Executive the research question that will be the

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Last updated: August 23, 2019

Executive SummaryThe purpose of this report is to go deeper into a caseanalysis of the Romanian healthcare system, in order to find out which are theflaws and weaknesses within, how does it actually operates, and neverthelesshow it can be optimized, reformed and improved by bringing in an innovativetechnology.Aftera short introduction, I will present my motivation that made me to write thisreport, together with the research question that will be the foundation of theentire paper and the main objective or purpose of this rehabilitation.Moreover,I will also go through the methodology part which will describe how I will beable to cover the research topic.Therelated literature and theoretical framework will help me to explore andelaborate a possible solution on how the implementation of Blockchaintechnology can contribute and add value to the Romanian healthcare system.1         Introduction These daysinnovation is one of the most popular subjects around the world.

There areseveral new frameworks and technologies that arise along the way. Most of thepeople are not really aware what types of advantages can be brought into ourdaily routine by making use of these innovations. Blockchain technologyrepresents a part of this. The enhancements and benefits that this technologyis bringing to the current setups is analyzed and studied by numerousresearchers in this area.

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Asit is known that all the public and private systems work in a way or another,it is also well known that all of them have flaws within and are struggling withdifferent approaches from a technological perspective to fulfill theirobjectives, but the policies surrounding them are subject to institutionalvariation, local practice, state laws or the strictness of national privacypolicy administration.Itis a fact already that initiatives investigating use cases of the Blockchaintechnology have become plentiful in the financial sector, but banking andpayments are not the only industries that could adopt it. Even though the onlyrecognized implementation of this technology is within crypto currencies field(e.g. Bitcoin), the tech community is now trying to find different other potentialuses for Blockchain.Justas a short summary and without entering into details, Blockchain, in essence, isa shared database with no central ownership. Alternatively, data is stored andmanaged through the consensus of participants in a network, who work together,to determine what gets added, while each participant upholds an exact full copyof all transactions.

Regardlessof the big challenges that are showing up, healthcare might be anotherpotential area where this developing technology might be implemented. Since theIT was introduced in the medical world, the relationship between these two hassuffered a significant increase during the last period of time, becomingstronger, more advanced and visibly bringing benefits among all countries aroundthe world.Byusing the Romanian case study, this report should conclude in the end thatinnovation, interoperability, data standardization, security and integrity aswell as privacy are the main actors that the healthcare system should focus on,which are clearly served by this new setup.1.1       MotivationTechnology is evolving very fast these days and lotsof improvements and major changes took place in all industries since Internethas appeared. There are very few sectors of business which does not use or requireInternet to function, but not the most prosperous ones, or the governmental andpublic organizations.

Notlong time ago, an article piqued my interest, where it is stated that Romaniaoccupies the last position in the European rankings of healthcare systems,which includes 35 countries and was realized by the Health Consumer Powerhouse,a Swedish organization specialized in health care system comparison.1 Thatbeing said, Romanian system is worse than all the others’ 28 state members ofthe European Union and not only on the overall statistics, but on manyparticular disciplines classifies itself on the last position. Some of themwould be patients’ access to information, privacy, results and access totreatments.After reading this article and the fact that since2005, Romania did not really show any progress in the healthcare system, Ibecame interested in finding out why is that and how it may be resolved.1.2       Research questionThe study is expected to shape a clear andunderstandable overview, answering the following research question:How could Blockchain technology contribute and addvalue to the Romanian healthcare system?Bymerging the theoretical framework together with interviews’ reflections fromthe scope, the project will try to cover the essential aspects related to apossible implementation of the Blockchain technology in the Romanian healthcaresystem.

1.3       ObjectiveImplementing a new technology in a healthcare system,might have its own advantages or disadvantages. Moreover, usually when this changetakes place, there are probably multiple and different objectives that arepursued.

