Blockchain Health - Remunerative Health Data Commons & HealthCoin RFPs

The bigger concept behind cryptocurrencies like bitcoin is blockchain technology. The blockchain (a chain of transaction blocks) is a public transaction ledger, automatically downloaded and stored digitally in electronic wallet applications; a digital record of all transactions in a certain asset class like bitcoin. There can be different kinds of blockchains (ledgers) for recording and tracking different kinds of assets. Blockchain health is the idea of using blockchain technology for health-related applications.

At least four principal blockchain health ideas have been articulated so far:

• Blockchain Personal Health Record Storage – Personal health records would be stored and administered via blockchain like a vast electronic EMR system. Taking advantage of the pseudonymous (e.g.; coded to a digital address not a name) nature of blockchain technology, personal health records would be encoded as digital assets and put on the blockchain just like other assets like currency (bitcoin, litecoin, dogecoin, etc.). Users would permission doctors and other parties into their records as needed via their private key. In addition to creating vast repositories of medical health data records, the blockchain could also be a mechanism for quantified self data commons to amass and analyze data for preventive medicine purposes.

• Blockchain Health Research Commons - Health research could be conducted by aggregating personal health records stored on the blockchain. Users may feel more comfortable contributing their personal health data to a public data commons like a blockchain 1) in an encrypted pseudonymous form, and 2) for some amount of remuneration via bitcoin, or different kinds of healthcoin (which could denominate HSA dollars and be spent back into health services). The benefit of storing health data on the blockchain is that it can be analyzed but remain private. DNA.bits is a startup in the blockchain health research space.

• Blockchain Health Document Confirmation Services - Confirming that certain kinds of health information exist like proof-of-insurance, test results, prescriptions, status, condition, treatment, and physician referrals are just a few examples of health document-related services often required. The ‘notary function’ is a standard application envisioned for blockchain technology. This is the digital encoding of all manner of important documents (driver’s license, identity card, passport, home/auto titles, auto insurance, etc.) to the blockchain, which can be verified in seconds with encryption technology as opposed to hours and days with traditional manual technology.

• Doctor Vendor RFP Services – doctors and health practices could bid to supply medical services needed by patient-consumers. Like Uber drivers bid for driver assignments with consumers, doctor practices could bid for hip replacements and other needed health services, at minimum bringing some degree of price transparency and improved efficiency to the health sector. Further, this bidding could be automated via tradenets. 

More Information: 
The Institute for Blockchain Studies
Presentation (summary) and slides:  Blockchain: The Information Technology of the Future

Bitcoin Newbie? How to get Started

Consult this primer: Getting Started with Bitcoin from bitcoin.org (an industry-supported foundation), and FAQ.

Step 1: Get yourself a wallet (app/client) such as Coinbase, Blockchain, Electrum (beginner's guide), Mycelium (Android), Bitcoin-Qt (now Bitcoin Core). 

Step 2. Obtain some Bitcoin - Ideally someone will have given you some, or you can buy some from someone local. Another possibility is gifting yourself some with eGifter or other services.You can always convert dollars to bitcoin. You will need to provide your identity if you are going to transfer dollars into bitcoin with one of the wallet services (such as via ACH, wire or credit card).

Step 3. Advanced - Mixing Transactions. When you actually go to do transactions, you may wish to use a mixing service like Send Shared (SharedCoin) to mask the funds original source by mixing them with other funds. Services typically charge a 1% fee.

Step 4: Check out the local Bitcoin community and the increasing number of ways to spend and earn Bitcoin. OpenBazaar is a decentralized marketplace for instantly trading with anyone using Bitcoin - local anonymous trading - maybe supplanting or augmenting eBay and CraigsList. LocalBitCoins remains an expanding local resource for buying and selling Bitcoin, and there are of course Bitcoin ATMs and kiosks.

Where did Bitcoin come from? 
The primordial Bitcoin or stone blockchain is Rai stones on the Island of Yap, used exactly as in the current purpose, as a public ledger of economic transactions inspectable by all.

Proximity Marketing: Opportunity for Rich-Attribute Conveyance

Real-time Location-based Services (RT-LBS or just RT-LS) is an important new concept in mobile marketing. These offerings are starting to tout the ability to deliver information and services based on the real-time location of a person. Some key examples are receiving a mobile phone-based notification of a restaurant offer while walking in a downtown area or a product coupon while shopping in a specific grocery aisle. (Although there would need to be a saturation algorithm adjustment as potential customers flock to a location.) As is true generally with the advent of newtech, there is a much richer level of attribute conveyance beyond that of economic incentive that could be demonstrated in new applications. For example, why not broadcast key real-time attributes that a user has affinity for beyond or in addition to price such as ambiance, noise level, wait time, including for example near real-time photos from the establishment. A time-to-be-seated comparison with map overlay app can be imagined, upleveling the concept from the harangue of groupon discounts.

