專訪 Jason Goldwater：區塊鏈可以解決哪些醫療問題？
The Blockchain Interview with Jason Goldwater
資料觀丨黃玉葉(編譯)
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Jason Goldwater, MA, MPA is senior director at National Quality Forum of Washington, DC.
Jason Goldwater，公共管理學碩士，華盛頓全美質量研討會高階主任
What healthcare problems can blockchain solve?
區塊鏈可以解決哪些醫療問題?
There are three, initially, that it has the potential to solve.
應用伊始，區塊鏈有潛力解決3個方面的問題。
First is access to data. The way that systems have been set up in hospitals or large integrated physician networks is that the data will either reside in a centralized server or now the trend is to reside it in a cloud.
首先是解決資料訪問的問題。在醫院或大型綜合診療網路中建立系統的方式中，資料要麼儲存在集中式伺服器中，要麼就按當下的趨勢上傳到雲儲存。
Blockchain is very different because it is what is known as distributed ledger technology. Essentially translated, that means the data is not all residing in one place. The data is residing in various different locations. Every time a change to the data is made, that change is reflected across all the locations of which the data is stored. If there are going to be threats or hacks to data, it’s easier, to some extent, to hack into a centralized location to find a large amount of patient-generated data, whereas it’s more difficult to be able to get a large amount of patient data when it’s distributed across a large number of networks.
區塊鏈就非常不同，因為它利用了所謂的分散式分類帳本技術。從本質上講，這意味著資料並不都滯留在一個地方。資料儲存在不同的位置，每次對資料進行更改時，該項更改都將反映到儲存資料的所有位置上。從某種程度上來說，侵入一箇中心化的區域來查詢大量資料漏洞進而攻擊資料會更容易得多，然而想要從分散式廣域網路中獲取大量資料漏洞卻並不輕鬆。
The second thing it potentially has the possibility of helping is in the area of interoperability. That’s where most of the attention has come from with respect to blockchain. A lot of individuals are looking at this as possibly a solution to the problems of interoperability over the years, Some have even gone so far as to label it as panacea of sorts. I don’t think it’s that, but I do think it has far-reaching potential to help with interoperability because it allows data to flow in whatever syntax and whatever structure to be stored across locations.
其二，區塊鏈在互操作性方面具有潛能。人們對區塊鏈的關注度大部分源於此。許多人認為這可能是多年來互操作性問題的一個解決方案，有些人甚至把它當做“靈丹妙藥”。我不認為真有那麼靈驗，但我確實認為它在互操作性方面具有深遠的潛力，因為它允許資料以任何語法和任何結構在不同位置之間流動。
If a provider, care team member, patient, or a patient’s family needs access to that data, the data can be delivered through the blockchain to whoever is requesting it as long as authorization has been given by the individual of where that data came from. If I’m the patient and you’re a doctor and you need to see my complete patient record to help aid in decision-making for a particular diagnosis, and I grant you access to the blockchain, then you’re able to get all of the data that has been stored. Regardless of how it is structured, you will be able to access all of that data and potentially use it.
如果資料提供方、護理人員、患者或患者家屬需要訪問該資料，只要資料來源方授權，資料就可以通過區塊鏈傳遞給任何申請資料的人。如果我是病人，你是醫生，你需要檢視完整的病歷記錄來幫助你做出診斷，而我也允許你訪問區塊鏈，那麼，你就能得到所有的儲存資料。不管資料結構如何，你都能夠訪問所有資料並使用它。
The third biggest potential for blockchain, is that it can help move forward the idea of patient engagement and patient empowerment. The emphasis now is that with the amount of technology that’s around us, we’re generating more data than we ever have before, through wearable technologies and through portals. Even through genomics, with organizations like 23andMe, where you can get an entire genetic profile that you then have and can then send off to whomever you so choose.
區塊鏈的第三大潛力，是它可以幫助推進患者參與和患者授權的理念。現在的重點是，隨著越來越多新興技術的誕生，我們通過可穿戴技術和入口網站創造了前所未有的資料量。甚至通過基因組學，通過諸如23andMe(加尼福利亞一家基因測試公司)這樣的組織，你可以得到一個完整的基因檔案，然後你可以選擇性發送給任何人。
If I’m a patient and I have data that I’m able to view, and you’re a provider and you want to view that data, or you want to examine that data and then work with me on how to improve particular aspects of my health based upon what you’re reading. You could help me interpret what that information means. I would be able to look at that data on a regular basis to be able to see if I’m making improvements. As long as I’m authorizing you to be able to examine the data, then you’re able to look at that and then work with me on aspects of health that need to be improved.
