2023 06 08 Cardea Lab Project Overview
Keela Shatzkin: Fantastic Keela Shatzkin: all Friday. Welcome everybody to today's edition. June sixth. of the Cardio working group under Hyper Ledger laps. We're excited today to have a presenter, and we'll get into that in just a minute before we have a couple of housekeeping items. that includes our antitrust policy. So Keela Shatzkin: we are not talking about specific business opportunities here, you know, financial gain and things like that. we're we're talking about that at a more general level. If anybody has concerns. please let us know you can. You can email me, or there are some ways to report that through Hyper Ledger directly. Keela Shatzkin: Similarly, our code of conduct which is linked in our meeting notes. I'll chat this to you guys. These are community notes. So feel free to participate or correct. Also, you can tell me to correct as we go, if that's helpful. But our code of conduct is is really that we're an inclusive community. We encourage everybody to have a voice. If anybody feels like they're they're not getting their voice that they they would like to have. Here, please. Again. You can reach out to me as a as a co-chair Keela Shatzkin: or again, through hyper ledger, to to escalate an issue. Ken, who is our other co-chair unfortunately, had a death in the family, so he's not able to join us today. We hope that he'll be able to take care of those things with his family and return soon. Keela Shatzkin: And so that takes care of our housekeeping items. Does anybody want to introduce themselves today?
Keela Shatzkin: Maybe been a while? I can go first, because I know we're talking about some very specific health things as co-chair. My name is Keela Shatskin. I'm based in New York. I work in health data, and operations sort of the intersection of health care data and operations primarily in the Health Information Exchange space. And I've been doing so Keela Shatzkin: for a very long time at this point. I do that both in New York and in other States across the Us. and so this obviously is very close to my heart as a data exchange method for Keela Shatzkin: health care data. Right? Did I miss something? And you want to chime in? Ry Jones: No, I was just raising my hand.
Ry Jones: Yeah, please raise your hand. Ry Jones: So I'm right, Jones. I'm a community architect here at the Linux Foundation. I've been working on hyper Ledger since before it was Hyper Ledger. And I I was working with Cardio when they were over in Lh Ry Jones: Which went through some turbulence. So I'm really glad to see that Cardea has moved to a hyper ledger lab and is working on becoming Ry Jones: you know what it promised to be. So I'm I'm really glad if you need any support. I'm on discord. Ry Jones: you know. Please reach out.
Keela Shatzkin: and we're forever grateful for your support. Rye. We really feel it here. So thank you. Keela Shatzkin: Would anybody else like to introduce themselves? Helen Garneau: I will, just because it's been a while. Hi, everybody! My name is Helen Garneau. I am, I do the marketing work here at Cardea. In conjunction with some of my colleagues Tim Spring and Trevor Butterworth and the community. I also do marketing for in Dco and was there when Guardia was born. I guess last year no, 2 years ago now. Helen Garneau: 3 years ago 2019, 2020, 2020, 2020 anyways. So again, happy to see it grow happy to see You know us move forward and be part of the Hyper Ledger foundation community. Helen Garneau: I'm also the Hyper Ledger membership marketing chair. So that's A role that Helen Garneau: I was elected in by the kind of do do paying members of hyper Ledger. all the all the groups that are part part of the community. And so if there's anything I can do to help support. yeah, just the visibility of cardiac. I have many, many hats that I wear that would support that effort. So if anybody has any ideas, please don't hesitate to reach out. I think Trevor might have an update on white paper potentially. So we might want to. Keela Shatzkin: I want to add, just grab some time at the end for that. at some.
Keela Shatzkin: Okay. So then, just for an update. We we've migrated all of our right housekeeping. We've migrated all of our things to the hyper ledger platform so that we're more integrated. It's been super helpful. Like, as I mentioned, we're eternally grateful for the support that we're getting here. And so I've left the minutes. about some of those transition things. If you're you know, if you come to late to the party. Keela Shatzkin: there's some cheat sheets about sort of what's changed and how we're operating and where to find things. You can see those here. So I'll leave those. We'll probably take them out moving forward. Keela Shatzkin: But just as a reminder that's there for you. And we're taking notes and hyper ledger labs Keela Shatzkin: space. Now, which I've linked in our chat. So today we are very excited. to have a speaker participate and join and talk about some of the
Keela Shatzkin: health care, vital stat space. I'm not going to do it justice in terms of the breath and scope of what we're going to learn about today, and how it intersects with the work we're doing here at Cardea. so I'm very pleased to introduce Sarah and to encourage participation from our community. If you have questions as we go through today's discussion, feel free to throw your hand up and we'll get that asked, or you could put it in the chat box, and I'll be monitoring Turing that through the course of today. So without further ado, Sarah, do you want to introduce your yourself and and Ivan? Sarah Samis: Sure, Hi, I'm Sarah Samas. I work at Gcom. We're a primarily state and local government product software product. And it services Company and we work with Sarah Samis: Moe states many states across the country. and one of our product areas that we focus on is vital records, issuance and management and then we also have been working on Sarah Samis: digital identity solutions using verifiable credentials. So we after talking with Ken and Helen and Kayla previously and heather we were invited to come speak to you guys and go through a little bit more of our Sarah Samis: design process on the vital records. Use cases for verifiable credentials. the vital records, national Association. has sort of made an a a a goal for its membership, that all of the vital records are restrictions across the country will figure out how to do at least some kind of pilot level. digital certificate issuance by 2,026 and we Sarah Samis: feel really strongly along with the Cardaira community that decentralized identity should be a component of that solution and process because it is more secure Sarah Samis: and and better user experience for constituents.
