1 (page number not for citation purpose) Blockchain in Healthcare Today ISSN 2573-8240 Abstract Over the past 50 years, although categorized as the “Information Age” or “Digital Age,” the vast amounts of digitized data have been sorely underutilized. Only recently, in response to the COVID-19 pandemic, efforts have accelerated to harness these data using blockchain technology as it pertains to healthcare. Today, through the blockchain infrastructure and its tokenization applications, we are able to leverage health- care data effectively into more efficient business processes. In addition, we can secure better patient engage- ment and outcomes, while generating new revenue streams for an array of healthcare stakeholders. It is in the application of blockchain technology to compile these stockpiled data into new, compliant business models that we can reap the full potential of the blockchain. Here are predictions by members of the BHTY editorial board members on how we might further advance the role of blockchain in healthcare in 2023. Submitted: 12 December 2022; Accepted: 19 December 2022; Published 06 January 2023 Monetization, Consumerization of Health Data, and the Metaverse Talisha Shine, MBA, CBE and Jane Thomason, PhD, MSc The COVID-19 pandemic was an accelerator for block- chain in healthcare. We saw rapid advances in block- chain in information exchange, pandemic prediction, tracking, supply chain integrity, provenance, and pay- ments. The COVID-19 pandemic removed barriers and accelerated the drive to care for patients remotely. We have become more reliant on data, and this trend will continue. In the next few years, we will witness the monetiza- tion of health data through health data marketplaces, the consumerization of healthcare, and the growth of metahealth. When combined with rapidly growing smart phone penetration and increasing adoption of smart wearable devices, Web 3.0, “the internet of value,” will un- derpin significant changes in healthcare. Access to medical data is needed for training artificial intelligence (AI), drug development, scientific discovery, medical research, and precision medicine. Yet, much med- ical data are not being used or monetized. Blockchain and non-fungible tokens (NFTs) allow people to exchange value on a decentralized network. Humans are also being digitalized with new devices, apps, and monitoring technologies that generate extraor- dinary volumes of data. This will enable data owners to monetize their data, leading to the development of health data marketplaces, which connect and monetize data for data owners, making it available for scientific discovery. The progress in self-sovereign identity will make it possible for individuals to monetize their health data in the future.1 Consumerization of healthcare will create opportuni- ties for new players with low-cost, convenient services. People will expect on-demand healthcare, and consumers will want to access their health records literally in the palm of their hands. Health data will become the new health- care currency, leading to operational savings, improved treatment effectiveness and safety, faster diagnosis, and the possibility of personalized medicine. The growing focus on data analytics will turn medical devices into com- modities, with patient-level data and the surrounding an- alytics becoming an essential source of revenue for digital health companies. EDITORIAL, DISCUSSION Blockchain in Healthcare: 2023 Predictions From Around the Globe Talisha Shine, MBA, CBE1*, Jane Thomason, PhD, MSc2 , Imtiaz Khan, PhD3 , Mohamed Maher, MBA3 , Kohei Kurihara4, and Osama El-Hassan, PhD5 1Hashed Health, Nashville, Tennessee, USA; 2University College London, Centre for Blockchain Technology, UAE; 3Cardiff Metropolitan University, Cardiff, UK; 4Privacy by Design Lab, Chiyoda-ku, Tokyo, Japan; 5Dubai Health Authority, Al Jaddaf, UAE *Corresponding Author: Talisha Shine, Email: tshine3@gmail.com Keywords: consumerization, digital twins, healthcare exchange, health data, metaverse, monetization, privacy, wearable devices https://orcid.org/0000-0003-2651-2293 https://orcid.org/0000-0001-7624-1319 https://orcid.org/0000-0003-2130-7717 mailto:tshine3@gmail.com Citation: Blockchain in Healthcare Today 2022, 5: 245 - http://dx.doi.org/10.30953/bhty.v5.2452 (page number not for citation purpose) Talisha Shine et al. Another significant change to watch will be the metaverse, the next iteration of the internet, as an immer- sive, always-on experience. The metaverse is an amalgama- tion of blockchain, virtual reality (VR, using a real-world setting), augmented reality (AR, an immersive virtual en- vironment), as well as mobile and computer technologies. In the future, we will increasingly see the metaverse used to change, enhance, and transform healthcare. The lead- ing use cases are collaborative working, education, clinical care, wellness, and monetization.2 In non-communicable diseases, there is potential to deploy the metaverse using gamification and incentives, as well as for education and care.3 Future healthcare metaverse ecosystems are being