Abstract
BackgroundIn the homeless population, barriers to housing and supportive services include a lack of control or access to data. Disparate data formats and storage across multiple organizations hinder up-to-date intersystem access to records and a unified view of an individual’s health and documentation history. The utility of blockchain to solve interoperability in health care is supported in recent literature, but the technology has yet to be tested in real-life conditions encompassing the complex regulatory standards in the health sector.ObjectiveThis study aimed to test the feasibility and performance of a blockchain system in a homeless community to securely store and share data across a system of providers in the health care ecosystem.MethodsWe performed a series of platform demonstrations and open-ended qualitative feedback interviews to determine the key needs and barriers to user and stakeholder adoption. Account creation and data transactions promoting organizational efficiency and improved health outcomes in this population were tested with homeless users and service providers.ResultsPersons experiencing homelessness and care organizations could successfully create accounts, grant and revoke data sharing permissions, and transmit documents across a distributed network of providers. However, there were issues regarding the security of shared data, user experience and adoption, and organizational preparedness for service providers as end users. We tested a set of assumptions related to these problems within the project time frame and contractual obligations with an existing blockchain-based platform.ConclusionsBlockchain technology provides decentralized data sharing, validation, immutability, traceability, and integration. These core features enable a secure system for the management and distribution of sensitive information. This study presents a concrete evaluation of the effectiveness of blockchain through an existing platform while revealing limitations from the perspectives of user adoption, cost-effectiveness, scalability, and regulatory frameworks.
Highlights
BackgroundAccording to Austin’s Ending Community Homelessness Coalition (ECHO), more than 7100 people in Austin experienced homelessness and needed housing and other supportive services in 2016 [1]
To solve these problems of transaction identity, we previously proposed the use of distributed ledger technology (DLT), or blockchain technology, to provide a validated, immutable identity and record of service transactions [2]
We found that the following set of assumptions must be tested and shown to be valid for the successful implementation of our solution: (1) our prototype platform would be appropriate for persons experiencing homelessness (PEH) in Austin, (2) PEH will be able to understand its features and will consent to participate in such a system, (3) providers will be able to access and trust the information on the platform, (4) blockchain technology is essential to manage identity for PEH, (5) privacy and confidentiality of data will be protected, (6) service delivery will be facilitated, and (7) interorganizational efficiency will increase by sharing data in a standardized manner with shared governance on the platform
Summary
BackgroundAccording to Austin’s Ending Community Homelessness Coalition (ECHO), more than 7100 people in Austin experienced homelessness and needed housing and other supportive services in 2016 [1]. Client data are often distributed between service providers, causing a deterioration in health and delays in service when accessing data from multiple sources Existing database systems such as Homeless Management Information System (HMIS) to manage documentation for the PEH lack interoperability for different document formats and organizations outside the system, do not facilitate data ownership for clients, and cannot guarantee data privacy and security. Objective: This study aimed to test the feasibility and performance of a blockchain system in a homeless community to securely store and share data across a system of providers in the health care ecosystem. Conclusions: Blockchain technology provides decentralized data sharing, validation, immutability, traceability, and integration These core features enable a secure system for the management and distribution of sensitive information. This study presents a concrete evaluation of the effectiveness of blockchain through an existing platform while revealing limitations from the perspectives of user adoption, cost-effectiveness, scalability, and regulatory frameworks
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