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You need the mic, okay. Turn it on then. All right, so I'm fortunate enough to have

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met a lot of physicians who are interested in bridging that gap between

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their world and ours and I've had the opportunity to work with them in the

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past. We did some research in the past, DEFCON 22 I think on 911 security

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presented on that and continue to work through things like I am the cavalry to

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talk about health care and information security and that's been awesome. Ryan

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and I have a shared background in that we both went to the Air Force Academy, we

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both did space and missiles and some other stuff and he came to me with the

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idea of this application, this concept and we said heck let's run with it. So we

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did this part.

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If I don't face the camera is that okay? Yes. Okay. So just to reiterate, it seems like

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we're all familiar with this technology. So let's press, let's get right into it. Slide. That's

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me. That's you. I'll take this. So over the last I mean these are pretty current, six months,

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seven months. We've just seen hack after hack. So this is something we were trying to

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address with this sort of relatively simple system for protecting you know, security and

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our health care records, our health care transactions, our health care communication. This

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is going to happen again. This is going to continue happening. And one of these days it's

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going to hit a system that everyone uses like Epic or Cerner. Anyone familiar with Epic or

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Cerner in here? Okay, good. Very good. Okay. And when that happens, I mean, it's going to be a

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shit storm. I mean, there's really nothing you can do because there's no redundant com built

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in. There's no Plan B. This system, TriGraph, what we're building now is not going to be that

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Plan B yet, but we hope that in the future this or something like it will be. So this is just

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the scare tactics to keep you engaged. Next slide. All right. So, yes. This is the

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obligatory legal language that we have to provide that was developed by trained ninja J.D.

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Monkeys. Here, this is just to reflect that this is not necessarily the opinions or the

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language, verbiage. This is just to reflect that this is not necessarily the opinions or the

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commentary associated with our employers. His, whether it be the medicine field. Yeah. He's

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still technically in the Air Force and he's in the medicine field. He's not going to provide any

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medical advice here anyhow. Oh, and patent pending. The work we've done here. All right. So

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this is objective. We did ask for a second microphone. Do we have enough cable to do this?

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Yes. All right. So long term we want to improve access efficient physician care. I mean that's

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the big take away here. And finally, we think that going forward, medicine is going to have to

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become more collaborative. Raise your hand if you've been on WebMD? I know you all have.

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You've all had some weird sore. Yeah. I know you all have. Something a little itchy? You're

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gross. So we think it will be helpful to be able to speak over a secure anonymous platform and say,

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hey, you're right. We want to improve access efficient physician care. That's the big

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man, I got this thing going on. Kind of like what you have on WebMD right now except with

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someone that you know is a physician because they've been credentialed through the

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blockchain, through a token to know that. Next slide. Longer term, and this is what I alluded

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to earlier. Right now we have a functional POC. We're going to show you that today. It's

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sped up though. So don't think we're cheating. It takes longer than a minute to do this. It

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takes like six minutes to do this. Which is still pretty good we thought. So these are the

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key tenets I want you to keep in mind as we go through this. The one I didn't mention was

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auditability. So for anything medical records, you have to be able to know who looked at what,

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what they saw, you know, if they had a reason for doing this. A blockchain will keep track of

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the externals so you'll know that physician X talked to patient Y. Maybe some sort of

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content. I guess with the contract on Ethereum you'll know that it was something about, I

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think I maybe broke something. I don't know. I don't know. I don't know. I don't know. I don't

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know. I don't know. Maybe I broke this bone or something. But you won't have the internals. So

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there's still privacy we hope, we think at play. Although we are looking to you guys to help

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pick this apart. Next slide. So why Ethereum? You know, it's kind of a, you know, poor man's

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crypto. We can do a lot of stuff with this with the blockchain. It'll cost a little bit of

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money. But even more importantly, what we're up against is, is frankly way too expensive to

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begin with. I mean a PAX system is millions a year and it's proprietary. Oh, and there's a talk on

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Sunday. I don't know who's giving it, but I think they're going to discuss the security. Any

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chance he or she is in here? No? Okay. They're going to hopefully talk about all the

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vulnerabilities in PAC systems that already exist. Additionally, health care, the costs have

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become just non-transparent. We think we're over $100 to read an X-ray. An MRI is probably

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more, probably a couple hundred dollars. But frankly, that's already too expensive and we

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think we can do better. We know we can do better. The payment system is already built in as

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long as your physician is willing to accept Ethereum. Who in here takes Ethereum? I think it

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took a nosedive the last few weeks. Who lost thousands? Yeah, sorry buddy. And then identity

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management, this is where we really think this could catch on because how do you know who

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you're talking to? How do you know this is a physician? Especially if you can de-identify it

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enough to know that, well, I don't know the physician's name, but I know that he's credentialed

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to the system. So I don't know who he is. So I don't know who he is. So I don't know who he is.

