MIT Sloan Management Review: When last we spoke, you noted it was important for managers to be able to predict the future as far as technology goes, because if you don’t see what’s coming down the line, it’s hard to prepare for it. Since then, you have gotten more interested in blockchain. Could you tell me a little bit about when and how you became interested in it? What kind of impact will it have on health care?
Dr. John Halamka: It’s very common that I talk to people about blockchain because they think I’m a sort of evangelist or zealot for the technology. I’m neither. With any Gartner-hype cycle in technology, you have to evaluate it and figure out how you get from the era of inflated expectations through the trough of disillusionment to the plateau of productivity.
I ask this question, given the work that I have done in the Bush and Obama administrations by their operability: Are there specific use cases where blockchain would solve a problem that isn’t solved by relational technologies or Hadoop or some other traditional data approach? I see three use cases. I’ll talk you through them and why they probably do require blockchain.
Sometimes Harvard professors are sued for malpractice. But, what happens? A plaintiff attorney comes to me as the CIO of the empire and says, “I need you to pull all the medical records for this patient, going back 17 years.” And I do. And they say, “These are fake. They were altered.” Well, I can pull all the audit trails that show the records have data integrity, and they’ll say, “The audit trails are fake, too.”
We actually spend vast amounts of cycled and malpractice assertions trying to guarantee the integrity of the data we’re presenting in a case. Imagine that in our public ledger we don’t write data, but we hash every note that a doctor writes after it’s signed.
Seventeen years have gone by. Here’s the hash of today’s note. Here’s the hash that was in the blockchain. They match, and there’s no way the data can be altered. Data integrity preservation is an interesting use case for blockchain that a relational data store cannot meet.
You may find the second use case a little bit bizarre.