By Pete Harris, Co-Founder and Executive Director, DecentraTech Collective

Many in the blockchain and MedTech world have fond memories of this day a year ago, when the Blockchain and Digital Transformation in Health 2020 symposium was held in Austin, TX. One of the conversations among the 100+ participants that gathered that day was the breaking news that the first cases of coronavirus had been detected in the U.S. A question that many had was what the impact here would be. Tragically, we now have at least a partial answer to that one.
 
The symposium – a unique collaboration between the Austin Blockchain Collective and Dell Medical School – featured keynotes from UCSD Health and IBM and combined presentations and panels from commercial innovators and academia. As such, it acted as a catalyst for a number of important conversations and partnerships that have continued since.

In particular, the symposium addressed several key themes that have risen in visibility and importance over the past year. Notable topics included:

• The need for individual privacy of health information and how blockchain and DecentraTech, including self-sovereign identity, will be important for implementation. This has been borne out by SSI being a central design component of many COVID-19 health passport and contact tracing apps.
  
  
• The applications of blockchain and SSI to allow secure access to patient information systems, as exemplified by UT/Dell Med’s MediLinker system, which builds upon Hyperledger’s Indy and Aries components.
  
  
• The concept that healthcare is a data business, and the monetization of personal healthcare information. This led to a discussion of the emergence of Web 3.0 approaches to allow individuals to benefit when their information is used for commercial endeavors, such as pharmaceutical development.

 
While hosting a follow up in-person symposium in 2021 is unlikely to happen due to the ongoing pandemic, we at the DecentraTech Collective continue to maintain a focus on the decentralization of healthcare and look forward to running online webinars and video conversations and will continue to engage with the medical and healthcare community. See you in person in 2022!

​By Pete Harris, Co-Founder and Executive Director, DecentraTech Collective

​DecentraTech is the short notation for decentralization technology. The business world already commonly uses terms like FinTech to mean financial technology, or MedTech for medical technology, or MarTech for marketing technology. Thus, adopting DecentraTech to refer to a collection of technologies that allows decentralization to be adopted by businesses is both consistent and long overdue.
 
To step back for a moment to consult the Miriam-Webster dictionary, decentralization is “the process by which the activities of an organization, particularly those regarding planning and decision making, are distributed or delegated away from a central, authoritative location or group.”
 
The concept of decentralization as an organizational approach is not at all new, having originated in France 200 years ago. Technological decentralization – which in current times is a requirement of most manifestations of decentralization – became a possibility with the creation of the internet, conceived as an open network that anyone can access, based on common standards and with no central governance.
 
Ironically, it is now increasingly accepted that the most popular commercial services delivered via the internet, especially the world wide web, are products of centralized corporations. And many consider that some of those players – including “Big Tech” companies such as Google, Facebook and Twitter – now wield too much control over service provision and personal data ownership for the public good.

One of the many with concerns about the power that Big Tech has amassed is Tim Berners-Lee, who created the web in 1990. He is now working on Solid, an open-source effort to reinvent the web so as to allow individuals to control their personal data. More broadly, Web 3.0, a term coined by Ethereum co-founder Gavin Wood, who went on to form the Web3 Foundation, is focused on creating “a decentralized and fair internet where users control their own data, identity and destiny.”

As a result of the recent actions of a few high profile companies – including Twitter cancelling the account of the then-sitting POTUS, and online financial app Robinhood suspending retail investor trading in certain wildly popular stocks – calls for the establishment of decentralized services that are censorship-resistant have grown loud.
 
As it happens, Twitter – or at least its CEO Jack Dorsey – has been pondering the responsibilities that come with operating a forum for open discourse in an era where some use it to spread misinformation and hate speech that can have public safety consequences. Following Twitter’s recent decision to suspend and remove a number of accounts, Dorsey wrote (on Twitter) that “I feel a ban is a failure of ours ultimately to promote healthy conversation.”

In the future, Twitter might be able to sidestep similar actions by becoming a decentralized service where (presumably) moderation processes would be under the jurisdiction of the crowd. At the end of 2019, it kicked off the bluesky project, which Dorsey characterizes as “an initiative around an open decentralized standard for social media. Our goal is to be a client of that standard for the public conversation layer of the internet.” A few weeks ago, ​​the project released a research paper covering a number of  existing decentralized social media ecosystems and noted that it is eager to hear about other projects. “Our DMs are open!”

​Hyperledger, the Linux Foundation’s blockchain initiative, just celebrated its fifth birthday. Initially known as the Hyperledger Project, it originally focused on a single enterprise blockchain development – a private/permissioned platform dubbed Fabric. Its early members were a couple of dozen major corporates, with IBM as a key champion, influencer and code contributor.
 
Five years on, Hyperledger has grown substantially. It now has more than 200 members big and small and comprises 16 core projects, including competing ledgers, development tools, identity frameworks, etc. Until recently, however, its focus remained on the private blockchain space. That changed in 2019 with the announcement of Hyperledger Besu, an Ethereum client built by ConsenSys, which supports both private and public chains. 
 
According to Hyperledger’s annual report for that year, “Besu represents the growing interest of enterprises to build both permissioned and public network use cases for their applications.” Another report in 2019 – commissioned by consultants EY and analyst firm Forrester Research – found that some 75% of enterprises were interested in exploring public blockchains. 
 
As those enterprises embark on their public blockchain research, they will find more than a few variants to choose from. Ethereum is by far the most established, and with its ETH 2.0 scalability upgrade now begun, it will surely remain the leader for some time to come. But many other public chains are now launched and being developed, including the Web3 Foundation’s Polkadot, Cosmos, Cardano, DigiByte, Decred, EOS, NEAR, Solana, NEM’s Symbol, VeChain, etc.
 
With so much innovation focused on (and investment in) the public blockchain space, and relatively little on private variants, bets against enterprise adoption of public chains would attract very long odds indeed.
 
Scalability aside, perhaps the most common criticism of public chains is that they are not relevant for – indeed not usable by – enterprises that need to keep their vast data assets private for competitive or regulatory reasons. It’s a valid POV, but this year the Baseline Protocol has emerged to counter it. Baseline is going to be very useful for businesses. And it’s going to be huge.

​I’ve known for a long time that healthcare relies on data in order to operate (no pun intended) effectively, safely and efficiently. It’s also been apparent that current processes to capture and share data are pretty much broken — one example that most patients can relate to are badly designed paper forms, usually partially completed with bad handwriting, and then faxed between providers. Some of it might end up being manually entered into an EHR system, mistakes and all, which of course can’t communicate digitally with similar systems at other providers.
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​All that paper, manual processing and silo-ed databases will need to change, and not just to make healthcare delivery more efficient and less costly for payers and providers, and to offer better outcomes for patients. Here’s why …