Blockchain and healthcare predictions for 2020

Last week I wrote a review of blockchain and healthcare in 2019. Give it a read if you haven’t already!

This week I compiled a few predictions for the coming year:

  • Enterprises will drive activity. Consumer facing applications in healthcare are hard in general and this is exacerbated by the complexities that blockchains bring. That means the most meaningful work can be done at an enterprise level right now.

  • We won’t see a blockchain based electronic health record in 2020. It’s the use case talked about the most, but we won’t see a full fledged blockchain based EHR this year, at least not one that has serious levels of adoption. I expect areas that don’t touch health data, like supply chains or administrative functions, to continue to see the most activity.

  • 2 new healthcare specific credentialing networks will be launched. Credentialing as a use case had a big year: ProCredEx expanded, two new credentialing business networks were stood up (see Veterinary Industry Credentialing Group and Trust Your Supplier), a handful of startups are creating credentialing products, there is a clear value story, and a number of industries outside healthcare are adopting similar solutions. I expect credentialing solutions to expand their networks and move into new areas within healthcare.

  • Hyperledger Fabric and Ethereum will retain their positions of dominance in the enterprise space. R3’s Corda is somewhere in third place for adoption. There are a few other protocols being used at the margins but these three are largely the protocols that are seen as “enterprise ready” today. Several new smart contract platforms will launch in the coming year, and while some of these might land a strategic partnership here or there, none of them will be adopted broadly in the coming year.

  • A healthcare focused decentralized autonomous organization (“DAO”) will be started. DAOs can be thought of as programmable and community owned digital organizations and they are excellent tools for managing collective resources or infrastructure. I doubt it’ll be a data union or anything like that, but the tooling around DAOs is getting really good, and there are some use cases around the edges in healthcare that are viable today.

  • Healthcare ICOs that are still around today will rework their tokens completely, return capital, or perish. See my 2019 review for the data, but several healthcare ICOs are already dead (measured by price, usage, & volume), and the tokens remaining are on life support. Teams will either iterate on their models to try to generate sustainable value, return remaining capital, or their tokens will properly die. Without any pivots I’d speculate 3 - 6 more tokens will be dead by this time next year.

There you have it!

These weeks are generally the slowest of the year, but next week I’ll return to sharing blockchain and healthcare updates. For now these are the things I’ve been reading:

CoinMetric’s excellent State of the Network Review

An interesting look at a bunch of data (e.g. usage, security, market cap) from major public blockchains. I found the above table to be the most interesting (the data is per day FYI). Basically, Bitcoin and Ethereum have far more miner revenue, and thus spend more on security, than any other blockchains. This is an important metric because this is how much miners are paid to act honestly and maintain the network. It’s also apparent from this table that Bitcoin and Ethereum have the most robust transaction fee markets, which will sustain miner revenue as annual issuance decreases over time, and that is very important in the long term.

USV’s Fred Wilson: What happened in the 2010s

From Fred

  1. Emergence of the big four web/mobile monopolies (Apple, Google, Amazon, Facebook)

  2. Capital as a moat (think Uber, WeWork) failed

  3. Machine learning came of age

  4. Subscriptions are the second scaled business for web and mobile buisnesses

  5. Silicon Valley’s position as a mecca for tech showed signs of weakness

  6. Cryptography emerged as a powerful technology that can solve some of the web’s most vexing problems

  7. Technology becomes embedded in society

  8. The rich got richer

  9. China emerged as a global superpower / tech superpower

The political philosophy of RadicalXChange

Wide ranging and long piece on political philosophy starting from the idea that our social technology (e.g. institutions, political economic systems) has not kept up with physical/communication technologies. Focuses on the phenomena of increasing return and the problems traditional political economy has with dealing with this.

Changes in Quality of Care after Hospital Mergers and Acquisitions

The conclusion

Hospital acquisition by another hospital or hospital system was associated with modestly worse patient experiences and no significant changes in readmission or mortality rates. Effects on process measures of quality were inconclusive. (Funded by the Agency for Healthcare Research and Quality.)

Pharma's broken business model: An industry on the brink of terminal decline

The author’s argument is that because of how drug discovery has been prioritized in the past the pharma industry’s return on investment will steadily decline. Indeed, he projected that by 2020 (!) the industry would achieve a 0% internal rate of return (“IRR”). The path out that is suggested is an evolution of the industry to tackle more complex problems with more complex biological solutions, such as cell and gene therapies. The particular methodology used to construct IRR here seems questionable but directionally the argument holds up.

How can blockchains improve the drug discovery process? Has anything been written on this subject? Moving the needle here could be very impactful.

State of Digital Securities

Well researched report on digital securities (think security token offerings). I found the market shift from issuance (launching security token offerings) to tokenization (turning existing assets into tokens) to be thought provoking and made a lot of sense.


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