By Dr. Samir Damani

Precision medicine is one of the most compelling ideas to enter the health care conversation in some time. New technologies, such as genomic sequencing and advanced bioinformatics, are allowing clinicians to pinpoint the unique composition of each patient's disease. Therapies are being developed to precisely target that disease.

These advances are important, necessary and easy to talk about. Research, cures and sophisticated medical technologies are the poetry of medical care.



But as important as they are, these technologies do not do enough to improve health. Cures are sexy, but they're also reactive. Prevention is, and should always be, the ultimate goal. The best body shop in the world is no substitute for simply avoiding the fender bender.

The success of precision medicine hinges on two, relatively boring elements. The first is data portability – the task of simultaneously securing patient information and making it available to help them. The second is developing a culture of wellness. These goals may be global, but they cannot succeed without addressing the individual.

Portability
Electronic medical records (EMRs) are a tremendous asset. They allow physicians, clinics and hospitals to securely share data. As long as the patient is visiting facilities that use the same EMR system, their history – diagnoses, films, prescriptions, surgeries – goes with them.

But take a step outside a particular health care system and the problems start to multiply. What happens if the patient gets sick on vacation or has an emergent health issue that requires treatment at a trauma center outside their normal network?

Suddenly, the clock gets turned back to 1992: patient records have to be faxed, burned to CD or transmitted in some other archaic format. Sometimes records cannot be retrieved in a timely manner and duplicative tests are taken and films shot. Perhaps a medication allergy is overlooked.

While this may be an episodic problem for some patients, it's an ongoing crisis for those with chronic diseases or even acute conditions like cancer. They quickly learn that, if they want to have a meaningful consult with that high-priced specialist, they need to tote their medical records with them.

This process slows care, increases costs and places an intolerable burden on both patients and the health care system. At present, EMRs are an incomplete solution that provide a vision for a more patient-focused future without actually making it a reality. Precision medicine relies on accurate, timely information. The inability to globally share that information is holding us back.

The Western Lifestyle
Preventable conditions such as diabetes and cardiovascular disease, kill more than 40 million people each year. These and other diseases reflect the "Western lifestyle," which has unfortunately permeated the world. People eat too much in general and too many fatty foods in particular. They spend an inordinate amount of time sitting and don't get nearly enough activity.

This is no surprise. Individuals understand they are the authors of their own misery – consider the thriving diet industry – they just lack the incentives to make changes. Simple adjustments, such as eating lean proteins and fewer processed foods, going on short walks or even taking a few deep breaths, are beyond their abilities.

To be fair, people are faced with constant encouragements to consume from both advertising and peer groups. To overcome this, we need to develop a powerful way to counterbalance these adverse messages.

So far, this has been a tough nut to crack. Physician admonishments to "adopt more healthy behaviors" are episodic and can't possibly compete with the consumption chorus. In addition, "being healthy" is an abstract incentive. A patient who has adopted an unhealthy lifestyle for years, or even decades, may not have the slightest inkling what that would look or feel like. In other words, we need to develop more tangible incentives to encourage healthier living.

Combining portability and wellness
Both of these issues can be remedied with one solution: blockchain. This technology has been popularized through crypto currencies, but its applications are much broader. By leveraging blockchain, we can give each patient control over their own self-sovereign medical records, which they can share at their discretion. In addition, blockchain can easily enable incentive programs to better support patients as they adopt healthier lifestyles.

Blockchain can do all this because it's decentralized, secure and auditable. Decentralization is key. Patient data are distributed through thousands of computer nodes, and these records are constantly audited against each other. This distributed model makes blockchain virtually impossible to hack.

Through encryption keys, patients have the ability to provide their records to anyone who needs them. This could be a specialist, an emergency department physician or an insurance or pharmaceutical company. Because the platform is EMR-agnostic, it could align multiple systems, removing this significant barrier. Blockchain would not eliminate existing EMR systems. Rather, it would harvest their data, boosting efficiency, lowering costs and improving outcomes.

With unobstructed access to their own medical records, patients would no longer be at the mercy of their health systems' proprietary EMRs. By sharing their cryptographic keys, they can provide access to their all-important medical information whenever they wish. They control their own data.

Blockchain also provides an avenue to incentivize patients to pursue healthier habits. Digital incentive tokens can easily be distributed by workplaces, insurance companies, biotechs, etc. By adopting specific behaviors – diet, exercise, medication compliance, clinical trial participation – patients receive tokens that can mitigate their health care and other costs. For example, insurance companies can take in tokens in exchange for reduced rates. Patients pay less and companies have healthier clients.

Incentives work, but social support is even better. Patients will be able to share their data through secure social networks, which also add a competitive, gamification element. Who is winning the effort to lose pounds, increase activity or improve cholesterol or blood glucose?

Numerous studies have shown incentives work. Even more importantly, patients have control over their own records and their own health. They do not have to rely on an increasingly paternalistic medical system to make choices for them. They become more educated consumers who have increased freedom to choose who will provide the services they need. And as they adopt healthier habits, they will need those services less often.


About the Author: Dr. Samir Damani is CEO and co-founder of MintHealth, a global, decentralized health platform that aligns health care stakeholders around the shared goal of patient empowerment and improved clinical outcomes, at lower costs. Prior to MintHealth, Damani was the founding CEO of MD Revolution (MDR) which has become the gold standard technology-enabled service platform for Medicare's chronic care management (CCM) program. In addition, Dr. Damani is on clinical faculty at the Department of Family & Preventive Medicine for the UC San Diego Medical School, and is a board-certified practicing cardiologist at Scripps Clinic.