With Hearthy we want to create a decentralized, open and sustainable ecosystem to improve health care access to everyone, regardless of income, making health care efficient, agnostic to jurisdiction and user-centered. Hearthy basically intends to create a transactional layer bound with healthcare that fixes the most common cases which nowadays limit the health care accessAbstract Existing healthcare models are based on antiquated paradigms. The truth is, European social security programs (being the most advanced) were established following World War II when the population was almost one-third of what it is now. The current demographic shift towards an aging population and more patients suffering from chronic diseases is straining healthcare systems resulting in a major global challenge. How can healthcare providers sustain universal, high-quality healthcare initiatives for this deluge of patients while endeavoring financial hardship and human resource constraints?
For the last 5 years, the authors have worked in the health and insurance sectors for organizations including SERGAS, Ginemed Telemedica, Medipremium, and AXA (first as Glue Digital and later as Hearthy) to help these companies in their digital transformation processes, but experienced mixed outcomes. While beneficial digital projects resulted, critical unresolved issues remain such as increased healthcare costs, late adopters, low adherence… turning access to digital health into a luxury asset
As a result, the authors are determined, as developers at Hearthy, to create a decentralized, open, and sustainable ecosystem to improve healthcare access regardless of income, making healthcare more efficient and user-centered. The proposed ecosystem will consist of:
- The Protocol - A Personal Health Record (PHR), which relies on distributed ledger technologies that can be used and owned by the patient.
- The Coin - The ❤️️(HER), which will empower the ecosystem.
- The Suite - Open source tools and applications, which will boost the traction of the protocol and create the first generation of services.
The Product: Blockchain-Based Health Ecosystem Within healthcare operations, there is no definitive EHR/PHR standard. Diverse standards, both proprietary and open source, are available and a 1996 consortium created HL7 for messaging between different HDOs, but without one standard in which to be aligned, interoperability between systems will continue to be a significant issue, EHR vendors also play a market strategy that generates fragmentation.
Interoperability is most evident in Spain’s healthcare program. While hosting one of the most effective, advanced, and well-designed health systems in the world (with an expenditure of $2,658 per inhabitant, universal healthcare, and a life expectancy of 83.08 years), the country’s varying regions are not uniform in their systems approach. This can result in a scenario where a patient moves from one region to another with no guarantee that their PHR is transferable. Why do we have to accept this?
Our protocol basically intends to create a transactional layer bound with healthcare that fixes the most common cases which nowadays limit the health care access allowing frictionless transactions.
Solution Architecture All PHR will be created by Hearthy Co. aligned with FHIR standards, the latest version provided by the HL7 consortium. The PHR will be entirely modular, so that organizations/apps/developers will be able to use aspects of it as they choose.
The exterior architecture of the solution will be structured as depicted in the next figure.
Moreover, the PHR will be separated into 3 layers: the first dedicated to security and privacy, conformance and terminology; the second dedicated to administration and defining all the roles generated by the ecosystem; and third dedicated to storing all medical data related to a medical process.
Hearthy Co. will explore ontology standards such as ICD-10 and SNOMED-CT since it increases interoperability and provides a common understanding of concepts used in clinical documents. This is not an easy task, as it was addressed by a group of researchers in their paper written in 2011; they were trying to fill in the gap between HL7 and SNOMED-CT. However, Hearthy Co. intends to close this burgeoning gap in order to accelerate the automatic and critical processing of health data.
Internally the PHR will be constructed following the FHIR specification, with the following structure.
Privacy and Cryptography To ensure patient privacy, cryptography will be utilized giving the patient a granular access to their data and choosing what details remain private. Hearthy Co. will also make it possible for verified medical professionals to add to the PHR following authenticality.
Once a medical milestone is created (stated by a doctor, the patient, or any automated agent) the system splits it into blocks and encrypts each block with a randomly generated key as depicted in Figure 4. In addition, an index is generated with each block and its key. The combination of index and encrypted blocks is signed by the doctor with their private key, to ensure that the data cannot be tampered with. Finally, the entire entry is encrypted with a random entry key and the key is sent to the user encrypted with their public key, ensuring that only the user can read it. This system affords the user access permissions by sharing either the entry key or any of the block keys, allowing the decryption of only the chosen data.
Distributed Ledger Topography The Hearthy Co. distributed ledger will consist of the following stakeholders.
The Hearthy Foundation The Foundation’s amends and updates are the core of the system. Any node and token holder can propose an upgrade to the overarching system with a suggested price attached. If the majority of token holders find the tip useful, they will be able to send tokens to the proposer so that they can complete the upgrade with enough resources. The Foundation board itself, will also propose and develop upgrades as well as wield veto power, at least for the first 3 years after launch (the Foundation is extensively described in the previous sections of this paper).
The Healthcare Provider The provider is a hospital, a healthcare professional, healthcare system, an insurance company...etc. Every provider buys enough tokens to maintain a node. By creating a node, the provider can ask any user for access. If the user consents, the provider is then able to access patient data in order to create a specific service. The provider is also able to send the user tokens for access. Furthermore, the provider can read and/or write data on the user’s PHR if the user agrees. As Hearthy Co. begins working with regions with uninsured/underinsured populations, the new ecosystem may be a great point of connection between providers and new healthcare users who will already have a PHR when the provider arrives.
