Autonomic, self-sufficient, and decentralized, blockchain’s distributed, and self-executing smart contracts set a new standard for social contracts. However, somewhere between the smart-city traffic sensor data to auto-pay for lane space with a bitcoin-denominated smart contract and the one-use QR code that pays for your rental car, hotel room, and medical procedure – simplicity has been misplaced.

Technology fungibility

Fungibility is a term rarely verbalized but when used it's often used incorrectly. What is functional, is not always fungible. Fungibility is technically when one unit is directly convertible into another unit of the same asset. When used in a health aid context, fungibility is usually technically incorrectly used to mean the ability to take funds intended for one purpose and spend them on something else. A practical example of fungibility is that a barrel of crude oil, currencies, and bonds are fungible, diamonds are not. Diamonds vary in cuts, colors, sizes and grades make it difficult to find different diamonds of the same cuts, colors, sizes, and grades. Likewise, a condo is not fungible either. It’s not because you just found out about the HOA lawsuit against the builders. It’s because the location, layout, size, and price make it difficult to find different condos with the exact requirements. That’s the intended usage.

Now the commonly used definition takes a broader meaning: the ability to replace an asset with another asset, that is similar but not the same. The idea of fungible technology is an asset being of such nature or kind as to be freely exchangeable or replaceable, in whole or in part, for another of like nature or kind. This hybrid concept of technology fungibility is important when we start applying fungibility to healthcare integration and interoperability, especially when we introduce the value of blockchain.

Mutual substitution

Fungibility reduces risk and provides options. This concept should be incorporated into information technology decisions. Standards must ensure fungibility and without raising IT costs and risk increases. In the ecosystem of Dapps, DAOs, DACs and DASs where do we strategically consider substitution of technology components and business capabilities? These terms are abbreviations of decentralized applications, decentralized autonomous organizations, decentralized autonomous corporations, and decentralized autonomous societies. Experience teaches us that people are not as fungible as one might initially think. Knowledge, skills, aptitude and productivity doesn’t substitute as many succession plans would imply. Similarly, technology and business capabilities appear to have similar functionality; they are not truly a mutual substitution. Customizations of functionality and code, skew the pure product.A creating a new product.B version with limited potential for enterprise support.

A system with great documentation, designed to uniform standards, and not requiring unique skills. Is this what comes to mind when imagining your EMR system? Not likely. Hardware and software fungibility is important when integrating systems, and this will be the case for blockchain technology applied to healthcare.

Pragmatism and Ockham's razor

Ockham’s razor, or the law of parsimony, is a problem-solving principle stating that simpler theories are preferable to more complex theories because simpler theories are more testable. Ockham, did not discover the law, it was nearly two millennia before Ockham, when the principle was first described. The term razor distinguishes between two hypotheses either by "shaving away" unnecessary assumptions or cutting apart two similar conclusions.

Let’s tilt this frame and apply it to blockchain technology for healthcare. Real-time digital identity verification and authentication services exist today. Proof of existence can be considered similar to a content verification service. Proof-of-Existence is also an online service that verifies the existence of computer files as of a specific time via time-stamped transactions in the bitcoin blockchain. This concept of identification and authentication is extensible.

We have shifted from the Agricultural Society (First Wave), Industrial Society (Second Wave), Information Age (Third Wave), Connected Society (Fourth Wave), and the Internet of Things (Fifth Wave). The Internet of Things and the sharing economy will expose new services that are essential for competition. Blockchain technology will enable cars that rent themselves, autonomous drones to propel city operations, and healthcare medical records that are seamlessly updated upon checkout. Centralization is a single point of failure. The simplest solution might be the most practical in the long term; creating a decentralized healthcare system sitting on Dapps that leverage the blockchain's trustless technology.

To unlock this enhanced internet of things future world where mutual substitution, and simplistic solutions are the norm pundits will embrace technology fungibility.