When strictly referring to the Blockchain technology implementation inthe healthcare system, the first and foremost goal of this innovation is tohelp people have a better and healthier life, with more privacy, security andtransparency when put in practice.Theaim of this project is to investigate the current setup of the health caresystem from Romania and how can Blockchain technology could contribute and addvalue to it. This implementation can very well be applied to other systems fromother countries around the world, for the simple fact that it could help medicalstructures to share more and more data between different stakeholders, or evencountries without implying any risk.1.4       MethodologyThis section provides information about how theproject will be covered in order to obtain the desired results. I will explorethe case analysis of the Romanian healthcare system, trying to answer the mainquestions, and gain an insight of how the system works nowadays.The project willbe based mostly on secondary research. It will be constituted by the course,other books and also desktop research.

Based on this, I will try to identifyand describe the main issues that the system is facing at the moment and howthese issues might be resolved by implementing a new technology. 1.5       LimitationsThe assignment is carried out in a given timeframe andthus has the following limitations:·                    Is bordered to Romania;·                    Is an analyticproject and we cannot test the results in real life;·                    The caseanalysis results cannot be applied on other companies than PayPal, even thoughthey might be online payment companies.2         Related literature and theoreticalframeworkInthe theoretical framework, I will cover the theories I considered relevant forthis topic. I have decided to write about them, as they are in direct relationto the problem formulation. I will use them in the case analysis of the Romanianhealthcare system and will go deeper to investigate the main problems andsolutions of it.2.

1       Blockchain TechnologyBlockchain is essentially a distributed system(ledger), for recording and storing transaction records. In detail, Blockchainis an immutable, shared record of peer-to-peer transactions created from linkedtransaction blocks and stored in a digital distributed ledger.2 Everytransaction in the distributed ledger is checked by consensus of a majority ofthe participants in the system. Once added, information can never be removed. Blockchainrelies on well-defined cryptographic techniques to enable every participantfrom a network to interact (store, exchange and view information), withoutbeing necessary to trust the parties, since it contains a certain andverifiable record of every single transaction ever made.3In general transactions are verified and stored by acentral authority, but Blockchain is replacing this centralized system, with adecentralized one where transaction records are stored and shared across allnetwork participants, reducing the typical security risk by removing the needof intermediaries, so the threat of hacking, corruption or involuntary errorsare significantly diminished.Furthermore, all the interactions that take place inthe system are visible and known by all participants and for that reason it isimpossible to add, remove or change data without being detected by the otherusers, fact that enables trustless cooperation between the participants whilerecording an immutable audit trail of all transactions.Even though the sets of data inside a Blockchainremain unaltered, it can still be categorized into:·        PublicBlockchains – allows all participants to handle data on the ledger, and each ofthem is possessing an identical copy of everything; in this case there is noofficial owner of the ledger (e.

g. Bitcoin);·        PrivateBlockchains – allows only certain participants to handle data on the ledger; meaningthat an owner exists and decides whether a user has access or not to the digitalledger.42.2       InteroperabilityThe standard definition of interoperability is:”5Theability of the systems, units, or forces to provide services to and acceptservices from other systems, units, or forces, and to use the services soexchanged to enable them to operate effectively together, and 6thecondition achieved among communications-electronics systems or items ofcommunications electronics equipment when information or services can beexchanged directly and satisfactorily between them or their users.”Thedefinitions contain a high level of abstraction because they try to cover asmany situations as possible where interoperability can be applied, but in thecontext of digital health, the Health Information and Management SystemsSociety (HIMSS), defines interoperability as “the ability of different informationtechnology systems and software applications to communicate, exchange data, anduse the information that has been exchanged. Data exchange schema and standardsshould permit data to be shared across clinicians, lab, hospital, pharmacy, andpatient regardless of the application or application vendor.”7HealthInformation and Management Systems Society presents interoperability in a verysimilar way as the second standard definition for from above.

