Blockchain Technology in Healthcare: A Systematic Review

The case for establishing a blockchain research and development program at an academic medical center

Objective

To develop a research and development program to study factors that will support research, education and innovation using blockchain technology for health in an effective and sustainable manner. We proposed to conduct qualitative research to generate insights for developing a market strategy to build a research lab for the promotion of blockchain technologies in health in academic environments. The team aimed to identify the key barriers and opportunities for developing a sustainable research lab that generates research, education, and application of blockchain in healthcare at an academic medical institution and test those strategies in a real-world scenario.

Methods

The research team identified potential customers and stakeholders through interviews and snowball sampling. The team conducted semi-structured interviews with 4 faculty researchers, 10 industry leaders, and 6 students from a variety of disciplines and organizations. The findings of these research activities informed our understanding of the needs of stratified customers and helped identify key assets and activities the lab will have to offer to meet those needs.

Results

The research insights from data analysis were used to build the business model for establishing a blockchain in health impact lab. This systematic study of areas where blockchain technology can impact health will guide the future development of research agenda for the researchers on campus.

Conclusion

Based on our learnings, we hope to design a Blockchain in Health Impact Lab to serve as a platform for students and faculty to come together with industry partners and explore current challenges of blockchain in healthcare. The academic medical center's partnership with other healthcare providers will help create real-world opportunities to demonstrate and implement new technologies.

Emerging Challenges and Opportunities in Pharmaceutical Manufacturing and Distribution

The rise of personalised and highly complex drug product profiles necessitates significant advancements in pharmaceutical manufacturing and distribution. Efforts to develop more agile, responsive, and reproducible manufacturing processes are being combined with the application of digital tools for seamless communication between process units, plants, and distribution nodes. In this paper, we discuss how novel therapeutics of high-specificity and sensitive nature are reshaping well-established paradigms in the pharmaceutical industry. We present an overview of recent research directions in pharmaceutical manufacturing and supply chain design and operations. We discuss topical challenges and opportunities related to small molecules and biologics, dividing the latter into patient- and non-specific. Lastly, we present the role of process systems engineering in generating decision-making tools to assist manufacturing and distribution strategies in the pharmaceutical sector and ultimately embrace the benefits of digitalised operations.

A Quantitative and Qualitative Review on the Main Research Streams Regarding Blockchain Technology in Healthcare

(1) Background: Blockchain technology has been gaining high popularity in the healthcare domain. This has brought about a spate of recent studies regarding blockchain technology in healthcare, creating high demand for quantitative or qualitative reviews on the main research streams thereof. In order to contribute to satisfying the high demand, this research presents a quantitative and qualitative review on studies regarding blockchain technology in healthcare. (2) Methods: A quantitative review was performed by searching the Web of Science database for articles published until 10 March in 2020, and a qualitative review was conducted by using the content analysis based on the integrative view of Leavitt’s diamond model. (3) Results: The quantitative review identified five research streams. The number of articles about blockchain technology in healthcare has dramatically increased since 2016, with a compound annual growth rate of 254.4%. English is the most dominant language used in the articles, and the USA and China are the top two countries of origin of the articles, representing overwhelming portions. The IEEE Access, Journal of Medical Systems, Journal of Medical Internet Research, Applied Sciences Basel, and Sensors are the top five journals in terms of publication. The articles showed an L-shaped distribution in terms of their annual average numbers of citations. The qualitative review revealed two research streams. Most of the top 10 articles ranked by their annual average numbers of citations concentrated on developing or proposing new technological solutions using blockchain technology to effectively revolutionize the current methods of managing data in the healthcare domain. The majority of the top 10 articles pursued the convergence of blockchain technology with cloud technology or IoT. (4) Conclusions: This article illuminates the main research streams about blockchain technology in healthcare through a quantitative and qualitative review, providing implications for future research on blockchain technology.

The Impact of COVID-19 Lockdown on People With Epilepsy and Vagal Nerve Stimulation

Objectives: Restrictive measures adopted during the COVID-19 pandemic, in order to limit contagion, have had a severe impact on mental health. The burden of lockdown has been particularly heavy on patients with chronic neurologic diseases such as People with Epilepsy (PwE). Our survey aims to describe the struggles and needs of Drug-Resistant (DR) PwE with implanted Vagal Nerve Stimulator (VNS) during the first wave of the COVID-19 lockdown in order to find strategies that help patients cope with present or future periods of restriction. Methods: We collected answers from 30 respondents who underwent an online survey including socio-demographic and clinical information and COVID-19-related information. Depression, anxiety symptoms, and sleep quality were investigated in patients through BDI II, GAD-7, and the PSQI scale. Results: In all, 46% of our sample reported an increase in the number of seizures; the entire sample complained of epilepsy-related issues (medication availability, VSN adjustments, anxiety, sleep disturbance); one out of three participants reported major epilepsy issues felt urgent; 30% had to postpone scheduled examination. Significantly higher scores for depression and anxiety scales were found in patients who perceived seizure frequency worsening and reported major epilepsy-related issues. Conclusion: Preliminary findings showed that the first lockdown influenced the clinical and psychological status of PwE and was related to seizures worsening. The lack of medical assistance and control on VNS therapy left patients to cope with the situation without a chance to contact a specialist. We discuss how a wider implementation of telemedicine programs could facilitate remote assistance of PwE with a VNS implant.

