Blockchain’s Potential to Disrupt the Public Sector

When most people think of blockchain, they think of Bitcoin and cryptocurrency

When most people think of blockchain, they think of Bitcoin and cryptocurrency. However, the applications of blockchain lie far beyond the realm of P2P payments. In fact, the blockchain has applications in an area that many would not consider the most technologically advanced or cutting-edge: the public sector, particularly in elections and healthcare.

The Blockchain and E-Democracy – Electronic Voting

With the recent allegations against Russia for hacking the 2016 US Presidential Election, the issue of cybersecurity in the political system is more relevant than ever. The current model for voting in an election has more or less stayed the same for the past few centuries – voters go to the polls, fill out their ballots, and the votes are counted and stored in a central database. It is a system based on trust between the citizens and the government, trust that the government will count the votes fairly. However, the centralized nature of the current system gives it two glaring weaknesses, which blockchain technology can help mitigate:

1 – With all the data stored in one place, election data is vulnerable to hackers who wish to manipulate the election results, such as the case with the 2016 US Presidential Election.

2 – The owner of the database, namely the government, can tamper with the data without voters knowing, as is the case in many developing countries where election fraud is commonplace.

In an election system based on a blockchain, each voter has a “wallet” (i.e. a user credential based on a verified, government ID) and a single “coin” (i.e. one opportunity to vote). Voters cast their vote by transferring their coin to the wallet of the candidate of choice, and each transaction is recorded by the ledger.

Because blockchains are decentralized with copies of the ledger distributed across multiple nodes, they have no single point of failure. If one or several nodes are hacked, there are still enough copies of the original, uncorrupted database to maintain the integrity of the system. Thus, an election system based on a blockchain would be resistant to denial of service attacks and other methods that are typically utilized by hackers. The transparent nature of the blockchain allows common voters to count the votes themselves in the history of the ledger rather than trust in a possibly corrupt central government. With greater transparency comes the possibility of greater voter engagement and participation, which can ultimately change the way democratic populaces approach election day.

One startup that is pioneering work in this area is the US-based Follow My Vote, which has created an open-source election system based on the blockchain. You can read in more detail about how they apply blockchain technology to online voting here.

The Blockchain and Healthcare – Electronic Medical Records (EMR)

Imagine you’re from Milan, but you’re traveling to Rome when you break your arm. Although you are still in Italy, the hospital you go to in Rome has no access to your medical records back in Milan because they use separate, incompatible computer systems. Thus, the doctor treating you in Rome lacks knowledge of vital information about your medical care including your treatment history, allergies, and possible comorbidities.

This problem in healthcare, where different records of a patient’s identity are distributed across multiple, incompatible systems is called the interoperability problem, costing roughly 150,000 lives and $18.6 billion per year in the US alone. Healthcare providers – such as pharmacies, hospitals, insurance companies – need to be on the same page in order to provide patients with the highest quality care. Although current healthcare IT systems do not facilitate this need well, the blockchain can help remedy many of these issues.

Rather than actually storing health data, a blockchain for EMR would give users permission to access data across many different systems. The patient ultimately holds the key to giving providers access to their health information through the blockchain. Essentially, a blockchain would overlay the current system of health records. Each patient’s wallet would keep a record of where their medical information is stored as well as how to access it. In the previous example, if the doctor needed your medical history and list of allergies from your primary care physician back in Milan, you would perform a blockchain transaction and give them the key to access your data on that system. If they needed your insurance data, you would perform another transaction and give them a separate key for your data stored in the insurance company’s system. The raw health data remains scattered across the systems, but the permissions to access it are centralized in the blockchain with the patient acting as the main judge of who gets to see what.

A blockchain based system for medical records can ultimately create a common record of truth across different healthcare institutions, allowing them to provide higher quality care. While this system requires substantial cooperation between the blockchain developers and existing systems, it has massive potential to improve efficiency and reduce error in healthcare practice.

One of the pioneers in this area is a system called MedRec, developed by MIT. You can read in more detail about their approach here. Another US based startup called Gem is also exploring further applications of blockchain in healthcare, recently sponsoring the ‘Distributed: Health’ conference this past October, the world’s first blockchain health conference.

Next Steps

As with the adoption of any new technology, the advent of blockchain will undoubtedly be met with pushback by current institutions. However, with these many different applications of the technology starting to take shape, it is obvious that the blockchain is not merely an enabler of digital currency. In fact, it may not be long before we see blockchain profoundly change the nature of the relationship between the people and the public sector.


Christopher Cao