[Update] PharmaLedger's use cases and more on platform first business networks

Updates on PharmaLedger's chosen use cases, more on platform first business networks, Civic's immunity passport, and LedgerDomain's simulation

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Blockchain and healthcare updates

PharmaLedger’s use cases and more on platform first business networks

At the end of February PharmaLedger was announced. PharmaLedger had brought together an impressive list of companies, including 12 global pharmaceutical companies. In contrast to a use case first approach, PharmaLedger was taking a platform first approach:

This would make PharmaLedger a platform first consortium, where a group of organizations come together with the intention to create a platform that supports multiple use cases (e.g. PhUN or HUN). The alternative is a use case first consortium which convenes a group around a particular use case (e.g. the Synaptic Health Alliance).

At the time PharmaLedger hadn’t made any decisions about what they would be building yet. Dan Fritz, Supply Chain Architect at Novartis and PharmaLedger Industry Project Lead, answered a few of my questions in an interview that week. In one question he reiterated that PharmaLedger was creating a “platform for all use cases,” and described a prioritization process that was underway.

This press release signals that prioritization process has finished. PharmaLedger has selected use cases and they break down into three categories. Starting with supply chain:

  • Tracking of investigational medicines in clinical trial supply chains

  • Tracability of finished goods in commercial supply chains

  • Blockchain-anchored eLeaflets

  • Anti-counterfeiting

Health data:

  • Matching patients to clinical trials

  • Personalize medicine (?)

  • Dynamic permissioning

Clinical trials:

  • eConsent

  • Medical device integrity

Altogether there are 9 use cases being taken up by PharmaLedger. Other business networks, like the Synaptic Health Alliance, Coalesce, or ProCredEx have spent a year or more developing a single use case. One of the faster moving and well funded business networks, MediLedger, has two (three if you count the FDA pilot) use case working groups and the project was initiated in the first quarter of 2017.

PharmaLedger does have 12 global pharmaceutical companies, but their job is to make medicine, not software. There are 17 other partners, though only 3 or 4 of those are software development companies, and that certainly is not enough for 9 use cases. Given the experience of other business networks and the composition of PharmaLedger, I am left wondering how they intend to build and execute on all of these use cases.

One answer is that they intend to leverage outside resources, though it would be a little odd if there were some software development partners inside PharmaLedger and some outside. Another answer is that these use cases will be placed on a roadmap and tackled incrementally, but that wouldn’t entirely solve the problem. 9 use cases in 2.5 years is a lot regardless of how you put them on a roadmap.

In February I wrote that a key challenge in taking a platform first approach is forming consensus within your member as to what use case to tackle:

In the past, other platform first consortia have struggled to form consensus between their members as to what use cases to tackle and this will certainly be a key challenge for PharmaLedger going forward given how many members they have.

Another way to look at their use case selection is that the group was unable to come to consensus on what use cases to prioritize. For other platform first business networks this has been fatal — many never developed anything because their members couldn’t agree on where to start. However PharmaLedger is bound together and funded by the IMI for the next three years, so disbanding isn’t an option. In the absence of consensus perhaps they are trying to pursue all or most of the use cases that their members were interested in.

One more thing, many of the use cases listed above involve stakeholders that don’t have representation in PharmaLedger. For example, if you want end to end traceability in your supply chain you need wholesalers to be involved, but PharmaLedger doesn’t have any wholesalers as members. Often times getting the right stakeholder around the table is where business networks will break down: one stakeholder group will want to build something, but another key stakeholder won’t have the incentives to do so, and thus the use case won’t ever move past a limited pilot.

Whether PharmaLedger can get buy in from the stakeholders they need for their use cases is an important test. Dan Fritz touched on this briefly in his interview:

RM: How is PharmaLedger thinking about engaging other stakeholders not represented in the consortium today?

DF: Depending on the use cases, we know that the project and our companies will have to engage different stakeholders.  So we want to start this process as early as possible, as it also has an impact on the feasibility of different use case realization.  There are different ways to engage – simply as a interested party with common interests, on the advisory board, in the “Partnership in Research” program or as a subcontractor.

With the right parties involved PharmaLedger could achieve their goal of building a platform with these use cases. Clinical and commercial supply chains might be different, but they are both supply chains, and there will be technical overlap that could form the basis of shared technology. The health data use cases could share core access management technology. But again, achieving that will mean bringing the right stakeholders into the fold and enabling them with the right level of resources.

Civic’s immunity passport application with Circle Medical is live

Civic was one of the first big ICOs of 2017, having raised $43 million to build decentralized identity solutions. They partnered with Circle Medical to create an immunity passport that employees and use to prove the results of their most recent COVID-19 test to their employers. It is available on the Apple and Google App Stores today.

I was excited by the idea of immunity passports a few months ago and wrote about them on my newsletter. My excitement has been tempered by this well argued piece by Elizabeth Renieris on the dangers of using a blockchain for immunity passports. In particular I worry about the actual public health utility, the risks to vulnerable populations, and the lack of strong assurances that the presenter of a credential is its rightful subject.

To drill down on my last worry, there isn’t a great way that I’m aware of to prove that someone who controls a private key tied to a record of immunity is who they say they are. Your brother, or someone on the darkweb, might have shared that private key with you. Given the incentives that immunity passports create we can expect a lot of fraud.

My sense is that the problem of assuring that the presenter of a credential is the right person will eventually be solved, but I haven’t seen anything yet that is particularly compelling. Similarly I think we’ll probably develop better antibody tests and the science around immunity will become more cemented. But with where we are today I think the drawbacks outweigh the utility right now.

LedgerDomain simulated running the entire US pharmaceutical supply chain

After publishing their DSCSA report LedgerDomain ran a test where they simulated the entire US pharmaceutical supply chain. On a single server they found that they could run 165 transactions per second, which is 2/3rds of what is required to host the entire US pharmaceutical supply chain in 2024. That kind of scale will be necessary to move past pilots into production.

TraceLink published their FDA DSCSA report, I haven’t read through all of this yet, but it looks to be good work.

What I’m reading this weekend

One Biohacker’s Improbable Bid to Make a DIY Covid-19 Vaccine

I wonder how the highlighted problems with DIY science could be solved. High quality biometric data to measure deviations from baselines and regularly hashed data posted to a blockchain would be very helpful in enabling us to make meaningful inferences from these experiments. But that doesn’t solve the problem of standardizing inputs.

Telehealth might be here to stay

“I just can’t imagine going back because people recognize the value of this,” - Seema Verma on telehealth

Andrew Gelman’s commentary on peer review

The alternative to peer review is not "backroom politics," or no review, instead it is "post-publication review."

Enigma and IBM partner

Enigma has built a privacy preserving smart contract platform, first on top of Ethereum and recently migrating to Cosmos. Using their platform, the Engima implemented a contact tracing application called SafeTrace that preserved user privacy.

Now any IBM Cloud clients can use Enigma’s platform for their own use cases, which makes it far easier to access Enigma’s offering. Privacy preserving tech had a break out year last year, and I fully expect that to continue this year. Partnerships like this one will be a key part of that.

Matter Labs on evaluating layer 2 solutions

Important table from their blog post. They break down all of these categories in the blog above. Layer 2 solutions can help blockchains achieve massive scale.

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