Keela Shatzkin: So let me share my screen. Yeah. Sarah Samis: and Sarah Samis: is it? Is it loading? Keela Shatzkin: It's thinking about it. Sarah Samis: Hmm! Sarah Samis: Let me let me try. It Sarah Samis: didn't work. Let me try again.
Keela Shatzkin: It's not a presentation without some technical glitches. Keela Shatzkin: And people see you now we are with you. We're in the Powerpoint view. Sarah Samis: how do I use the keyboard to do the screen Sarah Samis: slide view? Does anyone remember? Keela Shatzkin: If you cause you? Yeah, there's a little icon that looks like a screen being pulled down at the bottom. Right Sarah Samis: there you go. Sarah Samis: Oh, or there. Okay, cool. Where are you?
Sarah Samis: So first I was gonna talk a little bit about what vital records are and how they are somewhat unique in the United States compared to a lot of other national nations and international countries. Sarah Samis: so vital records are a form of identity credentials. that is true, both in the Us. And abroad. Sarah Samis: they're used for a range of identity verification when you go to get other types of identity documents, including your social security card and your passport and your driver's license. So they are one of the find foundational identity credentials in the United States. Sarah Samis: however, they are not issued at the Federal level in the Us. They are issued at the local jurisdiction level, and there are 57 State and territorial vital records offices across the country. there are 57, because some States have delegated some of this authority to counties and cities, and then we have our Us. Territories, including Guam, American, Samoa, Virgin Islands, that kind of thing. Sarah Samis: the States share all of their vital records data with the Federal Government through the Cdc and the National Center for Health Statistics, cooperative programs. So the Federal Government's help supports and makes investments in state. vital records it system so that they can do this data sharing and that kind of stuff.
Sarah Samis: Any questions about that. This is. This is very unique to the United States. Most other countries have vital records issued at the national level. Sarah Samis: and this sort of federated nature makes it a little harder to do sort of Sarah Samis: standardization and interoperability quickly across the jurisdiction. So I think, Kayla, you're super familiar with these types of challenges from working with health care providers on H. Ies. And you Sarah Samis: and some of those similar challenges occur at the vital records. Jurisdiction level napses does have a bunch of tools that help with that in a way that your hives also do that sort of matching and consolidation. so there there are investments in the vital records, technology space that have helped to massage and address these challenges. Keela Shatzkin: And I happen to live in one of the wonderful states that has 2, because there is a city new York City Department of Health, and there is a New York State Department of Health, and they have disparate systems that do not talk to each other. In fact, occasionally there's some bad blood there, and so they don't collaborate as much as you would hope that they do. So there's all sorts of nuances in. And and I think there's also Keela Shatzkin: and correct me. If I'm wrong, there's there is specific state law that also Keela Shatzkin: on levels. The playing field across these
Keela Shatzkin: State has its own State law that dictates Sarah Samis: how vital record should be collected and can specify even down to like the the data field level, what should be collected and and included in a birth and death certificate. State laws also often. govern Sarah Samis: how much it costs to get a further death certificate. But again, this is all somewhat varied by States, and the National Association does have a model law that it propagates for States to use and sort of drafting and updating their state legislation. Keela Shatzkin: But they can choose to go go row. Yes, it is clearly up to their own individual jurisdictional authority, though. Sarah Samis: So. Sarah Samis: in addition to this federated system, which is, we just discussed, has some data sharing and integration challenges. You also have a lot of different end users across Sarah Samis: all levels of government that use vital records. If we think back to the first slide where we talked about how this is an identity. Credential uses identity, verification to get other identity credentials. You can understand how
Sarah Samis: all of the lines in this high level user flow and data flow chart have been drawn because there's just so much interaction across different, both Federal and state and local jurisdictions as well as the private sector. Sarah Samis: So we've bucketed. And this is pretty industry standard. There's there's 3 primary end users of vital records. It systems and and the the the systems that store your information that's put into your birth and that certificate. So you have your state and local jurisdiction staff. Sarah Samis: You have your external data providers. Sorry the state and local jurisdictions after in the dark bill your external data providers that enter data about first and desk including people's names, their cause of death, their time of birth, time of death, all that stuff and relationship to relatives. Those are all in the yellow Sarah Samis: on this diagram, and then you have the general public. Sarah Samis: When you want to request a birth or death certificate. they are in the white blue here. So each of these 57 jurisdictions has to serve all of these stakeholder groups. Sarah Samis: And Sarah Samis: this means there's a lot of friction and interaction.
