Babbitt column | Blockchain + Medical: A bridge to restore trust? (under)

In the previous article, "Block Chain + Medical: A Bridge to Restoring Trust? (I) , the author introduced the role of blockchain technology in improving the diagnosis and treatment of patients, from the results, the effect is not obvious. In this way, it is necessary to turn to the cost side to study whether the blockchain technology can help alleviate the various costs of patients. According to relevant data, the main source of hospital income is currently drugs, and it is inferred that the main cost of patients seeking medical care is actually medicine. In this respect, the role of blockchain technology is actually not great. But this does not mean that it has no cost-cutting effect for patients. In combination with actual cases, some of the potential costs of patients when they see a doctor are caused by insufficient trust in the members of the medical system. So, what are the barriers to blockchain technology in reducing the cost of these trusts? In this regard, we must first sort out the links in the medical system that may generate trust costs. Specifically, there are the following aspects:

First, the video link: doctors may have a cost of trust.

It should be pointed out that in the process of communication between patients and hospital systems, the cost of trust does not only exist between doctors and patients. There is actually a similar situation within the medical system, which in turn increases the cost of medical treatment. The first thing that bears the brunt is the mistrust between doctors in the same hospital. The higher frequency is the crisis of ability trust between clinicians and imaging doctors.

It is well known that clinicians often need relevant imaging data (such as B-ultrasound, CT, MRI, etc.) as a basis for diagnosis when the diagnosis is made, and the imaging department, in addition to the film itself, is supplemented by reading the film. report. The problem is that although the imaging department will spend a lot of time and effort on reading, some clinicians do not recognize the report of the imaging department, skip it directly, but read it again. Especially in recent years, the relevant policies allow hospitals to outsource non-clinical services such as imaging, testing, and pathology to private organizations. In this regard, the industry once appeared "first-class doctors to see the film after watching the report, second-rate doctors look at the report after watching the film, third-rate doctors only see the report does not look at the film". Afterwards, it became even more common that "first-class doctors only watch movies, second-rate doctors watch movies, and third-rate doctors only read reports." Some clinicians have insufficient trust in imaging doctors.

Figure: In the eyes of many people (and even some clinicians), the video doctor is a "master of filming"

WeChat screenshot_20190401105354

It is not difficult to see that the clinical crisis of trust in imaging doctors belongs to the typical second type of trust crisis mentioned in the article "blockchain + education " – that is, two different stakeholders are targeting the same information. There are very different conclusions, so one of them will question the other party's "how to do it." The blockchain technology called "trust machine" is currently unable to do anything about it, and the solution given by digital technology is mainly to avoid the mistakes of imaging doctors due to fatigue and cognition through artificial intelligence reading. In order to reduce the redundancy cost caused by repeated reading, in this process, the blockchain technology may play the role of opening information islands, ensuring data security interaction, and finally improving the accuracy of the AI ​​algorithm, just as the author As mentioned in the previous article, the core technology of this process lies in the encryption technology behind the blockchain, not the blockchain itself, so there is still a long way to go. Before that, the manual reading still remains. It will be the mainstream of the industry, and the redundant costs (including economy and time) generated from it will eventually be passed on to patients. It is worth noting that if the imaging doctor and the clinician reach a diametrically opposite conclusion for an image, then the patient will fall into a more contradictory situation – because the imaging doctor has a professional advantage and the clinician has experience. Advantages (as mentioned above, clinicians who generally like to read their own films are classified as “first-rate”). Under the entanglement, they will eventually need to go to other hospitals, which in turn triggers the medical system. The second type of trust crisis – that is the mutual distrust between hospitals and hospitals.

Second, the diagnosis link: there may be trust costs between hospitals.

