Blockchain in Health Care: Hope or Hype?

The Use of Blockchain Technology in Public Health: Lessons Learned

Blockchain is a new technology utilized to develop creative solutions in different industries, such as health care. Blockchain is a decentralized and distributed encrypted system made up of interconnected blocks containing transaction-related information that can be shared with network participants. A blockchain network is utilized in the healthcare industry to safeguard and share patient information among hospitals, pharmacies, and doctors' diagnostic labs. Blockchain applications can precisely identify serious and potentially harmful mistakes within the medical sector. The objective is to comprehensively explore the potential use, present implementations, challenges, and future possibilities of blockchain in health management systems, and to provide information to researchers, policymakers, and practitioners on how to utilize new technology to enhance data security, efficiency, decentralization of data, authenticity of data, transparency, and verifiability of data compared to conventional databases in health management systems. Key review findings for blockchain technology in public health surveillance might include enhanced data security and accessibility of data, data storage and sharing, ensuring tamper-proof records are accessed, empowering patients, and improving overall healthcare outcomes. Its immutability proves to be important for securing healthcare data. It offers a safeguard for health records and clinical trial outcomes and ensures compliance with regulatory standards. This evaluation focuses on how it has transformed data protection, improved workflows, and safe health information interchange. Despite obstacles, further study and standardization initiatives have the potential to transform health care and guarantee patient care that is resilient and trustworthy. In the present healthcare industry, blockchain technology plays an essential role in healthcare systems. It can lead to computerized processes for collecting and validating data, accurate information collected from multiple sources, and data that are fixed, transparent to misuse, and secure, with a reduced risk of digital crimes. In addition, the study provides a detailed analysis of the potential applications for including the use of blockchain technology in transforming public health surveillance.

Identifying the Barriers to Acceptance of Blockchain-Based Patient-Centric Data Management Systems in Healthcare

A number of recent studies have shown that wastage and inefficiency are a significant problem in all global healthcare systems. One initiative that could radically improve the operational efficiency of health systems is to make a paradigm shift in data ownership-that is, to transition such systems to a patient-centric model of data management by deploying blockchain technology. Such a development would not only make an economic impact, by radically cutting wastage, but would deliver significant social benefits by improving patient outcomes and satisfaction. However, a blockchain-based solution presents considerable challenges. This research seeks to understand the principal factors, which act as barriers to the acceptance of a blockchain-based patient-centric data management infrastructure, in the healthcare systems of the GCC (Gulf Cooperation Council) countries. The study represents an addition to the current literature by examining the perspectives and views of healthcare professionals and users. This approach is rare within this subject area, and is identified in existing systematic reviews as a research gap: a qualitative investigation of motivations and attitudes among these groups is a critical need. The results of the study identified 12 key barriers to the acceptance of blockchain infrastructures, thereby adding to our understanding of the challenges that need to be overcome in order to benefit from this relatively recent technology. The research is expected to be of use to healthcare authorities in planning a way forward for system improvement, particularly in terms of successfully introducing patient-centric systems.

Clinical Impact of "Real World Data" and Blockchain on Public Health: A Scoping Review

The digitisation of healthcare has allowed a significant rethinking of the previous clinical protocols, improving their interoperability through substantial standardisation. These technological advances have ensured that data are comparable, as they are obtained from 'reliable' and certified processes; however, there are billions of data that are neither structured nor quality-controlled. They are collectively referred to as 'Real World Data' (RWD). Blockchain (BC) is a procedure with specific characteristics and algorithms that ensure that the stored data cannot be tampered with. Nowadays, there is an increasing need to rethink blockchain in a one-health vision, making it more than just a 'repository' of data and information, but rather an active player in the process of data sharing. In this landscape, several scholars have analysed the potential benefits of BC in healthcare, focusing on the sharing and safety of clinical data and its contact tracing applications. There is limited research on this matter; moreover, there is a strategic interest in managing RWD in a reliable and comparable way, despite the lack of knowledge on this topic. Our work aims to analyse systematically the most impacting literature, highlighting the main aspects of BC within the context of the new digital healthcare, and speculating on the unexpressed potential of RWD.