Sarah Samis: because you have multiple end users of one system. And you're trying to make that system seamless and a good user experience and also be able to produce. the certificates in a timely fashion Sarah Samis: the Cdc has set a goal that they want all births ideally registered within 72 h of birth, and I Sarah Samis: and blanking on the deaf cut off. But during Covid it was really important to have timely death reporting because that was really helping with the disease surveillance and understanding. the flow of the epidemic. So I think Covid really highlighted the need for timely death reporting Sarah Samis: And again, you can see that all of these people involved doing all of these different data entry pieces into the different portions of the vital record system really complicates all of those processes happening quickly. Keela Shatzkin: We have a question from Simon, I mean, do you want to ask your question, or you want me to relay it.
Keela Shatzkin: You're on mute time and relay it unless you come off. So there's a question about what? Why are these things not free to citizens of the Us. Keela Shatzkin: is that because it's state by state? I don't know if you have any insight to that, Sarah. Sarah Samis: that is a really good question. It is definitely Sarah Samis: The fees scale is set state by state. Sarah Samis: I would say that and I can go back and check more with the association on this, but Sarah Samis: the fees do help cover the operating cost of producing the birth and death certificate, so that money generally goes into the operating budget or the vital records division. normally, those are within state health departments. and so Sarah Samis: there's Sarah Samis: you all the staff here, right? The it systems. When you talk about paper certificates, there's very specific security paper with a lot of broad protection built in. And the same way your driver's licenses are continually being updated with new fraud, protection methodologies. They have the similar type of
Sarah Samis: frog protection approaches built into vital records. paper certificates as well. So there's all of this investment and operating cost around, keeping the system safe and secure and able to handle the again. As you can see from this diagram, the volume of users entering data into the system. Keela Shatzkin: Yeah, including that that there's an office there's like people that are having to be interacted with because it's not a seamless system, and again it varies widely, but because it's not seamless. There's like Keela Shatzkin: an office that you have to go to. They're on always Sarah Samis: walk in offices where you can order a birth and death certificate because you can't do it all online a lot of times. You can't do it online for some of those
Sarah Samis: exceptional relationship cases like adoption or Sarah Samis: custodial relationships where you're not a blood relative, you have to do a lot more identity verification to even be able to request the birth certificate. So they check that you're a valid requester. So there's a lot of Iv upfront when requesting a birth certificate. If you have a more complicated relationship or a death certificate to the the child or the deceased. So There's a again a lot of resource, intensive Sarah Samis: processes around that identity, verification and fraud protection because it it is in one of the foundational identity documents. You don't just. You don't just want to give it out to anyone. Simon Nazarenko: I think you're right sorry I apologize. I was on the mute. and I I don't know if you know the vital check. This is the company that issues battle credentials here in Idaho State. do you know if it's the government on the organization? Or is it a private organization?
Sarah Samis: vital check is a software product provided by lexing access and most jurisdictions use it for at a minimum, they're order processing. So when you want to order on an online birth or desktop here or over the phone or have a kiosk Sarah Samis: that that is generally the software system that's used to help with that process. So it's a private technical solution, but contracted by the public. Yes, and that is common. Most States either have purchased a private technical solution, or they've built their own home grown solution. So I would say the Sarah Samis: more of more jurisdictions have moved to the private hosted solutions or private maintained. even if it's not hosted by the vendor and there are, there are fewer homegrown systems anymore, because again, all of the maintenance required and the complexity and the business rules configuration, it becomes very laborious, and expensive. So more places have moved to
Sarah Samis: private vendor provided solution Simon Nazarenko: A and I have another following question, if you don't mind. So if all of the vital checks on the territory of the United States should, have the same architecture. And basically meaning that the the the birth certificate issued in the Hawaii should not be any different from the one issued in Arkansas or Alaska, isn't it doesn't make sense to unify the whole process and make one Simon Nazarenko: software solution that would issue mandate, that those processes and the content be exactly the same. But again, that's all set by individual State law and if it's not already conforming to the sort of model all minimum requirements it it does require the State to pass legislation Sarah Samis: amending and moving it closer, their own law closer to that direction.
Sarah Samis: Okay, thanks. Sarah Samis: Try to reach that. But there's still nuance and variation on top of it. Sarah Samis: These are. Keela Shatzkin: I. I think, one other thought I have is there, and and maybe it's more of just highlighting this, that blue which is the public
Keela Shatzkin: there are also. It's not just like me personally. It may be right. If I'm getting Sarah Samis: social security benefits, if I'm getting. If I have life insurance right? There's there's private companies that also need to know right, and they become end users as well. I think if we go back to this, this one is the birth one. But there's one of these. This is the generic sort of use case mapping that. I think Sarah Samis: the Cdc did. And I can put the link in the chat or send it as a follow up email. If people are interested. This is a great overview and this used case document goes through who all of those stakeholders are and talks a little bit more about some of the Clearinghouse integration systems that are similar to HIV. So this, like Steve and Sam's thing in the middle here. that helps to do some of that intermediary data sharing work. Keela Shatzkin: But yes, there are like on the Sarah Samis: It's more obvious on the on the death. One in terms of the private users. But here all, all of the Sarah Samis: the pink is Sarah Samis: private entities, not government, I mean. I guess it could be a a hospital or a birthing center. That's a public benefit corporation like when I worked at health and hospitals. But all of these people in the pink are the private slash public users of vital records for birth certificates
right? Sarah Samis: and then, just to underscore these are typical modules in a vital records it system each of these blue boxes in the middle with the weight. Sarah Samis: lettering. So when you asked about vital check, the order processing one is the one that they are most prevalent in, but they also have full stack Sarah Samis: system, so that provide all of these modules as well Sarah Samis: and just in full disclosure. Gcom has a cots vital records management system. So we have a software product that does all of these functionalities.