In the process of seeking medical advice, it is not uncommon to transfer to the hospital. In cases where the condition is difficult to diagnose or to be treated, patients often choose to go to other hospitals for treatment. The crisis of trust between hospitals is also triggered: for the detection and diagnosis of the previous hospital, how high the recognition level of the latter hospital is often a problem. Needless to say, the results of the diagnosis and treatment often appear to be completely reintroduced. As for the basis of the diagnosis and treatment, that is, the relevant tests, tests, and imaging results, it is sometimes difficult for a hospital to give complete trust to the former hospital. After all, in the current popularization of the graded diagnosis and treatment system, many related equipment in small and medium-sized hospitals are generally inferior to large hospitals.

A common example: imagery. It is well known that when patients are transferred to hospitals, image data is often carried by physical media such as film. However, a considerable part of the images are not high in resolution and resolution on the film. It is difficult to perform accurate reading. At the same time, some indicators are difficult to display on the film (for example, a certain local tissue) CT value, etc.). The digital version of the image, in the form of a model similar to 2D or 3D, is much more detailed than the image on the film, whether in sharpness, resolution, or interception of the slice. Therefore, under such circumstances, if the former hospital can share the digital files of the patient image data with the latter hospital, it can alleviate the interference caused by the shortcomings of the video film and greatly improve the diagnosis and treatment of the latter hospital. Accuracy.

Figure: When medical images are presented on a computer in a digital form, they are much more accurate than on a film.

Timg (1)

However, in the current medical system, due to a series of technical factors (such as different information system interfaces between hospitals) and data privacy and other self-management considerations, medical data often exists as a hospital, not a patient's assets. And the hospitals often do not interact with such information, thus forming a "data information island" problem that people are very familiar with. Therefore, in practice, patients often face the following two options: First, passive, temporarily use the relevant information collected in the previous hospital, the quality of the general information, but this may lead to inaccurate results of the diagnosis and treatment; It is a little more proactive, that is, to do another inspection and re-collect information collection in the latter hospital, but this has created some economic, time, and even health costs that are not necessary. Image inspection and data collection such as filming, it is likely to be a team of days, weeks, or even months, and some medical examinations including enhanced CT will also bring certain health benefits. The negative impact.

In such cases, the medical data is determined by the blockchain (this right may be attributed to the patient himself or to the hospital, and the specific matters need to be further clarified), while using encryption technology to ensure data ownership. In the case of the interests of the people, it is very important to complete the secure interaction of the data. In fact, if we look at the “blockchain+medical” solutions that are currently available on the market, we will find that quite a few solutions are aimed at the interaction of this medical data. Because it may involve an important problem: the early detection and prevention of the disease, and even the increase in life expectancy.

The first thing to be clear is that most people die of chronic diseases. In China, for example, this figure is as high as 80% or even close to 90% in some areas. In life, people often can see that some patients often wait until the symptoms are obvious, and when they are too late to seek medical treatment, they will have to wait for a long registration period, image cycle, and The surgical cycle, until the final pathological results came out, found that his condition has been difficult to treat because of the delay. The so-called "cancer is found in the late stage" is for this reason. However, if the patient can collect their own health data as soon as possible and detect the relevant health abnormalities, it is very likely that the disease will be rapid in the early stage of the disease, in the general outpatient clinic of the primary hospital, and by routine means such as taking medication. Strangled in the cradle, so for the medical system that is now overwhelmed, it is very necessary to sink the right to sense and detect the disease to a primary hospital that is easier to register and film, through a system similar to grading diagnosis and treatment. After all, although the medical clinical department is difficult to centralize, it does not mean that all aspects of medicine should be concentrated in the centralization organization. Some common monitoring operations can be decentralized to primary hospitals, even including wearable devices. Distributed equipment. However, if this sinking detection right has no way to complete a good connection with the downstream clinical institutions, that is, clear digital data cannot be transmitted to the hospital responsible for the clinic. It seems that some private schools cannot obtain social degrees. Admittedly, the effect of decentralized action like grading diagnosis and treatment will also face certain limitations. Just as some “Pheasant Schools” don’t make much sense, this is why many institutions focus on blockchain confirmation. Reasons for the safe interaction of medical data with related data: Because it is using a more feasible blockchain solution, it may be a higher-yielding thing.