A Systematic Review of Blockchain for Consent Management

Blockchain technology was introduced through Bitcoin in a 2008 whitepaper by the mysterious Satoshi Nakamoto. Since its inception, it has gathered great attention because of its unique properties—immutability and decentralized authority. This technology is now being implemented in various fields such as healthcare, IoT, data management, etc., apart from cryptocurrencies. As it is a newly emerging technology, researchers and organizations face many challenges in integrating this technology into other fields. Consent management is one of the essential processes in an organization because of the ever-evolving privacy laws, which are introduced to provide more control to users over their data. This paper is a systematic review of Blockchain’s application in the field of consent and privacy data management. The review discusses the adaptation of Blockchain in healthcare, IoT, identity management, and data storage. This analysis is formed on the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and a process of systematic mapping review. We provide analysis of the development, challenges, and limitations of blockchain technology for consent management.

Blockchain and AI-Based Solutions to Combat Coronavirus (COVID-19)-Like Epidemics: A Survey

The beginning of 2020 has seen the emergence of coronavirus outbreak caused by a novel virus called SARS-CoV-2. The sudden explosion and uncontrolled worldwide spread of COVID-19 show the limitations of existing healthcare systems in timely handling public health emergencies. In such contexts, innovative technologies such as blockchain and Artificial Intelligence (AI) have emerged as promising solutions for fighting coronavirus epidemic. In particular, blockchain can combat pandemics by enabling early detection of outbreaks, ensuring the ordering of medical data, and ensuring reliable medical supply chain during the outbreak tracing. Moreover, AI provides intelligent solutions for identifying symptoms caused by coronavirus for treatments and supporting drug manufacturing. Therefore, we present an extensive survey on the use of blockchain and AI for combating COVID-19 epidemics. First, we introduce a new conceptual architecture which integrates blockchain and AI for fighting COVID-19. Then, we survey the latest research efforts on the use of blockchain and AI for fighting COVID-19 in various applications. The newly emerging projects and use cases enabled by these technologies to deal with coronavirus pandemic are also presented. A case study is also provided using federated AI for COVID-19 detection. Finally, we point out challenges and future directions that motivate more research efforts to deal with future coronavirus-like epidemics.

Blockchain as an Approach for Secure Data Storage on Digital Consulting Platforms

This chapter examines the concept of data security in a society increasingly shaped by digital technologies. We show how secure data storage can be optimised regarding digital documentation in the implementation of health-related service offers based on established procedures. Security and privacy of data are therefore particularly important in this subject area since highly sensitive data is stored and processed during health-related online consultations. The advent of blockchain technology provides a valuable opportunity to create trust in digital platforms. After relevant concepts and terms have been clarified, the functionality of the blockchain in general, as well as the different types, will be discussed. From this, options for the use of online consulting are developed and illustrated on the basis of three use cases.

A Blockchain-Based Consent Platform for Active Assisted Living: Modeling Study and Conceptual Framework

BACKGROUND

Recent advancements in active assisted living (AAL) technologies allow older adults to age well in place. However, sensing technologies increase the complexity of data collection points, making it difficult for users to consent to data collection. One possible solution for improving transparency in the consent management process is the use of blockchain, an immutable and timestamped ledger.

OBJECTIVE

This study aims to provide a conceptual framework based on technology aimed at mitigating trust issues in the consent management process.

METHODS

The consent management process was modeled using established methodologies to obtain a mapping of trust issues. This mapping was then used to develop a conceptual framework based on previous monitoring and surveillance architectures for connected devices.

RESULTS

In this paper, we present a model that maps trust issues in the informed consent process; a conceptual framework capable of providing all the necessary underlining technologies, components, and functionalities required to develop applications capable of managing the process of informed consent for AAL, powered by blockchain technology to ensure transparency; and a diagram showing an instantiation of the framework with entities comprising the participants in the blockchain network, suggesting possible technologies that can be used.

CONCLUSIONS

Our conceptual framework provides all the components and technologies that are required to enhance the informed consent process. Blockchain technology can help overcome several privacy challenges and mitigate trust issues that are currently present in the consent management process of data collection involving AAL technologies.