For indoor locations where there is no line-of-sight to GPS, there are other solutions, and this is where imminent progress is being made. There are WiFi networks (where even having WiFi enabled is enough know that ‘you are here’ or at least that your phone is ‘here’), Bluetooth Low Energy (per most smartphones), and now iBeacon and similar technologies. iBeacon, etc. is essentially an RFID technology where there would be a beacon on each grocery store aisle that could track customers and deliver coupons or other notifications. However, Bluetooth would need to be enabled which most smartphone keep off. In all of the industry promoted excitement over proximity marketing with real-time couponing, one cannot help but notice that truly revolutionary progress, for example auto-checkout per item-level RFID tags or some other mechanism remains a hard, expensive, and unsolved problem. What about remote hover cam item selection and personalized drone delivery?

For outdoor retail locations, GPS is still a good solution as it can locate a person within a meter per satellite pings. GPS resolution is already available in centimeter resolution for professionals (at $1000 and reportedly now at $500). This cost/performance curve could continue to ratchet down and centimeter-level GPS resolution could harken exciting new classes of location-based technologies, for example medical applications that require sub-body level detail.

Top 5 Killer Apps: QS-Automotive Sensors

The Internet of Things means not just that computing devices have connectivity to the cloud but that they are connected to each other, and therefore that novel applications can be developed in this rich ecosystem. One area for development is linking quantified self wearable sensors with automotive sensors for applications including Fatigue Detection, Real-time Parking and Assistance, Anger/Stress Reduction, Keyless Authentication, and DIY Diagnostics.

The auto industry may be poised for tremendous change in the next two decades with self-driving cars, denser cities, more cars on the road, and alternative fuel sources expected. This suggests new concepts in personal transportation, including redefining 'what a car is' to shift from a 'dumb conveyance' to an interactive platform communicating in real-time with other drivers, smartcity infrastructure, driver and passenger biometric data, and other sensor/internet of things information streams.

 Smart Pod Conveyance of the Future?

 (Image: M. Ghezel)

Top 5 Killer Apps 

1. Fatigue Detection

• Fatigue is implicated in 20% of accidents. Early warning signs are a slower driver heart rate and breathing rate, and posture slump. These could be detected through wearable sensors or auto-based sensors, and an intervention provided (verbal alert, seat vibration, music, or puff of air). 

2. Real-time Parking and Assistance

• Up to 75% of city center congestion may be caused by drivers looking for parking. Parking garage data could be connected to on-board navigation systems to show and guide drivers to available spots, and further reserve and pre-pay for spots where a user presents a QR code on a smartwatch or smartphone to a smart parking gate like from SureSpot to obtain the parking ticket [and directions to the spot]. 
• A related idea is real-time automatic road-side assistance, where automotive sensors would assess crash impact and predict damage. Then if appropriate the vehicle could alert local trauma centers (tier 1-5) and first responders. If the accident is less serious, if the driver has permissioned such a service, an app could automatically request local vendor service quotes.

3. Anger/Stress Reduction

• Anger reduction is the most obvious area for improvement where most simply the driver’s mental state could be read from sensors and interventions provided such as breathing exercises, music, and question-based (re-focusing) intervention. 
• Smart steering wheels with heart sensors could be used to detect heart attacks. Medical emergencies are implicated in 1% of accidents, and this number is growing with active adults driving longer, and commute distances lengthening. 
• Wearable or auto-based sensors could provide a daily health check that is completely transparent to the driver measuring heart rate, respiration, blood pressure, skin conductance, and glucose levels, and sent through the cloud to the driver’s personal EMR or QS data portal. 
• Addressing stress as a complex adaptive system, multiple data streams could be integrated into a ‘leave on time’ app. A key stressor in distracted driving is being late. An individual’s online calendar could be connected with real-time traffic data so smarthome or smartwatch alerts communicate to leave earlier for an appointment and confirm if this happens, and measure drive-time stress. Financial incentives could be offered for both health and auto insurance discounts for reduced stress and smart driving.

4. Keyless Authentication

• Keyless authentication, could facilitate one-time or short-term access, for example for automated car rental, assuming anti-theft concerns are allayed. Vehicle authentication and access could be via Bluetooth, QR code, blockchain technologies, and/or smartwatch fingerprint readers for an added layer of validation.