Sarah Samis: so now, the focus, I think, for you guys was really like. Sarah Samis: what does this industry mean for a decentralized identity technology and distributed ledger technology? so we've mapped out a couple of use cases to discuss with you guys, and and we have some trust triangles to illustrate the different use cases. So Sarah Samis: the first one is the medical certifier. So if we go back to this diagram, we're talking primarily about the yellow external data providers. Here are the ones who certify records and say, like
Sarah Samis: This person was born at this time, and it was, you know, a a regular vaginal delivery versus Caesarean delivery, for this person died at this time, and it was a natural cause of death versus something else. so there's a way to use Sarah Samis: decentralized identity to make the certification process quicker and easier for the medical certifiers. Sarah Samis: and this one is pretty interesting because it can be done. Sarah Samis: It's not so clear from this. The like first glance who the the admin is who's issuing the credentials here? So if you're if you're a doctor or a funeral Home director generally, you're licensed at the State level, but that agency that's licensing. You may or may not be Sarah Samis: the the Health Department. So you might. You might need a different agency than the health Department to be your admin here.
Sarah Samis: And then your vital records are generally going to be in your health department. So your your verifier is still going to be within the health department, most likely, but the admin could potentially be a different agency. if that makes sense. I don't know if I'm being clear here. Sarah Samis: So this this type, are you suggesting that it could be like the hospital, for example, that becomes the initiating admin because Sarah Samis: the agency that oversees your medical license is the State Department of Education. So in in New York State's example, the admin would most likely be the State Department of Education here, and then your verifier in this case is the vital record system owned by the State Health Department, which says, Okay, I realize that you have a verify of a verifiable credential saying that you're this License. Medical doctor. Keela Shatzkin: Okay, so this is this is highlighting the trust triangle of saying, who's qualified to formally submit a birth or death by that. That is a perfect way to phrase it. thank you for being so succinct. Sarah Samis: And I think again, the interesting thing is that this used case may or may not be totally controlled by one agency, and might require some more interagency coordination. to implement. Sarah Samis: But we like this use case because it Sarah Samis: is more secure. Right now, there's a lot of biometric data stored often. for mobile apps that certifiers use. And we don't think that ideally long term. That's a great way to go because you're then centralizing storage of biometric data. And it's such a high security risk. I'm sure Ivan can go into way more Sarah Samis: elaboration on this point. so we think we're, we think that trying to get the industry more interested in moving to a verifiable credential
Sarah Samis: for medical certifiers would really accelerate security and lower costs. Keela Shatzkin: If you want to hear a funny story. The New York City Department of Health rolled out an app to people who were allowed to submit data to their vital stats, and it had facial recognition. Keela Shatzkin: and they had to roll it all back out because it didn't work and they were not able to meet those timeline requirements. They couldn't mark anybody as deceased. It was a major flop. Keela Shatzkin: very painful. Ivan, you came off you came on camera. Do you want to add? Ivan: No, yeah, I I was just gonna add that you know you, you have a a, a system with medical certifieders where you have a lot of different like systems that the the State can't necessarily manage. You have a lot of different doctors, providers, and whatnot so kind of a a decentralized identity. a solution for that makes a lot of sense. because the state doesn't necessarily have to manage that where, if you have a centralized system, it becomes a a fairly significant cost and an overhead burden on the State itself. Sarah Samis: I think one of the other interesting nuances to this use case. In addition to like the multiple agency coordination and the
Sarah Samis: the the comments Ivan was talking about is that the You might need some changes to state law because of what we're talking about earlier, where State law governs, like Sarah Samis: everything about vital records collection. Essentially, if State law says, you need certain types of identity, verification for the medical certifier. You might have to amend state law or get some kind of creative legal opinion talking about how this technology, which didn't exist. when those also written satisfies that existing state requirement. Sarah Samis: So when we think about implementation challenges like that, one also comes to my mind Sarah Samis: and any more questions on this. But we we again see real value in this, because and Kayla, you worked with hospital systems. So you know that anything that saves a doctor's time, or a clerk's time is like Sarah Samis: bottom line and freeze of time for patient care. Right? So if we can arm providers with the ability to use their verifiable credentials in a quick and easy fashion on their mobile device. Then they've freed up so much more time to do the things that really matter to their profession. Keela Shatzkin: Absolutely. So. How does this fit into the next step? So you've verified the certifier Keela Shatzkin: of the per. So this is the person who's now been rubber stamped basically to submit the the death record to the vital stat system. Keela Shatzkin: What are those submission protocols? Do they also does this, then, piggy back into another trust triangle for the submission process.
