The inspiration for this post came after seeing the documentary The Oxycontin Express. The film captures the prescription pill epidemic that peaked back in the late 2000's caused by doctors that were essentially allowed to operate as legal drug dealers. Thanks in part to the massive hypocrisy in governmental drug laws in the U.S., prescription pill deaths have soared to over 40 per day in the United States (1). Regulators have since implemented prescription pill monitoring programs to curtail the ability of both patients and doctors to acquire and prescribe massive quantities of pills (2). The programs act to electronically store the history of patients in order to help doctors and pharmacists identify high-risk patients (3). It may be possible to overhaul this system via multi-signature transactions through Bitcoin, which would lower overhead costs of monitoring programs and allow for a pseudonymous, non-hackable ledger of prescription pill transactions.
Below is a theoretical example of a multi-signature transaction that enables medical prescription monitoring via the blockchain, based on the following demo videos of Bitpay's Copay system (4, 5). This may be able to replace existing prescription pill monitoring programs by working in conjunction with the respective state laws. This will assist in monitoring the prescribing activity of doctors and the pick-up activities of patients. Because of the pseudonymity that Bitcoin inherently provides, we may also be able to work around problems with HIPAA regulations as well (although I don't know fully how HIPAA and PMPs work state-by-state or how that data is stored).
PillPal is a mobile application that also functions as a built-in Bitcoin wallet with multi-signature capabilities. Transactions would be conducted over the Bitcoin blockchain, but initiated using the PillPal application utilized by the patient, pharmacist, and doctor.
1. Doctor and Patient meet and doctor decides to issue a prescription.
2. Patient looks on PillPal application for a directory of local pharmacies based on zip code, for instance, (or large store chains elsewhere) for suggested pick-up location. Patient selects a desired location.
3. Doctor will ping the pharmacy location with the requested order information. The application will include a menu with all possible combinations of drug prescriptions, pill #, dosage, etc.
4. Pharmacy sees the incoming request and creates a 3 of 4 multi-signature buy order for the transaction of the requested prescription. The pharmacist invites both the doctor and the patient into the transaction via encrypted messaging on the application. The requesting doctor and relevant patient become required signatories on the transaction. Doctors using the PillPal network will have to be verified and patients would be registered with their preferred pharmacy (i.e. no fake doctor can issue a script without being easily noticed).
5. Information for the prescription is appended to the transaction itself.
6. Patient drives to pharmacy. The patient shows the pharmacist the relevant script information. Pharmacist finds the corresponding order and brings it up as a QR code on screen. The patient signs the 3 of 4 multi-signature transaction. The funds from the patient’s in-app wallet are put into escrow managed by PillPal (PillPal acts as a final arbiter in case of a severe mishap). The patient’s identity is linked to his/her signing key through the creation of their wallet in the application, using something like BitID.
7. During the time during step 6, the doctor also signs with his/her key, which is presented to him as a request in the application itself. This makes 2 of 4 signatures complete. The doctor’s information is also linked to his/her signing key.
8. The pharmacist sees that the patient and doctor have both signed the transaction and it is marked as paid. The pharmacist then fills the script and signs the third needed transaction key, releasing the patient’s funds from escrow to the pharmacist. In the event of some misunderstanding between parties, PillPal can step in as an additional key holder to sign and release the funds.
9. The patient leaves the store with the prescription. The pharmacy now has the funds.
10. Information included in the transaction is the doctor’s identifying info, the script information, the patient’s identifying info, the dollar (Bitcoin) amount, and the timestamp. This tracks all relevant information that is already collected under prescription monitoring programs. All that is needed to store electronically is a record of the above information attached to the actual Bitcoin address that received the funds. We are then free to verify that the particular transaction occurred at the specific time on the blockchain whenever we want.
While the transaction is visible to everyone on the blockchain, there is no way to know what the transaction was for or who was involved. The pharmacies and doctor's offices in the network would have a record of the transaction history of registered patients, such that they can look up the history to identify potential abuse cases. This is how prescription pill monitoring currently works.
-Additional security layers may perhaps be added via smart contracts, oracles, or time locks.
Please feel free to leave a comment if this is a viable example (I actually don't know) and contact me if you'd like to build the application. Coinbase is hosting a hackathon with submissions due May 19th.