The Covid-19 pandemic has changed healthcare forever. Among other things, it demonstrated the importance of data in the health sector. The global response to the pandemic showed that offering high-quality patient care depends on accessing and sharing large amounts of sensitive information in a secure manner - let us think of the logistic complexities of carrying out clinical trials, mass testing, and vaccinations under strict time constraints.

Today, accessing reliable data allows medical practitioners and institutions to pursue a patient-centered approach, i.e. to ensure adequate, personalized services at any time. We are witnessing a paradigm shift, which impacts both patient care quality and financial sustainability. Regardless of each nation's welfare system, residual or institutional, individualized healthcare is indeed one of the most effective ways to reduce costs and redirect money where it matters most - R&D, hirings, technology, facilities. 

The blockchain technology has the chance to play a critical role in supporting the data-driven evolution of healthcare. Thanks to its immutability and decentralization, the distributed ledger can ensure secure information exchange between healthcare providers and stakeholders. Especially in highly fragmented healthcare systems, it may offer interoperability and disintermediation of trust in the collection and management of data. This in turn enables greater agency for patients, who are empowered to access personal information in a simple, transparent manner. 

Blockchain and its applications - Smart Contracts, NFTs - can thus have a disruptive impact in some critical areas of contemporary healthcare, which the paper "Applications of Blockchain Within Healthcare" in the peer-review journal Blockchain in Healthcare Today identifies as

  • Drug Tracking - necessary to prevent diversion, counterfeit and overprescriptions throughout the supply chain
  • Healthcare Data Interchange - the integration of health data among different stakeholders such as hospitals, insurances, national health systems 
  • Nationwide Interoperability - i.e. ensuring access to health record across different incompatible service providers
  • Medical Device Tracking - to increase the efficiency of inventories and save money spent in repurchasing unnecessary devices 

Considering the centrality of these areas of intervention, it is easy to see why it is a booming business. The global market size of blockchain applications in healthcare was valued $1,5B in 2020, and it is estimated to reach $7,3B by 2028 (Source: Verified Market Research).

Let us take a look at 4 exciting use cases for blockchain-powered patient care.

Pharmaceutical Supply Chain Management

Counterfeit drugs are a significant problem, especially in developing countries. While figures are somehow difficult to come by, a 2019 OECD/EUIPO report estimated that the global market value of counterfeit pharmaceuticals amounted to $4,4B in 2016. We are talking about 0,84% of global imports in medicines.

In this regard, the implementation of blockchain-enabled services to track pharmaceuticals can offer transparency and security through the entire chain of custody. The immutability of the distributed ledger guarantees the authenticity of medical products from manufacturers to the pharmacist and patient.

In addition to the increase in traceability, blockchain-powered supply chain solutions can also increase efficiency and reduce costs thanks to AI/ML. Advanced streaming event analysis can detect anomalies in real-time and ensure the timely delivery of pharmaceuticals. 

Electronic Prescriptions

One of the most crucial stages of the pharmaceutical chain of custody is the prescription to the patient. Here, errors and communication mishaps can have devastating effects on a treatment plan. Let us also consider that in the US, 62% of prescriptions for controlled drugs are handwritten (source: Statista), which increases the risk of mistakes and prevents any automated safety feature. 

Blockchain-enabled electronic prescription systems can support healthcare providers in delivering a tailored service that takes into account patients' specific needs and clinical history. By integrating data from health records into a shared, secure database, blockchain can help prescribers check for allergies, interactions, and overprescriptions - also to avoid drug abuse or diversion.

The paper "Use of Blockchain Technology for Electronic Prescriptions" (2021), published in Blockchain in Healthcare Today, recounts an e-prescription pilot programme carried out in Tennessee clinics between 2021 and 2022. Switching to a blockchain-based electronic system automatized instantaneous patient safety checks (interaction, allergies), which resulted in practitioners changing the prescription 28% of the time. It also allowed them to save significant time - a mean of 1 min 48 sec per written prescriptions.

Electronic Health Record

No effective real-time patient safety check can be carried out without a reliable Electronic Health Record (EHR) system. Allowing patients and practitioners to securely access health records is fundamental both for transparency and clinical reasons. According to a Johns Hopkins study, medical errors, often resulting from uncoordinated or conflicting care, are currently the third cause of death in the US.

