Physician Licensing and Credentialing: The Blockchain Can Save Us

To the Editor.—The current process of licensing and credentialing (LC) US physicians is highly inefficient.¹  Obtaining initial LC, maintaining it, and obtaining LC in additional jurisdictions requires contact with central document repositories such as medical schools, licensing boards, and medical practices to confirm a physician's medical school diploma, previous active/inactive LC, previous employment, records of disciplinary action, etc. The process is slightly different for the federal government, each state and medical practice, and entails a substantial waiting period and expense.

Although the first well-publicized iteration of a blockchain was conceived as the basis of a new financial system, blockchain technology also has applicability in any system with deficit of trust such as physician LC. A blockchain can be designed as a decentralized, verifiable, constantly updated, and unalterable ledger of information that eliminates intermediaries and allows for rapid communication.²  In practical terms, once a physician has been awarded a diploma, passed boards, or any other LC-relevant event has transpired, the information can be entered into the LC blockchain. When the physician needs new LC, the medical board of that state could instantly access the LC blockchain. Smart contracts³  could be used to determine if, based on specific criteria, an LC request can be automatically approved or whether a manual document review is required. Once new LC has been completed, it can be recorded in the LC blockchain. Various levels of access can be created to serve the needs of different stakeholders. For example, limited information such as the physician's license number and standing with the board can be available to the public, while the board or medical practice can have access to additional information, such as the physician's home address and records regarding prior disciplinary action.

The main benefits of such an approach are its trustworthiness and efficiency. Documents uploaded directly by central authorities (eg, medical school, medical board) can become accessible immediately, eliminating verbal, email, or other time-consuming communications between central authorities. The result is rapid transmission of information and decreased expense. In addition, blockchains are dependent on robust cryptography, which is resistant to attacks by malicious entities. As such, despite not being initially designed for this purpose, blockchain technology is potentially an excellent vehicle for storing and accessing LC documents.

There are various barriers to implementation of blockchain-focused LC. First, building a blockchain needs funding and technical knowledge. Second, the LC processes at the state, federal, and practice levels have slight differences (such as the need for distinct documents) and are likely difficult to change. Third, an LC blockchain would decrease the need for personnel involved in the current LC process and would also decrease medical board revenues. Political will, redistribution of personnel, and finding new ways to fund medical boards will be required to create and implement such a new LC system.

Assuming that an LC blockchain does gain limited implementation, harmonization across LC stakeholders and, eventually, national, and possibly international, adoption across medical specialties will be possible.