According to California law, reports of domestic or other interpersonal violence must be forwarded by health care providers to law-enforcement authorities within 72 hours. The trouble is that there is no consistency in how these reports are filed: some are handwritten, some are transmitted by fax (never mind if the machine on the other end is actually working), and some are simply lost en route. In 2014, one study showed that less than one-third of domestic violence reports filed by California doctors and hospitals made it to the police within the mandated three-day reporting period, hampering crime investigations, identification of at-risk victims, and collections of available funds for victims of crime.
In 2018, RTI launched a pilot study with Collaborative Health Solutions (CHS) to implement a blockchain-based solution to this problem. Blockchain is a data-storage system, distributed across a network of computers, that almost guarantees the privacy and integrity of information without being controlled by any one entity. That is to say, the records are highly resistant to being altered, lost, or accidentally deleted, which is why this system is the backbone of virtual currencies like Bitcoin.
Before asking us to help with a blockchain-based solution, CHS had launched a browser-based version of the Domestic Violence Report and Referral (DVRR) program in Alameda County in 2014 and a browser-based version of the California Sexual Assault Forensic Medical Report in 2018. The electronic version of DVRR significantly improved the timely reporting of domestic-violence incidents. In the space of three years, the number of properly filed domestic-violence reports quadrupled, the percentage of victims receiving county support services increased from 4 percent to 48 percent, and the Alameda County District Attorney’s office reported a significant increase in felony charges filed.
DVRR and Blockchain: A Potent Combination
Considering how successful the web-based version of DVRR has been, what can blockchain add to the equation? As CHS seeks to expand the DVRR program to other counties in California, as well as to other states with mandated reporting laws, we are building a blockchain-based infrastructure that selectively leverages blockchain’s validated strengths to:
- Ensure the security, privacy, and integrity of medical reports submitted to law-enforcement authorities, which often include pictures as well as personal information
- Ensure that the photographs and data in medical reports are neither altered nor tampered with as they make their way through the “chain of custody” from hospitals to police precincts to courtrooms, facilitating the prosecution of offenders
- Enable secure communications between agencies for better case management and improved victim outcomes.
Potentially, blockchain can also enable the creation of “smart contracts” between hospitals and federally mandated repositories of funds, so that compensation funds (to victims, hospitals, caregivers, and support services) are paid in a timely fashion and the system cannot be “gamed” with false or duplicate claims. The federally mandated Crime Victims Fund currently has more than $10 billion earmarked for victims of violence, and underreporting of claims has been estimated at 70 percent. A blockchain-based claims-reporting system would greatly benefit victims and ease the financial and administrative burdens on other entities providing care and services to victims.
We believe that a blockchain-enhanced interpersonal-violence reporting platform will also reduce the financial pressure on hospitals and medical providers. The rule is not regularly enforced, but in California a mandated reporter that fails to report an incident of domestic violence can be fined anywhere from $300 to $10,000; in other states, the penalties are even higher, ranging as high as a million dollars. Implementation of a blockchain-based platform should ensure that the vast majority of domestic and other interpersonal violence reports are submitted within the legally prescribed deadline, allowing hospitals to spend their money not on legal penalties, but on the victims of domestic violence.