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And we're looking for those people to help us with these kinds of things, at this level. Even if

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he or she is living in India or even if he or she is living in Chile or something which can also

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help for 24.7 access to these kinds of medical services. And finally reputation management,

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we're not here yet but we envision something along the lines of an Uber type rating system which

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is difficult because you might not like what you hear from the physician. Yes, you do have

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herpes. I'm sorry. But you know, we're hoping that some day we can put together something that

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allows us to know that this physician who is credentialed and operating on this particular

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system is not full of shit. That's kind of what we want to get to. So when you're getting

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feedback from a physician on an image that you're providing to them, you want to make sure

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you're getting timely feedback, you're getting cost effective feedback and that it's detailed

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enough that you can take it and provide it to maybe your primary care provider or you get

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enough input on it to say yes, this is broken or yeah, that probably is what you think it

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is that's for. Slide. Slide. Alright, so this is me. So this is the architecture, what we

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designed to get this done. On the left-hand side you've got the patient and on the right-hand

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side you've got a physician. And originally when we were talking about this and designing it in

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our heads, TriGraph was the concept of the patient, the block chain and the doctor. And then

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we got to the point where we said, hey, you know what, we probably don't want to store imagery

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on the block chain. That would be annoying for everybody. And then we got to the point where

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we actually我们不做了.我们结果我们使用了一个外来数据文件座.

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And the external data store is depicted on the top. We've implemented that in the proof of

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concept using Django. And that's just basically an API that's sending information back

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and forth. In the design phase when we were looking at this, it was very important to us that

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we implement it such if that data store were compromised, none of the patient information,

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specifically the imagery, would be recoverable. So what was passed up there is public keys,

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encrypted image data and that's it. As far as the patient interaction with the block chain,

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that's something where they're sending the payment, right? They're paying the physician for

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that image read. They're paying the physician for that opinion. They're starting the contract

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and they're pushing state changes. The physician is also pushing state changes which we'll get

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to here in a moment and then the payment at the end goes to that happy physician in the lower

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right to say, yeah, that doesn't look good. All right, so when we designed the proof of

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concept, this was what we actually implemented in our network for testing. You can see

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basically it's a summary of it all and this is truly a mesh network with the Geth or the

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Go-based Ethereum clients talking to each other. But here what you've got is you've got at the

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top the dedicated block chain nodes that are operating the block chain. They're the ones that

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are doing the mining and the mining is required so that we can keep the transactions moving

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along. On the lower hand side, this was our implementation in the proof of concept to say we

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have an arbitrage. This is the proof of concept. This is what we actually implemented in our

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proof of concept. We have an arbitrage patient client, we have an arbitrage doctor client and

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we have the data store. The data store was the implementation of that Django app that we were

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talking about. All of those three are interfacing through Web 3, a Python library into the Go

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Ethereum client via RPC to the Go Ethereum client and then talks on the block chain. So this is

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how we implemented our proof of concept and we'll go over that and actually have some video on

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that later. Any questions?

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Okay. I'm going to speed through this. So one of the things that was important to us was

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authentication. How do we know who's talking, right? How do we know who's conversing? So for

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authentication on the block chain, we're relying on the Ethereum authentication, right? You're

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unlocking your wallet. You're using those secrets that are within that wallet, that private key, to

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send data, to send money, to send Ethereum. If you can unlock that, then you have authenticated

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yourself to the block chain. And for our purposes, we said that's what we're going to do. We're going to

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send money back and forth. That's going to be good enough, right? Because you're already doing

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that to send money back and forth. But for the data store, we had to come up with something, right?

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How do we know who is talking to the data store? So what we came up with was this is our

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prescription pad, right? You have a prescription pad. You hand it to the physician and they sign

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it. That's what we're doing, right? So the data store, when it is working with any one of the

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clients to it, whether it be a patient or a physician, they're sending them challenges. It's a

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challenge response authentication mechanism. It's a

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message that's essentially saying, hey, here's something that's unique. It's a unique token from

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the data store. We want you to sign it with your Ethereum private key. And when it gets back, the

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data store looks at it and tries to verify that signature. And if it can, and that contract, or

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I'm sorry, that address verifies up against the contract that it's looking for to say, yes, this

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is the patient, yes, this is the physician, you're good to go. And it progresses forward. So that