Exploring applications of blockchain in healthcare: road map and future directions

Blockchain technology includes numerous elements such as distributed ledgers, decentralization, authenticity, privacy, and immutability. It has progressed past the hype to find actual use cases in industries like healthcare. Blockchain is an emerging area that relies on a consensus algorithm and the idea of a digitally distributed ledger to eliminate any intermediary risks. By enabling them to trace data provenance and any changes made, blockchain technology can enable different healthcare stakeholders to share access to their networks without violating data security and integrity. The healthcare industry faces challenges like fragmented data, security and privacy concerns, and interoperability issues. Blockchain technology offers potential solutions by ensuring secure, tamper-proof storage across multiple network nodes, improving interoperability and patient privacy. Encrypting patient data further enhances security and reduces unauthorized access concerns. Blockchain technology, deployed over the Internet, can potentially use the current healthcare data by using a patient-centric approach and removing the intermediaries. This paper discusses the effective utilization of blockchain technology in the healthcare industry. In contrast to other applications, the exoteric evaluation in this paper shows that the innovative technology called blockchain technology has a major role to play in the existing and future applications of the healthcare industry and has significant benefits.

Fortifying Health Care Intellectual Property Transactions With Blockchain

BACKGROUND

Intellectual property (IP) is a substantial competitive advantage in the health care industry. However, the COVID-19 pandemic highlighted the need for open innovation and collaboration for the greater good. Despite this, the industry faces challenges with innovation owing to organizational and departmental barriers. A secure platform is necessary to facilitate IP sharing without compromising the rights of IP owners.

OBJECTIVE

This study proposes a blockchain-based framework to secure IP transactions in health care and bring social impact.

METHODS

This study reviews existing researches, publications, practical cases, firm and organization websites, and conferences related to blockchain technology, blockchain in health care, blockchain in IP management, IP pledge research, and practice of IP management blockchain. The platform architecture has 7 components: pledgers, advanced research technology (ART), IP pledge platforms, IP databases, health care research, seeking ART, and transaction condition setting. These components work together seamlessly to support the sharing and pledging of ART and knowledge, while ensuring the platform's transparency, security, and trust.

RESULTS

The open IP pledge framework can promote technology dissemination and use, reduce research and development costs, foster collaboration, and serve the public interest. Medical organizations' leadership and support and active participation from stakeholders are necessary for success. By leveraging blockchain technology, the platform ensures tamper-proof and transparent transactions and protects the rights of IP owners. In addition, the platform offers incentive mechanisms through pledge tokens that encourage stakeholders to share their ART and contribute to the platform.

CONCLUSIONS

Overall, the proposed framework can facilitate technological innovation, tackle various challenges, and secure IP transactions. It provides a secure platform for stakeholders to share their IP without compromising their rights, promoting collaboration and progress in the health care industry. The implementation of the framework has the potential to revolutionize the industry's approach to innovation, allowing a more open and collaborative environment driven by the greater good.

Examining public views on decentralised health data sharing

In recent years, researchers have begun to explore the use of Distributed Ledger Technologies (DLT), also known as blockchain, in health data sharing contexts. However, there is a significant lack of research that examines public attitudes towards the use of this technology. In this paper, we begin to address this issue and present results from a series of focus groups which explored public views and concerns about engaging with new models of personal health data sharing in the UK. We found that participants were broadly in favour of a shift towards new decentralised models of data sharing. Retaining 'proof' of health information stored about patients and the capacity to provide permanent audit trails, enabled by immutable and transparent properties of DLT, were regarded as particularly valuable for our participants and prospective data custodians. Participants also identified other potential benefits such as supporting people to become more health data literate and enabling patients to make informed decisions about how their data was shared and with whom. However, participants also voiced concerns about the potential to further exacerbate existing health and digital inequalities. Participants were also apprehensive about the removal of intermediaries in the design of personal health informatics systems.

