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Saul Marquez:
Hey, everybody! Saul Marquez with the Outcomes Rocket. Welcome back to the podcast. Listen, we’re having an incredible conversation today with no stranger to the podcast, this is his second time on. We’ve got Jim Nasr. He is the CEO of Acoer. Acoer is an award-winning technology firm based on building, usable, open blockchain-enabled software in healthcare and the lead for the HBAR Foundation Privacy Fund, which supports organizations developing innovative privacy-oriented products on the Hedera network. Prior to his current role, Jim was an acting CTO at Safe Health System, developing a digital health and connected diagnostics platform in collaboration with the Mayo Clinic. He’s been a chief software architect for the CDC and many other things. He’s an expert in the field, and so I’m excited to have him back on to talk to us about the latest that he’s been up to and his company, Acoer. Jim, thanks for joining us.
Jim Nasr:
Thank you, Saul. I appreciate you having me back.
Saul Marquez:
Absolutely. So, look, a lot has changed since we last talked. We got through COVID. There’s been advancements in digital health within our environment, quicker adoption. Talk to us a little bit about what you’re seeing and really sort of what’s brought you into the space. Why does all this matter to you?
Jim Nasr:
Saul, I believe the last time we spoke was in 2020, so at absolute height of, at least from my perspective, trying to work around COVID systems and reporting at the time, working with Safe Health Systems and Mayo and such. Oh yeah, thankfully, we’re past that phase. That was a very intense phase of our lives for all of us, obviously. You know, I think what continues to really drive me, Saul, is probably the same as yourself and many other folks, you know, trying to, if you like, innovate in this space is really there’s a personal angle, right? I’ve had significant experiences with my parents and some family and friends, you know, have gone through health situations that really have been the experience has been much worse than it should have been in every way. I think we’re easy to articulate the financial side, but there’s a lot more than just the financial side, there is a real personal side, so that keeps driving me. It’s been really, I feel like my energy for many years around this. But then the other side of it is that I feel, and I think there’s evidence, though, as with anything healthcare, slow evidence that there are some breakthroughs, some slow changes, right? Particularly in terms of enabling patients to have rights on their own health data, which seems ludicrous but really is a new thing in healthcare, but it’s being promoted and supported through laws and now really forcing the industry to catch up, remove some of the information blocking and just obvious inefficiencies and things like this. So that’s a positive. But also, I think COVID proved this, unfortunately, with a very large collateral damage, but that you could, you can improve clinical research, right? There are ways in which to do that. There are ways in which you can get data together. You can engage patients with their own data. You can accelerate clinical research in a really massive way and innovate around that. You know, and it’s not just a question of, for instance, machine learning, and AI, and things like this. There’s a lot, that’s a reductive way of thinking about it, there’s a lot more to it. And so those things excite me because I think that’s a place where I see us at a core playing a role, and we have some evidence of that, and it’s growing. And really, a lot of it comes down to this idea of, can you trust the information? Where is it coming from? You know, is it authentic? Is it the latest version? Has it been consented by whoever is the owner? And those are the kind of questions we try to proactively answer with what we do. So that’s, those are the kind of things that keep me going.
Saul Marquez:
I love it, man. No, and look, you brought up a lot of hot topics. And, you know, one of the things that I want to dive in with you today is really the topic of data and how we use software to manage that data, but also blockchain. A lot of people talk about it, but they don’t actually use it. Your technology actually has blockchain at its core, right? Leveraging non-fungible tokens, NFTs, to really take a look at data rights and protections. So let’s take advantage of today to really use it as a sort of like a learning session, but also an opportunity for people to start thinking about how to operationalize this type of technology, because I think a lot of people don’t know how to. So if that, sounds good with you, let’s roll with that angle.