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was used for authentication against the data store. The other thing that was important to us was

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authorization. And authorization is a very important part of authentication. It's a very important

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part. Authorization was handled at two levels. Authorization in the contract on the

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blockchain was baked into the contract using solidity. So you can see here we've got some

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modifiers that say only the patient can do certain things, only the doctor can do certain

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things. And then we've got the in-state aspects. And you've got some examples on the right-hand

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side. In-state just depicts the fact that we've got this kind of positioned out in different

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states where the contract is initiated by the patient and then it waits for it to be ready for

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the doctor. And then the doctor picks it up and reviews it. And then the doctor picks it up and

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gives it back to the patient. And the patient gets it and says, yes, you reviewed my image,

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here's your money. So that's basically how we're doing that authorization. As far as

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authorization within the data store, that was based on your authentication. So it's, again,

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based on patient or physician. If you have identified yourself using the authentication

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mechanism we referenced in the last slide as the patient and you're trying to do something a

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patient should be able to do with that contract, you're authorized to do it. All right. So how did

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we keep those images secure on the data store? This is basically a summary of what we did. This

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is a specific implementation of elliptic curve integrated encryption scheme, or ECIES. What we're

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doing is we're taking that ethereum private key data on the left-hand side for the patient and

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the doctor and we're creating elliptic curve keys, basically saying let's create pubs from the

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private key data that you have. And we're going to share the public keys via the data store.

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Again, that's authenticated back to, say, the private key data that you have. And we're going to

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say, are you the patient? Okay, then you get the doctor's public key. Are you the doctor? Okay,

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then you get the patient's public key, specifically for that contract. The public keys are

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exchanged via the data store and then those are used for ECDH, or elliptic curve Diffie-Hellman

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key exchange, right? So we're going to take that and we're going to generate a shared secret that

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now the patient and the doctor have. That shared secret is used as output from the ECDH, or

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elliptic curve Diffie-Hellman blocks, to throw into an AES key. And then we're going to use that as a

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key derivation function. And the salt that we're using to make it unique for each exchange is the

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contract address from Ethereum. That then will result in equal AES keys on each side. So the

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doctor has an AES key, the patient has an AES key. They're the same, but they never exchange it

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in the first place. So these are the stages that the contract will go through. The patient will

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initiate it. The patient will stage everything, put the data out there, say it's ready for the

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doctor. The doctor can then accept the key. And then the contract will go through. The patient will

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accept the contract and get everything ready to be able to, you know, exchange those public keys.

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Once the public keys are exchanged, then the patient can upload the file. And in the encrypted

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format. And then it can be downloaded by the doctor, reviewed, put back up there. And then the

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patient can say, yes, this is completed. I got back the advice from the doctor. There's also a

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stage for abortion. If we get to a point where the patient has put a contract out there and it has

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not been accepted, for example, if I put something out there and I didn't mean to or I put it out

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there and the value is too high or I want to decrease it, you can just nix the contract

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altogether. But it has to be in a non-accepted state and it has to be done by the patient. And

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we've got some details in this for everything I just said that I'm just going to skip past because

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I said it already. All right. Challenges. Okay. So it's changing quickly. That could wreck all

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the code that Peter's already written. Sorry. There are privacy concerns. Just like any system,

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the end users can still take a picture of something and put it on the Internet. We don't know

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how to fix that. So we can't really solve that problem. Additionally, de-identifying some of

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this data may prove impossible. Moral and ethical as well. This is something that Peter and I

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discussed at length for about ten minutes over a few beers. I'm sorry. I'm sorry. I'm sorry. I'm

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sorry. This same construct could be used to share some really bad stuff. And it would be

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completely anonymous and it would be completely secure. So you could do murders for hire. I'll

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let you speculate on everything else you could do over that. Finally, how do I know you're a

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real doctor? If you lose your token once it's been issued or if it's stolen from you, well,

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it's, we don't know that you're talking to a real doctor anymore. And then finally, oh

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two more things. So you do, we're not sure what's going to happen with this. The gas when we

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priced it a few days ago was just a few cents. The physician would pay a few cents to get into the

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network. Which is no big deal. But we don't know what the future is going to hold with that. So

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if Vitalik Buterin is around, does anyone know if he's around? I'd like to talk to him. I'm

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totally serious. I'd love to have him sit down, you know. Is he 21 yet? And finally, speed kills.

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If the network isn't fast enough, your average radiologist is going to move through a scan in

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about two minutes. If they can't do that in that sort of time with this network, it's

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pointless. They'll just go back to a PAC system. Slide. Next step. So what we want to do, we need

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to automate more of this. It needs to be, I'm not sure what you meant by checks and balances.

