Blockchain, Digital Identity, and Health Records: Considerations for Vulnerable Populations in California
In the early 2000s, blockchain took the private sector by storm. In addition to gaining notoriety for its applications in cryptocurrency, the technology was touted as a solution to dozens of organizational problems, from supply chain tracking to identity management. Although commercial applications of blockchain continue to show promise and are being pursued by startups and established companies alike, applications in the public sector have attracted far less attention. A few pilot projects in the United States and abroad have used blockchain platforms for voting, paying taxes and fines, and tracking educational credentials. But in order to build on promising cases in the public interest, further research is needed to guarantee secure digital identity systems, especially for programs that serve vulnerable populations like the unhoused.
In a research project conducted over the past nine months, my co-author Maitreyi Sistla and I asked: What opportunities might blockchain-based digital ID and health records management systems offer to improve services for housing-insecure and homeless populations in California? And what risks unique to this cohort should be considered before launching such programs?
Through a combination of expert interviews, surveys with state chief information officers, and findings from a year-long process with the State of California’s Blockchain Working Group, we find that blockchain-based identity and health records management systems may indeed offer advantages for unhoused populations in California. These technologies could streamline applications for public benefits, improve the management of medical records and facilitate sharing of medical data among healthcare organizations.
At the same time, challenges must be overcome for vulnerable populations to share in the benefits of blockchain-based identity and health records management solutions. First, reliable means of authenticating users may be problematic; the same circumstances that make it difficult for homeless individuals to retain their physical IDs will also hinder them to retain a smartcard or password, and evidence indicates that these individuals would be reluctant to use biometric data to access digital identity systems. In addition, it is unclear whether state or county governments will be willing to move to blockchain-based health records management systems given the millions of dollars that have already been spent to solve the current fragmented state of access to such records. Finally, concerns regarding long-term security of sensitive data must be addressed.
Overall, blockchain holds potential to improve public service provision for homeless residents in California and other states. However, issues with user authentication, cost, and trust must be addressed for these benefits to be realized. For more information on our project, please see Blockchain, Digital Identity, and Health Records: Considerations for Vulnerable Populations in California.