Keela Shatzkin: or is this, or do you see this as them using a credential to sort of like log in Sarah Samis: both. It could be longing into the the data entry portal. Okay for the vital record system. And it can also be about the submission. So you could have 2 potential ways to apply Sarah Samis: decentralized identity for certifiers. Sarah Samis: Excellent. Yeah. So I think this one you get. Not only is it more secure, potentially better workflows for the Sarah Samis: external data providers which helps timeless of reporting. But you can also potentially get 2 sort of used cases out of one application. Sarah Samis: Okay, any anything else. These are all great comments. They're really helping us like flesh out the the use case, value prop, as well.
Sarah Samis: Okay. So then we were going to switch to Sarah Samis: what the trust triangle looks like for the public customers, the people who are ordering the birth industrial type of yet. So. here's one where it's a parent. Sarah Samis: and there getting a birth certificate, a copy for their child, because often a birth certificate is required to do school enrollment for your child at the local school district level. So Sarah Samis: in this instance Sarah Samis: the issuer is the Health Department Office of Vital records. And then the verifier is the Sarah Samis: local school district. and there there are already some jurisdictions on local school districts that do online enrollment. But think about the sort of
Sarah Samis: security and vulnerability associated with like uploading a picture of your birth certificate to a local school district website. That's Sarah Samis: no boy, no. Sarah Samis: So this switching to a verifiable credentials would probably be easier from a resident parent perspective. And it's definitely a whole lot more secure. Sarah Samis: so Sarah Samis: in this workflow. You've got your digital verifiable first certificate credential on the parents phone, and then the local school district can have some kind of like Sarah Samis: QR scanner that scans it. And then the child's Sarah Samis: birth certificate information can get automatically ingested into their online registration system. This is also a really great use case to highlight, the
Sarah Samis: selective disclosure elements of or 0 knowledge proof, whichever your school district wants to move towards aspect of verifiable credentials, because if the school district just wants to know. Okay, this child is of age for Sarah Samis: this grade. Sarah Samis: Then that could be 0 knowledge proof. And if the school district just wants to know their Sarah Samis: first date to automatically determine the grade or and their parents address to automatically determine their Sarah Samis: Residency. Sarah Samis: that could also be 0 knowledge group or selected disclosure. So there the there's generally 2 forms of the birth certificate. There's the long form which has a whole lot of information like Sarah Samis: it has both parents names. It has information about the mom's health status and the type of delivery they had. whether there were some newborn screening health
Sarah Samis: characteristics collected at the time of birth, and the school doesn't need all of that. Nor would you want to share all of it with the school. So the short form is generally what people use for the school and the Sarah Samis: again, the selective disclosure functionality with a verifiable credential allows the residents to really easily make sure they're only giving the short form, level information, or even less than the short term level information to the school district. Sarah Samis: So we really like this use case because we feel it really highlights all of the capabilities around verifiable credentials. Sarah Samis: Ivan, did you have stuff to add? Ivan: not exactly, I I think, on the verifier side it it definitely presents a lot of value for these schools. I I mean a lot of times when you're applying for different school, you know programs, or even just the initial application to the whatever primary school it is. there is a lot of friction there in terms of ordering physical birth certificates. Ivan: and the presentation process of those fiscal pro certificates. so you know, we've seen a lot of positive feedback in terms of in that application process, you know, if there is a process where you can get your birth certificate, you know, instantaneously. At the same time you're applying for something. it just unlocks a lot of possibilities for the the local school districts and the parents.
Sarah Samis: I see Mike has his hand up. Mike Ebert (Indicio): Yeah. So this may be one of the most important credentials to be issued is verifiable, credential bar none anywhere in the entire world for any use case period. Mike Ebert (Indicio): So, for example, I I've been doing work with passport credentials. That's a a use case that actually spawned the you know, originally started with vaccine records, but morphed into
Mike Ebert (Indicio): the trials and aruba for Dtc. Passport stuff and to get a passport. I've recently gone through the the process with my Mike Ebert (Indicio): with my daughter. We had to mail her birth certificate into a Federal agency. Mike Ebert (Indicio): and then pray that it came back, you know. And So, besides having the friction of receiving the birth certificate, there's the fact that, you know. Do I really want to put this in? Trust? This to the mail system Mike Ebert (Indicio): and and, like you were mentioning with all of the data that they may not need to know.
