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Arif A, Hussain M, Subbe CP. Blockchain: What is the use case for physicians in 2024? A rapid review of the literature. Future Healthc J 2024; 11:100005. [PMID: 38646049 PMCID: PMC11025056 DOI: 10.1016/j.fhj.2024.100005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Blockchain is topical in many areas of science. The impact on clinical care of physicians is not known. We undertook a rapid review of the literature to identify areas of interest for clinicians in active practice focusing on evidence relevant to clinical care. We found limited evidence for use blockchain in clinical practice with most studies focusing on technical aspects of prototypes and implementation with no evidence of standardised metric to measure impact for patients, clinicians, and organisations. Personal Health Records for use across organisational and geographic boundaries emerged as the strongest clinical use-case. Defined metrics by professional bodies might aid research, development, and future impact.
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Affiliation(s)
- Aqib Arif
- Department of Medicine Ysbyty Gwynedd, Bangor, UK
| | | | - Christian P Subbe
- Department of Medicine Ysbyty Gwynedd, Bangor, UK
- School of Medical Sciences, Bangor University, Bangor, UK
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Wu TC, Ho CTB. Blockchain Revolutionizing in Emergency Medicine: A Scoping Review of Patient Journey through the ED. Healthcare (Basel) 2023; 11:2497. [PMID: 37761695 PMCID: PMC10530815 DOI: 10.3390/healthcare11182497] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Blockchain technology has revolutionized the healthcare sector, including emergency medicine, by integrating AI, machine learning, and big data, thereby transforming traditional healthcare practices. The increasing utilization and accumulation of personal health data also raises concerns about security and privacy, particularly within emergency medical settings. METHOD Our review focused on articles published in databases such as Web of Science, PubMed, and Medline, discussing the revolutionary impact of blockchain technology within the context of the patient journey through the ED. RESULTS A total of 33 publications met our inclusion criteria. The findings emphasize that blockchain technology primarily finds its applications in data sharing and documentation. The pre-hospital and post-discharge applications stand out as distinctive features compared to other disciplines. Among various platforms, Ethereum and Hyperledger Fabric emerge as the most frequently utilized options, while Proof of Work (PoW) and Proof of Authority (PoA) stand out as the most commonly employed consensus algorithms in this emergency care domain. The ED journey map and two scenarios are presented, exemplifying the most distinctive applications of emergency medicine, and illustrating the potential of blockchain. Challenges such as interoperability, scalability, security, access control, and cost could potentially arise in emergency medical contexts, depending on the specific scenarios. CONCLUSION Our study examines the ongoing research on blockchain technology, highlighting its current influence and potential future advancements in optimizing emergency medical services. This approach empowers frontline medical professionals to validate their practices and recognize the transformative potential of blockchain in emergency medical care, ultimately benefiting both patients and healthcare providers.
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Affiliation(s)
- Tzu-Chi Wu
- Institute of Technology Management, National Chung-Hsing University, Taichung 40227, Taiwan;
- Department of Emergency Medicine, Show Chwan Memorial Hospital, Changhua 500009, Taiwan
| | - Chien-Ta Bruce Ho
- Institute of Technology Management, National Chung-Hsing University, Taichung 40227, Taiwan;
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Tseng CY, Chen RJ, Tsai SY, Wu TR, Tsaur WJ, Chiu HW, Lo YS. Exploring the COVID-19 Pandemic as a Catalyst for PHR App User Behavior Change in Taiwan: A Development and Usability Study. J Med Internet Res 2021; 24:e33399. [PMID: 34951863 PMCID: PMC8734605 DOI: 10.2196/33399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background During the COVID-19 pandemic, personal health records (PHRs) have enabled patients to monitor and manage their medical data without visiting hospitals and, consequently, minimize their infection risk. Taiwan’s National Health Insurance Administration (NHIA) launched the My Health Bank (MHB) service, a national PHR system through which insured individuals to access their cross-hospital medical data. Furthermore, in 2019, the NHIA released the MHB software development kit (SDK), which enables development of mobile apps with which insured individuals can retrieve their MHB data. However, the NHIA MHB service has its limitations, and the participation rate among insured individuals is low. Objective We aimed to integrate the MHB SDK with our developed blockchain-enabled PHR mobile app, which