High-Level Design and Rapid Implementation of a Clinical and Non-clinical Blockchain-Based Data Sharing Platform for COVID-19 Containment

As the world has moved toward rigorous containment measures due to the spread of a novel coronavirus, it is crucial to push the boundaries of clinical data obtaining methods using real-time capturing facilities. During this time of crisis, data-centric technologies that could provide authenticity and immediate access to patient data are essential. A blockchain-based digital health protocol for access to real-time data with user-centric data protection measures can achieve these aims. Immediate and secure access to biomedical data can provide credible insights and also help in discovering intelligence to expediate the development of effective therapeutics. It also aids in altering policies for restrictions by extracting key insights required for modeling studies. This paper delivers a high-level design of a blockchain-based clinical research data collection and health service intervention platform, where the users can exercise control of data. This application also provides a platform to deliver technology-based interventions which would assist in streamlining aid for vulnerable users to prevent the NHS from being overwhelmed. Further steps are also recommended to achieve a data compliant solution for rapid deployment, based on available resources, allowing a collaborative effort, which is extremely necessary at times of such crisis.

A Review on Blockchain for the Internet of Medical Things: Definitions, Challenges, Applications, and Vision

Nowadays, there are a lot of new mobile devices that have the potential to assist healthcare professionals when working and help to increase the well-being of the people. These devices comprise the Internet of Medical Things, but it is generally difficult for healthcare institutions to meet compliance of their systems with new medical solutions efficiently. A technology that promises the sharing of data in a trust-less scenario is the Distributed Ledger Technology through its properties of decentralization, immutability, and transparency. The Blockchain and the Internet of Medical Things can be considered as at an early stage, and the implementations successfully applying the technology are not so many. Some aspects covered by these implementations are data sharing, interoperability of systems, security of devices, the opportunity of data monetization and data ownership that will be the focus of this review. This work aims at giving an overview of the current state-of-the-art of the Blockchain-based systems for the Internet of Medical Things, specifically addressing the challenges of reaching user-centricity for these combined systems, and thus highlighting the potential future directions to follow for full ownership of data by users.

HealthyBlock: Blockchain-Based IT Architecture for Electronic Medical Records Resilient to Connectivity Failures

The current information systems for the registration and control of electronic medical records (EMR) present a series of problems in terms of the fragmentation, security, and privacy of medical information, since each health institution, laboratory, doctor, etc. has its own database and manages its own information, without the intervention of patients. This situation does not favor effective treatment and prevention of diseases for the population, due to potential information loss, misinformation, or data leaks related to a patient, which in turn may imply a direct risk for the individual and high public health costs for governments. One of the proposed solutions to this problem has been the creation of electronic medical record (EMR) systems using blockchain networks; however, most of them do not take into account the occurrence of connectivity failures, such as those found in various developing countries, which can lead to failures in the integrity of the system data. To address these problems, HealthyBlock is presented in this paper as an architecture based on blockchain networks, which proposes a unified electronic medical record system that considers different clinical providers, with resilience in data integrity during connectivity failure and with usability, security, and privacy characteristics. On the basis of the HealthyBlock architecture, a prototype was implemented for the care of patients in a network of hospitals. The results of the evaluation showed high efficiency in keeping the EMRs of patients unified, updated, and secure, regardless of the network clinical provider they consult.

Combating Health Care Fraud and Abuse: Conceptualization and Prototyping Study of a Blockchain Antifraud Framework

BACKGROUND

An estimated US $2.6 billion loss is attributed to health care fraud and abuse. With traditional health care claims verification and reimbursement, the health care provider submits a claim after rendering services to a patient, which is then verified and reimbursed by the payer. However, this process leaves out a critical stakeholder: the patient for whom the services are actually rendered. This lack of patient participation introduces a risk of fraud and abuse. Blockchain technology enables secure data management with transparency, which could mitigate this risk of health care fraud and abuse.

OBJECTIVE

The aim of this study is to develop a framework using blockchain to record claims data and transactions in an immutable format and to enable the patient to act as a validating node to help detect and prevent health care fraud and abuse.

METHODS

We developed a health care fraud and abuse blockchain technical framework and prototype using key blockchain tools and application layers including consensus algorithms, smart contracts, tokens, and governance based on digital identity on the Ethereum platform (Ethereum Foundation).

RESULTS

Our technical framework maps to the claims adjudication process and focuses on Medicare claims, with the US Centers for Medicare and Medicaid Services (CMS) as the central authority. A prototype of the framework system was developed using the blockchain platform Ethereum (Ethereum Foundation), with its design features, workflow, smart contract functions, system architecture, and software implementation outlined. The software stack used to build the system consisted of a front-end user interface framework, a back-end processing server, and a blockchain network. React was used for the user interface framework, and NodeJS and an Express server were used for the back-end processing server; Solidity was the smart contract language used to interact with a local Ethereum blockchain network.