built, and surgeons have already performed AR proce- dures on live patients.4 Web 3.0 open metaverse will de- mocratize access, allow peer-to-peer transactions, and give everyone free access to this immersive space. Wearable Devices and Digital Twins Imtiaz Khan, PhD and Mohamed Maher, MBA In recent years, we witnessed a sharp rise of wearable devices, like the smart watch, capable of measuring key health parameters with high precision in real-time.5 Despite the growing use of smart watches and similar healthcare wearable devices,6 in the context of smart and connected healthcare aspirations of healthcare 4.0, the opportunities and transformative power the smart watch derived data (SWDD) are yet to be realized. In coming years, we will begin to realize the value proposition of SWDD, as well as how blockchain-like distributed and decentralized technologies can make that realization a reality. Under traditional healthcare systems, ownership and stewardship of health data lie with healthcare service providers and are considered as the data producer. With SWDD, the paradigm is reversed by replacing these providers with individuals as the data producer. From a health data consumer perspective (i.e. medical professionals, researchers, pharmaceuticals, and pol- icy makers), the availability of high-volume real-time health data along with environmental parameters (e.g. location, time of day, weather) will forge a new type of data that can provide a holistic spatiotemporal view at personal level. These real-time contextual personal data will bring a paradigm shift in terms of value cre- ation, since different machine learning and analytical techniques can be utilized for prognosis, discovery, di- agnosis, treatment, and follow-up purposes. Traditional cross-sectional and retrospective health data limit the use of machine learning algorithms and are confined to statistical analysis that has limited predictive and deci- sion-making capability. With the change of ownership and new role as data producer, individuals will start to perceive SWDD as NFT-like digital assets. This perception will create the demand to establish a digital health data marketplace,7 where, similar to the accommodation sharing economic model of Airbnb, individuals can earn revenue by sharing their SWDD. Real- time contextualized SWDD will also enable us to create industry 4.0 digital twins for health- care 4.0 as well as avatars in the metaverse. These digital twins and avatars will provide a new AI-assisted approach for monitoring and measuring our physical and mental health. Asymptomatic diseases, such as stroke or mental health diseases like depression (a leading cause of disabil- ity, worldwide),8 will benefit from this approach, as new insights about the progression of these diseases will be revealed. Blockchain technologies will be the enabler for the creation of such a marketplace. Smart contracts will en- sure fair distribution of revenues within the stakeholders, cryptography—privacy and security and cryptocoin— global micro transactions of revenues. The competition ethos of a free market economy will promote data qualit, while participation of global community promotes quan- tity health data. Availability, accessibility, and ability to choose the right dataset at right time will boost medical services and discovery. Privacy of Blockchain in Healthcare Kohei Kurihara In 2023, privacy will become one of the most signifi- cant topics, with blockchain in healthcare deploying new services at practical levels. On the application layer, some healthcare services were concerned with selling pa- tient data for commercial purposes. Under the research of Duke Clinical Research Institute, Duke University, Durham,9 the medical privacy regulation uncertainty covers the fundamental protection to share data with the first party against the restriction to disclose the patient’s agreement. Health Insurance Portability and Accountability Act (HIPPA) of 1996 (a U.S. federal law requiring creation of national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge) and General Data Protection Reg- ulation (GDPR, a European Union regulation on data protection and privacy) undermine the healthcare sur- veillance economy, but decentralized application is also applied to the legitimate requirement. Earlier this year, a blog from the U.S. Federal Trade Commission announced “The Commission is committed to using the full scope of its legal authorities to protect consumers’ privacy.10 We will vigorously enforce the law if we uncover illegal con- duct that exploits Americans’ location, health, or other sensitive data and investigate illegal action regardless of decentralized infrastructure, but prioritize the consumer safety and concerns. http://dx.doi.org/10.30953/bhty.v5.245 Citation: Blockchain in Healthcare Today 2022, 5: 245 - http://dx.doi.org/10.30953/bhty.v5.245 3 (page number not for citation purpose) Blockchain in healthcare: 2023 predictions from around the glob Healthcare data are no longer the information from hospitals and medical care centers that is censored in our home or physical