Figure: Comparison of the cycle of two medical treatment modes. If the blockchain can achieve secure interaction of image data between the primary hospital and the large hospital, it will be of great benefit to improve the accuracy of patient diagnosis.

WeChat screenshot_20190401103539

Third, the treatment link: mutual distrust between doctors and hospitals may push up the cost of patients.

Another possible factor in raising the medical cost of patients stems from the “excessive treatment” of some doctors, that is, the medical treatment given to patients exceeds the diagnosis and treatment needs of patients, causing additional pain and economically wasted medical treatment for patients. behavior. For example, a small illness doctor, through the exclusion method to confirm the condition. There are many reasons for this. One of the important factors is that the doctor's income is currently linked to the benefits of the hospital and the departments of the department. For hospitals, especially doctors, it is difficult to cover the registration fee of the clinic alone. The high operating costs can usually only rely on “medication by medicine” or “care by equipment”. Under such circumstances, some doctors may have an over-exposure tendency between intentional or unintentional.

Due to the ambiguity of medical treatment, there is currently no clear definition of “excessive treatment”. Therefore, fundamentally speaking, the fundamental solution to reduce the occurrence of “excessive diagnosis and treatment” and reduce the burden of patients’ burden is to improve the doctor’s economic treatment and to drive the diagnosis and treatment behavior from the lowest basic needs of Maslow’s demand theory. Upgrade to a higher level of self-realization needs. A sample survey of doctors in recent years shows that only 16% of respondents are currently satisfied with their income. Therefore, improving the treatment of doctors can be said to be an important and urgent task. In fact, in the case of doctors' contributions and income mismatches, the relevant departments have previously established regulations that allow doctors to practice more. That is, qualified medical practitioners can be employed by more than two medical institutions after being registered by the health administrative department. The practice of practicing, in the vernacular, is to "go to other fields to work part-time." However, in practice, some doctors' multi-point practice requests cannot be approved by the original unit. The data shows that although only about 17% of doctors in China currently want to remain in their original state and focus on the original medical institutions. However, 80% of doctors have not been able to get more experience, mainly because the hospital does not trust doctors, and believe that their odds will lead to the loss of talent and technology. No matter how the doctor defends, there is nothing to make up.

Figure: The original hospital did not trust the doctor and refused to practice more. It was one of the reasons for the doctors' low income and over-exposure.


As in the case of doctors, disputes between hospitals and doctors due to multiple practice are still typical of the “second type of trust crisis.” The same information for doctors going out to practice, doctors and hospitals give In a completely different interpretation, the blockchain is currently powerless in this situation: even if the doctor thinks that the more common treatments are recorded in the chain, the hospital may think that this is a category of technology loss. In fact, from the experience of other countries or regions that have realized independent practice of doctors, the increase in the trust between hospitals and doctors, and even the change in the relationship between the two, the future is mainly through the development of society and the promotion of public opinion. Completion, in recent years, the trend of IP and net redemption of practitioners in various industries has begun, and some young doctors have begun to intentionally build their own personal brands, vying to become "net red doctors", and then realize the foundation of sufficient wealth accumulation. In order to provide patients with more appropriate medical services. How high is the society's acceptance of such organizational changes, and how fast it can advance, remains to be seen in the next step.

Fourth, summary

From the above analysis, it is not difficult to see that the blockchain can play a positive role in the future in terms of medical data confirmation, artificial intelligence reading for the video link, and smooth flow of patient digital images. If it can be combined with reliable wearable devices in the future, it will help to achieve a “medical-based” to “prevention-oriented” transition in some vertical areas. However, since medical care is a large and comprehensive system that is composed of multiple disciplines, it is difficult to say what kind of obvious promotion of the blockchain technology can be made to the whole. In addition to digital technology, the future substantive development of this industry It will still depend on the common progress of physics, chemistry, imaging, and even institutional reform, just as the improvement of human health is not only due to the development of medical technology, but also to the common progress in environmental, biological, behavioral lifestyles, etc. .