CONCLUSIONS

The proposed framework and the initial prototype have the potential to improve the health care claims process by using blockchain technology for secure data storage and consensus mechanisms, which make the claims adjudication process more patient-centric for the purposes of identifying and preventing health care fraud and abuse. Future work will focus on the use of synthetic or historic CMS claims data to assess the real-world viability of the framework.

Recommendations for enhancing the usability and understandability of process mining in healthcare

Healthcare organizations are confronted with challenges including the contention between tightening budgets and increased care needs. In the light of these challenges, they are becoming increasingly aware of the need to improve their processes to ensure quality of care for patients. To identify process improvement opportunities, a thorough process analysis is required, which can be based on real-life process execution data captured by health information systems. Process mining is a research field that focuses on the development of techniques to extract process-related insights from process execution data, providing valuable and previously unknown information to instigate evidence-based process improvement in healthcare. However, despite the potential of process mining, its uptake in healthcare organizations outside case studies in a research context is rather limited. This observation was the starting point for an international brainstorm seminar. Based on the seminar's outcomes and with the ambition to stimulate a more widespread use of process mining in healthcare, this paper formulates recommendations to enhance the usability and understandability of process mining in healthcare. These recommendations are mainly targeted towards process mining researchers and the community to consider when developing a new research agenda for process mining in healthcare. Moreover, a limited number of recommendations are directed towards healthcare organizations and health information systems vendors, when shaping an environment to enable the continuous use of process mining.

The Current State of Research, Challenges, and Future Research Directions of Blockchain Technology in Patient Care: Systematic Review

Background

Blockchain offers a promising new distributed technology to address the challenges of data standardization, system interoperability, security, privacy, and accessibility of medical records.

Objective

The purpose of this review is to assess the research on the use of blockchain technology for patient care and the associated challenges and to provide a research agenda for future research.

Methods

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We queried the Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, Excerpta Medica dataBASE (EMBASE), and Web of Science databases for peer-reviewed research articles published up to December 2019 that examined the implementation of blockchain technology in health care settings. We identified 800 articles from which we selected 70 empirical research articles for a detailed review.

Results

Blockchain-based patient care applications include medical information systems, personal health records, mobile health and telemedicine, data preservation systems and social networks, health information exchanges and remote monitoring systems, and medical research systems. These blockchain-based health care applications may improve patient engagement and empowerment, improve health care provider access to information, and enhance the use of health care information for medical research.

Conclusions

Blockchain health information technology (HIT) provides benefits such as ensuring data privacy and security of health data, facilitating interoperability of heterogeneous HIT systems, and improving the quality of health care outcomes. However, barriers to using blockchain technology to build HIT include security and privacy vulnerabilities, user resistance, high computing power requirements and implementation costs, inefficient consensus algorithms, and challenges of integrating blockchain with existing HIT. With 51% of the research focused on medical information systems such as electronic health record and electronic medical record, and 53% of the research focused on data security and privacy issues, this review shows that HIT research is primarily focused on the use of blockchain technologies to address the current challenges HIT faces. Although Blockchain presents significant potential for disrupting health care, most ideas are in their infancy.

Blockchain in Health Care: Hope or Hype?

There has been an increasing interest in blockchain technology from the health care sector in the last couple of years. The value proposition for using blockchain technology in the health care sector is to share sensitive patient data among health care entities securely and to empower patients. Blockchain technology allows patients to have an active role in developing and updating their own patient data. However, is blockchain technology really the silver bullet it seems to be? With this paper, we aim to understand the benefits and challenges of blockchain technology in the health care sector. We discuss innovation and security implications concerning blockchain technology in health care. Furthermore, we show that there is a need for more use cases to ensure the secure sharing of data within the health care sector. In our opinion, blockchain technology will not solve the issues encountered by the health care sector; in fact, it may raise more issues than it will solve.

Digital microbiology

BACKGROUND

Digitalization and artificial intelligence have an important impact on the way microbiology laboratories will work in the near future. Opportunities and challenges lie ahead to digitalize the microbiological workflows. Making efficient use of big data, machine learning, and artificial intelligence in clinical microbiology requires a profound understanding of data handling aspects.

OBJECTIVE

This review article summarizes the most important concepts of digital microbiology. The article gives microbiologists, clinicians and data scientists a viewpoint and practical examples along the diagnostic process.

SOURCES

We used peer-reviewed literature identified by a PubMed search for digitalization, machine learning, artificial intelligence and microbiology.

CONTENT

We describe the opportunities and challenges of digitalization in microbiological diagnostic processes with various examples. We also provide in this context key aspects of data structure and interoperability, as well as legal aspects. Finally, we outline the way for applications in a modern microbiology laboratory.

IMPLICATIONS

We predict that digitalization and the usage of machine learning will have a profound impact on the daily routine of laboratory staff. Along the analytical process, the most important steps should be identified, where digital technologies can be applied and provide a benefit. The education of all staff involved should be adapted to prepare for the advances in digital microbiology.

