Using Blockchain Technology to Mitigate Challenges in Service Access for the Homeless and Data Exchange Between Providers: Qualitative Study

Abstract

Background In 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. 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. Methods We 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. Results Persons 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. 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.

Advancing Health Equity for People Experiencing Homelessness Using Blockchain Technology for Identity Management: A Research Agenda

“…Our prior study based on qualitative interviews with PEH in Austin, Texas, showed that at least one third of clients lacked a basic identity document when they entered the health and human services system in the city. 11 A survey of homeless service providers conducted by the National Law Center on Homelessness and Poverty revealed that the lack of a photo ID prevented PEH from receiving food stamps, social security income (SSI) benefits, Medicaid, shelter or housing services, or medical services; furthermore, ever since September 11, 2001, federal and state laws and administrative policies have made it more difficult for PEH to obtain a photo ID. 12 Second, health care and social services in the U.S. are fragmented and siloed, and in the absence of a truly person-centered and integrated approach, health care and social service systems lack interoperability and are unable to accurately collect, share, and verify even basic identity information for a person experiencing homelessness.…”

“…Blockchain technology can be used to ensure secure and portable identity management in health care, and holds great promise to be a techQuity solution for the problem of identity management for PEH. 11,14 Fundamentally, blockchain can be described as a distributed trust network that uses cryptography or encryption to share ledgers of transactions across a large number of nodes. 16 Each piece of information must be verified by a consensus mechanism where all participants of the network agree on the truth of each transaction.…”

“…14 The results of the study showed that blockchain technology, using an Ethereum platform, allowed PEH to create accounts, upload documents, share documents with differentiated permissions, enable service providers to share documents and information, and allow an individual to hold their personal identity information as an asset in their blockchain account. 11 One of the key features of blockchain that may provide some innovative ways to help address inequities in health is that its foundations are based on mathematical algorithms that can be scrutinized and audited to rectify any systematic discrimination or bias. While the concern of biased algorithms is being raised more widely now, the research to address these concerns is still in its early stages.…”

“…While applications of blockchain technology have been reportedly used in rural Indonesia, Kenyan slums, and Syrian refugee camps for identity management, we are not aware of any empirical research, other than our own preliminary pilot work, that evaluates blockchain's applicability for identity management with PEH. 11,14,28 Given this lack of empirical evidence for the use of blockchain technology for identity management to improve health equity, we propose a research agenda that can help answer critical questions. We derived this research agenda from three main sources: first, was a rationale, pragmatic set of questions that arose based on our own clinical work caring for this population as well as our own pilot project using blockchain technology; second, was a critical review of the literature described above, noting key research gaps; and third, we drew constructs and questions from well-described theoretical frameworks concerning the adoption and uptake of new technologies, including the technology acceptance model (TAM) and the unified theory of acceptance and use of technology (UTAUT).…”

“…Our own pilot data show that photo IDs and other vital documents are required to access services at nearly every health care or homeless services agency in our community. 11 We must better quantify this, in larger populations across multiple locales, particularly in terms of the associated costs (both time and money) that lost identity has on PEH and the systems that serve them. The next step will be to quantify the effect this has on access to medical and social services, and how this translates into driving poor health outcomes and/ or perpetuating homelessness.…”