Blockchains for Secure Digitized Medicine

Blockchain Revolutionizing in Emergency Medicine: A Scoping Review of Patient Journey through the ED

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.

[Medical consent in the era of personalized medicine: Issues and recommendations]

Free and informed consent as a manifestation of adherence to a therapeutic act in medicine is central to the patient-physician relationship. Despite the medical advances of personalized medicine, it weakens the patient-physician relationship and thus the patient's capacity to consent, due to the increasing complexity of the analysis of available data and the intervention of a large number of specialist physicians in the care trajectory. This article proposes to examine the consequences of personalized medicine on the transmission and nature of information, to rethink the patient-physician relationship and the conditions under which consent is possible. Beyond the impacts of personalized medicine, we believe that the role of the doctor is similar to that of a coordinator capable of ensuring the transmission and coherence of information communicated to patients according to their needs with a view to restoring their understanding of the disease and the therapeutic proposals made to them.

Comprehensive review for healthcare data quality challenges in blockchain technology

There are several features inherent in blockchain, including decentralized storage, distributed ledger, immutability, security and authentication, and it has shifted away from the hype to be used practically in different industries, such as in the healthcare sector. The use of blockchain technology has allowed the provision of improved services to industries. The objective of this paper is to demonstrate how the use of blockchain is influenced by data quality issues in the healthcare industry. The article is structured as a systematic literature review study that uses several articles issued in various databases from 2016 onwards. In this review study, 65 articles were chosen and grouped into a single key aspect of the challenge in the healthcare sector. The findings obtained were analyzed based on factors in three domains, classified as issues pertinent to the adoption, operational and technological domains. This review study aims to use the findings to provide support to the practitioners, stakeholders and professionals, whose purpose is to carry out and manage transformation projects pertinent to blockchain in the field of healthcare. In addition, the organizations would be facilitated in their decision-making processes when the potential blockchain users are made to comprehend the implicit factors related to blockchain.

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.

MedShard: Electronic Health Record Sharing Using Blockchain Sharding

Electronic health records (EHRs) are important assets of the healthcare system and should be shared among medical practitioners to improve the accuracy and efficiency of diagnosis. Blockchain technology has been investigated and adopted in healthcare as a solution for EHR sharing while preserving privacy and security. Blockchain can revolutionize the healthcare system by providing a decentralized, distributed, immutable, and secure architecture. However, scalability has always been a bottleneck in blockchain networks due to the consensus mechanism and ledger replication to all network participants. Sharding helps address this issue by artificially partitioning the network into small groups termed shards and processing transactions parallelly while running consensus within each shard with a subset of blockchain nodes. Although this technique helps resolve issues related to scalability, cross-shard communication overhead can degrade network performance. This study proposes a transaction-based sharding technique wherein shards are formed on the basis of a patient’s previously visited health entities. Simulation results show that the proposed technique outperforms standard-based healthcare blockchain techniques in terms of the number of appointments processed, consensus latency, and throughput. The proposed technique eliminates cross-shard communication by forming complete shards based on “the need to participate” nodes per patient.

Blockchain Personal Health Records: Systematic Review

BACKGROUND

Blockchain technology has the potential to enable more secure, transparent, and equitable data management. In the health care domain, it has been applied most frequently to electronic health records. In addition to securely managing data, blockchain has significant advantages in distributing data access, control, and ownership to end users. Due to this attribute, among others, the use of blockchain to power personal health records (PHRs) is especially appealing.

OBJECTIVE

This review aims to examine the current landscape, design choices, limitations, and future directions of blockchain-based PHRs.

METHODS

Adopting the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, a cross-disciplinary systematic review was performed in July 2020 on all eligible articles, including gray literature, from the following 8 databases: ACM, IEEE Xplore, MEDLINE, ScienceDirect, Scopus, SpringerLink, Web of Science, and Google Scholar. Three reviewers independently performed a full-text review and data abstraction using a standardized data collection form.

