[equalarrow]

This is the big picture and it most aligns with how I feel about this emerging space.

There's a problem with developers and cs people and that is that they are looking at one small spec - the blockchain data structure. From there, the work their way up through sensationalist headlines and shout "blockchain is crap, it should go away, we don't need more 'money', this whole space with its ico's is a scam!", etc, etc.

But it's not a scam. It should not go away. And, it is the future.

No one I think is debating that the 'blockchain' (I'm referring to the bitcoin data structure here) is slow. Anyone that holds on to that nugget is entirely missing the point and needs to grab their 56k modem and 386 and go hunker down in the closet, because that's their mindset.

Bitcoin (and other tokens) are not valuable because of their slow data structure. They are valuable because, like the article says, they are permissionless and globally distributed (immutability is also key and not mentioned).

If you think that is not important, you are fooling yourself. It's a revolution just as big as webapps were over non-connected desktop apps. Just as mobile was over desktop web apps.

Take my super high level case of 'blockchain' medical company (I use this when I talk to people about why this next wave is important).

Currently today companies own your medical data. If you move from one medical provider to another, in order to get your history over to the new provider, the new guy has to either call or request a fax of that data and then double enter it into their system. Maybe this exchange is automated but I doubt it.

What happens when you leave that company? New company has to go through the same laborious process. And so on and so forth.

This is today's problem: silo'd data 'owned' by various companies out there. The end user/customer has little power because they own nothing. They are at the mercy of that data because companies do not want to share (they want to corner markets and destroy competition) and companies do care enough about securing 'your' data, so thieves then break in and steal it. It's funner for them to build teams, have company parties, tout their prowess and expertise in the press. Securing data and making it interoperable - not very fun or profitable.

What (smart) people are working towards is turning this equation on its head and encrypting and distributing globally all the data. So, instead of using 10 medical companies throughout your life, the potential is to use a distributed system that stores your data in some kind of 'blockchain' (zoom out an think an immutable record of your entire health history) that only you have the full pub/private key(s) to. (Yes, wallets and keys are a potential problem here and we'll have to work more towards making recovery easier. This is a big, deep topic in and of itself.)

This is not far fetched. We already use ssh keys on remote servers where root has the ultimate permissions and then we can add/remove users at will with their own keys and permissions. So, we understand conceptually how to use pub/priv keys with regard to access. It's not a stretch to start figuring out how to apply this to global data and companies and teams have already been doing this.

Of course, the 'old' medical companies would have to use this system as well and they probably will go kicking and screaming since the data to _them_ is not as valuable because they are not in control anymore. But to _you_ it is. It really is _your_ data and you can take it wherever you want over your lifetime.

This is a total paradigm shift of how tech companies will need to operate in the future.

Tokens, blockchains, dlt's, yah, they're all buzzwords. But so are saas, elastic ip's, spa's, and load balancers. There was a time when you didn't need any of those things and now, they're part of everyday life even if you don't know it.

So, hate if you will, but I already know people working on things like this. Tokenization, dlt/blockchain/dag, gloabal pki access, true micro txn's - these are all things already in play and we'll see more and more of them in the coming years.

[JumpCrisscross]

> What happens when you leave that company? New company has to go through the same laborious process.

I like how de-centralisation is a pro until it's versus centralization on a blockchain.

TL; DR If everyone can agree on a single blockchain, everyone can agree on a single data format. That data format agreement is faster, more adaptable, more extensible and more resilient (in not requiring users to keep private keys) than a blockchain.

Screaming blockchain at everything is a new twist on an old mistake: thinking political problems have technical solutions.

> hate if you will

Discarding reasonable criticism as hate is immature. So is arguing "if you think X is not important, you're fooling yourself."

[mratzloff]

> TL; DR If everyone can agree on a single blockchain, everyone can agree on a single data format. That data format agreement is faster, more adaptable, more extensible and more resilient (in not requiring users to keep private keys) than a blockchain.

Exactly. If you're looking for a model of personal medical data ownership, DNS would be better.

Various companies that hold your data (registars) and allow you to share with the appropriate parties (zone files), or delegate that ability if you so choose (name servers). If you want to transfer that data to another company, you can (domain transfer).

Furthermore, I question the assumption that immutability is entirely useful for medical records.

[loceng]

Immutability is useful for medical records for accountability purposes, to prevent doctoring (no pun intended).

[mratzloff]

If you start from a place of distrusting your medical professional, now you need a way of uniquely identifying them in a way that can tie back to them for accountability purposes. So we've introduced some kind of notarized identity service.

Furthermore, doctors are only going to read the most recent entry for any given data point: doctors won't read the entire file, especially in emergency situations.

[loceng]

Just because the status quo and doctor's behaviour is currently a certain way, doesn't mean it's the right way. The efficiency lacking in our health-"care" systems is astonishing - there needs to be self-regulation mechanisms and accountability.

Emergency situations is an orange if everything else is an apple, so of course there can be protocol and acceptable boundaries for each.