5. DIY Diagnostics

• DIY diagnostics accessed with tools like the CarChip could be an important app. Just like DIYscience and DIY health, on-board diagnostic data could be collected and linked to user-friendly consumer apps for pro-active notification and preventive maintenance. Asynchronous reminders (later while the driver is relaxing at home) could consist of the vehicle tweeting the driver more granular detail about its condition and potential maintenance, including the projected cost per different future time points if the maintenance is delayed.

More Details and References to Statistical Citations: Sensor Ubiquity: Blockchain Tech and Automotive-Quantified Self Integrated Sensor Applications developed for Toyota's Collaborative Safety Research Center.

Cognitive Nanorobots for Pathology Resoulution and Enhancement

One way to think of cognitive nanorobots is as a subset of medical nanorobots, meaning nanorobots for use in the body related to medical purposes, in this case, neural processes. Nanorobots are tiny computing machines at the nanoscale that can perform a variety of operations within the human body and beyond.

In the strictest sense, nanorobots are still conceptual: the Oxford English Dictionary definition of nanorobots (nanobots) is hypothetical very small (nanoscale) self-propelled machines, especially ones that have some degree of autonomy and can reproduce. While this definition that includes autonomy and reproducibility is one for the farther future, in reality there are a number of nanoscale inorganic objects that have already been in use in the body for some time in a variety of medical applications. So far, the activity scope of these nano-objects has been pathology resolution, but the same kinds of techniques and characterization of the underlying biological processes could be explored for enhancement purposes.

The most developed area of nanomedicine is nanoparticle drug delivery (designed particles that disgorge cargo in cellular destinations per simple onboard logic instructions) and other therapeutic techniques, followed by nano-diagnostics, and nano-imaging (like quantum dot imaging) (Boysen 2014). Some of the more recent interesting applications are nanosponge waste soak-up and biomimetic detoxification (Hu 2013), optogenetics (controlling the brain with light) (Klapoetke 2014), and neural dust brain sensors that might be able to read whole sections of brain activity externally (Seo 2013). The current status of the development of neural nanomedicine is well covered in the scientific literature (Provenzale 2010, Kateb 2013, Schulz 2009, Mavroidis 2014, and Boehm 2013).

Thinking in the longer-term, Robert Freitas has designed several classes of medical nanorobots such as respirocytes, clottocytes, vasculoids, and microbivores that could perform a variety of biophysical clean-up, maintenance, and augmentation functions in the body (Freitas 2003). One example of neural nanorobotic clean-up is autonomous diamondoid “defuscin” class nanodevices. These are conceptual nanodevices designed to eliminate the residual lipofuscin waste granules in lysosomes (the ‘trash compactor’ of the cell) that the body cannot fully digest.

References:
Boehm, F. (2013). Nanomedical Device and Systems Design: Challenges, Possibilities, Visions. New York, NY: CRC Press, especially Chapter 17: Nanomedicine in Regenerative Biosystems, Human Augmentation, and Longevity, 654-722.
Boysen, E. (2014). Nanotechnology in Medicine – Nanomedicine. UnderstandingNano.com. Retrieved from http://www.understandingnano.com/medicine.html.
Freitas, R., Jr. (2003). Nanomedicine, Vol. IIA: Biocompatibility. Austin, TX: Landes Bioscience.
Kateb, B. & Heiss, J.D. (Eds). (2013). The Textbook of Nanoneuroscience and Nanoneurosurgery. New York, NY: CRC Press.
Klapoetke, N.C., Murata, Y., Kim, S.S., Pulver, S.R., Birdsey-Benson, A., et al. (2014). Independent Optical Excitation of Distinct Neural Populations. Nature Methods, 11, 338–346.
Mavroidis, C. (2014). Nano-Robotics in Medical Applications: From Science Fiction to Reality, Northeastern University. Retrieved from http://www.albany.edu/selforganization/presentations/2-mavroidis.pdf.
Provenzale, J.M. & Mohs, A.M. (2010). Nanotechnology in Neurology: Current Status and Future Possibilities. US Neurology, 6(1), 12-17.
Seo, D., Carmena, J.M., Rabaey, J.M., Alon, E., Maharbiz, M.M. (2013). Neural Dust: An Ultrasonic, Low Power Solution for Chronic Brain-Machine Interfaces. arXiv, 1307.2196 [q-bio.NC]. Retrieved from http://arxiv.org/abs/1307.2196.
Schulz, M.J., Shanov, V.N., Yun, Y. (Eds.). (2009). Nanomedicine Design of Particles, Sensors, Motors, Implants, Robots, and Devices. New York, NY: Artech House.