Mike Ebert (Indicio): So you know where birth certificates are this not only required to go to school, you need them for drivers, license, and a passport which are, you know, the the later on universal identities that people use? I'd be really excited about this becoming reality. this on the horizon. Or is this just a really awesome presentation about Mike Ebert (Indicio): the possibilities and the use case. Sarah Samis: We we think it's on the horizon again. There was a lot of interest and we did some really great implementation Sarah Samis: brainstorming at the Knapses Conference in April, where this was heavily investigated. So I do think that there are a lot of there is a lot of momentum on the vital records side right now. In addition, some states, and Ivan can go into more detail, are really moving towards
Sarah Samis: their own policies and regulations around digital identity, to begin with. So, Ivan, I don't know if you want to talk about Utah as well. That was just past. But there, there's this sort of this confluence, like vital records themselves, is really interested in this. And then some states are approaching digital identity, you know, from a a whole statewide policy perspective. Ivan: I I think there's there's a couple of different things to to talk about there. you know, you mentioned that birth certificates are kind of a foundation for both passports and drivers, license and and the reality is in the United States that both certificates have lags behind drivers, licenses, and passports Ivan: due to simply their portability. in in terms of how you can use the actual credential itself. And what we recognize is that, you know, if we can take growth certificates and digitize them in any way, even if you didn't use the centralized identity in any way. it makes the the birth certificate and a lot of those other processes after the birth certificate, and, like drivers, license and passports much more efficient and much simpler. and it reduces a lot of overhead and burden on both state Ivan: the resident as well as anybody that wants to use it. so there is a a very significant use case for this.
Ivan: and, like Sarah was saying, you know, at at NASA this this was the biggest topic of discussion here was, how do we bring birth certificates and all vital records into a modern age? and yes, there I mean a lot of different states we've seen in Utah and Michigan and and Rhode Island. A lot of different States are are really trying to push a decentralized identity, and recognizing that first certificates are a kind of a genesis credential for just about everything. Ivan: So if you can solve birth certificates, you can then use this to apply, for you know your snap benefits or unemployment, or you can use this actually as The credentials intended to be that kind of driver's license and passports have taken the place up. Sarah Samis: I would also add that Sarah Samis: the Sarah Samis: input impetus in the field right now is Sarah Samis: even though we're behind on the vital record side compared to the Dma. Sometimes it's easier to do that leapfrogging to the more advanced technology when you haven't tried to go the intermediate route first. So I feel like personally, as somebody who's worked in innovation for a while. Now. Sarah Samis: this might be the more ready use case because there haven't been intermediate digital identity solutions already. piloted or rolled out and so it might be more ripe for decentralized identity to adoption from the beginning. for a conference of reasons right like the cost to ledger stuff is coming down now. I kind of feel like this is we're at this moment where Sarah Samis: decentralized identity is very similar to the credit card chip technology, where it was clearly the superior and more secure technology from the get go. But the cost of production was so high that you haven't seen mainstream adoption until like 20 years after, it was technically physically manufacturerable. Right? So I feel like again, if if there's this sense of urgency and momentum on the State registrar side.
Sarah Samis: and the State registrars have so many operational pressures on them, especially post Covid. They're short on staff. They want to like, offer their staff more flexibility and remote work options to keep the staff that they have. They want to simplify their workflow and processes to be able to provide better customer experience and do more order processing, because again that gets them more revenue. the faster they can issue to more certificates. and Sarah Samis: then you have the cost to use decentralized identity technology coming down. And they're not tied down by an intermediate solution that they've already invested in right. There's no some costs in some of the Dmv type approaches that have already happened. So we might be able to do that leapfrog in this market. and for this use case in particular, I think it's it's very appealing. And The timing might really work out Keela Shatzkin: fantastic. I have one question on this flow, and then we'll get to Mike's technical question 1 s. so this is very interesting that you brought this one up because we've been sitting at the space where we're talking about the intersection of health care, verifiable credentials which isn't dissimilar from the vital stats data. But also, for example, the school based health requirements and those could be credentials. So if you start to pair these things together. Keela Shatzkin: you really start to see the ecosystem coming to fruition with. you know, the birth certificate sharing, but also the immunization record, sharing and etc. That we've been working on in terms of
Keela Shatzkin: conceptualizing that for Cardi, as our extension use case, I totally agree with you, and I think this school enrollment example is the perfect confidence of that where you can use the immunization credential with the birth certificate credential together to almost fully automate and digitize the process. So the parent literally doesn't have to produce any paper for the school Sarah Samis: to get their kid enrolled like that really excites me. and I feel like there's high potential here for this use case for it to be almost fully digitized. Going forward. Keela Shatzkin: Right, Mike, you have a question about the technical structure, and I, I heard you say, selective disclosure which would lend itself to an on cred. But where do you see this from a technical perspective going in terms of credential formats? Do you have any Keela Shatzkin: read on that. Ivan: Yes. Ivan: Well, I guess. No, it would be the answer. So I I guess in in in our discussions that we've had both at NASA and kind of around the country. The focus right now is less on the the the technical aspect of it. Like there, there really is a desire, just period from a a business use case to just digitize credentials, digitize vital records. and we've kind of pushed this to centralized method of doing that. But I don't think there is.
