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Medical records on the blockchain – the history of a bad idea

davidgerard.co.uk

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Re: Medical records on the blockchain – the history of a bad idea

#131

Post by tuesdayrain »

davidgerard wrote: post #125
smt88 wrote: post #83

Earlier quoted context omitted.

I put "true" in quotes because there are so many competing definitions for blockchain. I agree with other commenters that there is an original definition, but people rarely talk about blockchain these days without having the Bitcoin model in mind.

I had a good old rant about that previously: https://davidgerard.co.uk/blockchain/2018/06/28/ibm-the-gdpr... You might come up with a reasonable definition, like "append-only ledger with a consensus mechanism" - but in marketing terms, "blockchain" literally only means "whatever I'm trying to sell you today." And then there's weasel terms like "blockchain technology", which means "I can't even claim this thing is act…

I don't think it's fair or relevant to talk about hypothetical marketing definitions of a blockchain here. You wouldn't be discussing the merits of a linked list by mentioning the creative descriptions marketers can come up for it.

Re: Medical records on the blockchain – the history of a bad idea

#132

Post by DebtDeflation »

smt88 wrote: post #43
tracker1 wrote: post #36

I cringe every single time someone suggests blockchain in our space. Either it's easier with other tech (even public/private key tech doesn't require blockchain), or open to potential leaks/abuse in the future (tracking how everyone voted). There are a lot of use cases, most even, where it's not a great fit, and there are other, better, approaches. Disclosure, I work for an election services company...

I've discovered that some people say "blockchain" when they mean "immutable, distributed, cryptographically-verified database" -- which is actually a useful thing for many people. The Byzantine fault tolerance, public consensus, and mining aspects that we associate with "true" blockchains are the parts that people can't find a way to justify and can typically be ignored.

>"immutable, distributed, cryptographically-verified database"

>Byzantine fault tolerance, public consensus, and mining

Why would I want ANY of these things associated with the system that manages my medical records?

I don't want them to be immutable, if there's an error I want it corrected. Clearly there should be security to control who (my provider) can update them, and perhaps turn on the database transaction log to track what updates were made by whom and when.

I don't want my medical records to be distributed for obvious reasons.

Encrypted, sure, but "cryptologically verified" seems to be overkill as there's little incentive for third parties to try and forge medical records.

Byzantine fault tolerance? Lol. My medical records get updated maybe once per year, by my provider, and no one has an incentive to insert false data.

Public consensus? See above.

Mining? Come on.

99.9% of the time when someone says we should use blockchain, they really just need a database, this is one of those cases.

Re: Medical records on the blockchain – the history of a bad idea

#133

Post by dikei »

DebtDeflation wrote: post #132
smt88 wrote: post #43

Earlier quoted context omitted.

I've discovered that some people say "blockchain" when they mean "immutable, distributed, cryptographically-verified database" -- which is actually a useful thing for many people. The Byzantine fault tolerance, public consensus, and mining aspects that we associate with "true" blockchains are the parts that people can't find a way to justify and can typically be ignored.

>"immutable, distributed, cryptographically-verified database" >Byzantine fault tolerance, public consensus, and mining Why would I want ANY of these things associated with the system that manages my medical records? I don't want them to be immutable, if there's an error I want it corrected. Clearly there should be security to control who (my provider) can update them, and perhaps turn on the database transaction log…

>> I don't want them to be immutable, if there's an error I want it corrected.

Immutable here means no in-place update, you have to update using an "errata" record. This is the requirement for many type of official documents, even before computers were used.

>> I don't want my medical records to be distributed for obvious reasons.

Distributed here means no single point of failure.

>> Encrypted, sure, but "cryptographically-verified" seems to be overkill as there's little incentive for third parties to try and forge medical records.

Encryption without authentication opens up many types of attack. You almost always want authenticated encryption

Re: Medical records on the blockchain – the history of a bad idea

#134

Post by magnamerc »

drcode wrote: post #77
fishB wrote: post #71

Earlier quoted context omitted.

Because they offer consensus among multiple organizations. Also is good for supply chain tracking. But I understand why people avoid the blockchain space altogether. There was so many bad projects that were not suitable for the tech when all the hype was going on. Not to mention all the cryptocurrency scams. Fortunately a lot of the private blockchain tech has nothing to do with cryptocurrencies.

Yeah I used to think this too at one point, but it's much easier to just have multiple companies share a database- the idea that a consortium chain is somehow better than this hasn't born out empirically so far, in my opinion. Things are different with true public blockchains, they really do have some novel use cases.

Case in point is Nightfall by Ernst and Young.

