[bduerst]

I've had someone pitch the same blockchains-as-EMR to me, and they made the same mistake of construing data integrity with data security.

Blockchains are public record, which you do not want your health data stored in. Even this article acknowledges that and recommends using private blockchains, which offers no competitive benefit over other decentralized databases.

This just seems like another hammer looking for a nail.

[kysar_tom]

The Bitcoin blockchain is really great for value transfer and data integrity.

You want a hash of your data stored in the Bitcoin blockchain, that can referenced at a later point in time to validate the accuracy of the data.

[zaphar]

You are describing the Merkle Tree which is not unique to the blockchain and existed some time before bitcoin. This isn't an argument for bitcoin it's an argument for the Merkle Tree.

[kysar_tom]

Tierion anchors the root of a Merkle Tree made up of all inbound records every 10 minutes into a Bitcoin transaction. With that root in a Bitcoin transaction, you can use a portable cryptographic proof (Tierion calls them blockchain receipts) to validate the integrity of each record at a later point in time.

The Bitcoin blockchain is a global immutable data ledger that makes for a great place to anchor hashes to.

[bduerst]

Okay, that is not blockchains for healthcare, that is third party validation for hashing. You're just storing the validation in Bitcoin's public network instead of your own secure servers. There are problems with this:

- You can't guarantee which block the transaction is on [1], which means all your customer encryption is asynchronous (slow).

- Your customers are assuming that you're keeping your private keys safe, which is not any different than trusting a non-bitcoin verification provider.

- The first quantum computer is going to destroy ECDSA, meaning your private keys will be reversed and every health product depending on your service will be trustless. Merkle trees can theoretically be used in a post-quantum world [2], but the method by which you're generating the root for the tree is not safe because you're relying on a network you don't control (Bitcoin).

How is this competitively good for healthcare?

[1] http://www.ibtimes.com/bitcoins-big-problem-transaction-dela...

[2] https://en.wikipedia.org/wiki/Post-quantum_cryptography#Hash...

[grubles]

As per [0], cryptography standards such as ECRYPT II tend to say that Bitcoin's 256-bit ECDSA keys are secure until at least 2030-2040.

[0] https://en.bitcoin.it/wiki/Quantum_computing_and_Bitcoin

[bduerst]

Just because the bitcoin wiki says it, doesn't make it a good prediction. Experts also used to say that a computer couldn't beat a Go Grandmaster until 2030.

The other points are still problems of using bitcoin right now.

[lliw]

A more interesting application would be storing health "meta data" - for example, permissions around viewing health data, or focused data like advanced directives ("code status"). For advanced directives, this could be really valuable to guarantee that disparate health care systems that don't share data are aware of your wishes.

[bduerst]

That's just an exercise in signalling at this point, and as far as I'm aware, there aren't many issues with the current implementation of advanced directives. In fact, the few U.S. healthcare systems that implement advanced directive programs are working surprisingly well [1]. Hammer -> nail.

[1] http://www.npr.org/sections/money/2016/10/05/496751771/episo...

[lliw]

The point is that advanced directives should not be tied to a specific healthcare system. Decentralization (blockchain or otherwise) is an interesting way to make this more accessible.

Practically, advanced directive knowledge requires verbal confirmation with the patient or healthcare proxy; or something like a MOLST (paper).

[swalsh]

That's probably because the blog article was written by a hammer company.

[est]

> over other decentralized databases

Can you share some example?

[davidgerard]

Frankly, you get most of the claimed benefits of blockchains by just putting the transactions in git, which is very fast and efficient, and there's a ton of tooling relating to copying git repos around and using the hashes in them and so forth. And doesn't use as much power as Ireland.

[sit12]

hammer looking for a nail in terms of healthcare applications yes but I am sure finance or government are better nails for the hammer.