Improving data transparency in clinical trials using blockchain smart contracts

Retrospective analysis and decentralized distribution to improve the lifecycle of Ah receptor research assets

Scientific progress benefits from the sharing of "research assets" such as data, reagents, models, and experimental samples. To improve asset shareability, we evaluated the availability, quality, and characterization of recombinant DNA molecules, recombinant mouse models, and tissue samples described by our laboratory in ten publications spanning over thirty years. Employing state-of-the-art molecular technologies, we identified existing samples, updated their localization, generated modern sequences and maps of recombinant models, and ported the associated metadata to an internal blockchain-dependent resource using a standardized description for each asset class. We also created non-fungible tokens representing research assets on the public blockchain network Solana. In addition to providing an audit of previously reported shareable assets and improving the value of recombinant models, this re-analysis also provides evidence for the utility of extant tissue samples that may be difficult and expensive to regenerate. The results demonstrate how retrospective analysis can improve and expand upon the spectrum of shareable research assets through updates on molecular characterization and physical location, as well as improving the availability of biological samples of potential high experimental value. Moreover, the development of a decentralized ledger harboring this revised metadata provides a path to the description and tokenization of scientific assets and provides a strategy to extend the life of scientific assets even after laboratories or sources close.

A systematic review of the blockchain application in healthcare research domain: toward a unified conceptual model

Recently, research on blockchain applications in the healthcare research domain has attracted increasing attention due to its strong potential. However, the existing literature reveals limited studies on defining use cases of blockchain in clinical research, categorizing and comparing available studies. Therefore, this study aims to explore the significant potential and use cases of blockchain in clinical research through a comprehensive systematic literature review (SLR). To thoroughly investigate all aspects of the subject, we analyzed primary studies based on research questions (RQs) and developed a unified conceptual model using step-based model creation. Studies from 2015 to 2023 were reviewed, and 34 primary studies were comprehensively analyzed by using the PICO template. In our findings, privacy emerged as the most frequently cited requirement in clinical research. The most mentioned use cases for blockchain are ensuring data immutability and security. A significant issue identified beyond the common blockchain limitations of capacity and scalability is the lack of standards for compliance with legal frameworks like GDPR and HIPAA. After all these efforts, we developed a conceptual model, which, to our best knowledge, is the first in the literature to support software developers and clinical researchers in developing and using blockchain-based research platforms efficiently.

Validation and user experience testing of DataCryptChain: An open-source standard combining blockchain technology with asymmetric encryption for private, secure, shareable, and tamper-proof research data

DataCryptChain is an open-source standard combining blockchain with advanced encryption ensuring research data remains private, secure, shareable, and tamper-proof. Ability to detect intentional tampering of data was measured, and user experience was evaluated. In this study, simulated datasets were randomized to be tampered with or not tampered with, and detection of tampering was measured. Volunteer's ability to complete assigned tasks using the software was evaluated. Among 10000 simulated datasets (4436 randomized to tampering) there was 100% sensitivity and specificity for detection. All volunteers successfully installed DataCryptChain and 5/6 completed their tasks. All participants were able to transmit data without ever exposing unencrypted data and with no need to share passwords. Several deficiencies in the user experience were noted. Importantly, the test users felt that although they would be willing to use DataCryptChain in practice, it would need a more user-friendly interface. This study demonstrates a novel algorithm using blockchain and asymmetric encryption that, although previously documented theoretically, has never been published as a working software package. While DataCryptChain has 100% sensitivity and specificity for detecting data tampering, further development is needed to improve the user experience.