Inregards to the health information technology, interoperability can becategorized on three different levels8:·        Foundational –allows data to be exchanged from an IT system to another one, but withoutrequiring that the receiving one must be able to interpret the data·        Structural – representsan intermediate level which establish the structure of data exchange with thepurpose of conserving and not altering it, while making sure that it can beinterpreted by IT systems at the data field level·        Semantic – isthe most advanced level of providing interoperability between multiple systemsthat are exchanging information with the purpose of using it while using bothstructuring and codification of the data in order for the IT systems to be ableto interpret it.Itis required that the IT systems that are exchanging the data to create a commonlanguage to be able to receive and interpret the data, which in other words itis called common standards and when these standards exists, the potentialof  interoperability among these systemsincreases significantly both internally and externally. Using common standards,the products and services defined to meet the healthcare needs grows notably.2.3       StandardizationStandardization in health has anchors in history eversince Sir Henry Dale presented the first International Standard for insulin in1926, which was embraced by the League of Nations Health Organization (theprecursor of the World Health Organization) as a biological standardizationwith the purpose of aligning the calibration of therapeutic substances.

9But the meaning of this process started to take different connotations as thepeople perceived it in different ways.After information technology revolutionized computingand communications in the past few decades and all signs still indicate thattechnological progress and IT will still continue at a rapid pace,standardization can be separated in two forms10:·        As a means ofagreeing common interfaces to allow interoperability between different players:o   Physical Interfaces: So devices can connect with eachother and function (e.g. USB, HDMI)o   Virtual Interfaces: So modules of code can interact (e.g.

Adobe Flash functioning on Internet Explorer and Google Chrome)·        As a means of acceptingcommon data formats: – So content can be accessed by different applications (e.g.MP3 can accessed by WinAmp, RealPlayer, WMP)Standards are meant to facilitate cooperation andcompatibility, which in one word it could be defined as interoperability,because organizations gain the opportunity to cooperate in order to establishstandards which allow them to interconnect and share their networks effectivelycreating a single network.Standards are like network effects: the more peoplethat adopt a standard, the more valuable and important it becomes as thesystems can interconnect causing to expand the network externalities whichimplicitly makes the network larger and increases its value.

2.4       Theory of Innovation”Change that creates a newdimension of performance”11 or”The ability to deliver new value to a consumer”12 aresome of the representations of innovation. More than that, a theory about thediffusion of innovations was defined by Roger Everett13.Here the concept of innovation theory is defined as a mechanism which has as afirst step the invention of a new element. The invention is getting to the ideaof practical improvement of the product or service for commercial usability.The organizations implementthis process, which has usually attached many efforts to get the new product/serviceembraced by the consumers and to develop it for productive usability. For thatreason, the product or the service should be both useful and inexpensive and itshould add value.

In a simplistic way, innovation represents something totallynew or on the other hand, more effective products, services, processes, technologiesor ideas that are accepted by the market, governments and society as a whole.The trilogy of innovationincludes invention, innovation and diffusion. Innovation is characterized asone or more points of the following:·        introduction ofa new item, a new quality, or a new method of production (e.g a new usabilityfor an actual product)·        the beginning ofa new market ·        begin using anew source of raw materials in the company, even it has been used before byother entities·        bringing a newstructure in the market (for example by modifying or breaking down a monopolysituation)14One of the most significantaspects that should be noted is that innovation involves the production of newknowledge.15Innovation is the positive catalyst for the growth of an organization and ifthe organization does not shape its offers to the customers’ needs or the wayof creating and delivering the products or the services, there is theprobability to be over-taken by others who are doing this.One of the most importantmodels strong linked to the technology adoption is Diffusion of Innovations(DOI).

