Blockchain Technology for a Patient-Centred Clinical Pathway Feasibility Study

“NHS在利用新兴技术改变商业实践方面落后于其他行业。人们一致认为，数字技术有可能改变患者接受服务的方式，提高护理的效率和协调，并协助人们管理自己的健康。采用数字技术改变医疗的速度一直是最近政策和讨论的焦点。英国国家医疗服务体系（NHS）未来五年描述了一个缩小护理和质量、资金和效率以及健康和福祉方面差距的数字化愿景。从NPfIT吸取的教训导致对中央授权的解决方案持谨慎态度。国家信息委员会PHC2020描述了发展地方数字路线图的实际步骤，2016年Wachter报告呼吁将更大的临床领导力和互操作性作为数字化NHS的核心目标。通过独特的临床技术合作模式，我们开发并部署了针对特定人群的综合护理途径，这些人群已经在全国范围内扩散，这是由于临床驱动的解决方案跨网络的方法，在一个中央平台上托管核心临床过程，而不会干扰已建立的当地服务交付模式。我们相信，这种跨组织的数字化全护理途径支持社会和临床网络，并为转型变革提供了机会。这项可行性研究将测试使用新兴区块链技术构建的并行系统，使用分布式账本而不是集中托管信息，是否可以在整个系统中提供更高的成本效率，特别是通过在患者层面捕获交易进行调试，以及从人群中提取大量数据进行高级分析的能力，这些数据目前由于组织内部的数据仓库实践而无法获得。我们计划通过在两个系统上并行模拟病人流动和事务来测试区块链技术的可行性；一种是在共享的中央平台上使用开源技术，另一种是使用区块链开发的相同临床过程，在一个明确的和充分了解的人群中进行。成本效益可以根据现状进行分析，患者水平的数据在当地输入一个国家数据库，通过对与收费相关的人群进行简单的风险分层，对活动进行回顾性年度分析，为委托提供信息。比较将跨两个系统建模，一个系统可以从基于web的动态临床过程中提取实时数据，另一个系统使用分布式区块链方法对相同的临床过程进行事务性分析。”

"The NHS trails behind other industries in use of new and emerging technologies to transform business practice. It is agreed that digital technology holds the potential to transform the way patients engage with services and improve the efficiency and co-ordination of care and to assist people in managing their own health.The speed of adoption of digital technologies to transform care has been the focus of recent policy and discussion. The NHS England five year forward describes a digital vision to close gaps in care and quality, funding and efficiency and health and wellbeing. Lessons learned from NPfIT resulted in caution around centrally mandated solutions. The National Information Board PHC2020 describes practical steps in development of local digital roadmaps and the 2016 Wachter report calls for greater clinical leadership and interoperability as core goals of a digitised NHS.With a unique clinical-technical collaborative model we have developed and deployed integrated care pathways for specific populations that have been diffused nationally due to an approach of clinically driven solutions across networks, on a central platform that hosts the core clinical process without interfering with well-established local service delivery models. We believe this approach to digitised whole-care pathways across organisations supports social and clinical networks and provides opportunity for transformational change. This feasibility study will test whether a parallel system built using emerging blockchain technology, with a distributed ledger rather than centrally hosted information, could deliver greater cost efficiencies across the system, specifically around commissioning through capture of transactions at patient level and the ability to pull large volumes of data from populations for advanced analytics that are currently not available due to current practice of data warehousing within organisations. We plan to test the feasibility of blockchain technology by modelling patient flow and transactions on two systems in parallel; one using open source technology hosted on a shared central platform, and the same clinical process developed using blockchain, within a defined and well understood population. Cost-benefits can be analysed against current status, where patient level data is entered locally into a national database that informs commissioning through retrospective annual analysis of activity based on simple stratification of risk across the population linked to a tariff. Comparison will be modelled across two systems, one where real time data can be extracted from a web-based dynamic clinical process versus the potential for transactional analysis using distributed blockchain approach for the same clinical process.?"