Blockchain-Based Applications in Neurological Surgery

Paper-based patient records have been associated with disorganization and redundancy and thus lack of efficiency and security. The electronic health record (EHR) is an electronic record for patient health information that has alleviated many of the traditional issues associated with paper-based records. However, in the current era of the internet and with the variability of EHR systems, privacy, security, and interoperability remain challenges of the current patient health information management systems. Blockchain technologies provide an opportunity to address many of the challenges associated with current EHR systems. In addition, new frameworks have explored the utility of blockchain-based applications in addressing concerns in different medical disciplines such as neurosurgery. This review discusses these applications, including blockchain-based solutions impacting all of medicine, relating to the EHR, and directly relating to neurosurgery. This review also discusses blockchain technology and the related intricacies for appreciating the relevant frameworks, while also highlighting the challenges associated with this technology.

The Digital Platform and Its Emerging Role in Decentralized Clinical Trials

Decentralized clinical trials (DCTs) are becoming increasingly popular. Digital clinical trial platforms are software environments where users complete designated clinical trial tasks, providing investigators and trial participants with efficient tools to support trial activities and streamline trial processes. In particular, digital platforms with a modular architecture lend themselves to DCTs, where individual trial activities can correspond to specific platform modules. While design features can allow users to customize their platform experience, the real strengths of digital platforms for DCTs are enabling centralized data capture and remote monitoring of trial participants and in using digital technologies to streamline workflows and improve trial management. When selecting a platform for use in a DCT, sponsors and investigators must consider the specific trial requirements. All digital platforms are limited in their functionality and technical capabilities. Integrating additional functional modules into a central platform may solve these challenges, but few commercial platforms are open to integrating third-party components. The lack of common data standardization protocols for clinical trials will likely limit the development of one-size-fits-all digital platforms for DCTs. This viewpoint summarizes the current role of digital platforms in supporting decentralized trial activities, including a discussion of the potential benefits and challenges of digital platforms for investigators and participants. We will highlight the role of the digital platform in the development of DCTs and emphasize where existing technology is functionally limiting. Finally, we will discuss the concept of the ideal fully integrated and unified DCT and the obstacles developers must address before it can be realized.

The value of decentralized clinical trials: Inclusion, accessibility, and innovation

In this Review, we explore the transformative potential of decentralized clinical trials (DCTs) in addressing the limitations of traditional randomized controlled trials (RCTs). We highlight the merits of DCTs fostering greater inclusivity, efficiency, and adaptability. We emphasize the challenges of RCTs, including limited participant diversity and logistical barriers, geographical constraints, and mistrust in research institutions, showing how DCTs are preferred in addressing these challenges by utilizing remote digital technologies and community providers to enable broader, more inclusive participation. Furthermore, we underscore the potential of DCTs for democratizing clinical research. We also stress the importance of addressing unresolved challenges, including data security and privacy, remote patient monitoring, and regulatory variations. Research is needed to devise standardized protocols to streamline DCT processes, explore its long-term impacts on patient outcomes, and overcome challenges through equitable stakeholder engagement.

Blockchain technology and raft consensus for secure physician prescriptions and improved diagnoses in electronic healthcare systems

With electronic healthcare systems undergoing rapid change, optimizing the crucial process of recording physician prescriptions is a task with major implications for patient care. The power of blockchain technology and the precision of the Raft consensus algorithm are combined in this article to create a revolutionary solution for this problem. In addition to addressing these issues, the proposed framework, by focusing on the challenges associated with physician prescriptions, is a breakthrough in a new era of security and dependability for the healthcare sector. The Raft algorithm is a cornerstone that improves the diagnostic decision-making process, increases confidence in patients, and sets a new standard for robust healthcare systems. In the proposed consensus algorithm, a weighted sum of two influencing factors including the physician acceptability and inter-physicians' reliability is used for selecting the participating physicians. An investigation is conducted to see how well the Raft algorithm performs in overcoming prescription-related roadblocks that support a compelling argument for improved patient care. Apart from its technological benefits, the proposed approach seeks to revolutionize the healthcare system by fostering trust between patients and providers. Raft's ability to communicate presents the proposed solution as an effective way to deal with healthcare issues and ensure security.