enables patients to access, store, and manage their cross-hospital PHR data. We also collected and analyzed the app’s log data to examine patients’ MHB use during the COVID-19 pandemic. Methods We integrated our existing blockchain-enabled mobile app with the MHB SDK to enable NHIA MHB data retrieval. The app utilizes blockchain technology to encrypt the downloaded NHIA MHB data. Existing and new indexes can be synchronized between the app and blockchain nodes, and high security can be achieved for PHR management. Finally, we analyzed the app’s access logs to compare patients’ activities during high and low COVID-19 infection periods. Results We successfully integrated the MHB SDK into our mobile app, thereby enabling patients to retrieve their cross-hospital medical data, particularly those related to COVID-19 rapid and polymerase chain reaction testing and vaccination information and progress. We retrospectively collected the app’s log data for the period of July 2019 to June 2021. From January 2020, the preliminary results revealed a steady increase in the number of people who applied to create a blockchain account for access to their medical data and the number of app subscribers among patients who visited the outpatient department (OPD) and emergency department (ED). Notably, for patients who visited the OPD and ED, the peak proportions with respect to the use of the app for OPD and ED notes and laboratory test results also increased year by year. The highest proportions were 52.40% for ED notes in June 2021, 88.10% for ED laboratory test reports in May 2021, 34.61% for OPD notes in June 2021, and 41.87% for OPD laboratory test reports in June 2021. These peaks coincided with Taiwan’s local COVID-19 outbreak lasting from May to June 2021. Conclusions This study developed a blockchain-enabled mobile app, which can periodically retrieve and integrate PHRs from the NHIA MHB's cross-hospital data and the investigated hospital's self-pay medical data. Analysis of users’ access logs revealed that the COVID-19 pandemic substantially increased individuals’ use of PHRs and their health awareness with respect to COVID-19 prevention.
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Affiliation(s)
| | - Ray-Jade Chen
- Taipei Medical University, 250 Wu-Hsing Street, Taipei city, Taiwan 110, Taipei, TW
| | - Shang-Yu Tsai
- Taipei Medical University, 250 Wu-Hsing Street, Taipei city, Taiwan 110, Taipei, TW
| | | | | | - Hung-Wen Chiu
- Taipei Medical University, 250 Wu-Hsing Street, Taipei city, Taiwan 110, Taipei, TW
| | - Yu-Sheng Lo
- Taipei Medical University, 250 Wu-Hsing Street, Taipei city, Taiwan 110, Taipei, TW
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Ng WY, Tan TE, Movva PVH, Fang AHS, Yeo KK, Ho D, Foo FSS, Xiao Z, Sun K, Wong TY, Sia ATH, Ting DSW. Blockchain applications in health care for COVID-19 and beyond: a systematic review. Lancet Digit Health 2021; 3:e819-e829. [PMID: 34654686 PMCID: PMC8510632 DOI: 10.1016/s2589-7500(21)00210-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/03/2021] [Accepted: 08/16/2021] [Indexed: 01/04/2023]
Abstract
The COVID-19 pandemic has had a substantial and global impact on health care, and has greatly accelerated the adoption of digital technology. One of these emerging digital technologies, blockchain, has unique characteristics (eg, immutability, decentralisation, and transparency) that can be useful in multiple domains (eg, management of electronic medical records and access rights, and mobile health). We conducted a systematic review of COVID-19-related and non-COVID-19-related applications of blockchain in health care. We identified relevant reports published in MEDLINE, SpringerLink, Institute of Electrical and Electronics Engineers Xplore, ScienceDirect, arXiv, and Google Scholar up to July 29, 2021. Articles that included both clinical and technical designs, with or without prototype development, were included. A total of 85 375 articles were evaluated, with 415 full length reports (37 related to COVID-19 and 378 not related to COVID-19) eventually included in the final analysis. The main COVID-19-related applications reported were pandemic control and surveillance, immunity or vaccine passport monitoring, and contact tracing. The top three non-COVID-19-related applications were management of electronic medical records, internet of things (eg, remote monitoring or mobile health), and supply chain monitoring. Most reports detailed technical performance of the blockchain prototype platforms (277 [66·7%] of 415), whereas nine (2·2%) studies showed real-world clinical application and adoption. The remaining studies (129 [31·1%] of 415) were themselves of a technical design only. The most common platforms used were Ethereum and Hyperledger. Blockchain technology has numerous potential COVID-19-related and non-COVID-19-related applications in health care. However, much of the current research remains at the technical stage, with few providing actual clinical applications, highlighting the need to translate foundational blockchain technology into clinical use.