Jim Nasr:
I would love to. You know, I think, again, we all evolve on these things, and certainly, I have, Acoer has over the last few years. Some things have remained the same, and as an example, we always thought that blockchain and really cryptography can be used, public blockchains, as a means to impute computational trust. So that hasn’t changed, and in fact, if anything, it’s become easier for us because we have been doing this for a number of years. The technology has got better, cheaper, faster. But also, I think the premise makes, there are more people that kind of echo this. They may not say exactly these words, but it makes sense. It’s not a strange thing. But things that have changed as example is, how we go about like baking it in or making it part of the system. And I’m one of the things, as examples, you mentioned of non-fungible tokens, so we have been using this idea of a non-fungible token really since day one, since 2017 or so. And it really, all it does is that it represents a number, if you like, at its simplest form, it’s a big long number that uniquely represents anything. It could be a cryptocurrency, it could be a transaction, it could be consent, patient consent in our example. But unfortunately, like particularly a couple of years ago, NFTs became very, very heavily associated to, as an investment or a collectible and things like this, and that created a lot of noise, and that distracted many people from really the core functionality of what, which is really using tokens, and very simply to represent something uniquely an indivisible way global index, if you like. So all to say, as we have gone through, we have changed not necessarily our approach, but also just some of the language and semantics, because I think in some ways or in some avenues, NFTs have become like a four-letter word these days, because they are heavily, I think, associated to scams, you know, and like bored apes and things like this that, that people, you know, are very hyped up about. But then, as we had a bear market and people have become disillusioned about certain things, now there is this backlash, but that was never certainly our approach and nor really something that we promoted much more than the underlying concepts. But back to the germane idea of where we’re at with blockchain is really this, I think of it as an abstraction, which is we’re using blockchain and a public blockchain as part of our technology stack, like you would use a, like a distributed database if you like, or storage from Amazon or whtever it is. But we bake it in, and we try to talk about the functions that we are providing, such as dashboards for public health reporting or de-siloing healthcare data, or proving that something happened, as we say, it happened, and then using blockchain basically behind the scenes. That’s the way we look at it. So it’s not overt, you know, we’re not out there trying to be Maxie, this or that or, you know, going on about, you know, like the pure decentralization or the cryptocurrency or whatever. There’s many other angles. And those are those may be fine within certain conversations, but in our world, really, what we’re trying to do is think about the higher value that’s provided to patients, to clinical networks, to clinical research, public health, as opposed to like what is in of itself like really a technology. So that’s it. And I think the good news from my perspective is that we’re seeing some success. We’re seeing evidence of that. We’re seeing more and more both projects and implementations of our products, but also bigger, bigger outfits coming to us and saying, Hmm, interesting. What do you guys really doing? And let us hear some more.
Saul Marquez:
That’s great. Hey, thank you so much for that, Jim. And folks, I hope you found that interesting. I certainly did. A lot of us think of NFTs as the stuff you see on the news and the hype cycle, but really, Jim is sort of simplifying it for us. It’s a unique representation of a certain thing, in this case, patient consent, but it could be anything, a contract. And so there’s an opportunity for us to use this type of technology. Jim, let’s dig into it further and help us understand some applications, right? Like, who’s using it? Is it mainly payers? Is it mainly providers? Can companies use it, right? Talk to us about how we could put the shoes on.
Jim Nasr:
Yeah, sounds really good. So, there’s a few things to kind of unpack it from that, Saul. Let me take your last part of your question first, which is, can companies use it in a way that isn’t necessarily like this idea of tokens, not just non-fungible tokens? You can have fungible tokens like a dollar note. That’s fungible because, you know, if I gave you a dollar note and you gave it to your brother, you know, and so on, it’s all really the same. It represents the same thing, looks the same. You know, you can exchange it freely for something that’s recognized and non-fungible. Is that, if I had the gymnast or Memorial $1 note, that only has a sentimental value, right? There’s, obviously, nobody would ever pay anything for it, but I give it to you. There’s only one of them that is a non-fungible, if you like token, right? You can exchange it with anything else because there’s only one of them, or maybe there’s only ten of them, but they all have like, editions, like one through ten. That’s like a simple silly analogy, but can companies use these tokens? 