RESULTS

A total of 58 articles met the inclusion criteria. In the review, we found that the blockchain PHR space has matured over the past 5 years, from purely conceptual ideas initially to an increasing trend of publications describing prototypes and even implementations. Although the eventual application of blockchain in PHRs is intended for the health care industry, the majority of the articles were found in engineering or computer science publications. Among the blockchain PHRs described, permissioned blockchains and off-chain storage were the most common design choices. Although 18 articles described a tethered blockchain PHR, all of them were at the conceptual stage.

CONCLUSIONS

This review revealed that although research interest in blockchain PHRs is increasing and that the space is maturing, this technology is still largely in the conceptual stage. Being the first systematic review on blockchain PHRs, this review should serve as a basis for future reviews to track the development of the space.

Blockchain research in healthcare: a bibliometric review and current research trends

The literature on blockchain-enabled use cases has grown exponentially over recent years. Yet, studies are missing that apply bibliometrics and visualization techniques to unravel the dynamics and current discussions pertaining to the nexus of blockchain technology (BCT) and the healthcare field. To close this knowledge gap, we examine the knowledge base and research hotspots of BCT research in the field of healthcare. We carry out a series of bibliometric analyses on the extant literature, including the scholarly production, developmental pattern of the annual total number of authors, and identification of productive academic institutions, countries, and leading authors. Additionally, we conduct a keyword co-occurrence analysis and identify the major research hotspots and trends for the future. The findings of this research are valuable for scholars and practitioners who seek to better understand the development status, dynamics, and trends pertaining to BCT in healthcare.

Evaluation of Decentralized Verifiable Credentials to Authenticate Authorized Trading Partners and Verify Drug Provenance

Summary

In 2013, the Drug Supply Chain Security Act (DSCSA) was signed into law to address the growing threat of counterfeit drugs and to ensure prescription drugs remain safe and effective for patients. As part of this law, US pharmaceutical supply chain stakeholders are required to confirm the authorized status of trading partners for transactions and information disclosures, even when there is no prior business relationship. While larger Authorized Trading Partners (ATPs) have connectivity solutions in place, newer and smaller ATPs have not traditionally participated, including tens of thousands of dispensers. To unlock the full potential of the interoperable system mandated by the DSCSA, the authors tested eXtended ATP (XATP), a blockchain-backed framework for ATP authentication and enhanced verification in a real-world pharmacy with genuine drug packages. The objective of this research study was to prove that electronic authentication and enhanced verification can be achieved between ATPs using a mobile-based solution. Moreover, we tested accurate reading of drug and associated electronic med guides, flagging of expired and recalled drugs, and correct generation of documentation to support saleable returns.

Methods

This study involved two dispensers and three participating manufacturers. Dispensers were onboarded to a mobile application and used supporting documentation to authenticate their identities, and then scanned 2D drug barcodes to submit drug verification requests to manufacturers (including 11 additional, randomly selected manufacturers). Genuine and synthetic drug package barcodes were used to test workflows against genuine and synthetic manufacturer serialization data records. Manufacturers authenticated the identity of requesting dispensers with verifiable credentials and responded to verification requests.

Results

Enhanced drug verification was achieved, with 100% of requests successfully delivered to participating manufacturers and 88% of requests being delivered to other manufacturers (based on the pharmacist selection of random packages from the pharmacy). Drug verification matching against synthetic serialization data records resulted in 86% accuracy, with the 14% error rate attributed to human factors. All barcodes were successfully scanned and provided package-accurate data, and 97% of randomly selected packages successfully generated drug package inserts. All synthetic recalls and expired drugs were successfully flagged. Four of the manufacturers contacted were among the top 15 pharmaceutical manufacturers globally; all four responded.