Healthcare 5.0: A secure and distributed network for system informatics in medical surgery

INTRODUCTION

Health records serve not only as a database of a patient's health history and treatment process but also as a crucial tool for doctors to diagnose and treat patients. However, the storage and sharing of these records are sensitive issues as they involve maintaining patient privacy and ensuring data transparency, security, and interoperability between different parties. Challenges to achieving these goals in the current surgical process can impact the allocation of medical resources and surgical outcomes.

METHODS

This article proposes a healthcare 5.0 framework for medical surgery that deploys a secure and distributed network using Blockchain to demonstrate transactions between different parties in the orthopedic surgery process. The proposed network uses the Hyperledger Composer platform for deployment, and a patient-doctor-supplier orthopedic surgery network is designed and implemented to enable the safe sharing of medical records.

RESULTS

A benchmarking tool was implemented for analyzing different scenarios of applying blockchain technology to orthopedic surgery. The application of blockchain technology to orthopedic surgery presents a promising solution for data sharing and supply chain management in the field. The integration of blockchain with cloud storage and hybrid encryption ensures secure and efficient storage of Electronic Health Record (EHR) and Personal Health Record (PHR) data. By leveraging the tamper-proof nature of blockchain and addressing concerns regarding centralized data storage, this scenario demonstrates enhanced security, improved access efficiency, and privacy protection in medical data sharing.

CONCLUSIONS

The article demonstrates the feasibility of using an IoT-based blockchain network in orthopedic surgery, which can reduce medical errors and improve data interoperability among different parties. This unique application of blockchain enables secure sharing of medical records, ensuring transparency, security, and interoperability. The network design may also be applicable to other surgeries and medical applications in the future.

Blockchain integration in healthcare: a comprehensive investigation of use cases, performance issues, and mitigation strategies

Healthcare is a critical area where blockchain technology (BT) is being heralded as a potential game-changer for facilitating secure and efficient data sharing. The purpose of this review is to examine BT applications, performance challenges, and solutions in healthcare. To begin, This review paper explores popular blockchain networks for data exchange, encompassing both public and permissioned platforms, such as Ethereum and Hyperledger Fabric. This paper analyzes the potential applications of BT's decentralized, immutable, and smart contract capabilities in healthcare settings, including secure and interoperable health data exchange, patient consent management, drug supply chain oversight, and clinical trial management. The healthcare industry might greatly benefit from the increased privacy, transparency, and accessibility that these technologies provide. Despite BT's promising medical uses, the technology is not without its drawbacks. High energy consumption, throughput, and scalability are all concerns. We wrapped up by discussing the solutions that have been implemented, including consensus processes, scalability measures like sharding, and off-chain transactions that are designed to mitigate the drawbacks.

Machine Learning in Cardiovascular Risk Prediction and Precision Preventive Approaches

PURPOSE OF REVIEW

In this review, we sought to provide an overview of ML and focus on the contemporary applications of ML in cardiovascular risk prediction and precision preventive approaches. We end the review by highlighting the limitations of ML while projecting on the potential of ML in assimilating these multifaceted aspects of CAD in order to improve patient-level outcomes and further population health.

RECENT FINDINGS

Coronary artery disease (CAD) is estimated to affect 20.5 million adults across the USA, while also impacting a significant burden at the socio-economic level. While the knowledge of the mechanistic pathways that govern the onset and progression of clinical CAD has improved over the past decade, contemporary patient-level risk models lag in accuracy and utility. Recently, there has been renewed interest in combining advanced analytic techniques that utilize artificial intelligence (AI) with a big data approach in order to improve risk prediction within the realm of CAD. By virtue of being able to combine diverse amounts of multidimensional horizontal data, machine learning has been employed to build models for improved risk prediction and personalized patient care approaches. The use of ML-based algorithms has been used to leverage individualized patient-specific data and the associated metabolic/genomic profile to improve CAD risk assessment. While the tool can be visualized to shift the paradigm toward a patient-specific care, it is crucial to acknowledge and address several challenges inherent to ML and its integration into healthcare before it can be significantly incorporated in the daily clinical practice.

