The concept of identity cannot be taken for granted in an increasingly digital world. Our digital identities, more than our real identities, are complex, sprawling, changeable, inconsistent, and vulnerable to attack.
Defining what exactly constitutes a digital identity – and who owns that data – is critical to our ability to use digital information to exchange money and information. Individuals should also be aware that this data is valuable and that privacy and autonomy are frequently eroded to capitalize on its value.
Emergency physicians often worry about a parallel process occurring within our specialty: an erosion of autonomy (and privacy) due to an increasingly complex professional structure overseen by corporations paid to navigate business complexities on our behalf.
This parallel is even closer than it first appears: the disparate systems (educational bodies, employers, hospitals, accrediting bodies, insurance companies, etc.) that make up our professional identities are all as extensive, changing, inconsistent and vulnerable to attack as our online accounts. Our lack of autonomy over our professional identities makes us vulnerable to professional exploitation.
I discussed this issue with Leah Houston, MD, founder of Humanitarian Physicians Empowerment Community (HPEC), a company that aims to protect a physician’s professional identity using blockchain technology.
“HPEC uses decentralized identity to make the individual the owner and single point of control of their credentials and identity,” she said. “You paid for your medical school, your degrees and your medical license. All of those credentials actually belong to you, but since there was never a way to authenticate your ownership, doctors had to use third-party systems for verification. HPEC is an automated primary source verification tool. »
The solution proposed by HPEC is already used to respond to other issues around digital identity; this is called decentralized identity (DID) based on distributed ledger technologies such as blockchain.
“Blockchain” is a buzzword that conjures up images of bubble markets, fraud, and bitcoin bros, but it’s really best viewed by a non-technical person as a trusted record-keeping system. Each time a user adds new information to the record (recording events in the system as transactions or additions), this new record is permanently linked to the old record. Each user can track and verify each of these transactions as they occur; the security comes from the fact that there is no single “owner” of the transaction record, which is why it is called decentralized. DID solutions are already being explored by several large companies, including IBM and Microsoft.
“Blockchain creates a truth machine because you cannot remove or erase any of the blocks on the chain,” Dr. Houston said. “Once we graduate from medical school, it should be permanently documented and not controlled by any entity that could delete or erase it. We’re sure your degree was issued on the blockchain, so when you want to show off your degree, it comes with a provenance log that points to a place on the chain that proves the title is genuine.
Participants in DID solutions receive an encrypted digital wallet that contains their credentials. Verified information (like a degree) can be placed by another verified user (like a medical school) in the wallet, and this information, controlled by the user, can then be shared to communicate and verify credentials immediately and safely.
“The average cost of accrediting a doctor is about $1,500 a year,” Dr. Houston said. “Rather than third-party systems making big bucks selling our data, we’re providing a mechanism for you, as a physician, to truly own your data.”
HPEC’s goal is to provide a more streamlined and secure tool for traditional accreditation services at a significantly reduced cost. It costs nothing to join or use its services, Dr. Houston said, and the app is also free to download and use. The company may add services in the future that doctors can purchase, but the current version will still be free, she said.
free the doctors
“We want to create a network that allows us to collaborate toward common goals when it comes to advocacy, legislative issues, or things that affect our practices right now,” she said. “Our medical societies are in conflict; they let us down. HPEC enables physicians to find themselves and be found. With the proper architecture, we can design consensus mechanisms to discuss issues, delegate, and vote on major issues. »
It’s clear from my discussion with Dr. Houston that HPEC’s ambitious goal is to liberate physicians. Allowing us to own the credentialing process allows us to move more easily to other states and medical practices, potentially increasing our own influence. Having a safe way to associate freely allows us to form ad hoc unions, advocate on important issues, and compete collectively in other ways. Extrapolated even further, decentralized health data could revolutionize what it means to be a patient seeking medical care.
I must say that I pursued this interview with a great deal of skepticism, a characteristic often advantageous in emergency medicine. We are prone to distrust things we do not understand; blockchain is a concept that emergency physicians will likely encounter as novices rather than with our typical expertise. This startup, while trying to apply new technology to the notoriously rigid medical industry, is also navigating the difficult business of just being a startup. A skeptical mindset is a valid starting point; new and conceptually difficult technology pushed by a startup carries real risks.
Even so, it would be foolish to dismiss ideas because they are new or use technological advances. Every good idea was new at some point; this one has significant potential and certainly deserves open consideration.
Dr. Belangeris secretary of the Locum Tenens chapter of the American College of Emergency Physicians and an emergency physician in McKinney, TX. Read his past articles onhttp://bit.ly/EMN-numbERs.