The Patient The patient is the most important element of this innovative platform. Users will have various registration options. By default, the registration process uses only biometric identification utilizing just a selfie and a signature. Such systems create a unique user ID, which is recorded on the blockchain. The resulting selfie and signature are then stored on the device and all the information that circulates on the Internet is anonymized. Once a user is registered, a small amount of tokens is sent as a reward, which promotes engaging.
A user will access the ecosystem via an app/dapp. Hearthy Co. will develop the initial apps, but the environment is as open and fluid as possible to enable any organization to create its own apps/dapps. All services must be paid with tokens, and the user has to buy or obtain them through incentives. The providers can also send tokens to specific users in order to allow them to receive medical services (for example, some insurance companies may offer a variety of services inside the platform by buying and sending their policyholders a certain quantity of tokens every month, which could be used for prevention services, medication...etc.).
A user will not have karma, but they can post a positive or negative review of any other agent in the blockchain.
The Research Organization The medical researcher needs structured data for their clinical research. Every time a researcher creates a node on the network, he can create a request for all the desired data, including demographic information, and establish the price they are willing to pay per user. All the selected users then receive a notification within their apps asking them to share their data with the researcher. If the user agrees, all the data becomes visible for the researcher. However, this access will have an expiration date based on the associated smart contract. Hearthy Co. will also develop a dapp in order to make accessing the resulting data easier for researchers.
A researcher has a karma, which can be earned every time a user agrees to share their information. However, researchers lose karma when more users choose not to agree to share their data. In situations of extremely low karma, a researcher might be banned from the network. Researchers must be held accountable, hence the Foundation or any token holder can issue a petition for a researcher to share the outcomes of their research under certain conditions. Se
The Medical Practitioner Through the new platform, every medical professional becomes a user on the blockchain as well as on the developer's app. The doctor delivers healthcare in markets created by app developers and providers, either in the form of telemedicine or an alternative means. The doctor sets a price for their services or makes an agreement with the provider and/or with the app developer. Every consultation a doctor makes carries a fee based on tokens. The tokens are digitally transferred from the patient’s wallet to the doctor’s wallet. Then, the doctor can convert them into FIAT currencies. Every doctor has a karma, so they are held accountable as well.
Hearthy Co. is also planning to develop specific tools that can aid doctors with diagnosing conditions more accurately.
The Automated Agent/The Device Automations are crucial for the future of healthcare delivery. Automated apps, such as chatbots, are a prime example as they can help users manage tasks such as medication adherence or even carry out a complete treatment or diagnosis. Automated apps write and read on the blockchain as any other player. The app developer must buy enough tokens to manage the node and be able to set up a price for the service in form of tokens. Users, providers, or the Foundation itself can pay the associated fees.
By consensus, the Foundation can reward developers of automated agents with tokens in order to generate new business models and to test ideas. Tokens will be released when specific milestones are achieved (it could be based on health outcomes and/or on design/development states).
Hearthy Co. will deliver the first automated healthcare apps; one for medication adherence and a chatbot intended to work with depression/anxiety patients that is similar to the one designed by Standford University earlier this year. Automated agents will have their own wallets and the developer can use the tokens from these wallets for whatever purpose.
Automated agents have karma as well.
The EHR/EMR Vendor User patient data will be created by Hearthy and is intended to be inclusive of software developers. The goal is to create a suite of integrations that allow any EHR vendor to be integrated.
Token Anatomy Hearthy is introducing an open source cryptographic token named ❤(HRT), which is visualsed as a health cryptocurrency to be used in health services. ❤ is a pure cryptocurrency of a fixed supply. It is fractionally divisible and long-term deflationary by design.
❤ is intended to be bought by users and by providers and researchers, as it is the fuel of the transactional layer we want to create. Only the 65% of the ❤ will be liquid in the short term. Similar to other cryptocurrencies, the units of ❤ are mutually interchangeable and transferable, and they will be expected to trade in cryptocurrency exchanges.
Implementation❤ will be implemented on the public Ethereum blockchain as an ERC20 token. The Ethereum blockchain is currently the industry standard for issuing custom digital assets and smart contracts. The ERC20 token interface allows the deployment of a standard token that is compatible with the existing infrastructure of the Ethereum ecosystem, such as development tools, wallets, and exchanges. Thanks to Ethereum’s ability to deploy Turing-Complete trustless smart contracts, it is possible to issue complex rules for cryptocurrencies, digital financial contracts, and automated incentive structures. These advanced features and active ecosystem make Ethereum a natural fit for ❤.
Transaction FeesThere is a transaction fee for every transaction on the blockchain. Every time the fee is split into two: a certain percentage goes to the owners of the blockchain nodes (providers, data storage providers, etc.) as gas, and another part goes directly to the Foundation which will later use this liquidity to facilitate the growth of the ecosystem, to reward the developers as well as to amend and update the distributed ledger.