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Right now, so right now, we don't have some of the checks that I'd like to do. I'd like to do some

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of those things to say, okay, you know, where is the state of the contract with respect to what

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you're doing at the data store, right? So if you're trying to download an image and it isn't

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actually at that state on the data or on the blockchain, it'll all error out. But I'd like to

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tighten that up. Yeah. Thanks, Pedro. So we need to also credential physicians. How much time

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do we have? A minute or two? Okay, cool. So this is the hard part. If anyone knows any

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companies that can do this for us, we'd love to know. Because once they're credentialed, I'm

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mean, that's it. We don't have any way to sort of police them. We need to know that they are who

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they say they are, that they have gone to this residency or have had this medical training.

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User-friendly interface right now. There's maybe three people in this room who would know how

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to do this on this system. So we're going to need to make this interface with a browser of some

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sort or an app. If anyone can do that, let us know afterwards. Monetization. We do, we would

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like to monetize it. I mean, I don't think we're looking to make crazy profits on this. But

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we're looking to make a lot of money out of it. So we're looking to make a lot of money out of it.

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There's a few different ways we could do it, but we want to do it in a way that we're not a third

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party. It would have to be the sort of thing where the contract is already fulfilled and everyone's

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happy and then somehow in some sort of, you know, subcontract or something we're paid

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afterwards. We're not exactly sure how we're going to do that yet. The rating system, already

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discussed. Go live on Ethereum. We haven't done this yet. So we still technically don't know if

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this will work end to end because it hasn't been done on the live network. Okay. I hope we left

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time for questions.

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Let's get the demo going.

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So we're afraid of the, and wow, this is really terrible, terrible graphics. I'm so, so sorry about this.

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Let's see if we can zoom in. How do you max zoom in? Max zoom in.

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Yeah. And we can make this available afterwards. This is just a video. It's unfortunately

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grainy. What this is, and as we sped this up, this is a video of the interaction on the top of an

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end-to-end script. The problem with actually doing this, you know, in person is it's something where

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I would do something as a patient. Dr.

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Would do something. I would do something as a patient. Doctor would do something. And that's

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actually going to take hours and hours. Plus the blockchain has to mine everything to verify all the

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transactions.

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So, so my question is, have you felt of running a, instead of using public blockchain, you can use a

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private blockchain, let's say based off on a proof of authority consensus are similar to oracles.org

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project that they're trying to do. Um, have you thought of this approach because it's a green

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mining, nobody has to, it's like a simplified proof of stake.

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Yeah.

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So, what he said was right now we're using a private blockchain and it's working. Um, we do wanna

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push it out to a public blockchain just to make it so that it's readily available. It's monetized

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right there. It's money, right? People pay. Right. People pay in the money.

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Yeah, we can do very bad things with this blockchain. So, we wanna make sure that it's verified by

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other people. We want to make sure that it's money that people can get, that they, you know,

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radiologists can do this thing. They get their ethereum and they get it out of Coinbase.

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whatever they needed to do. Alright. Last question. Last question. Okay. So I see you guys

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aren't really storing patient information, but you are storing encrypted image data. Yes.

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Maybe certain what? Patient information. Would HIPAA apply here? Are you taking that into

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consideration that you'd be legally required to do certain things according to HIPAA guidelines?

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No. Okay. Enjoy. No, because, because this is, in this case, in all the scenarios we are

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putting up here, it's the patient uploading this. With your medical records, you can do

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whatever you want. Now, going forward, we would need to get some sort of HIPAA certification

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for this. I don't know that it would be a huge problem because once this stuff is encrypted,

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it's there in the data store and it's just there. HIPAA is very strong.

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So, you know, we're not going to have to construct regulations of how you store it.

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I'm familiar. How you audit the server and how you do everything. I violated it a few

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times. I'm familiar with it. Yeah, enjoy the fines. Yes, there are heavy fines. So, no, we

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see this starting off as a poor man's second opinion to begin with. That would be outside the

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bounds of HIPAA. But you're right. Going forward, that would be a problem and a concern. And

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not one we're really that worried about because when you start talking about auditability, this

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is the public ledger, right? This is the blockchain. So now we kind of know where everything's

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transiting. So the data store also supports all kinds of logging that we can do with that.

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It's something that we could achieve. I'm not that concerned about it. But to get to the point

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where we were proof of concept and it was actually moving data back and forth in an encrypted

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fashion, we did not achieve HIPAA compliance today. All right. Cool. Thanks, guys.