100%. And can they do it in a way that doesn’t necessarily become like a public tradable token? 100%. I think people make this, um, you know, kind of again, it’s a little bit reductive that this kind of equation that just because you have a token, you’re going to trade it, you’re going to have it on the market, it’s going to be on FDX, it’s going to be on OpenSea and things like this, and that really isn’t the case, right? So I think let’s be clear about that. So could you use the token? And the question would be about, why would you use it? And I think the reasons are really the simple reasons, very much like you said, which is you could use it to track something with a global unique identifier, right? So you don’t have to trade it. You don’t have to put it on a market and buy and sell it. That is an option. You could do that. You could put some, and maybe you’re representing art or property or something. But in our case, even though we’re using those tokens, we don’t put them on a market. We’re not trying to trade them. We’re not trying to create arbitrage from that. Like, for instance, if we’re uniquely referencing in a privacy-preserving HIPAA-compliant way, obviously if we’re referencing, referencing, for instance, your consent to potentially be part of a clinical research study, we’re not selling that. We’re not trading it. We’re not trying to speculate on its value going up. We’re just trying to say, here’s a unique reference, and if that reference changes, we update the NFTO, or we update the reference to it. This idea of a dynamic NFTO, where you could update the metadata, things like this, so 100% enterprise can use it, and they can use it in a number of different use cases. I give you, I mentioned the patient consent, which is like anything to do with clinical research requires patient consent, and more and more, so I think people are understanding that this idea that you’re going to sign a piece of paper or a PDF, that’s like a consent for life for, which is effectively or a redundant thing that you keep signing, which is our experience, typically. That doesn’t really make sense, it’s certainly not efficient; but also, it doesn’t respect like real-life situations such as, say, as an example, you’re, this is the work we’re doing right now around pediatric cancer and neuroblastoma specifically. So it’s a child, and they’re going through this very onerous and unfortunately deadly cancer. And so the treatment is very, it’s long, it’s serious, it’s complicated. There are many consents required from the parents. If the child becomes, has a, maybe it becomes an adult or has some kind of guardianship change, or there is a change in status, or if they pass away, there’s a next of kin, there’s like so many variations of this. So you can’t just have one piece of paper represent your consent to be involved forever. So that dynamic nature is something that we captured. But then beyond that, there is this element of, okay, now you have these data sets that are available to clinical research. You know, they’re aggregated, they’re pseudonymized or anonymized. How do they know like what is what, where is it coming from? If you applied the right level of, for instance, anonymization based on various metrics, all of that can be represented, again, with authenticity at the data set level for clinical researchers. So that significantly moves them forward. And then another element, and this is really core to blockchain, is this idea of collaboration. So you and I can collaborate openly with some degree of openness, yet have visibility, have accountability of who provided what, when, right, and be able to share openly without, you know, in an open, with like an open ledger if you’d like to track things without necessarily putting ourselves in a place of intellectual property disadvantage. And that’s a really big thing when it comes to clinical research. That’s why oftentimes you have clinical research initiatives that take many, many years, up to ten years, you know, and they fail, they cost billions of dollars. All of that, with proper accountable collaboration, can be done a lot better, and that’s one of the other use cases we do where Big Blue, I think it is solid on tracking basically public health situations such as infectious diseases, airborne diseases, where that data is coming from everywhere, from multiple, multiple cities, counties, countries, geographies, time zones, geopolitical situations. COVID is a very good example. And then providing a way to track it in real-time, but also providing authenticity so the data is not manipulated. Unfortunately, we saw that a lot in 2020, right? I mean, I’m not going to rehash that, but we all saw it, and then all of us as humanity paid a price. So many examples, I won’t itemize anymore, but certainly, it’s more than 1 or 2 use cases.
Saul Marquez:
Yeah, no, I love it. Thank you, Jim. And look, you know, this last one that you mentioned, the tracking of public data, everybody understands the flow of disease transmission, particular to like the flu, right? It has a pattern. And as you’re looking for ways to manage your operations, say you’re a provider, and you want to manage your operation better, understand how many people you’re going to need, it might be really useful for you to understand the flow of the flu season better with a little more certainty. I’m hearing from you, Jim, there’s really a lot of operational efficiencies that could be gained from this, as well as authenticity and traceability benefits.