Transaction fees work in various ways:
- Incentivizing blockchain adoption by node owners
- Redistributing wealth, in form of paying invoices for those developers who create more value
- Ensuring deflationary tendencies over time, so that the token becomes more and more valuable
Rights to the token ownersThe primary use of tokens is for their owners to receive medical services by using them. Therefore the patients, health care organizations and doctors can use tokens in their daily health care-related transactions.
Token holders may have right to vote on changes in the Foundation as soon as we setup governance.
ICO Terms Coming soon.
Demo Apps Coming soon.
Roadmap The progress of the company can be seen in the following roadmap, the company started as a telemedicine company, where the PHR was secondary, as we have progressed we understood the PHR as the backbone of the medical revolution that is about to arrive and Blockchain as the most promising technology to undertake this revolution.
The Team Javier Blanco Thomas: CEOJavier Blanco has been developing digital products for the last 11 years. He holds a degree in Audiovisual Communication in The Complutense University of Madrid as well as two Master degrees in IED and Trazos School, related with art direction and digital production. He has worked in Havas Media/MPG, and in projects with award winning studios and agencies like FarFar/Waskman or Duplostudio. Javier Blanco Founded Glue Digital in 2010, nowadays Glue Digital employs 7 people and manages about 25M users each year, working with Fortune500 clients all around the world (Carrefour, Mondelez, KFC, AXA,…). Glue Digital has been awarded with some design awards and nominations, such as Awwwards, German Design Council or Laus Awards.
In the health field Javier has been working in different projects for more than 5 years, dealing with clients such as SERGAS, Ginemed, AXA or Medipremium. He founded Hearthy in 2015, first as a complete mhealth solution, and later as an entire ecosystem, Hearthy has been featured in programs like Google Launchpad and at conferences such as Health2.0. It has been the core of apps such as Medipremium, the first mobile health service deployed on the Spanish market.
David Conde Sayans: CCO David Conde, a fintech entrepreneur, started Txstockdata in 2015 and has been its Managing director ever since. With his skills and team leading talent, he has introduced this project from scratch to a recognized company.
Txstockdata boasts of a multidisciplinary team of talented professionals dedicated to bringing innovative changes to the fintech industry. The Company is mainly focused on creating more efficient solutions related to savings and investments
David Conde studied Business and Administration degree at the Universidad Oberta de Cataluña and he was one of the first European Financial Planners in Spain. He also is a MBA and MBA executive at IESIDE and Nebrija University.
As managing director, David is leading the team behind Txstockdata’s flagship product, Senseitrade. Senseitrade is a platform which turns big data from the Internet into trading opportunities.
Recently they have launched another fintech product called Coinscrap. Coinscrap is a smartphone app that allows users to round up their daily purchases and automatically transfer the change to a saving product.
Juan Sebastian Valencia: CMIO Medical doctor from Paris Descartes University with a medical thesis on creating an online decision support system for healthcare professionals, dealing with accidental blood exposure (ABE)
Director of MD thesis of general practice residents interested in innovative solutions applied to healthcare
Co-founder of Bress Healthcare, a french startup that created a full-web system of tele-expertise (exchange between healthcare professionals) that is used now in 6 countries of Africa and Southeast Asia in order to do cardiac tele-echography of pediatric patients
CMIO of Carians, a French startup that created a full web platform that will allow patients from all over the world to have access to the world’s best medical expertise
President of the R&D Committee of France eHealthTech, an association bringing together 138 French e-health startups.
In his time off he works as a consultant on the creation of healthcare decision support systems
https://www.linkedin.com/in/juansebastianmd/
Anxo Soto: CTO Anxo has more than 10 years of experience writing software for the web. For the last 3 years, he has been working at Glue Digital doing full stack development and managing a small team of talented developers. He has participated in the latest eHealth developments at Glue Digital and Hearthy, helping to define the technological stack and integrating with heterogeneous systems from clients and providers. Anxo also has extensive experience in cryptographic systems. He studied Computer Engineering at the University of A Coruña.
Diana D. Reinoso: Lead Frontend Designer Diana has over 7 years experience in the design and generation of UX projects. She has already participated in diverse health-related projects such as Medipremium, Meedica, or Whitecloud. In the last 4 years, her work as a designer at Glue Digital has been honored with several design awards and nominations from entities such as Awwwards, German Design Council, and the Laus Awards. She holds an Advertising degree from the Vigo University. Diana is also an accomplished photographer with her work having been featured in Playground Magazine, Lamono Magazine, and exhibited at Matadero Madrid or Bright Trade Show Berlín.
Alex B. Ferrín: Developer Alejandro has 5 years of experience in web and the interface design. Part of that time has been spent working as a front-end developer at Glue Digital developing the competences and skills needed to design and implement web projects, services, and apps.He has a Design degree from the Antonio Failde School of Art and Design (Ourense) and a postgraduate diploma in Web Project Management and Design from Pompeu Fabra University and ELISAVA Barcelona School of Design and Engineering.
César Caride: Developer For the last six months, César has been working for Glue Digitial as a backend developer. He previously studied Computer Engineering at the University of Vigo where he also worked as a trainee for over a year. He has also worked as a developer and analyst on key projects related to the implementation of ERPS.