Blockchain and Fog Computing in IoT-Driven Healthcare Services for Smart Cities

Nowadays, technology has been evolving rapidly. Due to the consequent impact of smart technologies, it becomes a ubiquitous part of life. These technologies have led to the emergence of smart cities that are geographic areas driven by advanced information and communication technologies. In the context of smart cities, IoT, blockchain, and fog computing have been found as the significant drivers of smart initiates. In this recognition, the present study is focused on delineating the impact and potential of blockchain, IoT, and fog computing on healthcare services in the context of smart cities. In pursuit of this objective, the study has conducted a systematic review of literature that is most relevant to the topic of the paper. In order to select the most relevant and credible articles, the researcher has used PRISMA and AMSTAR that have culminated in the 10 most relevant articles for the present study. The findings revealed that IoT, blockchain, and fog computing had become drivers of efficiency in the healthcare services in smart cities. Among the three technologies, IoT has been found to be widely incorporated. However, it is found to be lacking in terms of cost efficiency, data privacy, and interoperability of data. In this recognition, blockchain technology and fog computing have been found to be more relevant to the healthcare sector in smart cities. Blockchain has been presented as a promising technology for ensuring the protection of private data, creating a decentralized database, and improving the interoperability of data while fog computing has been presented as the promising technology for low-cost remote monitoring, reducing latency and increasing efficiency.

User Control of Personal mHealth Data Using a Mobile Blockchain App: Design Science Perspective

Background

Integrating pervasive computing with blockchain’s ability to store privacy-protected mobile health (mHealth) data while providing Health Insurance Portability and Accountability Act (HIPAA) compliance is a challenge. Patients use a multitude of devices, apps, and services to collect and store mHealth data. We present the design of an internet of things (IoT)–based configurable blockchain with different mHealth apps on iOS and Android, which collect the same user’s data. We discuss the advantages of using such a blockchain architecture and demonstrate 2 things: the ease with which users can retain full control of their pervasive mHealth data and the ease with which HIPAA compliance can be accomplished by providers who choose to access user data.

Objective

The purpose of this paper is to design, evaluate, and test IoT-based mHealth data using wearable devices and an efficient, configurable blockchain, which has been designed and implemented from the first principles to store such data. The purpose of this paper is also to demonstrate the privacy-preserving and HIPAA-compliant nature of pervasive computing-based personalized health care systems that provide users with total control of their own data.

Methods

This paper followed the methodical design science approach adapted in information systems, wherein we evaluated prior designs, proposed enhancements with a blockchain design pattern published by the same authors, and used the design to support IoT transactions. We prototyped both the blockchain and IoT-based mHealth apps in different devices and tested all use cases that formed the design goals for such a system. Specifically, we validated the design goals for our system using the HIPAA checklist for businesses and proved the compliance of our architecture for mHealth data on pervasive computing devices.

Results

Blockchain-based personalized health care systems provide several advantages over traditional systems. They provide and support extreme privacy protection, provide the ability to share personalized data and delete data upon request, and support the ability to analyze such data.

Conclusions

We conclude that blockchains, specifically the consensus, hasher, storer, miner architecture presented in this paper, with configurable modules and software as a service model, provide many advantages for patients using pervasive devices that store mHealth data on the blockchain. Among them is the ability to store, retrieve, and modify ones generated health care data with a single private key across devices. These data are transparent, stored perennially, and provide patients with privacy and pseudoanonymity, in addition to very strong encryption for data access. Firms and device manufacturers would benefit from such an approach wherein they relinquish user data control while giving users the ability to select and offer their own mHealth data on data marketplaces. We show that such an architecture complies with the stringent requirements of HIPAA for patient data access.

The Health Care Sector's Experience of Blockchain: A Cross-disciplinary Investigation of Its Real Transformative Potential

BACKGROUND

Academic literature highlights blockchain's potential to transform health care, particularly by seamlessly and securely integrating existing data silos while enabling patients to exercise automated, fine-grained control over access to their electronic health records. However, no serious scholarly attempt has been made to assess how these technologies have in fact been applied to real-world health care contexts.