Blockchain, Information Security, Control, and Integrity: Who Is in Charge?

SUMMARY

Blockchain technology has attracted substantial interest in recent years, most notably for its effect on global economics through the advent of cryptocurrency. Within the health care domain, blockchain technology has been actively explored as a tool for improving personal health data management, medical device security, and clinical trial management. Despite a strong demand for innovation and cutting-edge technology in plastic surgery, integration of blockchain technologies within plastic surgery is in its infancy. Recent advances and mainstream adoption of blockchain are gaining momentum and have shown significant promise for improving patient care and information management. In this article, the authors explain what defines a blockchain and discuss its history and potential applications in plastic surgery. Existing evidence suggests that blockchain can enable patient-centered data management, improve privacy, and provide additional safeguards against human error. Integration of blockchain technology into clinical practice requires further research and development to demonstrate its safety and efficacy for patients and providers.

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.

Unraveling a blockchain-based framework towards patient empowerment: A scoping review envisioning future smart health technologies

The COVID-19 pandemic shows us how crucial patient empowerment can be in the healthcare ecosystem. Now, we know that scientific advancement, technology integration, and patient empowerment need to be orchestrated to realize future smart health technologies. In that effort, this paper unravels the Good (advantages), Bad (challenges/limitations), and Ugly (lacking patient empowerment) of the blockchain technology integration in the Electronic Health Record (EHR) paradigm in the existing healthcare landscape. Our study addresses four methodically-tailored and patient-centric Research Questions, primarily examining 138 relevant scientific papers. This scoping review also explores how the pervasiveness of blockchain technology can help to empower patients in terms of access, awareness, and control. Finally, this scoping review leverages the insights gleaned from this study and contributes to the body of knowledge by proposing a patient-centric blockchain-based framework. This work will envision orchestrating three essential elements with harmony: scientific advancement (Healthcare and EHR), technology integration (Blockchain Technology), and patient empowerment (access, awareness, and control).

Gene expression variation underlying tissue-specific responses to copper stress in Drosophila melanogaster

Copper is one of a handful of biologically necessary heavy metals that is also a common environmental pollutant. Under normal conditions, copper ions are required for many key physiological processes. However, in excess, copper quickly results in cell and tissue damage that can range in severity from temporary injury to permanent neurological damage. Because of its biological relevance, and because many conserved copper-responsive genes also respond to other non-essential heavy metal pollutants, copper resistance in Drosophila melanogaster is a useful model system with which to investigate the genetic control of the response to heavy metal stress. Because heavy metal toxicity has the potential to differently impact specific tissues, we genetically characterized the control of the gene expression response to copper stress in a tissue-specific manner in this study. We assessed the copper stress response in head and gut tissue of 96 inbred strains from the Drosophila Synthetic Population Resource (DSPR) using a combination of differential expression analysis and expression quantitative trait locus (eQTL) mapping. Differential expression analysis revealed clear patterns of tissue-specific expression, primarily driven by a more pronounced gene expression response in gut tissue. eQTL mapping of gene expression under control and copper conditions as well as for the change in gene expression following copper exposure (copper response eQTL) revealed hundreds of genes with tissue-specific local cis-eQTL and many distant trans-eQTL. eQTL associated with MtnA, Mdr49, Mdr50, and Sod3 exhibited genotype by environment effects on gene expression under copper stress, illuminating several tissue- and treatment-specific patterns of gene expression control. Together, our data build a nuanced description of the roles and interactions between allelic and expression variation in copper-responsive genes, provide valuable insight into the genomic architecture of susceptibility to metal toxicity, and highlight many candidate genes for future functional characterization.