E-Health in Hypertension Management: an Insight into the Current and Future Role of Blood Pressure Telemonitoring

PURPOSE OF REVIEW

Out-of-office blood pressure (BP) monitoring techniques, including home and ambulatory BP monitoring, are currently recommended by hypertension guidelines worldwide to confirm the diagnosis of hypertension and to monitor the appropriateness of treatment. However, such techniques are not always effectively implemented or timely available in the routine clinical practice. In recent years, the widespread availability of e-health solutions has stimulated the development of blood pressure telemonitoring (BPT) systems, which allow remote BP tracking and tighter and more efficient monitoring of patients' health status.

RECENT FINDINGS

There is currently strong evidence that BPT may be of benefit for hypertension screening and diagnosis and for improving hypertension management. The advantage is more significant when BPT is coupled with multimodal interventions involving a physician, a nurse or pharmacist, and including education on lifestyle and risk factors and drug management. Several randomized controlled studies documented enhanced hypertension management and improved BP control of hypertensive patients through BPT. Potential additional effects of BPT are represented by improved compliance to treatment, intensification, and optimization of drug use, improved quality of life, reduction in risk of developing cardiovascular complications, and cost-saving. Applications based on m-health and making use of wearables or smartwatches integrated with machine learning models are particularly promising for the future development of efficient BPT solutions, and they will provide remarkable support decision tools for doctors. BPT and telehealth will soon disrupt hypertension management. However, which approach will be the most effective and whether it will be sustainable in the long-term still need to be elucidated.

Blockchain Technology: Principles and Applications in Medical Imaging

Blockchain is an immutable, encrypted, distributed ledger technology. While initially devised for and most commonly referenced with cryptocurrencies, there are an increasing number of applications outside finance, many of which are relevant to medical imaging. In this paper, the concepts and principles underlying the technology and applications relevant to medical imaging are discussed, in addition to potential challenges with implementations such as public versus private key access, distributed ledger size constraints, speed, complexity, and security pitfalls. Potential use cases for blockchain specifically relevant to medical imaging include image sharing including direct patient ownership of images, tracking of implanted medical devices, research, teleradiology, and artificial intelligence. While blockchain offers exciting ways to facilitate the storage and distribution of medical images, similar to the advent of picture archiving and communication systems decades ago, it does have several key limitations of which healthcare providers of medical imaging and imaging informatics professionals should be aware.

Blockchain-Based Healthcare Workflow for Tele-Medical Laboratory in Federated Hospital IoT Clouds

In a pandemic situation such as that we are living at the time of writing of this paper due to the Covid-19 virus, the need of tele-healthcare service becomes dramatically fundamental to reduce the movement of patients, thence reducing the risk of infection. Leveraging the recent Cloud computing and Internet of Things (IoT) technologies, this paper aims at proposing a tele-medical laboratory service where clinical exams are performed on patients directly in a hospital by technicians through IoT medical devices and results are automatically sent via the hospital Cloud to doctors of federated hospitals for validation and/or consultation. In particular, we discuss a distributed scenario where nurses, technicians and medical doctors belonging to different hospitals cooperate through their federated hospital Clouds to form a virtual health team able to carry out a healthcare workflow in secure fashion leveraging the intrinsic security features of the Blockchain technology. In particular, both public and hybrid Blockchain scenarios are discussed and assessed using the Ethereum platform.

Engineering Approaches for Addressing Opioid Use Disorder in the Community

Many communities in the United States are struggling to deal with the negative consequences of illicit opioid use. Effectively addressing this epidemic requires the coordination and support of community stakeholders in a change process with common goals and objectives, continuous engagement with individuals with opioid use disorder (OUD) through their treatment and recovery journeys, application of systems engineering principles to drive process change and sustain it, and use of a formal evaluation process to support a learning community that continuously adapts. This review presents strategies to improve OUD treatment and recovery with a focus on engineering approaches grounded in systems thinking.

Blockchain and Artificial Intelligence Technology for Novel Coronavirus Disease-19 Self-Testing

The novel coronavirus disease 2019 (COVID-19) is rapidly spreading with a rising death toll and transmission rate reported in high income countries rather than in low income countries. The overburdened healthcare systems and poor disease surveillance systems in resource-limited settings may struggle to cope with this COVID-19 outbreak and this calls for a tailored strategic response for these settings. Here, we recommend a low cost blockchain and artificial intelligence-coupled self-testing and tracking systems for COVID-19 and other emerging infectious diseases. Prompt deployment and appropriate implementation of the proposed system have the potential to curb the transmissions of COVID-19 and the related mortalities, particularly in settings with poor access to laboratory infrastructure.