This pattern explains how, why and how easily or how difficult some newtechnologies (or ideas and new systems) can be incorporated in a civilization,and of course how these possible changes are perceived by the people of acertain culture. The theory “sees innovations as being communicated throughcertain channels over time and within a particular social system.”16 Eachperson has a different disposition to embrace an innovation, and therefore, thenumber of the persons which tend to cooperate with a new idea is approximatelynormally distributed over time. According to this theory there are fivedifferent categories of people, which adopt a certain innovation in a differentpoint in time: innovators, early adopters, early majority, late majority,laggards.

On the other hand, within a company there are employees that accept anew idea very easily, but also persons who do not agree with implementing aninnovation in the organization’ system.The organizationalinnovativeness depends on different factors, both internal and external. One ofthem is the attitude of the leader toward a change, how different people withinan organization perceive an innovation and how they understand the new ideathat could be implemented for their benefit. The next element that influencesthis level is represented by internal variables of organizational structure,such as: centralization, complexity, formalization, interconnection and thesize of the organization. The last element is represented by the externalfeatures of the organization, which is referring to how much a company iswilling to receive new ideas, different innovations to implement in the actualsystem.In a normal market, theusers adopt a new technology, behavior or service differently in time. Some ofthem are more capable or more open to adopt an innovation than others as mentionedbefore. Furthermore, there are fiveelements that determine the process of adoption, related to the five adoptercategories: ·        RelativeAdvantage – The level to which a new technology or product is understood asbetter than the current product/ technology·        Compatibility –the degree to which innovation is compatible with the adopter, if this fulfillsits preferences·        Complexity – thelevel to which the individual feels that the innovation is too hard to use·        Trials – thedegree to which the person who wants to adopt the innovation, can try it beforewithout any engagement·        Observing – thedegree to which the innovation offers concrete outcome.

173         AnalysisIn this chapter I will make an analyseof the current setup of Romanian healthcare system in which I which I willinclude also the main findings that I have aquired through some interviews, theissues and problems that the people and the system is facing at the moment, aswell as I will try to come with a solution for his by predicting how Blockchainmight contribute and add value to the current system, views from twoperspectives: marco-level (nationwide) and micro-level (a specifc medicalinstitution).1 Dan Radu (2017) –Retrived from: https://vocea.biz/social/2017/feb/06/un-urias-sarac-din-est-care-incearca-degeaba-sa-imite-vestul-sistemul-romanesc-de-sanatate/2 Scholer K. (2016) – An Introduction to Bitcoin and BlockchainTechnology3 Crosby M., Nachiappan(2015) – Blockchain Technology Beyond Bitcoin4 Thompson C. (2016) Thedifference between a Private, Public & Consortium Blockchain – Retrievedfrom: http://www.blockchaindailynews.com/The-difference-between-a-Private-Public-Consortium-Blockchain_a24681.

html5 Chartrand G.(1977) Introductory Graph Theory, Dover Publications6 CJCS (2000) Interoperability and Supportability of National Security Systems andInformation Technology Systems7 HIMSS (2013) Definitionof interoperability – Retrieved from: http://www.himss.org/sites/himssorg/files/FileDownloads/HIMSS%20Interoperability%20Definition%20FINAL.pdf8 NCVHS – National Committee on Vital and Health Statistics (2000)Report on Uniform Data Standards for Patient Medical Record Information9 Jeffcoate SL.

(1991) Role of reference materials in immuno-assaystandardization.10 Hedman J. (2017) – DigitalBusiness Models Two Sided Markets & Standardization (Session 6)11 Drucker P.

(2006) Drucker Institute – Retrieved from:http://www.druckerinstitute.com/project/nonprofit-innovation-award/12 Campos J. (2004) An Exchange on Definitions of Innovation13 Rogers E.M. (2003) Diffusion of Innovations14 Sundbo J.

(1999) The Theory of Innovation: Entrepreneurs, Technologyand Strategy.15 Gibbons M. and Limoges C. (2010) The new production of knowledge16 Rogers E.M.

(2003) Diffusion of Innovations17 Behavioral Change Models (N/A) – Retrived from: http://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories_print.html

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