Ivan: The the conversation is ready yet for which standards should prevail. Kind of across the United States and the realities. You will see stratification in different States and and what they choose. it's not. It's not one central location. Of course there will be the recommendations from the Association. so I would say, we're we're probably not Ivan: probably at least 2 years away from, you know, one standard emerging as what's going to be the the standard going forward? But until then, you know, I think for the next few years you're probably just going to continue to see pilots happen around the space to where that question will get answered eventually. But I don't think is answered now. Keela Shatzkin: And Ivan, do you anticipate, or maybe have nightmares about a state where Ivan: that doesn't get a Consolidated single answer, and the States go in deviating directions around their specific technical standard. Ivan: we can just hope to to come together, I guess, as a as a community, and and try to push one of them over time, which everyone kind of gets the most popular and traction is about, you know, the most secure and best for the use case, but I think the reality is, you will see stratification. It's unfortunate, but with 57 different jurisdictions. It's it's very difficult to come to one. Sarah Samis: I I will say that there is a potential role for the Federal funding aspect of vital records, jurisdictions to help steer people towards the preferred standards. so
Sarah Samis: the national pro cooperative data sharing program does provide funding for the States, and so they can Sarah Samis: attach some guidelines or requirements around the systems that share the data with the Federal Government for that program. And then the Cdc also provides data modernization funding for better record jurisdictions usually on a more discretionary basis. But should they. Sarah Samis: you know, really want to dictate more in this space. I think a a Grant Sarah Samis: opportunity would help move the industry in one direction if if there was consensus, I'm sure naps and the Cdc folks are talking about this but which is the that provides an opportunity. I don't know how whether there's a corollary and the Dmb side and whether that was even a lever on the Dmb side. But that is certainly a carrot lover that the Federal Government could help Sarah Samis: with.
Keela Shatzkin: Right. And it's interesting. I heard you mentioned. Cdc, right? So that means that there it, because Cdc. Is heavily involved in Federal standards, in in health care and other, you know, tangental health care spaces. And so there is an opportunity for some Keela Shatzkin: mandates Ivan: potentially in that slowdown, Ivan. I'm so sorry. Did I cut you off? You were going to. No, you're you're absolutely correct, and it's not just to see. I think the Department of Homeland Security is doing some work around this space as well, in terms of trying to, I guess, find Federal standards. I mean, we hope that that kind of work reports with between the Cdc. And them as well. But I guess to Mike what might just put in the chat is is going to be key. I mean, you're we are going to need to have software that's just going to work. I mean, this States care about the use case and the State cares about the outcomes. Ivan: and you know, there. If they want to interoperate with another state that has a different credential, we kind of have to make it work. and I think that's.
Ivan: I guess early on. Now that we, we can kind of predict that that's going to happen based on what's happening with drivers, licenses. I think we just have to be prepared to to support whatever whatever direction the state in the legislature goes down. Sarah Samis: Great! I just want to do a quick time check. We have about 10 min left. I don't know how much more you, Mormon, how many more use cases you have here that you should delve into before we move on to the death use case, which is the one we have the least fleshed out. So far. one more aspect of the birth use case is that the revocable credential functionality could be really applicable for birth certificates, for example, like you would, you might want to revoke the parent being able to have access to the child's Sarah Samis: for certificate once they come of legal age. so that is another functionality that we feel like really highlights. The birth use case. Keela Shatzkin: do you? Are there also complicating factors around parental Keela Shatzkin: accessibility, like, if somebody is removed? Keela Shatzkin: would that be a similar application of that use case Sarah Samis: less Sarah Samis: investigation into that aspect. But I do think that yes, some of these complicated Sarah Samis: guardianship cases could be Ivan: made easier for all involved with the verifiable credential solution. Yeah, it it might brought up guardianship. in the comments. I think that's a that's one of those. It's it's been kind of interesting and discussing like how that should or shouldn't work. Ivan: from what my understanding of my feeling now is that it? It may not be like a technical level of guardianship. But I think what you said with the revocation and reissuance is significant. This, the reality is today, and that birth certificate is the parent gets the birth certificate in a that they hold on to it regardless of what happens.
Ivan: so anything we do around guardianship is an improvement over the existing process. So this may not be an error where you need, you know, engineer, you know, a a more robust guardianship, I think just the ability to revoke and reissue is already a massive improvement over today's systems. Sarah Samis: And just to add on to what I was saying, that would apply, not just to guardianship, but to amendments and correction so often. especially with Sarah Samis: different languages being spoken, and some legacy credential or legacy vital records. there could be a lot of manual errors that require manual correction to people's names and spellings, and all that stuff. And so again, the verifiable credential, where you can easily revoke and reissue, could make that
Sarah Samis: back and forth like a lot of back and forth happens between the the supervising clerks and the issuing day to day data entry clerks because of these types of things, and the public customer has to bring in. Sarah Samis: you know, proof of all these changes all the time, and that's like a huge burden on them. One of the really interesting Sarah Samis: edge cases that was presented at the NASA's Conferences 8 in April is. There are people who are born in the Us. To
Sarah Samis: to non- citizen parents, and then go back to their home, their parents, home, country, without a burs or to they? Sarah Samis: because the parents have never fulfilled the process or been able to get the birth certificate because they're not a citizen in the same way. So then, you have an undocumented Us. Citizen in a foreign country, and the steps they have to go through to actually get the Us. Birth certificate is Sarah Samis: incredible. Very state by State often involves tons of lawyers and representation. And so, again, figuring out a, a, a verifiable credential solution would make it a lot easier for them. They're stateless people. They're they're actually like, not often eligible to even enroll in school in the foreign country that they went home to with their parents Sarah Samis: because they don't have an identity. document.