OBJECTIVE

The primary aim of this paper is to assess whether blockchain's theoretical potential to deliver transformative benefits to health care is likely to become a reality by undertaking a critical investigation of the health care sector's actual experience of blockchain technologies to date.

METHODS

This mixed methods study entailed a series of iterative, in-depth, theoretically oriented, desk-based investigations and 2 focus group investigations. It builds on the findings of a companion research study documenting real-world engagement with blockchain technologies in health care. Data were sourced from academic and gray literature from multiple disciplinary perspectives concerned with the configuration, design, and functionality of blockchain technologies. The analysis proceeded in 3 stages. First, it undertook a qualitative investigation of observed patterns of blockchain for health care engagement to identify the application domains, data-sharing problems, and the challenges encountered to date. Second, it critically compared these experiences with claims about blockchain's potential benefits in health care. Third, it developed a theoretical account of challenges that arise in implementing blockchain in health care contexts, thus providing a firmer foundation for appraising its future prospects in health care.

RESULTS

Health care organizations have actively experimented with blockchain technologies since 2016 and have demonstrated proof of concept for several applications (use cases) primarily concerned with administrative data and to facilitate medical research by enabling algorithmic models to be trained on multiple disparately located sets of patient data in a secure, privacy-preserving manner. However, blockchain technology is yet to be implemented at scale in health care, remaining largely in its infancy. These early experiences have demonstrated blockchain's potential to generate meaningful value to health care by facilitating data sharing between organizations in circumstances where computational trust can overcome a lack of social trust that might otherwise prevent valuable cooperation. Although there are genuine prospects of using blockchain to bring about positive transformations in health care, the successful development of blockchain for health care applications faces a number of very significant, multidimensional, and highly complex challenges. Early experience suggests that blockchain is unlikely to rapidly and radically revolutionize health care.

CONCLUSIONS

The successful development of blockchain for health care applications faces numerous significant, multidimensional, and complex challenges that will not be easily overcome, suggesting that blockchain technologies are unlikely to revolutionize health care in the near future.

Applications of Blockchain in the Medical Field: Narrative Review

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.

A Review of Artificial Intelligence, Big Data, and Blockchain Technology Applications in Medicine and Global Health

Artificial intelligence (AI) programs are applied to methods such as diagnostic procedures, treatment protocol development, patient monitoring, drug development, personalized medicine in healthcare, and outbreak predictions in global health, as in the case of the current COVID-19 pandemic. Machine learning (ML) is a field of AI that allows computers to learn and improve without being explicitly programmed. ML algorithms can also analyze large amounts of data called Big data through electronic health records for disease prevention and diagnosis. Wearable medical devices are used to continuously monitor an individual’s health status and store it in cloud computing. In the context of a newly published study, the potential benefits of sophisticated data analytics and machine learning are discussed in this review. We have conducted a literature search in all the popular databases such as Web of Science, Scopus, MEDLINE/PubMed and Google Scholar search engines. This paper describes the utilization of concepts underlying ML, big data, blockchain technology and their importance in medicine, healthcare, public health surveillance, case estimations in COVID-19 pandemic and other epidemics. The review also goes through the possible consequences and difficulties for medical practitioners and health technologists in designing futuristic models to improve the quality and well-being of human lives.

Test, Trace, and Put on the Blockchain?: A Viewpoint Evaluating the Use of Decentralized Systems for Algorithmic Contact Tracing to Combat a Global Pandemic