Big data in digital healthcare: lessons learnt and recommendations for general practice

Big Data will be an integral part of the next generation of technological developments-allowing us to gain new insights from the vast quantities of data being produced by modern life. There is significant potential for the application of Big Data to healthcare, but there are still some impediments to overcome, such as fragmentation, high costs, and questions around data ownership. Envisioning a future role for Big Data within the digital healthcare context means balancing the benefits of improving patient outcomes with the potential pitfalls of increasing physician burnout due to poor implementation leading to added complexity. Oncology, the field where Big Data collection and utilization got a heard start with programs like TCGA and the Cancer Moon Shot, provides an instructive example as we see different perspectives provided by the United States (US), the United Kingdom (UK) and other nations in the implementation of Big Data in patient care with regards to their centralization and regulatory approach to data. By drawing upon global approaches, we propose recommendations for guidelines and regulations of data use in healthcare centering on the creation of a unique global patient ID that can integrate data from a variety of healthcare providers. In addition, we expand upon the topic by discussing potential pitfalls to Big Data such as the lack of diversity in Big Data research, and the security and transparency risks posed by machine learning algorithms.

Overcoming Alzheimer's Disease Stigma by Leveraging Artificial Intelligence and Blockchain Technologies

Alzheimer's disease (AD) imposes a considerable burden on those diagnosed. Faced with a neurodegenerative decline for which there is no effective cure or prevention method, sufferers of the disease are subject to judgement, both self-imposed and otherwise, that can have a great deal of effect on their lives. The burden of this stigma is more than just psychological, as reluctance to face an AD diagnosis can lead people to avoid early diagnosis, treatment, and research opportunities that may be beneficial to them, and that may help progress towards fighting AD and its progression. In this review, we discuss how recent advents in information technology may be employed to help fight this stigma. Using artificial intelligence (AI) technologies, specifically natural language processing (NLP), to classify the sentiment and tone of texts, such as those of online posts on various social media sites, has proven to be an effective tool for assessing the opinions of the general public on certain topics. These tools can be used to analyze the public stigma surrounding AD. Additionally, there is much concern among individuals that an AD diagnosis, or evidence of pre-clinical AD such as a biomarker or imaging test results, may wind up unintentionally disclosed to an entity that may discriminate against them. The lackluster security record of many medical institutions justifies this fear to an extent. Adopting more secure and decentralized methods of data transfer and storage, and giving patients enhanced ability to control their own data, such as a blockchain-based method, may help to alleviate some of these fears.

A Decentralized Peer-to-Peer Remote Health Monitoring System

Within the Internet of Things (IoT) and blockchain research, there is a growing interest in decentralizing health monitoring systems, to provide improved privacy to patients, without relying on trusted third parties for handling patients’ sensitive health data. With public blockchain deployments being severely limited in their scalability, and inherently having latency in transaction processing, there is room for researching and developing new techniques to leverage the security features of blockchains within healthcare applications. This paper presents a solution for patients to share their biomedical data with their doctors without their data being handled by trusted third party entities. The solution is built on the Ethereum blockchain as a medium for negotiating and record-keeping, along with Tor for delivering data from patients to doctors. To highlight the applicability of the solution in various health monitoring scenarios, we have considered three use-cases, namely cardiac monitoring, sleep apnoea testing, and EEG following epileptic seizures. Following the discussion about the use cases, the paper outlines a security analysis performed on the proposed solution, based on multiple attack scenarios. Finally, the paper presents and discusses a performance evaluation in terms of data delivery time in comparison to existing centralized and decentralized solutions.

Examining the Potential of Blockchain Technology to Meet the Needs of 21st-Century Japanese Health Care: Viewpoint on Use Cases and Policy

Japan is undergoing a major population health transition as its society ages, and it continues to experience low birth rates. An aging Japan will bring new challenges to its public health system, highlighted as a model for universal health coverage (UHC) around the world. Specific challenges Japan’s health care system will face include an increase in national public health expenditures, higher demand for health care services, acute need for elder and long-term care, shortage of health care workers, and disparities between health care access in rural versus urban areas. Blockchain technology has the potential to address some of these challenges, but only if a health blockchain is conceptualized, designed, localized, and deployed in a way that is compatible with Japan’s centralized UHC-centric public health system. Blockchain solutions must also be adaptive to opportunities and barriers unique to Japan’s national health and innovation policy, including its regulatory sandbox system, while also seeking to learn from blockchain adoption in the private sector and in other countries. This viewpoint outlines the major opportunities and potential challenges to blockchain adoption for the future of Japan’s health care.

