prescription and then we There's ways around that that they do If it's a it's permitted to make copies of prescriptions that they're not controlled You keep one copy you give the patient the other copy you cross out the ones that you filled Um, so, I mean, I don't know. It's I'm not trying to pick it pick it apart I'm just saying that I I'm just trying to make sure we've thought through the market need of this But the inefficiency part I get the inefficiency part I totally get it's the fraud part that I don't really get But the inefficiency part is totally understandable from my from my point of view And Erica, I mean the uh, I think the uh, this is something that uh kent was Explaining earlier also and I am not a pharmacist So I may not be able to answer this but what I I'm thinking is This what you're describing might not be common in us But it can be in other countries Depending upon where you are The intent is how do we figure out the endorsement whether it's partial or full if even if we are if we are doing a full endorsement Okay, this pharmacy is filling the prescription I have the flexibility to do it full or half. It doesn't matter, you know from system perspective Yes, from from process perspective, I understand your viewpoint that Is there really a need to to manage the partial prescription? There may be not in in in the context of us But there might be in context of some other countries workflows and mechanics and whatnot. Nonetheless, if we are managing that Uh, you know, whether this prescription was was filled or not Or fulfilled or not Then we can manage even the partial piece as well. So from technical standpoint, that's that's just perhaps I can just kind of one more thing. So for example, quite often The doctor medical doctor would have described One calendar month, okay So it's up to the pharmacist to decide whether it is the 28 days or 30 days or 31 days So very often the medicine comes in a 28 tablet pack We give one original 28 tablet pack However, the patient is always lacking at least one or two or three tablets And so we can never give medicine without a prescription because first of all, it's illegal and then no one pays for it And the flip side is if we give 31 days for every single prescription Then there's always something left over and the patient always has extra tablets for no reason So it's about reconciliation Yeah, and I appreciate that it's probably a bigger problem outside the us But we have we have systems that account for the 28 versus 31 days here Um and ways of ways of doing that pretty pretty seamlessly But yeah, and and we we So yeah, I I totally heard what you guys are saying. Um, I just wanted to give you my feedback. So thank you Erica something tells me you will be a great addition to our group Definitely, I agree Erica has to be has to come to our group. I insist. Thank you Erica And and also revision. I think one good point you made is that you know, there are So many different use cases. I think we are not only trying in this group. We are not only trying to Just solve a real healthcare problem, but we are also trying to Create a use case, you know for For blockchain that can become a basis for like an expanding the use cases to other areas So, you know, I think I think that's just an important Distinction we need to make as far as our, um, you know creativity here is concerned Yep So Erica, I mean I would really request you, uh, you know, personally if you if you can join our meetings that will be great value add I mean everything is online as well. Um, and I'll show you we we have started a use case document You know, challenging some of those use cases something that would be very valuable for to us to ensure that we are not solving for something that is not needed Um, and and this is where the SME knowledge comes into picture as well And I think the supply chain also has to be modified. That's Delivery has to be that is it to that bedside of the vision that is the It has to reach the That is so that so that fragmented That prescription can be haunted in fragmented that supply That is the Going to a pharmacy and getting medicine If we have to deliver to that That is that type Yeah, jika. I mean the the delivery aspect is also there. I mean, it's just uh Yeah, there are so many use cases we cannot we have to start at a point simplified And then start adding those layers, you know, like what Erica is talking about like what you're talking about Absolutely as we go forward we we have to look into some of those things So just quickly sharing the viewpoint wherein As we think about the blockchain, we are we have thought about four major Players in this particular use case Um, obviously there will be many players but to start with uh with this particular use case the poc that we are building It's going to be a round provider as a participant a pair as a participant patients and pharmacy And you can see what data that we are trying to deal with when it comes to um, you know Writing to the blockchain or reading from the blockchain Um, as I mentioned, there are too many questions to be answered yet Who will run these nodes? Will it be a prayer provider pharmacy? Who's gonna who is going to run those, you know, nodes What all data should be on the chain and off the chain How to manage the identity will it be a single identity across various pairs or a different identity across Different pairs You know consent should be per transaction or one time but revocable I mean all these questions are there. I mean should be retrieved all the Should be alert based on all retrievals of prescription or should it be based on you know my I want to I I usually go to this pharmacy But if there is a pool of my prescription by any other pharmacy, I should know so it depends what kind of alerts we need We talked about partial fulfillment or you know complete fulfillment How to handle coordination of benefits if there are multiple pairs if I have insurance or supplementary insurance No between the pairs For the same medication. I may be able to build both of them before it, you know, I It gets reconciled across the pairs with the coordination of benefits You may have, you know, the fraud might have happened. So there are those scenarios Again, there are plenty of other questions to be answered But the intent is, you know, just demonstrating