Yet, that is one of the very countries in which the theoretical effectiveness of EHR system is hampered by the fragmentation and lack of interoperability of service providers. It is estimated that there currently exist at least 500 vendors of EHR products - other sources claim more than 1 thousand! - with the average hospital running 16 platforms simultaneously.

The blockchain technology can thus be used as a way to connect different data sources and create a secure, decentralized ledger of patient records. In the words of a 2021 study carried out by the US Department of Health and Human Services, "Blockchain-based medical record systems can be linked into existing medical record software and act as an overarching, single view of a patient’s record".

Device Tracking & IoMT

The transparency and security of blockchain can benefit the management of medical devices throughout the chain of custody, from manufacturer to the hospital and patient. A thorough tracking of medical assets can help identification and verification against counterfeits and unapproved products, as with drugs. It also offers significant financial advantages, saving hospitals' money spent repurchasing devices. 

Implementing blockchain-based solutions for tracking medical devices can integrate with the widespread RFID technology, i.e. radio-frequency identifiers. These cost-effective tags, both active and passive, are currently employed to digitalize the inventory of medical items and drive the effectiveness of resource management. RFID-generated data can thus be transferred to the immutable ledger, to store in a secure and compliant way the history, lifecycle, and salient features of tracked devices. 

Blockchain can also provide data integrity for the messages exchanged via sensors and devices employed by patients at home. Remote monitoring is becoming more and more important for telehealth, also thanks to the increased availability of high-speed wireless connectivity (5G) - and this raises concerns about cybersecurity. The blockchain technology can limit unauthorized data access and manipulation, guaranteeing at the same time high transparency and agency for patients. 

These are just but a few use cases for blockchain in the healthcare sector. Other potential applications leverage smart contracts for service payment or trustless communication with insurance companies, to name a few. And other use cases will certainly appear in the next future, while the technology continues to develop and spread. What is certain is that the blockchain has the potential to transform healthcare for good, and help improve all stages of the patient journey.

Bitrock has global expertise and proven experience in developing blockchain-based solutions and applications. If you want to know more about our consultancy services, and learn how we can jumpstart your blockchain project, book us a call and we'll be happy to talk!

Author: Daniele Croci, Digital Marketing Specialist @ Bitrock

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It all started with a horse. In 2006, Bethesda popularized the notion of microtransactions in gaming with the launch of the (in)famous horse armor DLC - i.e. downloadable content - for The Elder Scrolls 4: Oblivion. For the somehow affordable cost of $2,50, PC and Xbox 360 players could unlock a cosmetic add-on for an in-game asset, that is the horse used by the player's diegetic surrogate. It did not provide any significant gameplay advantage, just a shiny metal armor to brag about with oneself in a single-player game.

It was not the first time players had had the chance to buy in-game items for real-world money. Microtransaction had been around since the democratization of internet F2P (free-to-play) gaming, featuring for instance in Nexon's Maplestory (2003), or proto-metaverse experiences such as Habbo (2001) or Second Life (2003). The last two, in particular, pioneered the offering purchasable cosmetic items for players who wanted to differentiate themselves in crowded online multiplayer spaces. 

And let us not forget Expansion Packs, full-fledged additional experiences that could be bought and added to videogames for more plot, quests, items and hours of entertainment, and that first came on physical media and only later via digital download. Some notable examples include Warcraft 2: Beyond the Dark Portal, a 1996 expansion to the wildly popular Warcraft 2: Tides of Darkness (1995), and The Sims: Livin' Large (2000), released in the same year as the original life simulation game. 

Even though we cannot underestimate Expansion Packs' role in transitioning the gaming industry from a Game-as-a-Product towards a Game-as-a-Service (GaaS) business model, today they have somehow waned in favor of parcelized microtransactions and DLCs. These forms of continuous content have now become dominant, with add-ons - both functional and cosmetic - coming at a lower, less affordable price for players and providing a consistent revenue stream to publishers. Even Bethesda's scandalous Horse Armor proved successful at the end of the day. 

The financial advantages of the GaaS model is still more evident with F2P games, where the ongoing sale of digital goods constitutes the sole source of revenue for the publisher. These addictive mobile games have often turned into viral phenomena that generate way more money than many conventional $70 AAA products - we are talking about games like Fortnite, which generated $9 billion in revenue in 2018 and 2019, League of Legends, $1.75 billion in 2020, or newcomer Genshin Impact, which is estimated to have totalled $3,5 billion in its first year. Seeing these figures, it is easy to understand how the global gaming industry generated a whopping $54 billion in 2020 with in-game purchases only - and numbers are only projected to increase (source: Statista). 