devices such as smart watches. Location data become more sensitive to use for commercial pur- poses. Blockchain has the capacity to integrate, under a secure decentralized network, an application causing the claim from regulatory authorities. To predict the risk against healthcare data abuse, block- chain experts should consider multiple actions in 2023 as follows: 1. Proper risk assessment containing application layer 2. Third party and network evaluation 3. Cross-border healthcare data transfer Risk assessment is not sufficient with security checkboxes because risk categories are diversified and enlarge the defi- nition of sensitive data. A few years ago, location data were not a pain point for commercial utilities, but regulatory au- thorities have changed their stance for vigorous enforcement in accordance with the transition from social feedback. Compliance is the methodology for the patients to access healthcare service safeguards. In addition, appli- cation providers should reconsider the definition of com- pliance with an eye on diversifying products. Patients will find that third party connections will be ben- eficial for monitoring their status and for personalized medi- cal care with comprehensive data integration, although they prohibit sharing the patient’s data with commercial third parties such as advertisers or e-commerce platforms. Block- chain has an essential benefit to develop a wider network on a holistic system and process the data automatically. Of course, this system is superior to a centralized database but embraces the impact with wrong connections. Cross-border healthcare data become realistic by lower server cost on the cloud; however, cloud systems rely on local regulation and government action to access corporate data- bases in case of national emergency. The EU and USA have promised to commit to a mutual relationship to create a new framework in consecutive data flows based on the same level of data protection. Blockchain may have to follow when it comes to the selection on chain or off chain to store patient data. It explicitly falls on the healthcare industry to use pa- tient data under different jurisdictions. Changes in 2023 will exhibit an important shift to the application level in order to apply new rules of regulatory regimes. Blockchain Enabled Patient-Mediated Healthcare Exchange Osama El-Hassan, PhD Today, we still have very few convincing blockchain enabled solutions for healthcare. This is due to the complexity of the domain and the nature of healthcare data, which is still relatively large, unstructured, and amenable to changes. In 2023, I predict there will be greater emphasis on utilizing blockchain to enable patient-mediated health- care exchange, especially with pharma and clinical trials platforms. Patients with interesting data (e.g. rare dis- eases) will be able to monetize their information as NFT. Additionally, blockchain technology will find its way to empower the workforce through talent management and career development frameworks that provide incentives for training, mentoring, and knowledge-transfer through digital attraction (i.e. cryptocurrencies-based rewards). Funding Statement No funding was provided for the writing or publication of this article. Financial and non-Financial Relationship and Activities The authors declare no financial or non-financial relation- ships in the development of this article. Contributors Each author contributed their section of the article. Acknowledgments None. References 1. Thomason J. Big tech, big data and the new world of dig- ital health. Global Health J. 2021;5(4):165–8. https://doi. org/10.1016/j.glohj.2021.11.003 2. Thomason J. MetaHealth – how will the metaverse change health care? Journal of Metaverse. 2021;1(1):13–6. Available from: https://dergipark.org.tr/en/download/article-file/2167692 [cited 10 December 2022]. 3. 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Location, health, and other sensitive information: FTC committed to fully enforcing the law against illegal use and shar- ing of highly sensitive data. Federal Trade Commission. Avail- able from: https://www.ftc.gov/business-guidance/blog/2022/07/ location-health-and-other-sensitive-information-ftc-commit- ted-fully-enforcing-law-against-illegal [cited 11 July 2022]. Copyright Ownership: This is an open access article distributed in accor- dance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, adapt, enhance this work non-commercially, and license their derivative works on dif- ferent terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0 http://dx.doi.org/10.30953/bhty.v5.245 https://www.ftc.gov/business-guidance/blog/2022/07/location-health-and-other-sensitive-information-ftc-committed-fully-enforcing-law-against-illegal https://www.ftc.gov/business-guidance/blog/2022/07/location-health-and-other-sensitive-information-ftc-committed-fully-enforcing-law-against-illegal https://www.ftc.gov/business-guidance/blog/2022/07/location-health-and-other-sensitive-information-ftc-committed-fully-enforcing-law-against-illegal http://creativecommons.org/licenses/by-nc/4.0