Re: Medical records on the blockchain – the history of a bad idea

#135

Post by _fizz_buzz_ »

encloser wrote: post #39
tracker1 wrote: post #36

I cringe every single time someone suggests blockchain in our space. Either it's easier with other tech (even public/private key tech doesn't require blockchain), or open to potential leaks/abuse in the future (tracking how everyone voted). There are a lot of use cases, most even, where it's not a great fit, and there are other, better, approaches. Disclosure, I work for an election services company...

I like to provide people the NIST Blockchain Overview pdf. Particularly the decision flowchart. https://nvlpubs.nist.gov/nistpubs/ir/2018/NIST.IR.8202.pdf

I prefer this decision flowchart ;) https://twitter.com/MalwareTechBlog/status/93264913325659750...

Re: Medical records on the blockchain – the history of a bad idea

#136

Post by davidgerard »

tuesdayrain wrote: post #131
davidgerard wrote: post #125

Earlier quoted context omitted.

I had a good old rant about that previously: https://davidgerard.co.uk/blockchain/2018/06/28/ibm-the-gdpr... You might come up with a reasonable definition, like "append-only ledger with a consensus mechanism" - but in marketing terms, "blockchain" literally only means "whatever I'm trying to sell you today." And then there's weasel terms like "blockchain technology", which means "I can't even claim this thing is act…

I don't think it's fair or relevant to talk about hypothetical marketing definitions of a blockchain here. You wouldn't be discussing the merits of a linked list by mentioning the creative descriptions marketers can come up for it.

I think it's entirely fair to discuss the marketing of a linked list when they keep calling it "blockchain" and assigning nigh-magical properties to it, which is what is happening here.

Re: Medical records on the blockchain – the history of a bad idea

#137

Post by acdha »

AmericanChopper wrote: post #121
ramraj07 wrote: post #114

Earlier quoted context omitted.

How is this different from git?

What makes git different from a blockchain? A blockchain is a data structure, and a data structure doesn’t change based on who has permission to write to it.

Those terms don’t have the meanings you’re using. Being a data structure is not a distinguishing factor – try finding a common definition which excludes Git – and there’s no definition of the term which excludes modifications.

Re: Medical records on the blockchain – the history of a bad idea

#138

Post by GoblinSlayer »

DebtDeflation wrote: post #132
smt88 wrote: post #43

Earlier quoted context omitted.

I've discovered that some people say "blockchain" when they mean "immutable, distributed, cryptographically-verified database" -- which is actually a useful thing for many people. The Byzantine fault tolerance, public consensus, and mining aspects that we associate with "true" blockchains are the parts that people can't find a way to justify and can typically be ignored.

>"immutable, distributed, cryptographically-verified database" >Byzantine fault tolerance, public consensus, and mining Why would I want ANY of these things associated with the system that manages my medical records? I don't want them to be immutable, if there's an error I want it corrected. Clearly there should be security to control who (my provider) can update them, and perhaps turn on the database transaction log…

If something goes wrong, you don't want tampered data, hence immutability.

Re: Medical records on the blockchain – the history of a bad idea

#139

Post by dreamcompiler »

Uptrenda wrote: post #15

I feel its become very fashionable to dismiss the simpler applications of the tech because of how unrealistically its been applied. It's so easy to do too. Look at the insane valuations, the fraud, and hype cooked up by marketers, and the whole thing looks very stupid. But its a mistake to let this get in the way of critical thinking. There is a reason why the topic is brought up so often and its because among all th…

Maybe if the transaction rate can be increased by a few orders of magnitude.

The biggest problem is that decentralized systems tend over time toward recentralization. That pressure will not go away, and it can only be fought against if there is no friction in the decentralized system.

Re: Medical records on the blockchain – the history of a bad idea

#140

Post by bunderbunder »

smt88 wrote: post #43
tracker1 wrote: post #36

I cringe every single time someone suggests blockchain in our space. Either it's easier with other tech (even public/private key tech doesn't require blockchain), or open to potential leaks/abuse in the future (tracking how everyone voted). There are a lot of use cases, most even, where it's not a great fit, and there are other, better, approaches. Disclosure, I work for an election services company...

I've discovered that some people say "blockchain" when they mean "immutable, distributed, cryptographically-verified database" -- which is actually a useful thing for many people. The Byzantine fault tolerance, public consensus, and mining aspects that we associate with "true" blockchains are the parts that people can't find a way to justify and can typically be ignored.

To kinda-sorta paraphrase myself from last week[1], I suspect that when people say "blockchain", what they typically mean is that they think implementation details are the most important thing, and what the product actually does is just an afterthought.

[1]: https://news.ycombinator.com/item?id=19699807

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