Mobile gamer

NFTs to overcome the limitations of DLCs

However, microtransactions and in-game purchases as we know them have a major limitation. When a horse armor is bought in a game, it stays in the game. It is not really an asset owned by the player, but rather a service that is accessed only in the context of the title that originated it. If we are talking about online-only multiplayer games, as many F2P are, the purchase practically ceases to exist when the game servers are shut down. Furthermore, digital assets bought or earned via gameplay cannot be normally exchanged on secondary markets for real world money - while there currently exist some under-the-desk reselling of items in some MMORPGs, like World of Warcraft, it is a risky practice that tends to go against End-Users License Agreements and leads to inglorious bans. 

This is where blockchain and NFTs come into play. Non Fungible Tokens allow players to acquire true ownership of the assets they have bought or earned in game, opening up to  collecting, exchanging and reselling. In a word, stronger players' engagement, fuelled by the Copernican revolution in the flow of value. Companies are no longer the sole beneficiaries of the gaming economy, with players empowered to (re)claim the value of their money or time investments. 

All this is possible thanks to tokenization, enabled by the blockchain technology. The term refers to the process of converting an asset, digital or physical, into a virtual token that exists and circulates via the blockchain. In this sense, tokens are representations of assets (money, real estate, art - you name it) that store information in a transparent, efficient, and secure way via the blockchain's immutable ledger. This allows all users to trace not only the token’s provenance, but also the history of transactions carried out by the users. 

NFTs are a special kind of tokens characterized by being - well - non-fungible, meaning that they are endowed with individuality as such and cannot be interchanged with another one. A Bitcoin is the same as every other Bitcoin, just like a dollar is the same as every other dollar. A NFT, by contrast, has unique and permanent metadata that identify it unequivocally. As a sort of authenticity certificate, this record details the item’s nature and ownership history. Another feature that differentiates NFTs from Bitcoin is indivisibility. It is possible to own a fraction of Bitcoin, while it is not possible to have a quarter of a tokenized work of art or gaming item.

All these features suggest why tokenized game assets can offer significant benefits for the players. Unlocking real ownership for unique items earned and bought redefines a user's relationship with the game, creating a greater sense of engagement that can also exceed the barriers of the game itself. Indeed, the interoperable nature of NFTs means that the gaming items can also be virtually transferred to and reused in other connected games, provided that the game engine and framework supports such functionality. In addition, blockchain-enabled games offer the chance to monetize item ownership in a legitimate way via reselling. We are witnessing the rise of the play-to-earn model, where gaming leads to the acquisition of NFTs that can be later sold for legitimate income. 

And benefits are not only limited to the players. Secondary trading of gaming NFTs may also generate immediate revenues for gaming companies via royalties inscribed within tokens themselves. This is one of the most exciting features of NFTs in general, with huge applications for the art world. In a nutshell, it is technically possible to mint a token in a way that automatically guarantees the payment of royalties to the original creator whenever the token is traded between third parties. The system still needs perfecting, being currently some limitations due to the interoperability between different platforms - more info here -, but it nonetheless is a great way to potentially ensure a fair distribution of profits between owners and creators. 

Tezos NFT Gaming

NFT Games & dApps to Know

To understand the impact of NFTs in the gaming industry, we need to consider at least two different applications: on the one hand, play-to-earn games that are structured upon the blockchain technology and NFTs, and which often are Decentralized Apps, or dApps; on the other hand, conventional games that variously adopt and integrate NFTs as part of the videoludic experience, without depending on them. 

The most popular dApp game is arguably Axie Infinity (2018), developed by Vietnamese studio Sky Mavis. It is a Pokemon-inspired online RPG where players can breed and fight their NFT creature called Axies. Available for mobile and PC, the game was initially based on Ethereum. Yet, Sky Mavis later launched their sidechain Ronin, optimized for NFT gaming due lower gas fees and transaction time (more info here). Axie Infinity can be said to fully leverage the blockchain possibilities by also integrating fungible tokens called ASX and SLP, which serve as in-game currency and can be traded like every other cryptocurrency on the market.

