Two years ago, I was involved in a Design Thinking session at a major research institute to brainstorm and discuss how blockchain can be used to address a social problem i.e. the Opioid Abuse. However, blockchain alone cannot provide a solution but when combined with IoT and AI could result in a better solution. The following article is based on a concept that needs further discussion and evaluation. The focus of this article is on a social problem and does no try to address fraud or criminal activities.
The Blockchain provides many benefits and these include trust, transparency, immutability and smart contracts among many others. A public blockchain has some advantages such as focus on the smart contract while delegating transaction validation and consensus to the network of validators and miners. The downside is that they many have fluctuating transaction fees and finality latency. Permissioned blockchains will require members such as clinics, pharmacies and health plan providers to collaborate on a permissioned network which could be challenging without a clear business model.
IoT technology is transforming many traditional business processes and enabling newer ones. Several advances in IOT such as reduced form factor, lower power requirements, functional diversity and location independence make them very suitable for newer applications. The challenge is the availability of internet connectivity where these devices may be installed.
Lastly, AI and ML enable real time predictive analytics and insights that could trigger smart decision making in real-time.
What are Opioids?
Opioids are a class of drugs naturally found in the opium poppy plant. Prescription opioids are used mostly to treat moderate to severe pain. However, opioids can become addictive and the potential for misuse of the drug is very high. Currently, our society is facing a huge crisis of opioid abuse, over-dose, and misuse of prescriptions.
For patients, there is also a lack of easy availability of treatments and care facilities. Patients are uncomfortable seeking treatment due to the social stigma associated with “drug addicts” and hence they are afraid to go to the doctor. Naloxone is a medication designed to rapidly reverse opioid overdose, but its formulations are not easily available in rural and remote areas. Doctors are afraid of receiving drug-addicted patients due to the fear of losing their regular patients.
Tackling this social issue requires collaboration between the public, government, health care providers and private support groups to weed out this problem from our communities. At the same time, advances in technology can also be leveraged effectively.
Another issue is the availability of illegal and counterfeit drugs in the market. New research in verifiable technology can also be leveraged to address these such as encoding pills with edible silica micro-tags. IBM Research has developed a technology called crypto anchors. A crypto anchor ties a UID to the physical object with a property of the object that is hard to clone, forge and transfer to another object. Other technologies such as copy-proof tags and labels can also be leveraged to prevent counterfeiting and tracking legal supplies.
Here we examine the use of blockchain technology coupled with electronic dispensing machines with IoT sensors and smart prescription cards to assist in tracking, dispensing and automatic prescription management for patients in a trusted, anonymous, yet verifiable environment.
Examining a potential architecture:
The three main aspects of a solution architecture are shown in the following diagram.
The blockchain and smart contracts
The healthcare industry is looking at blockchains as a potential technology to improve health care in the communities. The blockchain is the system of record for prescriptions and anonymous patient information (minus PII). Smart contracts enable interaction with Doctors, Patients, Pharmacies, and Insurance companies in a trusted, transparent, and anonymous fashion. The blockchain executes smarts contracts that serve many purposes:
- Authenticates patients and authorizes the dispensing of medicines
- Ensures the dispensing machines are well stocked when they run out of stock
- Maintains accurate record of the prescription, refills and dosage
- Notifications to dispense medicine upon verification
- Sends events when patients run out of prescriptions or the frequency of dispensing is not as per prescription policy
The electronic prescription card:
The main purpose of this smart card is to work with blockchain enabled dispensing machines. The card is encoded with the patient’s authentication using Zero Knowledge Proofs (ZK Proofs), thus allowing patients to transact anonymously. The card will hold prescription information and record updates sent from smart contracts when the doctor or hospital re-issues or modifies prescriptions. The card will enable insurance verification, submitting insurance claims and making payments as additional features.
The Intelligent Dispensing Machine
This machine will have connectivity to a blockchain network via an embedded client that is resident within the machine or can connect to a cloud client via the public internet. It can read the “Smart Prescription Card”. The machine can be placed in all pharmacies, rural locations and public places of concern to help patients have easy, yet verifiable and anonymous access to the drug or its treatment. When a patient inserts a card:
- It will authenticate the patient using ZK Proofs
- Review prescription, usage, compliance and dosage
- Review updates to prescriptions
- Dispense appropriate medication
- Send transactions to update blockchain records
The Machine Learning component will analyze prescriptions, frequency of dispensing, 3rd party data from local and other and other available resources, and detect misuse, fraud, possible causes for concern and whether the system should accept the request for refill.
The central theme of this approach is to do the following:
- Enable easy access to medication in all locations — rural, impacted areas, cities etc.
- Help patients avoid the stigma of being labeled as an addict by providing anonymity
- Enable pharmacies and doctors to support patients without being labeled as a place for drug addicts to hang out or intimidate other patients
- Enable remote updates to prescription and treatments
- Make dispensing verifiable, manage abuse using intelligent smart contracts.
A typical flow:
- A patient inserts the electronic prescription card into the “Intelligent Dispensing Machine”
- The IDM authenticates the patient via ZK Proofs using voice or touch screen actions
- If the patient is authentic, it verifies the prescription against a smart contract running on the “Opioid Chain” , reviews amount dispensed, abnormal dispensing habits, pending dispensation and any updates to the prescription. For example if the patient is not following the prescription routine, it could flag the behavior, or it could deny dispensation, if the patients dosage does not match consumption patterns.
- If required, it could collect payment and send notifications and messages to the doctor, insurance company and others
- Dispense medicine
Deploying the Solution
A typical deployment of the network may look like this:
The IoT network is a separate blockchain network. It is a consortium of all dispensing machines, helps authenticate them and record data points. They operate either within the same ecosystem on a separate channel (Hyperledger Fabric) or as an edge network where smart contracts send notifications to the core. The Core Healthcare Network deals with the health care business processes such as patient verification, prescription management and clinic-patient relationship.
The concept can be extended to use 3D Printing technology to prepare the medication “Just In Time” to avoid abuse or criminal behavior.
In summary, one avenue to address the opioid abuse is to leverage technology. The cost of deploying the technology may be recovered many more times than the cost to the community and country as a whole. I am not a healthcare provider nor a pharmacist. The focus here is on technology and does not reflect the opinions of Chainyard or its affiliates.