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Affiliation(s)
- Wei Yan Ng
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tien-En Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Prasanth V H Movva
- Certis Commercial and Industrial Security Corporation Security, Singapore
| | - Andrew Hao Sen Fang
- Duke-NUS Medical School, National University of Singapore, Singapore; SingHealth Polyclinics, Singapore
| | - Khung-Keong Yeo
- Duke-NUS Medical School, National University of Singapore, Singapore; National Heart Centre Singapore, Singapore
| | - Dean Ho
- Institute for Digital Medicine and Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; N.1 Institute for Health, National University of Singapore, Singapore; Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Fuji Shyy San Foo
- Certis Commercial and Industrial Security Corporation Security, Singapore
| | - Zhe Xiao
- Institute of High Performance Computing, Agency for Science, Technology and Research, Singapore
| | - Kai Sun
- Data Science Institute, Imperial College London, London, UK
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Alex Tiong-Heng Sia
- Duke-NUS Medical School, National University of Singapore, Singapore; KK Women's and Children's Hospital, Singapore
| | - Daniel Shu Wei Ting
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore.
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Xie Y, Zhang J, Wang H, Liu P, Liu S, Huo T, Duan YY, Dong Z, Lu L, Ye Z. Applications of Blockchain in the Medical Field: Narrative Review. J Med Internet Res 2021; 23:e28613. [PMID: 34533470 PMCID: PMC8555946 DOI: 10.2196/28613] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/12/2021] [Accepted: 09/10/2021] [Indexed: 02/06/2023] Open
Abstract
Background As a distributed technology, blockchain has attracted increasing attention from stakeholders in the medical industry. Although previous studies have analyzed blockchain applications from the perspectives of technology, business, or patient care, few studies have focused on actual use-case scenarios of blockchain in health care. In particular, the outbreak of COVID-19 has led to some new ideas for the application of blockchain in medical practice. Objective This paper aims to provide a systematic review of the current and projected uses of blockchain technology in health care, as well as directions for future research. In addition to the framework structure of blockchain and application scenarios, its integration with other emerging technologies in health care is discussed. Methods We searched databases such as PubMed, EMBASE, Scopus, IEEE, and Springer using a combination of terms related to blockchain and health care. Potentially relevant papers were then compared to determine their relevance and reviewed independently for inclusion. Through a literature review, we summarize the key medical scenarios using blockchain technology. Results We found a total of 1647 relevant studies, 60 of which were unique studies that were included in this review. These studies report a variety of uses for blockchain and their emphasis differs. According to the different technical characteristics and application scenarios of blockchain, we summarize some medical scenarios closely related to blockchain from the perspective of technical classification. Moreover, potential challenges are mentioned, including the confidentiality of privacy, the efficiency of the system, security issues, and regulatory policy. Conclusions Blockchain technology can improve health care services in a decentralized, tamper-proof, transparent, and secure manner. With the development of this technology and its integration with other emerging technologies, blockchain has the potential to offer long-term benefits. Not only can it be a mechanism to secure electronic health records, but blockchain also provides a powerful tool that can empower users to control their own health data, enabling a foolproof health data history and establishing medical responsibility.
