Abstract
The availability of health data for learning on a global scale seems to be what most actors engaged in the digitalization of society would like to see. Different views regarding how to achieve this state of affairs are, however, emerging. In an attempt to stimulate a discussion on alternative paths forward, this chapter juxtaposes the governance arrangement of today’s state-based health information exchanges (HIEs) with that of a potential decentralized (blockchain-based) HIE scenario. Based on interviews with individuals involved in the health care field, we outline some questions regarding the ability of current HIEs as well as completely decentralized (blockchain-based) infrastructures to enable the desired level of global data exchange. We conclude that a combination of decentralization and new forms of centralization will characterize the infrastructures of the future, be they blockchain based or not. Much effort will be required to reach agreement regarding how these infrastructures and governance models will best serve the interests of individuals, society, and humanity alike.