Self Sovereign Healthcare

Web3 is coming for Healthcare.

Decentralized Finance (DeFi) is dominating discussions on how cryptography and blockchains will reshape industries and eliminate gatekeepers. However the world is more than just finance alone. Another massive sector — the Healthcare industry — is about to be disrupted.

To understand how Healthcare will change let’s look at the web’s evolution and apply Healthcare concepts to it. From the charts below it is clear the same trajectory resulting in decentralized financial tools will result in decentralized Healthcare tools.

Fabric Ventures Max Mersch’s and Richard Muirhead’s article “What is Web 3.0 & Why It Matters” included the following image.

To put this image in the context of Healthcare we need to make two adjustments. First for generational understanding and secondly for the evolution of Healthtech.

The first adjustment is below where generations are juxtaposed against the web’s evolution. Also keep in mind GenX, as the caregiver generation for their baby boomer parents, is deceptively large.

What becomes immediately clear is GenZ, Millenials and the younger-side of GenX grew up with the Social Web — Web 2.0. For them, the web was not a static information source but a dynamic tool where they interacted, posting information and receiving personalized responses. The leap to decentralized technologies, starting with finance, is just an extension of the interactions they historically had with the web.

Pivoting to Healthcare brings the image’s second adjustment, the evolution of Healthtech. This modification demonstrates the parallels between Healthcare’s technology journey and web’s evolution.

Healthcare’s version of Web1, the static web, was kicked off by “Meaningful Use” discussions and the HITECH (Health Information Technology for Economic and Clinical Health) Act. It resulted in Healthcare technology solutions such as Electronic Health Records (EHR’s) built by EPIC, Cerner and others. The corollaries between Healthcare’s “Web1” and the internet’s “Web1” moment are striking — static pages of information and very limited interactions from the eyes of the patient. Web1 for Healthcare gave patients a portal to view their charts, send a message and pay bills but not much else.

Just as Web2 marked a shift to a cloud-based, social, and richer interactions Web2 for Healthcare saw the rise of cloud adoption (AthenaHealth) and social interactions (PatientsLikeMe). Patients can capture their own data (wearables) but it goes to centralized gatekeepers (Apple, Fitbit, etc.).

In the same way Web2 resulted in Facebook, Uber and Amazon using technology to gather data about our opinions, travel and shopping, Web2 for Healthcare resulted in a few companies using technology to gather significant health insights which, after being anonymized, is frequently resold to third parties.

In short Web2 for Healthcare is pretty much the same as Web2 for every other industry. Gatekeepers emerged centralizing and monetizing data.

But the transition to Web3 for Healthcare is already underway and it has the potential of putting patients in charge of their health information and decreasing the power of centralized HealthTech companies.

It is the beginning of Self-Sovereign Healthcare.

To see it in action look at the COVID Health Credential market. Many states, and governments around the world, are enabling patients to generate verifiable COVID credentials which the patient controls. There are two essential elements to note here:

1. Unlike printing a document from a health record, these credentials are verifiable. They are signed using cryptography and the person reviewing them can confirm the information’s source. This does not require an intermediary. Just as two entities can directly exchange value using Defi tools now entities can directly exchange healthcare information.
2. Individuals can self-custody their health information and share as they desire. They do not have to pay a provider to fax information to someone else. Individuals control their data and the receiving party can verify it is true even though it came from the patient and rather than a medical provider.

The great news is this is already happening. Over 60 million Americans have access to self-custody COVID credentials thanks to work in New York, California and other states. In Europe, where COVID verification technology is more widely adopted, the number with self-sovereign health credentials is even higher.

It is not just finance, and DeFi, benefiting from Web3's decentralization innovations. Other industries where two parties must establish trust and exchange information, such as Healthcare, will benefit significantly. Web3 for Healthcare will continue enabling patients to control their health information including how they custody and share it. It is the beginning of Self-Sovereign Healthcare.

Updated on Jan 3, 2022 and May 25, 2022. Originally published Nov 2, 2021.