Conclusions

The XATP framework provides a secure, reliable, and seamless remote method to conduct enhanced verification as required by law. Interoperability between manufacturers and dispensers with no prior business relationship can be achieved on 'day zero' using mobile devices that enable digital authentication and rapid barcode scanning. As users retain control of their own private keys, the framework also mitigates the single-point-of-attack risks associated with centrally managed systems.

Cybersecurity in PACS and Medical Imaging: an Overview

This article provides an overview on the literature published on the topic of cybersecurity for PACS (Picture Archiving and Communications Systems) and medical imaging. From a practical perspective, PACS specific security measures must be implemented together with the measures applicable to the IT infrastructure as a whole, in order to prevent incidents such as PACS systems exposed to access from the Internet. Therefore, the article first offers an overview of the physical, technical and organizational mitigation measures that are proposed in literature on cybersecurity in healthcare information technology in general, followed by an overview on publications discussing specific cybersecurity topics that apply to PACS and medical imaging and present the "building blocks" for a secure PACS environment available in the literature. These include image de-identification, transport security, the selective encryption of the DICOM (Digital Imaging and Communications in Medicine) header, encrypted DICOM files, digital signatures and watermarking techniques. The article concludes with a discussion of gaps in the body of published literature and a summary.

Blockchain in Health Care Innovation: Literature Review and Case Study From a Business Ecosystem Perspective

Background

Blockchain technology is leveraging its innovative potential in various sectors and its transformation of business-related processes has drawn much attention. Topics of research interest have focused on medical and health care applications, while research implications have generally concluded in system design, literature reviews, and case studies. However, a general overview and knowledge about the impact on the health care ecosystem is limited.

Objective

This paper explores a potential paradigm shift and ecosystem evolution in health care utilizing blockchain technology.

Methods

A literature review with a case study on a pioneering initiative was conducted. With a systematic life cycle analysis, this study sheds light on the evolutionary development of blockchain in health care scenarios and its interactive relationship among stakeholders.

Results

Four stages—birth, expansion, leadership, and self-renewal or death—in the life cycle of the business ecosystem were explored to elucidate the evolving trajectories of blockchain-based health care implementation. Focused impacts on the traditional health care industry are highlighted within each stage to further support the potential health care paradigm shift in the future.

Conclusions

This paper enriches the existing body of literature in this field by illustrating the potential of blockchain in fulfilling stakeholders’ needs and elucidating the phenomenon of coevolution within the health care ecosystem. Blockchain not only catalyzes the interactions among players but also facilitates the formation of the ecosystem life cycle. The collaborative network linked by blockchain may play a critical role on value creation, transfer, and sharing among the health care community. Future efforts may focus on empirical or case studies to validate the proposed evolution of the health care ecosystem.

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.

Attitudes Toward Blockchain Technology in Managing Medical Information: Survey Study

BACKGROUND

The recently developed blockchain technology uses a peer-to-peer network to distribute data to all participants for storage. This method enhances data safety, reliability, integrity, and transparency. To successfully introduce blockchain technology to medical data management, it is essential to obtain consent from medical doctors and patients.

OBJECTIVE

The aim of this study was to examine medical doctors' and patients' attitudes toward the use of blockchain technology and interpret the findings within the framework of expectancy theory.

METHODS

In this questionnaire survey, we examined medical doctors' (n=90) and patients' (n=90) attitudes toward the use of blockchain technology in the management and distribution of medical information. The questionnaire comprised 8 questions that assessed attitudes toward new means of managing and distributing medical information using blockchain technology. Responses were rated on a scale that ranged from 1 (very negative) to 7 (very positive).

RESULTS

Medical doctors (mean 3.7-5.0) reported significantly more negative attitudes than patients (mean 6.3-6.8). Furthermore, self-employed doctors reported more negative attitudes than employed doctors and university professors.

CONCLUSIONS

To successfully introduce blockchain technology to medical data management, it is necessary to promote positive attitudes toward this technology among medical doctors, especially self-employed doctors.