Humans are humans, mistakes can happen - especially that we aren't aware we're making, and therefore bound to make them again. Accountability will lead to necessary learning and improvement.

[slfnflctd]

What if the data is wrong?

[spiralx]

You append a correction, it's the same process as an edit.

[spookthesunset]

So, use git?

[weego]

Everything implementation idea you touched on could be done without blockchains and would likely be better for it.

None of the drivers for why that doesn't happen today are technology caps. It's entirely the perceived (and real) value of data ownership and the lack of desire for universal integration not only from business leadership but also constant 'I know better' ecosystem fragmentation from developers.

Blockchains are just bad and inefficient tech right now and that deserves criticism but the endless naivety of the tech industry thinking that socioeconomic problems can be solved entirely by an implementation of a technology is just infuriating.

[ghthor]

From my anecdotal experience, non technical users largely have zero trust or misguided trust in the technology they use. My dream from the application of crypto networks is to help improve trust in technology, and help guide the trust to the right parties without requiring all my users be trained computer sciencetists.

[rdiddly]

This is a political problem, not technical. If my doctor were willing to store my info however I want them to, the problem is solved. And if they were willing to store it on a block chain, then presumably they'd also be willing to just put it on a thumb drive for me? Or a piece of paper? A centralized solution, centered on me.

[langitbiru]

I think one of the values that blockchain can bring on the table in this context is convenience.

Passing data to a thumb drive or a piece of paper is a decentralized strategy but inconvenient one.

I imagine in the future, the doctor in Brazil writes your medical data into his/her local computer. You ask the data and show the QR code or public address in your mobile phone. The doctor sends your data to this QR code or public address. You store this data into the blockchain.

Next year, you go to Singapore and do some medical operation. You pass the data from the blockchain via your mobile phone to the doctor in Singapore.

I guess that is the selling point.

Can this be done with centralized approach? Of course. We can build a Paypal company but for medical records. The problem with that is some countries are reluctant to share the medical data with American company. They, I assume, will trust the algorithm which does not have the bias compared to an American company.

Paypal right now is not supported in Iran. I imagine this is one of the reasons doctors around the world would trust the blockchain compared to an American startup company.

[Edited] If we want to build a platform where Chinese and Americans can collaborate on sensitive data, blockchain could be the answer. You don't expect Chinese to trust an American startup company or vice versa. [/Edited]

This is my hypothesis.

[marcus_holmes]

You might want to do some actual research on non-US medical systems before investing your cash into this.

There are already several international standards on the interchange of medical records. There are some limits on requesting your own medical records (for apparently good reasons) but basically the system you describe already exists, minus the need for blockchain (which apparently is more "convenient" than a thumb drive... how?) outside the USA.

Also, the problem with Chinese-Americans collaborating on sensitive data is that they don't want to, not that they don't have a suitable format for data interchange.

Again, solution chasing problem... as always with blockchain...

[icebraining]

Why is the doctor sending your data to some public address shown on your phone, and not to your phone directly?

[slfnflctd]

My phone has zero reception at my doctor's office. It also runs out of space regularly, since manufacturers decided to screw consumers over by taking out SD card slots. There could be plenty of other reasons.

[icebraining]

Why do you need reception to transmit something from a computer to a phone in the same room?

As for out of space, that's a valid concern. But the blockchain itself can store almost nothing - a few bytes per transaction at most. So you'll have to store the data somewhere else anyway, and only point to it using the blockain. And therefore, the question returns: why not store that pointer in the phone itself?

[dnomad]

Yeah, it's like Americans have this massive blindspot when it comes to government. The "problem" of standardized medical record storage and distribution has been thoroughly solved in France. There you have a nationwide system of healthcare and there are largely no issues with medical record access. (Which is not to say it's perfect but what you're dealing with are largely internal organizational issues not the massive coordination issues that make American healthcare so unpredictable and expensive.)

There's this very naieve view that blockchains are somehow going to replace governments. I think a lot of people are in for a very rude awakening. The government, as they say, are the guys with the guns. It highly unlikely that they will surrender enormous power and privilege to decentralized networks. When it comes to currency, capital formation, medicine, energy, defense and transportation the governments will step in to ensure they remain firmly in control. These are political "core competencies" that no government in their right mind will abrogate.

This is what makes all these blockchain delusions about a blockchain of medical records so stupid and pointless. If there were such a blockchain it would be controlled by the government in which case you wouldn't need a blockchain at all as everything could be done much faster, cheaper and more securely using a centralized, government-controlled database. I mean, really? Do people not see this?

And the idea of "forking" Google or Amazon is so hilariously dumb all I can do cringe that somebody seriously wrote that and put their name behind it.