如果我是一個擁有可檢視資料的病人，你是一個想檢視資料的資料提供方，或者說你想和我一起檢視資料，然後和我達成合作，你根據檢視到的內容來改善我的健康狀況。你可以幫我解釋資料資訊的醫學含義，我則可以定期檢視這些資料，以判斷自己的健康是否在改進。只要我授權你檢查資料，你就能看到資料，然後幫我一起改善健康方面的問題。
Every time that data changes, the blockchain changes. Since I’ve authorized you to have access to that blockchain, you’re viewing that data as it’s changing. You can then view and see exactly what changes are being made in my health as a result of activities that I’m doing.
每次資料發生變化，區塊鏈就會隨之改變。因為我已經授權你訪問區塊鏈，你可以看到資料的波動。然後，你可以檢視並確切地分析出，我所從事的哪些活動導致了這些變化。
Profit and legislative mandate drive much of what happens in healthcare. Who would benefit financially to move forward with blockchain?
盈利和立法授權驅動著醫療保健的發展。誰會在經濟上受益於區塊鏈呢?
Where blockchain can assist in value-based care is that if you have a distributed ledger where data is going to be shared across a number of areas, you are authorizing the blockchain to receive the data, and you’re working with your provider to be able to look at that data on a regular and continual basis, the provider can understand what needs to be done in order to improve the outcomes of your health and what processes need to be taking place. That, in turn, then meets the value threshold for reimbursement. As such, by doing that, they’re able to continually examine and understand a patient’s health in a way that they may not have been able to before. Because it usually relied upon a patient coming in, or in some cases having a virtual visit, and they would diagnose and look at the patient then and be able to prescribe the appropriate treatment protocols.
如果你有一個分散式賬本用以資料的跨域共享，區塊鏈可以提供基於價值的護理，你授權區塊連結收資料，你和你的資料提供方協作，定期並持續地檢視資料，資料提供方就可以知道為了改善您的健康需要做什麼，以及需要進行哪些過程。這就滿足了償付的價值門檻。因此，通過這種前所未有的新方法，他們可以不斷檢查和了解病人的健康狀況，因為它通常依賴於病人的到來，在某些情況下通過虛擬訪問，自動診斷並觀察病人就能夠開出適當的治療方案。
With blockchain, you’re taking a large amount of data, personally available data that patients are generating, and being able to look at that on a regular and continual basis to drive better outcomes of care, which then in turn drives value. That’s the first thing.
有了區塊鏈，你就擁有了大量的資料——病人產生的個人可用資料，並且能夠在定期和持續的基礎上觀察這些資料以達到更好的護理結果，然後反過來驅動價值，這是其一。
The second thing is the market dynamics are changing. Twenty-some odd years ago, it was a pretty basic concept. A patient would come in, they would say, "This is wrong with me," or they would come in for a regular checkup. They would be diagnosed and the provider then would recommend the appropriate medications, treatment protocols, whatever it may be. The only data that was generated at that point was the data that was generated during the encounter.
其次，市場動態正在發生變化。二十多年前，這還是一個相當基礎的概念。病人進來會說：“我哪哪有問題”，或者他們來做常規體檢。他們會接受診斷，然後醫生推薦合適的藥物，治療方案等等，以至於在特定階段(生病或體檢期間)才生成了唯一的資料。
That is not the case any more. The data is being generated everywhere. There is more data available for a patient than there has ever been. It’s not just the data that would come from wearables, portals, and smartphones, it’s also the data that’s available on social media sites, where patients write very eloquently about their health. It’s available through validated instruments that they have filled out over the course of their care. It’s available through sites like PatientsLikeMe that store an abundance of patient-generated data.
現在，資料的生成已經擺脫了傳統模式， 資料隨處而生。 一個病人產生的資料比以往任何時候都多，不僅僅是可穿戴裝置、入口網站和智慧手機上的資料，還有社交媒體網站上的資料。在這些網站上，病人們滔滔不絕地講述自己的健康狀況，可以通過他們在護理過程中使用的精確儀器獲得資料。上到諸如PatientsLikeMe等網站，可以獲取儲存其中的大量患者資料。
Blockchain allows the data to be distributed across a variety of locations, but the benefit of that is that the patient and the provider both have access to it. I have to authorize you to look at that, and every time that data changes, every time on a daily basis, if things begin to change — my heart rate changes, my blood pressure changes, my mood changes, I’m not exercising as much, I’m not taking the medications I need to be — that data is updated and sent to the provider on a regular basis.