The enormous pressure of the increasing case numbers experienced during the COVID-19 pandemic has given rise to a variety of novel digital systems designed to provide solutions to unprecedented challenges in public health. The field of algorithmic contact tracing, in particular, an area of research that had previously received limited attention, has moved into the spotlight as a crucial factor in containing the pandemic. The use of digital tools to enable more robust and expedited contact tracing and notification, while maintaining privacy and trust in the data generated, is viewed as key to identifying chains of transmission and close contacts, and, consequently, to enabling effective case investigations. Scaling these tools has never been more critical, as global case numbers have exceeded 100 million, as many asymptomatic patients remain undetected, and as COVID-19 variants begin to emerge around the world. In this context, there is increasing attention on blockchain technology as a part of systems for enhanced digital algorithmic contact tracing and reporting. By analyzing the literature that has emerged from this trend, the common characteristics of the designs proposed become apparent. An archetypal system architecture can be derived, taking these characteristics into consideration. However, assessing the utility of this architecture using a recognized evaluation framework shows that the added benefits and features of blockchain technology do not provide significant advantages over conventional centralized systems for algorithmic contact tracing and reporting. From our study, it, therefore, seems that blockchain technology may provide a more significant benefit in other areas of public health beyond contact tracing.

Barriers to blockchain adoption in health-care industry: an Indian perspective

Purpose

This paper aims to identify barriers toward the adoption of blockchain (BC) technology in Indian health-care industry and also examines the significant issues of BC applications in health-care industry.

Design/methodology/approach

The barriers of the study are identified by two phases including the review of literature and semistructured interviews with hospital staff and administration operating in India. The experts (N = 15) are being taken from top-level management, IT experts and patients from the hospitals. The study implemented integrated total interpretative structural modeling-FUZZY-Cross-impact matrix multiplication applied to classification (TISM-FUZZY-MICMAC) methods for identifying the interrelationship among the barriers.

Findings

A total of 15 barriers have been determined in the Indian health-care industry through discussion with the selected experts. TISM is applied to develop multilevel structure for BC barriers. Further, FUZZY-MICMAC has been used to compute driving and dependent barriers. The findings suggest that low awareness related to legal issues and low support from high level of management have maximum driving power.

Research limitations/implications

The present study applies multicriterion approach to identify the limited barriers in BC adoption in health care. Future studies may develop the relationship and mark down the steps for implementation of BC in health-care setting of a developing economy. Empirical study can be conducted to verify the results along with selected case studies.

Practical implications

The present study identifies the BC adoption barriers in health-care industry. The study examines the pertinent issues in context to major support required, bottlenecks in adoption, key benefits of adoption planning and activities. The technology adoption practices are expected to provide applications such as distributed, secured medical and clinical data and patient centric systems that will enhance the efficiency of the health-care industry.

Originality/value

The study is among few primary studies that identify and analyze the BC adoption in health-care industry.

Perspectives of Patients, Health Care Professionals, and Developers Toward Blockchain-Based Health Information Exchange: Qualitative Study

Background

Although the electronic health record system adoption rate has reached 96% in the United States, implementation and usage of health information exchange (HIE) is still lagging behind. Blockchain has come into the spotlight as a technology to solve this problem. However, there have been no studies assessing the perspectives of different stakeholders regarding blockchain-based patient-centered HIE.

Objective

The objective of this study was to analyze the awareness among patients, health care professionals, and information technology developers toward blockchain-based HIE, and compare their different perspectives related to the platform using a qualitative research methodology.

Methods

In this qualitative study, we applied grounded theory and the Promoting Action on Research Implementation in the Health Service (PARiHS) framework. We interviewed 7 patients, 7 physicians, and 7 developers, for a total of 21 interviewees.

Results

Regarding the leakage of health information, the patient group did not have concerns in contrast to the physician and developer groups. Physicians were particularly concerned about the fact that errors in the data cannot be easily fixed due to the nature of blockchain technology. Patients were not against the idea of providing information for clinical trials or research institutions. They wished to be provided with the results of clinical research rather than being compensated for providing data. The developers emphasized that blockchain must be technically mature before it can be applied to the health care scene, and standards of medical information to be exchanged must first be established.

Conclusions

The three groups’ perceptions of blockchain were generally positive about the idea of patients having the control of sharing their own health information. However, they were skeptical about the cooperation among various institutions and implementation for data standardization in the establishment process, in addition to how the service will be employed in practice. Taking these factors into consideration during planning, development, and operation of a platform will contribute to establishing practical treatment plans and tracking in a more convenient manner for both patients and physicians. Furthermore, it will help expand the related research and health management industry based on blockchain.