How do you determine if your organization is designing innovating experiences? There is a simple question that provides that answer. Ask yourself, \u201cIs the organization talking about IPFS?\u201d If the answer is yes, you\u2019re likely relevant to the healthcare innovation discussion. If, however, the answer is no, your organization has missed the innovation bus. IPFS, a foundational technology, will transform healthcare by 2020.\nThe relationships between IPFS and blockchain\nThe joining of IPFS and blockchain technologies is a natural partnership. Together the outcome is a powerful distributed permanent digital ledger that is accessible across heterogeneous systems.\nIPFS, InterPlanetary File System, is a peer-to-peer distributed system that connects networks using the same system of files forming a generalized Merkle-DAG. The DAG structure is a system of connected objects, connected usually by their hash.\nIPFS is \u201cthe permanent web.\u201d It accomplishes this feat through a combination of distributed peer-to-peer file system storage and Merkle data structures that enable versioned file systems to communicate. Peers (or nodes) do not need to trust each other. IPFS provides five main benefits:\n\nDeduplication: addressing data by hashes, providing integrity, distributed persistence (e.g. removing duplication medical records).\nSelf-distribution: removal of dependencies to content distributors (e.g. the payers and providers in healthcare).\nPeer-to-peer transfers: proximal users\u00a0can share content between each other, reducing bandwidth requirements (e.g. two local hospitals can share information, not required to go through centralized servers).\nArchiving: immutable data storage and offline data access, similar to Git, that is helpful in low-connectivity environments with weak infrastructures (helpful for immediate local access to medical histories, for example).\nDirectory browsing: faster browsing of data (e.g. quicker searching through medical notes for themes or clinical trends that could impact outcomes).\n\nBlockchain removes \u2014 or disintermediates \u2014 the middleman from business transactions and by doing so improves the value of existing products, services and interaction. Blockchains provides five main benefits:\n\nDisintermediation: removes the middleman or "go-between" from transactions (e.g. removing healthcare players that are not adding value).\nEmpowered consumers: consumers own their data (for example, patients control who can view and access their medical information).\nData integrity: a\u00a0distributed, public (for authorized miners), time-stamped, and persistent list of transactions (every update to medical records is carved in stone; you could add stones but not remove them).\nPreventing double spending: stopping duplicate expenditures of assets (thus curbing the ability to send conflicting medical records).\nEstablishing consensus: network of computers that agree on the state of transactions (providing a single source of truth of your medical history).\n\nBlocks are a record of transactions and chains are a series of connected transactions, thus the word blockchain.\nBlockchains already have a DAG structure inherent in the protocol, which links historical blocks to hash values. One challenge of generic blockchains is the duplication of data supported by blockchain structures. IPFS solves this problem.\nA blockchain-state database is a writable stream for applications that consume blocks. This blockchain-state is used to process, in order, blockchain blocks (e.g. for searching the blockchain or a medical wallet). With a traditional blockchain, every transaction needs to be stored. However, using IPFS foundational blockchain only the state entries (or changes between two blocks) need to be stored. The result is a performance gain from deduplication, a simplification of block accessibility, and the formation of a simplified and easier to maintain data structure.\nChain tagging\nStoring information on-chain or off-chain is a frequent debate. The root of this debate centers around whether all data should be stored on-chain or if only the hashes should be stored on-chain. I\u2019ve yet to meet an individual who doesn\u2019t have a clear preference leaning one way or the other on this issue.\nSeveral blockchains like Ethereum require miners to pay a fee for blockchain storage. This fee is charged to miners (peers or nodes) that want to commit transactions to the consensus-driven and peer-to-peer distributed ledger. Changing the associated state database required \u201cproof\u201d which has a cost. This cost is charged back to the miner. The reason for this fee is to limit miners storing non-value-add data or creating \u201cblockchain bloat.\u201d To prevent blockchain bloat, large blockchain implementations often choose to store only the hashes on-chain, not the data. This action reduces fees associated with storing data for the associated database-state.\n\u201cChain tagging,\u201d or \u201cWhat\u2019s the chain tag?\u201d will soon be as popular as the common phrase \u201cWhat\u2019s the website link?\u201d\nDefining the on-chain or off-chain state for data is critical. IPFS (used as a blockchain-state database) would need to tag each piece of data with either an\u00a0on-chain or off-chain tag. In this deceptively simple approach, data would be managed off-chain and changes would not require miner intervention. Data would also be permanently addressable.\nInterestingly IPFS offers a solution for a permanent version-controlled file system for data storage. Imagine that the data you have could be linked securely to any other database, system or platform in the world \u2014 and never have a broken link \u2014 on a global healthcare blockchain. This is the future of healthcare, a connected web of ecosystems where any data, anywhere, at any time could be linked.\nHealthcare leaders should be asking questions about IPFS\nWe have all been there. We\u2019re sitting in a meeting, and we hear it this sentence for the first time: \u201cThis technology will transform how we do business, and our interactions with customers and business partners.\u201d Everyone who has been in technology for more than a year has watched this show. Usually, it\u2019s a short production that never makes it to Broadway.\nBut then there were those few times when we didn\u2019t believe and that fledgling technology was, in fact, transformative. Which side of the table are you going to sit on? The pessimistic side of \u201cwe\u2019ll wait until it proves itself\u201d or the optimistic side of \u201clet's experiment, explore, and validate the potential.\u201d You need to decide for yourself, your team and your organization.\nMy recent proposal paper, "An e-Government Interoperability Framework to Reduce Waste, Fraud, and Abuse" tackles how to solve interoperability for citizens, businesses and governments. IPFS and blockchain provide a stablized foundation for interoperability. IPFS has the potential to create a new layer of the internet.\u00a0A layer where data can be accessed across value-based ecosystems, with industry agnosticity:\n\nGovernment agencies to government agencies\nCompanies to companies\nTowns to towns\nCities to cities\nStates to states\nCountries to countries\n\nGovernment agencies, companies, towns, cities, states and countries could all share data, information, knowledge and ultimately wisdom. IPFS presents the "web of value."\nThe problem with healthcare isn\u2019t that we don\u2019t have enough technology. It is also not an issue of broken processes (of which we have many). The single greatest problem in healthcare are the nonbelievers \u2014 people who don\u2019t believe, deep down, that transformation is possible.\nLet\u2019s create a new revolution together, a revolution of believers (#DrmeRevolution). Healthcare can change. It just requires more believers. If you don't believe for yourself that change in healthcare is possible \u2014 believe for someone you love.