A Blockchain-Based Smart Contract System for Healthcare Management

Blockchain is evolving to be a secure and reliable platform for secure data sharing in application areas such as the financial sector, supply chain management, food industry, energy sector, internet of things and healthcare. In this paper, we review existing literature and applications available for the healthcare system using blockchain technology. Besides, this work also proposes multiple workflows involved in the healthcare ecosystem using blockchain technology for better data management. Different medical workflows have been designed and implemented using the ethereum blockchain platform which involves complex medical procedures like surgery and clinical trials. This also includes accessing and managing a large amount of medical data. Within the implementation of the workflows of the medical smart contract system for healthcare management, the associated cost has been estimated for this system in terms of a feasibility study which has been comprehensively presented in this paper. This work would facilitate multiple stakeholders who are involved within the medical system to deliver better healthcare services and optimize cost.

Opinions on Sustainability of Smart Cities in the Context of Energy Challenges Posed by Cryptocurrency Mining

Next to climate change on the list of challenges faced by humankind in today’s technological age is energy management. While “smart” ideas continue to gather momentum as some of the ways earmarked to combat the menace of a changing climate, coupled with efficient management of energy, research and development in the blockchain is not retracting, recently giving rise to digital currencies capable of fueling massive energy consumption via mining of “crypto-coins”. Given that sustainability is a crucial goal in the design of smart cities nowadays, there are currently no assurances of sustainable cities where cryptocurrency mining is at full scale. Nevertheless, alternative energy sources may come to the rescue in no distant time. In this paper, we contextualize energy-use in smart cities through mining of virtual currencies, in order to predict whether or not smart cities can truly be sustainable if crypto-mining is sustained. An attempt is also made to emphasize the possible ways of reducing energy use and all activities involving digital currencies by seeking to replace “Proof of Work” (PoW) with improved alternatives.

Blockchain: Current Challenges and Future Prospects/Applications

Blockchain is a new technology, often referred to as the Internet of Value. As with all new technologies, there is no consensus on its potential value, with some people claiming that it will bring more disruptive changes than the Internet and others contesting the extent of its importance. Despite predictions that the future is perilous, there is evidence that blockchain is a remarkable, new technology that will change the way transactions are made, based on its ability to guarantee trust among unknown actors, assure the immutability of records, while also making intermediaries obsolete. The importance of blockchain can be confirmed by the interest in digital currencies, the great number of published blockchain papers, as well as MDPI’s journal Future Internet which exclusively publishes blockchain articles, including this special issue covering present and future blockchain challenges. This paper is a survey of the fast growing field of blockchain, discussing its advantages and possible drawbacks and their implications for the future of the Internet and our personal lives and societies in general. The paper consists of the following parts; the first provides a general introduction and discusses the disruptive changes initiated by blockchain, the second discusses the unique value of blockchain and its general characteristics, the third presents an overview of industries with the greatest potential for disruptive changes, the forth describes the four major blockchain applications with the highest prospective advantages, and the fifth part of the paper ends with a discussion on the most notable subset of innovative blockchain applications—Smart Contracts, DAOs (Decentralized Autonomous Organizations) and super safe networks—and their future implications. There is also a concluding section, which summarizes the paper, describes the future of blockchain, and mentions the challenges to be overcome.

Blockchain-Enabled iWellChain Framework Integration With the National Medical Referral System: Development and Usability Study

Background

Medical referral is the transfer of a patient’s care from one physician to another upon request. This process involves multiple steps that require provider-to-provider and provider-to-patient communication. In Taiwan, the National Health Insurance Administration (NHIA) has implemented a national medical referral (NMR) system, which encourages physicians to refer their patients to different health care facilities to reduce unnecessary hospital visits and the financial stress on the national health insurance. However, the NHIA’s NMR system is a government-based electronic medical referral service, and its referral data access and exchange are limited to authorized clinical professionals using their national health smart cards over the NHIA virtual private network. Therefore, this system lacks scalability and flexibility and cannot establish trusting relationships among patients, family doctors, and specialists.

Objective

To eliminate the existing restrictions of the NHIA’s NMR system, this study developed a scalable, flexible, and blockchain-enabled framework that leverages the NHIA’s NMR referral data to build an alliance-based medical referral service connecting health care facilities.

Methods

We developed a blockchain-enabled framework that can integrate patient referral data from the NHIA’s NMR system with electronic medical record (EMR) and electronic health record (EHR) data of hospitals and community-based clinics to establish an alliance-based medical referral service serving patients, clinics, and hospitals and improve the trust in relationships and transaction security. We also developed a blockchain-enabled personal health record decentralized app (DApp) based on our blockchain-enabled framework for patients to acquire their EMR and EHR data; DApp access logs were collected to assess patients’ behavior and investigate the acceptance of our personal authorization-controlled framework.

Results

The constructed iWellChain Framework was installed in an affiliated teaching hospital and four collaborative clinics. The framework renders all medical referral processes automatic and paperless and facilitates efficient NHIA reimbursements. In addition, the blockchain-enabled iWellChain DApp was distributed for patients to access and control their EMR and EHR data. Analysis of 3 months (September to December 2018) of access logs revealed that patients were highly interested in acquiring health data, especially those of laboratory test reports.