It's clear now that many of these blockchain advocates don't really understand where the blockchain is actually useful. There actually is a class of problems that require global, decentralized, democratic consensus and are not susceptible to economies of scale but are susceptible to network effects. (I say democratic consensus here because this idea that blockchains are "trustless" is nonsense. Every blockchain is a democracy and democracy requires enormous trust. As we've seen again and again if the majority of nodes vote one way you have no choice but to follow or lose all your assets. Blockchains do not fulfill this libertarian fantasy of freedom from democracy.) This class of problems does not overlap with what governments at all. But it does overlap almost 100% with those problems that the internet has already solved so successfully. Particularly investors like USV should be looking at their previous tech investments -- Twitter, blogging, open source companies, digital collaboration, content generation, messaging -- and thinking about how blockchains could help these problems. TLDR: the blockchains aren't anything new. They're global, decentralized networks that let millions of people communicate and coordinate in real-time. Just like the internet itself.

[icebraining]

The "problem" of standardized medical record storage and distribution has been thoroughly solved in France. There you have a nationwide system of healthcare and there are largely no issues with medical record access.

What happens when a French citizens moves to another country? Some people even live a few months every year on different countries, what happens then?

[PeterisP]

Whatever solution you'd propose for ensuring global adoption and interoperability of hypothetical blockchain-based medical records would also work just as well (or better) for any other type digital healthcare records. That's mostly a political problem, and not one where blockchain provides any advantage.

[icebraining]

I don't disagree, I don't think the blockchain makes any sense here (or mostly anywhere). I just disagree that France has "solved" the problem.

[PeterisP]

One could argue that France is one of multiple examples that demonstrate that the technical parts of the problem are already solved. If we actually wanted to (IMHO we don't), had the political decision to implement global interchange of health data, and had solved the political problems required to get the resources and will to implement it, then we could just copy and deploy the solution of France or Estonia or whatever, knowing that the technical and organizational structures are reasonably appropriate, and there's no need to suppose that something fundamentally technically different is needed, there are no obvious technical problems that need solving.

[dboreham]

Except almost nobody does that.

[icebraining]

Perhaps. I know at least three retirees doing that (spending winters with their family abroad), and apparently there's a term for it in the UK ("mouseholing"), but I can't find any statistics.

[dboreham]

That's seasonal living between two places (e.g. Snow Birds). Presumably there is already a workable solution for those folks. Parent was talking about people who randomly move country to country.

[snarf21]

Okay, but the US doesn't have a nationwide health system and probably never will. So how do we fix the medical record access issue?

Saying "solve it with regulation" is no more helpful than saying "solve it with blockchain". A working solution is better than something "better" that is theoretical.

[psyc]

HN seems collectively to have taken the stance lately that blockchain is 100% useless, and does not do anything it is claimed to. HN also collectively tends to naysay, think narrowly and literally, and display extreme hubris about its peculiar 'hard facts and certainty only' attitudes towards novel information. If HN were a person, they would have the least amount of imagination it's possible for a person to have. For me, this is the #1 thing that limits the usefulness of the comments section here.

[JumpCrisscross]

> HN seems collectively to have taken the stance lately that blockchain is 100% useless

I don't think this is the case. Many here find these systems genuinely fascinating. The pitches that get sharp rebuke are:

1. Tokens shouldn't be regulated; and

2. You should buy my token.

It is unfortunate that the bulk of statements regarding cryptocurrencies are 1 (as is this article) or 2.

There is a strong scammy undercurrent to cryptocurrencies which simply didn't exist for many other technologies at comparable stages in their development. (There was vaporware, and there were scams. But the latter wasn't nearly as prevalent.)

[ghthor]

I want to talk to the keyloss and key securing problem. This should be a fairly straightforward service that is backed heavily by well trusted institutions. Perhaps banks or technology companies can fill this role, but as a non technical user I can use this type of service to secure my recovery keys until I need them.

The most important part is that I MAY use this type of service, I'm not required too. The current state of ID I'm required to use a service to protect my "private keys".

[guiomie]

"is turning this equation on its head and encrypting and distributing globally all the data".

I've got some interesting ideas similar I want to explore, but quite hesitant its realistic, aren't you scared that encrypting data isn't enough? If you store medical records on IPFS, isn't there nothing stopping someone from copying this data locally, and in 50, 80 or 100 years, couldn't this person break the encryption with latest techniques?

[marcus_holmes]

yeah. Outside America, where the rest of us have worked out that healthcare isn't a profit thing and that it should be provided by the state, this isn't a problem that needs solving.

Your "global" solution. Isn't.

[icebraining]

My grandmother used to spend the Winter in a country and the rest of the time in another. Health data portability was absolutely an issue.

[marcus_holmes]

I get that. But there are several formats for health data records. As someone else said, the issues with these systems are political not technical.

And in most socialised healthcare systems you can obtain your medical records in a format that other healthcare systems can read.

[snarf21]

You're not wrong but which will be easier in the US: solving the political problem with a technical solution or the technical problem with a political solution?

Until one wins, why is it a problem to try to solve the problem one way but not the other?

[JetSpiegel]

By definition, you can't solve a political problem with technical means.