Sarah Samis: So there's a lot of benefits to the birth. Sarah Samis: certificate use case. Keela Shatzkin: Excellent.
Sarah Samis: Okay, so really, quickly, on the death use case. Sarah Samis: the issuer. Here is again the Vital Records office, generally at the Health Department. your, you know, your relative or or legal representative would be the the holder. after the deceased is gone, and then some of the Sarah Samis: verifier used cases, are include, not just government. But as we're talking about before a bunch of private sector functions, so title search companies, life insurance. that kind of stuff. And then government often hires Sarah Samis: third party services to do program integrity for benefit programs. So think about Kayla Medicaid or social security pension benefits for any local pensions for for government ex government workers and their beneficiary. So there, there's a whole industry out there that uses the death certificates to figure out when to terminate benefits. so there the that those would be some of the
Sarah Samis: verifiers for the desk. Digital Sarah Samis: verifiable credential for death certificates. Keela Shatzkin: I think. from my own experience. The the selective disclosure is super valuable here, too, because so many people don't need any detail. They just need a fact of death which I know NASA has worked on for many years. I've been engaged with that. But it's been really tricky. Just to say, Is this person, alive or not? so that they can take their appropriate follow up action. They don't need the details of related to their death, or even the date. They just need to know, like yes or no, what happened here?
Keela Shatzkin: so at that, it plays another role into that selective disclosure on the death scenario as well, and that people find death data Keela Shatzkin: to be very sensitive. Sarah Samis: That makes a lot of sense. Keela Shatzkin: it especially like causes. We think about the crisis. For example, right? Highlighting that they had a substance use issue is super sensitive data on the why they died. Sarah Samis: or like thinking back to the aids crisis in the eighties and nineties. Right? That was, that was a sensitive cause of death. Back then. as well. Sarah Samis: I think some of the exciting Sarah Samis: implementation nuances for this one is when you think about the verifiers in in the desk certificate use case. There's a lot of heavy it investment already in like Iv Sarah Samis: for these Sarah Samis: entities. And so figuring out like what makes sense to do as like standard integrations across industry fields would be, I think, some of the interesting sort of scoping and implementation next steps.
Keela Shatzkin: Excellent. And so and there's that play in the middle again in terms of generating the death certificate, where a medically verified person had to submit. The reason for that. The certifier used case that we talked about applies to either a birth or desk, or if it gets Keela Shatzkin: excellent. Keela Shatzkin: does anyone have any questions as we come to the end of our session here.
Sarah Samis: Ivan, do you have anything else to add on the desk. Use case. Ivan: No, I think it's I think it's pretty straightforward. I I think the one thing about death certificates is that we're Ivan: what we've seen is longer Ivan: like times to delivery in terms of the death certificates as well like, you know, in certain States, taking weeks or months to to process those. so I think, just from an operational standpoint. there is a a pretty intense emphasis on
Ivan: making those processes more efficient which is significant. Sarah Samis: And the certifier used case would play heavily into that Keela Shatzkin: timeliness for the death certificate as well. Right? Right? Absolutely Keela Shatzkin: okay, excellent. I think this has been really wonderful, very, very
Keela Shatzkin: critical to the conversations we've been having here in this community. And so we hope that we'll be able to connect with you guys again in the near term future. because I think there's a huge overlap in in sort of what Cardi is focused on, and from the health based credential, and how it intersects with these vital stats credentials. Keela Shatzkin: So I found this very interesting that this is quite possibly one of the best meetings we've had. Most informative. Sarah Samis: Yeah. And we recorded it. Keela Shatzkin: It was spot on so very, very, very relevant for what we've been working on. And I really appreciate what you've done. I took a couple of screenshots from the of the interesting deck Sarah Samis: pictures. I don't know if that's okay to put in the meeting notes, and maybe there, we can just give you the whole deck a Pdf. Of the whole deck, too. And then We'll put a link to that use case document that I was talking about as well. and I don't know I mean anything else you can think of. We should add, based on this conversation.
Ivan: You there's something the the Cdc use is every time of these Ivan: did just bear in mind that is supposed to be a generalizable one across all 57 jurisdictions, and they all have nuances to that. All of them Keela Shatzkin: see the future and interacting in some of these spaces. So again, huge. Thank you to both of you. Really appreciate your time. I hope we will help you back soon. Sarah Samis: definitely Keela Shatzkin: and hopefully. Everybody has a wonderful day. I took a lot of notes. People are welcome to go. Read them. If you have any corrections, feel free and we will talk to you all soon. In 2 weeks is our next meeting, June 20 s. We'll be sending out some notes on what to expect in that meeting. Mike Ebert (Indicio): Excellent.