that we are just in the beginning step There might be a lot of refinement to the use case that we just talked about and that's where we are looking for You know help and advice and you know, like Erika, you mentioned about the partial fulfillment might not be a significant use case As we, you know do the analysis we may find out. Okay Great, we can look into it later on but the priority is to look at something else first So those things are there Um, I'm sorry someone Yeah, I think most of this problem can be solved if that is supply chain is modified so that the online pharmacy has to be delivered That is up to the best side Because most of the opiates that the medicines are that are for that More, more city patients by standard when they go for a pharmacy, they will misuse that So it has to be a patient's best side or that is I think that Yeah, joker, uh, as I said earlier, there are there are layers that we need to work through Um, yes, you are right. I mean there are you know, it can be done at the supply chain Supply chain has to do their bit pharmacy has to do their bit Pair has to do their provider has to do their there are a lot of these peripheral things as well And you know healthcare is like, you know a web, you know You talk about one thing before you realize you are you have to touch 50 other things at the same time So definitely I I understand what you're saying But yes, there is there is complexity in the use case itself Yeah, I mean the supply chain in the end user level Understood. I mean, uh, obviously, I mean that can happen. Um, I mean, uh, are you talking about when let's say a pharmacy is delivering something to Some patient even some diversion can happen there as well If they somebody that is Take the prescription and go to their pharmacy This year It has delivered to the Yep Cool. So just to quickly summarize as I mentioned, there is the use case document that we're working on If you it's available online, uh, the link is there. You can anyone can go and edit it It's on the hyper ledger repository What we have done is we are trying to detail it based on, uh, let me just quickly show you guys um The use cases. I mean what is happening at the provider level Based on that what can we use Uh as a solution. So for example consent, we can use that Yeah, for example, even providers should require consent by the member to write this on the blockchain, right? So Uh, so those those pieces of use cases we are trying to describe here And we're working through this. Um Erica I would love for you to take a look at it and make sure that we are working on the real thing Since since you've been in the industry and and you can easily point out some of these things and uh, and obviously, I mean, we also have I'm sorry, I think you are you guys were not uh, give me one second. Let me just share my screen. I was I don't know whether you had a chance to look at the document that I was talking about. So Um, can you guys see my screen? Do you see a uh word document? Yeah, it looks good Okay, okay So here we have the use cases as I mentioned documented. What are the scenario? Who are the actors? So on and so forth at the at the provider office at the pharmacy office Um, and depending on that we are detailing what else is needed for each step if you will and then obviously The github repo is there. You can you can see the initial We just started with some basics. I mean initial commit has been made by Kent And I think all the other members are going to be We will start contributing and we plan to build a small You know prototype wherein you know provider can submit this prescription When pharmacist tries to pull some notification to the member Member gives the consent They are able to fulfill and mark the prescription fulfilled. Now if you try to pull it from another pharmacy It will indicate it has been fulfilled and things like that I think I have covered most of the items. Um Anything else can be as be anything else to add Rich, I think I'm I've covered most of the things again. Uh, thank you very much for listening. I I hope It gave a good idea of what exactly we are working on And would welcome any inputs anyone to join the team and and see if they can contribute Especially I would request, um, you know anyone who has the pharmacy You know Knowledge or how the system works would be a great addition Erica like you. I mean it would be a great addition to the conversation And yeah, I just I just sent you a I sent you a message on the chat ravish. Thank you though for the presentation. It's great And we do have a request if you can put the the use case document link up on on chat So folks can get to it. That would be great Yes, I'll do that Well, uh, thank you so much ravish. This this was a really great presentation And I particularly enjoyed the the discussion and some of the good questions that came out of it And it it really does sound like you're you're moving forward. You're maturing the the use cases Pretty significantly And again, I'm really happy to see that we're getting this work sort of documented through the subgroup as well as up on Hyperligial labs. So that's fantastic Kudos to both yourself and and your team. Uh, this is really really nice to see this work coming together So thank you so much for that Um, any questions or comments before we close out? We are just a minute or two Up to the top of the hour. Uh, any last minute thoughts Already. Well, so just a quick reminder, of course, we are still dealing with the covid virus And on our wiki page, there are uh, it continues to be additional sort of resources that I maintain and update Please please take take advantage of those resources To stay up to date on any work that you may be doing in that space And then as well in general, please stay safe yourself. This is getting to be a very difficult time. I think Certainly here in the united states, we're starting to see an upsurge again in viruses and virus cases. And so just just reminder that The virus isn't very discriminatory and so it just will continue to to progress unless we sort of take it into our own hands Uh, already. Well, we will see you in two weeks And uh, thanks again, uh to revision revision team, uh for a pair subgroup and we will see you Thank you so much. Have a great weekend and again be safe. Thank you Thank you very much guys