Scrybe: A Secure Audit Trail for Clinical Trial Data Fusion

Clinical trials are a multi-billion dollar industry. One of the biggest challenges facing the clinical trial research community is satisfying Part 11 of Title 21 of the Code of Federal Regulations [7] and ISO 27789 [40]. These controls provide audit requirements that guarantee the reliability of the data contained in the electronic records. Context-aware smart devices and wearable IoT devices have become increasingly common in clinical trials. Electronic Data Capture (EDC) and Clinical Data Management Systems (CDMS) do not currently address the new challenges introduced using these devices. The healthcare digital threat landscape is continually evolving, and the prevalence of sensor fusion and wearable devices compounds the growing attack surface. We propose Scrybe, a permissioned blockchain, to store proof of clinical trial data provenance. We illustrate how Scrybe addresses each control and the limitations of the Ethereum-based blockchains. Finally, we provide a proof-of-concept integration with REDCap to show tamper resistance.

Smart Contracts in Blockchain Technology: A Critical Review

By utilizing smart contracts, which are essentially scripts that are anchored in a decentralized manner on blockchains or other similar infrastructures, it is possible to make the execution of predetermined procedures visible to the outside world. The programmability of previously unrealized assets, such as money, and the automation of previously manual business logic are both made possible by smart contracts. This revelation inspired us to analyze smart contracts in blockchain technologies written in English between 2012 and 2022. The scope of research is limited to the journal. Reviews, conferences, book chapters, theses, monographs, and interview-based works, and also articles in the press, are eliminated. This review comprises 252 articles over the last ten years with “Blockchain”, “block-chain”, “smart contracts”, and “smart contracts” as keywords. This paper discusses smart contracts’ present status and significance in blockchain technology. The gaps and challenges in the relevant literature have also been discussed, particularly emphasizing the limitations. Based on these findings, several research problems and prospective research routes for future study that will likely be valuable to academics and professionals are identified.

Artificial Intelligence, Wearables and Remote Monitoring for Heart Failure: Current and Future Applications

Substantial milestones have been attained in the field of heart failure (HF) diagnostics and therapeutics in the past several years that have translated into decreased mortality but a paradoxical increase in HF-related hospitalizations. With increasing data digitalization and access, remote monitoring via wearables and implantables have the potential to transform ambulatory care workflow, with a particular focus on reducing HF hospitalizations. Additionally, artificial intelligence and machine learning (AI/ML) have been increasingly employed at multiple stages of healthcare due to their power in assimilating and integrating multidimensional multimodal data and the creation of accurate prediction models. With the ever-increasing troves of data, the implementation of AI/ML algorithms could help improve workflow and outcomes of HF patients, especially time series data collected via remote monitoring. In this review, we sought to describe the basics of AI/ML algorithms with a focus on time series forecasting and the current state of AI/ML within the context of wearable technology in HF, followed by a discussion of the present limitations, including data integration, privacy, and challenges specific to AI/ML application within healthcare.

Developing a blockchain-based digitally secured model for the educational sector in Saudi Arabia toward digital transformation

New universities and educational organizations are increasing in Saudi Arabia with the increase in the need for high-quality education. This increased the need for a fast transformation to digitise the educational system in Saudi Arabia, which is one of the important pillars of the Saudi Vision 2030. The students who study in these organizations suffer the verification of academic records and other educational documents. Students who want to study at universities abroad also face the challenge of academic records and certificates verification. A secure, fast, and transparent model is required in the education sector in order to verify academic certificates issued by various educational organizations. Blockchain technology can be used with high data security to empower the educational sector of Saudi Arabia in the digital transformation and to help the educational organizations in verifying academic documents. In order to avoid any document fraud and forgery, along with the ease of verification of academic records and educational documents for the students. This research focuses on developing a model which will be helpful in achieving digital transformation in academic document verification by blockchain technology.

