The Potential of Blockchain in Education and Health Care

In our nursing program, we require a transcript for every course taken at any university or college, and it is always frustrating when we have to wait for copies to arrive before making our decisions. To be honest, if a candidate took Religion 101 at a community college and later transferred to the BSN program, I would be willing to pass on the community college transcript, but the admissions office is less flexible. And, although we used to be able to ask the student to have another copy sent if we did not have a transcript in the file, we now must wait for the student to have the college upload the transcript into an admissions system and wait for verification. I can assure you, most nurses, like other students today, take a lot of courses across many colleges without getting a degree. I sometimes have as many as 10 transcripts to review. When I saw an article titled “Blockchain: Letting Students Own Their Credentials” (Schaffnauser, 2017), I was therefore intrigued. I had already heard of blockchain as a tool to take the middleman out of the loop when doing financial transactions with Bitcoin. Now the thought of students owning their own credentials got me thinking about the movement toward new forms of credentialing from professional organizations (e.g., badges, certification documents). Hence, my decision to explore blockchain and its potential. Let’s start with some definitions. Simply put, blockchain is a distributed digital ledger. Technically speaking, it is “a peer-to-peer (P2P) distributed ledger technology for a new generation of transactional applications that establishes transparency and trust” (Linn shared repository of learning certificate for institutions that have formed a global alliance of universities; global assessment database such as the Sony Global Education (www.sony.net/SonyInfo/News/Press/201602/16-0222E/index.html); continuing professional education; and repository of apprenticeships and corporate learning. IMPORTANCE FOR HEALTH CARE Health care suffers from having too many silos of health information, with a lack of full access to shared patient databases. Blockchain, it is believed, can “liberate data from entrenched silos, empowering patients to securely ‘own’ their data,” with skeptics seeing all hype and no value (Gordon, Wright, patient-generated database from individual sensors and devices for sharing with clinicians; patient and provider identity sharing; insurance eligibility and claims processing; and, in public health, for influenza reporting and identifying pandemics. According to Linn and Koo (n.d.), blockchain also offers opportunities for clinical research, real-time access to personalized data for use in personalized medicine endeavors, and the ability to set permissions for data access to ensure security. They also agree that blockchain can be used to gather patient-generated data for patient-reported outcomes and prevention, as well as real-time monitoring of data to improve care coordination and identification of emergency situations. The Office of the National Coordinator for Health IT initiated a blockchain in health care challenge. There were 15 winners from more than 70 submissions (US Department of Health and Human Services, 2016). Here is a sampling of the winning ideas: alternative payment model, patient-reported outcomes measures, various electronic health record systems, new model for health care delivery for Medicaid population, health information exchanges on state or regional level, and peer-to-peer authorization and authentication within an accountable care organization. Like all innovations, blockchain will at some point be integrated within higher education and health care. That may not be tomorrow, and, as usual, higher education and health care will be late adopters. Gordon et al. (2017) quote a technology analyst from the firm Gartner, Inc., noting that “new technology often follows a predictable hype cycle: from onset, through a ‘peak of inflated expectations,’ down the ‘trough of disillusionment,’ and up the ‘slope of enlightenment,’ before reaching the ‘plateau of productivity.’” As a faculty member reading this column, you will be ahead of the curve by at least having a basic understanding of blockchain. When this new technology reaches “the slope of enlightenment,” you will be able to articulate its importance. In the meantime, I am dreaming of the day that students and patients can have control over their credentials and their health data. As always, you can reach me at email protected.