Conclusions

This study is a pioneer of blockchain applications for medical referral services, and the constructed framework and DApp have been applied practically in clinical settings. The iWellChain Framework has the scalability to deploy a blockchain environment effectively for health care facilities; the iWellChain DApp has potential for use with more patient-centered applications to collaborate with the industry and facilitate its adoption.

Benefits of Blockchain Initiatives for Value-Based Care: Proposed Framework

Background

The potential of blockchain technology to achieve strategic goals, such as value-based care, is increasingly being recognized by both researchers and practitioners. However, current research and practices lack comprehensive approaches for evaluating the benefits of blockchain applications.

Objective

The goal of this study was to develop a framework for holistically assessing the performance of blockchain initiatives in providing value-based care by extending the existing balanced scorecard (BSC) evaluation framework.

Methods

Based on a review of the literature on value-based health care, blockchain technology, and methods for evaluating initiatives in disruptive technologies, we propose an extended BSC method for holistically evaluating blockchain applications in the provision of value-based health care. The proposed method extends the BSC framework, which has been extensively used to measure both financial and nonfinancial performance of organizations. The usefulness of our proposed framework is further demonstrated via a case study.

Results

We describe the extended BSC framework, which includes five perspectives (both financial and nonfinancial) from which to assess the appropriateness and performance of blockchain initiatives in the health care domain.

Conclusions

The proposed framework moves us toward a holistic evaluation of both the financial and nonfinancial benefits of blockchain initiatives in the context of value-based care and its provision.

Beyond Genes: Re-Identifiability of Proteomic Data and Its Implications for Personalized Medicine

The increasing availability of high throughput proteomics data provides us with opportunities as well as posing new ethical challenges regarding data privacy and re-identifiability of participants. Moreover, the fact that proteomics represents a level between the genotype and the phenotype further exacerbates the situation, introducing dilemmas related to publicly available data, anonymization, ownership of information and incidental findings. In this paper, we try to differentiate proteomics from genomics data and cover the ethical challenges related to proteomics data sharing. Finally, we give an overview of the proposed solutions and the outlook for future studies.

Enabling the Internet of Mobile Crowdsourcing Health Things: A Mobile Fog Computing, Blockchain and IoT Based Continuous Glucose Monitoring System for Diabetes Mellitus Research and Care

Diabetes patients suffer from abnormal blood glucose levels, which can cause diverse health disorders that affect their kidneys, heart and vision. Due to these conditions, diabetes patients have traditionally checked blood glucose levels through Self-Monitoring of Blood Glucose (SMBG) techniques, like pricking their fingers multiple times per day. Such techniques involve a number of drawbacks that can be solved by using a device called Continuous Glucose Monitor (CGM), which can measure blood glucose levels continuously throughout the day without having to prick the patient when carrying out every measurement. This article details the design and implementation of a system that enhances commercial CGMs by adding Internet of Things (IoT) capabilities to them that allow for monitoring patients remotely and, thus, warning them about potentially dangerous situations. The proposed system makes use of smartphones to collect blood glucose values from CGMs and then sends them either to a remote cloud or to distributed fog computing nodes. Moreover, in order to exchange reliable, trustworthy and cybersecure data with medical scientists, doctors and caretakers, the system includes the deployment of a decentralized storage system that receives, processes and stores the collected data. Furthermore, in order to motivate users to add new data to the system, an incentive system based on a digital cryptocurrency named GlucoCoin was devised. Such a system makes use of a blockchain that is able to execute smart contracts in order to automate CGM sensor purchases or to reward the users that contribute to the system by providing their own data. Thanks to all the previously mentioned technologies, the proposed system enables patient data crowdsourcing and the development of novel mobile health (mHealth) applications for diagnosing, monitoring, studying and taking public health actions that can help to advance in the control of the disease and raise global awareness on the increasing prevalence of diabetes.

A Review on the Role of Blockchain Technology in the Healthcare Domain

Recently, there have been increasing calls for healthcare providers to provide controls for patients over their personal health records. Nevertheless, security issues concerning how different healthcare providers exchange healthcare information have caused a flop in the deployment of such systems. The ability to exchange data securely is important so that new borderless integrated healthcare services can be provided to patients. Due to its decentralized nature, blockchain technology is a suitable driver for the much-needed shift towards integrated healthcare, providing new insights and addressing some of the main challenges of many healthcare areas. Blockchain allows healthcare providers to record and manage peer-to-peer transactions through a network without central authority. In this paper, we discuss the concept of blockchain technology and hurdles in their adoption in the healthcare domain. Furthermore, a review is conducted on the latest implementations of blockchain technology in healthcare. Finally, a new case study of a blockchain-based healthcare platform is presented addressing the drawbacks of current designs, followed by recommendations for future blockchain researchers and developers.