Because the security underpinning blockchain is either "spend a bunch of expensive electricity and get extra tokens" (proof of work) or "lock up some tokens for a chance to get more" (proof of stake)
These tokens have to be worth something in order for the security to functionally exist. You can't separate the monetary side from the security, because the monetary side incentives the security. And security is the only thing blockchain adds.
I don't completely agree with that. Yes the network must be secured that way, and the native token must be worth real money, but that's not something applications built on top necessarily need to worry about or interface with. You can build applications that do not use the native token (outside of transaction fees) and that doesn't affect the app's security.
I do not want my health record to be both public and immutable.
Not wanting it to be public should be obvious. Immutable though, what if I need to change my name/gender to match reality?
It's not enough to just update the value, because the old value still exists on the blockchain. That's just another method to find my deadname and use it for harassment.
So I am not an expert in blockchain or web3, I've only completed a few courses implementing a blockchain in golang and I work in the digital health industry.
But the points you raise, are exactly the issues I've been thinking could be solved with web3. I am imagining using it to give control to the patient of who has read access(to what and when), who can add data, etc.
I.e. give full transparency and control to the patient. Instead of the current situation where a patients data is on different systems, you don't know what it actually says, besides what a doctor tells you.
I can try, but to be totally clear this is only an idea that I have in my head, and is far from fully formed.
But as far as I understand, it should be possible for a user on a blockchain, to have their set of data encrypted in the ledger. It should also be possible to implement a sort of permission scheme.
So I am imagining, instead of relying on things like Epic Systems and other EHR systems, that control your data and might have incentives to not share them with other systems. One could imagine a EHR system based on a blockchain. The patient can then grant permission to, say a hospital, to read certain data from the ledger. This could be scoped to what is necessary in the context of their visit or procedure.
After the visit to the hospital, the patient has full transparency to read what data has been added to their own records.
Anyway, I am not capable to give a full technical solution, since I have not thought it fully through, and not nearly knowledgable enough to actually know. So I might be very wrong in my assumptions, and would gladly be told otherwise if that is the case.
Then there's the whole issues of how do you get existing systems as Epic to integrate with said "blockchain EHR".
The question is not just how do you get existing systems to integrate, it's how do you ensure that everyone uses the same blockchain? Technological solutions don't magically force anyone to agree on things and interoperate.
I think that's the killer feature personally (I work in the space). It has uses for censorship resistant communication and things like identity. Not sure if I see the use case in health data though.
AFAIK all transactions on a blockchain require spending some associated currency (e.g. "gas fees"). For investors, I think the killer feature is being able to make money off of every transaction involving identity and health data.
Yes, the gas fees would be very expensive in the current state (think hundreds to thousands of dollars for a regular appointment, tens of thousands for an x-ray). There would have to be some benefit for healthcare providers to pay that and I don't see what that is..
Maybe not the healthcare provider, but a service that allows the patient to be in control of their health records. Control who can read and write to their own data.
And is it not up to the implementor of the blockchain, to specify how difficult it is to calculate a new block? So lowering the "gas price"?
I think a system like that is a great idea, I'm just not sure how a blockchain helps. The things that make a blockchain interesting (uncensorable, immutable etc) aren't that important here, and with a public blockchain you still need a whole separate system that's doing access checking (maybe your doctor has a key that decrypts the onchain data). To me that system of sharing data with providers, and giving them credentials to access the data is the difficult part, and blockchain doesn't help.
Well, I do think that that is exactly things that are important.
You'd want uncensorable, to give transparency to the patient. E.g. a hospital can't add a record without you knowing, that you might not want an insurance company to have access to later.
Immutable, as a patient you would want to know exactly what your data looks like at any given time. Again insurance is a good example.
If the blockchain is private, could it not be part of the implementation that does the access checking? Can't part of the ledger be unencrypted while other parts are not?
It might be wishful thinking. It's just an idea I have floating in my head, as an actually useful real world implementation for a blockchain.