區塊鏈允許資料分佈在不同位置，好處是患者和資料提供方都可以訪問資料。我授權你查閱資料，每次資料變化以及每天的波動，如果情況有所改變——我的心率、血壓、情緒的變化，我鍛鍊少了，我不按時服藥了……資料都將更新和定期反饋給資料提供方。
If the provider understands that they’re going to get that data on a regular basis and that it will aid in the decision-making, that they can put that data into an EHR and send that data around to provide access to that patient’s care, and understand that that data is then available to not only aid in decision-making, but to provide the impetus for better decisions — because the value based market is demanding that — then certainly that’s going to be an impetus to push towards better interoperability and better use of the data.
如果資料提供方知道他們會得到定期的資料，這將有助於決策。他們可以把資料轉換為電子健康檔案，並將資料傳送至周邊以提供對患者資料的訪問，如此一來，這些資料不僅可以幫助制定決策，而且可以為更好的決策提供動力。因為基於價值的市場有這樣的需求——那麼，這勢必成為推動良好互操作性的動力，人們也能更好地利用資料。
Does blockchain provide enough scalability for them to be able to increase the amount of data they can have for a patient? Does it provide the ability to exchange data across partners that could access that where they could either add to the blockchain or they could use the blockchain to help provide care for the patient?
區塊鏈是否提供了足夠的伸縮性，以儲存患者增加的資料量呢?它是否提供了在合作伙伴之間交換資料的能力：這些合作伙伴可以訪問並新增內容到區塊鏈，又或利用區塊鏈為病人提供護理嗎?
Now let’s start to look at the access security issues with respect to blockchain. That’s always going to be a paramount issue. The real thrust right now is for patients to have access to data. It’s the patients’ data. They should have access to it and they should be able to engage in a shared conversation with their provider using the data to understand their care better and for the provider to work with them on what needs to be improved. Understand how blockchain can improve access security between the provider getting data and the patient getting data and how that dynamic would change. How that dynamic would improve outcomes, enhance patient care, and enhance patient engagement, which is another part of this value-based dynamic.
現在，讓我們來看看區塊鏈的安全訪問問題。這一向是非常重要的問題。現在真正的推動力是讓病人能夠獲得資料。對於病人自己的資料，他們應該能夠訪問它，並與資料提供方進行共享對話，利用資料來掌握現有的治療並一起進行完善。我們要了解區塊鏈如何提升資料提供方和患者獲取資料的訪問安全性，以及動態的變向——這種動態如何改善資料結果，改進病患護理，提高患者參與度，這是基於價值動態的另一部分。
They really should also look at their data and their data privacy. How is their data stored? How is their data encrypted? How is their data protected? Is it vulnerable? Does it have the potential to be accessed and hacked? Is there a potential for a breach? No technology will solve that completely, but blockchain provides a greater ability to be able to protect data because it’s not stored in a centralized location. It’s stored in a peer-to-peer network.
人們真的應該關注自己的資料和資料隱私。他們的資料是如何儲存的?他們的資料如何加密?如何保護他們的資料?資料是否易受攻擊?它們有可能被訪問和攻擊嗎?是否存在潛在漏洞……沒有技術可以完全解決這個問題，但是區塊鏈提供了更大的能力來保護資料，因為資料並不儲存在一個集中的位置上，它儲存在點對點網路中。
The EHR on the blockchain can be access control manager. Who gets access to the data? What data flows into it? Does that significantly improve what they already have? If it does, then it’s a solution worth considering, because it can scale upwards in the ability of for them to not only gather more data, provide more data to the patient, and be able to exchange more data. It not only addresses better access security between the provider and the patient, but it may also improve privacy overall. Rather than the data being in a centralized location — whether it’s a cloud storage system or whether it’s in a centralized server — a distributed ledger provides a better mechanism by which data privacy can be maintained.
區塊鏈上的電子健康病歷可以成為訪問控制管理器。誰可以訪問資料?哪些資料流入其中?是否顯著改善現有狀況?如果是這樣，那麼這是一個值得考慮的解決方案，因為它可以擴大他們的能力，不僅可以收集更多資料，向病人提供更多資料，還能夠交換更多資料。它不僅解決了資料提供者和患者之間的訪問安全性問題，而且有望全面提高隱私性，因為分散式分類帳提供了一種更好的維護資料隱私的機制。
注：《專訪 Jason Goldwater：區塊鏈可以解決哪些醫療問題？》來源於 ofollow,noindex"> HIStalk (點選檢視原文)。資料觀編譯/黃玉葉，轉載請註明譯者和來源。
責任編輯：黃玉葉