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Affiliation(s)
- Yi Xie
- Department of Orthopedics Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Laboratory of Intelligent Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiayao Zhang
- Department of Orthopedics Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Laboratory of Intelligent Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Honglin Wang
- Department of Orthopedics Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Laboratory of Intelligent Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pengran Liu
- Department of Orthopedics Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Laboratory of Intelligent Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Songxiang Liu
- Department of Orthopedics Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Laboratory of Intelligent Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tongtong Huo
- Laboratory of Intelligent Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,School of Artificial Intelligence and Automation, Huazhong University of Science and Technology, Wuhan, China
| | - Yu-Yu Duan
- Laboratory of Intelligent Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei University of Chinese Medicine, Wuhan, China
| | - Zhe Dong
- Wuhan Academy of Intelligent Medicine, Wuhan, China
| | - Lin Lu
- Department of Orthopedics Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Laboratory of Intelligent Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhewei Ye
- Department of Orthopedics Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Thomson C, Beale R. Is blockchain ready for orthopaedics? A systematic review. J Clin Orthop Trauma 2021; 23:101615. [PMID: 34671546 PMCID: PMC8507193 DOI: 10.1016/j.jcot.2021.101615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION The unique attributes of distributed ledger blockchain systems including robust security, immutability, transparency, and decentralisation, make them highly suitable solutions for many healthcare-related problems. This review examines the potential applications for blockchain technology in the field of orthopaedics, by taking a systematic approach to the evolving blockchain literature and mapping potential use cases against the current needs of orthopaedic practice. METHOD A literature search was performed using Pubmed, EMBASE, OVID and the Cochrane library with the primary aim of identifying detailed accounts of blockchain solutions and use cases in healthcare. These articles were then reviewed and mapped against current orthopaedic practice to illustrate applications specific to that specialty. RESULTS One hundred and forty-one papers were identified which described case studies, simulations, or detailed proposals of blockchain solutions in healthcare. Most studies described blockchain solutions at the simulated or prototype testing phase, with only 10 case studies describing blockchains in "real-world" use. The most frequently cited use cases for blockchain technology involved the storage, security and sharing of electronic medical records. Other blockchain solutions focused on the "Internet of Things", research, COVID 19, supply chains and radiology. There were no solutions focusing specifically on orthopaedics. Many of the described blockchain solutions had considerable scope for application in orthopaedic practice however, providing the potential for greater inter-institutional collaboration, cross border data exchange, enhanced patient participation, and more robust and transparent research practices. CONCLUSION Blockchain solutions for healthcare are increasing in number and scope and have multiple applications relevant to orthopaedic practice. The orthopaedic community needs to be aware of this innovative and growing field of computer science so that surgeons can leverage the power of blockchain safely for the future of orthopaedics.
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Affiliation(s)
- Calum Thomson
- Royal Orthopaedic Hospital, (Birmingham), The Woodlands, Bristol Rd S, Northfield, Birmingham, B31 2AP, UK,Corresponding author.
| | - Russell Beale
- Advanced Interaction Group, School of Computer Science, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Tan L, Tivey D, Kopunic H, Babidge W, Langley S, Maddern G. Part 2: Blockchain technology in health care. ANZ J Surg 2020; 90:2415-2419. [PMID: 33236489 DOI: 10.1111/ans.16455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/02/2020] [Accepted: 10/31/2020] [Indexed: 11/30/2022]
Abstract
Blockchain technology is one of the many disruptive technologies of the Fourth Industrial Revolution that will irrevocably change the way we live and work. These technologies are well embedded in the areas of global finance, health care and defence, to name a few. This review focuses on the relevance of blockchain technology to health care. Blockchain technology will be the unifying platform for sharing patient data currently inaccessible due to the siloed architecture of legacy software systems, and as a result potentially be the basis for precision or individualized patient treatment. It will also strengthen digital security of sensitive patient data that is presently a lucrative target for cyber criminals. In the current COVID-19 environment, clinicians will rely more on telehealth to reduce person-to-person contact. This service can be delivered by the clinical team with confidence in the veracity of the patient data made accessible through the blockchain platform. Smart contracts written on the blockchain platform will reduce the possibility of international humanitarian aid to low- and middle-income countries being misspent. The pharmaceutical supply chain industry is adopting blockchain technology to ensure supply chain provenance. Similarly, the health insurance industry recognizes how the blockchain ecosystem can improve services to its members and expedite reimbursements to clinicians.
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Affiliation(s)
- Lorwai Tan
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - David Tivey
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia
| | - Helena Kopunic
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Wendy Babidge
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sally Langley
- Plastic and Reconstructive Surgery Department, Christchurch Hospital, Christchurch, New Zealand
| | - Guy Maddern
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia
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Durneva P, Cousins K, Chen M. The Current State of Research, Challenges, and Future Research Directions of Blockchain Technology in Patient Care: Systematic Review. J Med Internet Res 2020; 22:e18619. [PMID: 32706668 PMCID: PMC7399962 DOI: 10.2196/18619] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/02/2020] [Accepted: 05/13/2020] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Polina Durneva
- Department of Information Systems & Business Analytics, Florida International University, Miami, FL, United States
| | - Karlene Cousins
- Department of Information Systems & Business Analytics, Florida International University, Miami, FL, United States
| | - Min Chen
- Department of Information Systems & Business Analytics, Florida International University, Miami, FL, United States
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