by Peter B. Nichol

The permanent web for healthcare with IPFS and blockchain

Feb 24, 2017
Health and Fitness SoftwareHealthcare IndustryInnovation

The internet of data structures (IoDS) has arrived for healthcare. IPFS combined with blockchain creates a new layer of the internet. Is your business exploring it?

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How do you determine if your organization is designing innovating experiences? There is a simple question that provides that answer. Ask yourself, “Is the organization talking about IPFS?” If the answer is yes, you’re 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.

The relationships between IPFS and blockchain

The 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.

IPFS, 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.

IPFS is “the permanent web.” 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:

  1. Deduplication: addressing data by hashes, providing integrity, distributed persistence (e.g. removing duplication medical records).
  2. Self-distribution: removal of dependencies to content distributors (e.g. the payers and providers in healthcare).
  3. Peer-to-peer transfers: proximal users can share content between each other, reducing bandwidth requirements (e.g. two local hospitals can share information, not required to go through centralized servers).
  4. Archiving: 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).
  5. Directory browsing: faster browsing of data (e.g. quicker searching through medical notes for themes or clinical trends that could impact outcomes).

Blockchain removes — or disintermediates — the middleman from business transactions and by doing so improves the value of existing products, services and interaction. Blockchains provides five main benefits:

  1. Disintermediation: removes the middleman or “go-between” from transactions (e.g. removing healthcare players that are not adding value).
  2. Empowered consumers: consumers own their data (for example, patients control who can view and access their medical information).
  3. Data integrity: a distributed, 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).
  4. Preventing double spending: stopping duplicate expenditures of assets (thus curbing the ability to send conflicting medical records).
  5. Establishing consensus: network of computers that agree on the state of transactions (providing a single source of truth of your medical history).

Blocks are a record of transactions and chains are a series of connected transactions, thus the word blockchain.

Blockchains 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.

A 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.

Chain tagging

Storing 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’ve yet to meet an individual who doesn’t have a clear preference leaning one way or the other on this issue.

Several 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 “proof” 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 “blockchain bloat.” 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.

“Chain tagging,” or “What’s the chain tag?” will soon be as popular as the common phrase “What’s the website link?”

Defining 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 on-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.

Interestingly 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 — and never have a broken link — 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.

Healthcare leaders should be asking questions about IPFS

We have all been there. We’re sitting in a meeting, and we hear it this sentence for the first time: “This technology will transform how we do business, and our interactions with customers and business partners.” Everyone who has been in technology for more than a year has watched this show. Usually, it’s a short production that never makes it to Broadway.

But then there were those few times when we didn’t believe and that fledgling technology was, in fact, transformative. Which side of the table are you going to sit on? The pessimistic side of “we’ll wait until it proves itself” or the optimistic side of “let’s experiment, explore, and validate the potential.” You need to decide for yourself, your team and your organization.

My 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. A layer where data can be accessed across value-based ecosystems, with industry agnosticity:

  1. Government agencies to government agencies
  2. Companies to companies
  3. Towns to towns
  4. Cities to cities
  5. States to states
  6. Countries to countries

Government agencies, companies, towns, cities, states and countries could all share data, information, knowledge and ultimately wisdom. IPFS presents the “web of value.”

The problem with healthcare isn’t that we don’t 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 — people who don’t believe, deep down, that transformation is possible.

Let’s 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 — believe for someone you love.