Jim Nasr:
Yeah, and I would say so, again, I’m not one of these Pollyanna lens kind of people, but I think there’s a time and place for that and be productive. I think the practical reality is, at least from what I’ve seen, efficiencies is a factorial of a number of different things. So it’s, so blockchain can help, but it could also hurt if you don’t do it correctly. It could actually create a lot of now-decentralized, you know, kind of tracking information that doesn’t match with your, for instance, information supply chain or flow of physical assets, etc. However, traceability, 100%. And I think that is a very important thing because when you’re talking anything public. So you and I, you know, and the rest of American citizens here in the US, we are paying for things that are public, right? It’s coming from our taxes. We have a right, and particularly when it impacts our health. This idea that, can you trace public information that the public needs, or for instance, an … like the CDC or the FDA are going to use to make decisions that impact policy and impact our lives? That is a very important thing because there are rules and regulations already about traceability, and probability, and flow and showing evidence of your work. So it’s not of this is a new thing or we’re not saying as prove it, have some kind of, like if you say you’re traceable, where is the evidence? And the evidence cannot be, well, let’s do it through a discovery, we get an army of lawyers, spend three years, and posthumously prove something at a massive cost, like $100 million cost to an army of lawyers and an e-discovery process. That is what typically happens and, or even a FOIA, a Freedom of Information Act, the reality is for average citizens or an average use case, you will never get there. It just costs so much money. It’s one of these things that, you know, it sounds good in theory academically, you know, it checks a box, but in reality, it serves no purpose, or it serves the purpose of people who have a disincentive to be traceable to be public. So, I think, I’m a big believer in this idea of accountability, traceability. I’ll give you another little example outside of healthcare. We have all heard about the implosion at FTX last year and all the money that was lost, billions of dollars.
Saul Marquez:
Disaster.
Jim Nasr:
Now, and that’s a really bad thing for all of us. Now, here’s the thing, though. This is the thing about blockchain, public blockchains. So a lot of this money has gone from 1 or 2 wallets or some wallets, digital wallets, into some other place, right? So digital, like bits and bytes, are moved from one place to the next. Now, in order for that money to be used, in order for you to go and buy a superyacht somewhere and put it in Dubai, you actually have to take that money and exchange it or use it to buy and sell things. That’s where the traceability comes in. And that’s a real issue because say you move, and you have scammed people out of their Bitcoin. But now, in order for you to actually use it, you have to go to some kind of a central exchange or some means to exchange it, something liquid. That traceability is going to come back and haunt you because it’s basically impossible with this public ledger. Almost impossible, nothing is completely impossible, you could argue there’s quantum computing or whatever, but to remove the traceability is almost impossible. And that, to me, is one of the key concepts of why and how would you use it in this kind of regulatory uses or more garden variety, for instance, consent or siloing of data or de-siloing of data; things like this is because that traceability is part of your ethical practices. So just, again, kind of taking these big ideas, we can really make it simple and make it practical, and that’s really the angle that, to me, makes sense. Okay, so all to say traceability, yes, efficiency, I think, honestly, I would love for it to happen, but I think it’s probably a factor of like decade or two out, just because the US healthcare is so broken.
Saul Marquez:
Wishful thinking on my side. 100%, I get the traceability piece, Jim. And look, Wow, I mean, this is super interesting. The truth is, folks, hopefully, you found it interesting. If you did, look, we’re going to post this on social media for feedback, so make sure you comment in the comments below. We’ll ask you for that, too, when we post this. We want to hear your thoughts, we want to start a conversation about blockchain in healthcare. What are your thoughts, and was this helpful? I think it was, and honestly, Jim, I think we should do a part two and dig deeper, and also maybe on a part two, dive in a little bit more on Acoer and some of the use cases that healthcare organizations are utilizing you guys. So look, for today, I want to thank you for jumping on with us. Let’s just say there will be a part two if you’re up for it.
Jim Nasr:
Yeah, definitely. I really appreciate your time, Saul, with so many good questions, and yeah, certainly I’d love to. I love to as a practitioner in this world, get into the details because I think it’s too easy to just have soundbites without real evidence of kind of work being done.
Saul Marquez:
Yeah, and that’s why I appreciate having you here, is that it’s more than just the sizzle, like you’re actually giving us the full view. So really appreciate it, Jim, and let’s let’s plan for our next one. Thanks for jumping on.
Jim Nasr:
Thank you.
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