Despite the steep entry price - 3 competitive starting Axies can cost the player $300 and more -  Axie Infinity has quickly become a huge phenomenon. It is played each month by 2,8M users, with 10M total players estimated in December 2021. Even more staggering is the overall value of Axies NFTs transactions carried out on Ethereum and Ronin, which in March 2022 reached 4,17 billion dollars!

Due to the features of NFTs, collecting and trading are central in many - if not all - dApp games. CryptoKitties (2017) is another example of a game that focuses on breeding and exchanging NFT pets - there is no other discernible gameplay feature . It is often mentioned as the gateway to blockchain gaming for many players. Immutable's Gods Unchained (2021) is a trading card game à la Magic the Gathering that offers real ownership of the NFT virtual cards. It leverages Immutable X, the company's own Layer 2 Scaling Solution for NFTs that allows reducing gas fees. Gods Unchained also features its own homonym cryptocurrency, that enables players to buy card packs and vote in governance proposals that influence the game’s own development. It’s a growing phenomenon: the company reports 80k weekly players in January 2022, with $25 million in Gods Unchained assets traded on Immutable X.

Compared to the huge success of dApps, the relationship of traditional gaming companies and players with NFTs has been less straightforward. Quartz, Ubisoft’s proprietary platform for NFTs - or Digits, as they rebranded them - has been welcomed with mixed feelings since its launch in December 2021. The platform, now in beta, allows players to buy or earn some cosmetic items for the PC version of Tom Clancy’s Ghost Recon Breakpoint, which in turn can be resold on third-party marketplaces. Quartz is based on Tezos, a proof-of-work blockchain that, according to the publisher, “needs significantly less energy to operate. As an example, one transaction on Tezos consumes as much energy as 30 seconds of video streaming while a transaction on Bitcoin consumes the equivalent of one year of video streaming”.

Quartz’s lukewarm reception can be attributed to different factors. First of all, inaugurating the project with only one game, the PC version of a poorly-received 2019 shooter - 58 on Metacritic, with overwhelmingly negative user reviews. Secondly, limiting the acquisition of NFTs to Ghost Recon Breakpoint players that have reached a certain level in the game, effectively leaving out collectors and enthusiasts. Third, publishing sets of cosmetic items that look all the same and are merely differentiated with a serial number. However, despite all this, all Breakpoint NFTs appear to be sold out as of late March 2022.

Another gaming company that has been struggling with NFT implementation is GSC Game World, the Kiev-based developer behind the renowned S.T.A.L.K.E.R. series. On 15 december 2021, they announced that the upcoming S.T.A.L.K.E.R. 2: Heart of Chernobyl would include tokens to be purchased on DMarket, with the most prized allowing its owner to actually become a NPC in the game. The announcement garnered negative feedback from the community, which prompted GSC to backpedal on the very following day: “we’ve made a decision to cancel anything NFT-related in S.T.A.L.K.E.R. 2”. 

Konami had greater success with the launch of a NFT collection dedicated to the Castlevania series. The tokens were not items to be used in games, but 14 unique pictures and videos commemorating the 35 year-old franchise. Players seem to have appreciated the nostalgic set, which was auctioned off for ~$160k in total. This achievement prompted Konami to plan more NFTs for the future, as mentioned in their Outlook for the Fiscal Year Ending March 31, 2022.

Phenomena like Axie Infinity or Gods Unchained, and Ubisoft, GSC and Konami’s varied experiences with the blockchain demonstrate one thing: the gaming world is interested in NFTs when these enhance the experience and provide players with unique, valuable prizes that reflect their own passion and dedication. Gaming is a sophisticated medium, and gamers are sophisticated audiences. We have come a long way since the horse armor, and slapping a serial number on mass produced virtual items may not be enough. Today, integrating NFTs within a video ludic experience must be underpinned by a well-designed strategy that takes into account the specific features of the medium. 

Within this strategy, technological choices take on a primary importance. The variety of standards - paired with the lack of well-established business models - may hinder gaming companies’ efforts at creating scalable, flexible and environmentally sustainable blockchain solutions. This is why working with a reliable partner is increasingly important.

As a high-end tech consulting company, Bitrock has global expertise in supporting gaming and non-gaming companies for NFT, Smart Contract, cryptocurrencies and blockchain-enabled projects. Thanks to our integrated offering, we can accompany you from the project definition and to the deployment of the last line of code and optimization of the user interface.

To know more about how we can help you, contact us now!

Author: Daniele Croci, Digital Marketing Specialist @ Bitrock

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