Blockchain technology applications in the health domain: a multivocal literature review

Blockchain technology has been changing the nature of several businesses, from supply chain management to electronic record management systems and copyright management to healthcare applications. It provides a resilient and secure platform for modifications due to its distributed and shared nature and cryptographic functions. Each new technology, however, comes with its challenges alongside its opportunities. Previously, we performed a systematic literature review (SLR) to explore how blockchain technology potentially benefits health domain applications. The previous SLR included 27 formal literature papers from 2016 to 2020. Noticing that blockchain technology is rapidly growing, we extended the previous SLR with a multivocal literature review (MLR) approach to present the state of the art in this study. We focused on understanding to what degree blockchain could answer the challenges inherited in the health domain and whether blockchain technology may bring new challenges to health applications. The MLR consists of 78 sources of formal literature and 23 sources of gray literature from 2016 to 2021. As a result of this study, we specified 17 health domain challenges that can be categorized into four groups: (i) meeting regulatory requirements and public health surveillance, (ii) ensuring security and privacy, (iii) ensuring interoperability, and (iv) preventing waste of resources. The analysis shows that blockchain makes significant contributions to the solutions of these challenges. However, 10 new pitfalls come with adopting the technology in the health domain: the inability to delete sensitive data once it is added to a chain, limited ability to keep large-scale data in a blockchain, and performance issues. The data we extracted during the MLR is available in a publicly accessible online repository.

Enhancing Competitive Capabilities of Healthcare SCM through the Blockchain: Big Data Business Model’s Viewpoint

The reasons why supply chain management (SCM) needs blockchain technology include simplification of transaction procedures, time and cost reductions, and reliability improvement. This study emphasizes the necessity of introducing a blockchain-based joint logistics system to strengthen the competency of medical SCM and proposes a healthcare supply chain management (HSCM) competency measurement item through an analytic hierarchy process. The variables needed for using blockchain-based joint logistics are the performance expectations, effort expectations, promotion conditions, and social impact of the unified theory of acceptance and use of technology (UTAUT) model, as well as the HSCM competency results in increased reliability and transparency, enhanced SCM, and enhanced scalability. By analyzing the importance of securing reliability based on blockchain technology in the establishment of a supply chain network for HSCM competency, we reveal that joint logistics can be achieved, and synergistic effects can be created by implementing the integrated database to secure HSCM competency. Strengthening partnerships, such as joint logistics, will eventually lead to HSCM competency. In particular, HSCM should seek ways to upgrade its competitive capabilities through big data analysis based on the establishment of a joint logistics system.

The Use of Blockchain Technology in the Health Care Sector: Systematic Review

Background

Blockchain technology is a part of Industry 4.0’s new Internet of Things applications: decentralized systems, distributed ledgers, and immutable and cryptographically secure technology. This technology entails a series of transaction lists with identical copies shared and retained by different groups or parties. One field where blockchain technology has tremendous potential is health care, due to the more patient-centric approach to the health care system as well as blockchain’s ability to connect disparate systems and increase the accuracy of electronic health records.

Objective

The aim of this study was to systematically review studies on the use of blockchain technology in health care and to analyze the characteristics of the studies that have implemented blockchain technology.

Methods

This study used a systematic review methodology to find literature related to the implementation aspect of blockchain technology in health care. Relevant papers were searched for using PubMed, SpringerLink, IEEE Xplore, Embase, Scopus, and EBSCOhost. A quality assessment of literature was performed on the 22 selected papers by assessing their trustworthiness and relevance.

Results

After full screening, 22 papers were included. A table of evidence was constructed, and the results of the selected papers were interpreted. The results of scoring for measuring the quality of the publications were obtained and interpreted. Out of 22 papers, a total of 3 (14%) high-quality papers, 9 (41%) moderate-quality papers, and 10 (45%) low-quality papers were identified.

Conclusions

Blockchain technology was found to be useful in real health care environments, including for the management of electronic medical records, biomedical research and education, remote patient monitoring, pharmaceutical supply chains, health insurance claims, health data analytics, and other potential areas. The main reasons for the implementation of blockchain technology in the health care sector were identified as data integrity, access control, data logging, data versioning, and nonrepudiation. The findings could help the scientific community to understand the implementation aspect of blockchain technology. The results from this study help in recognizing the accessibility and use of blockchain technology in the health care sector.

Blockchain applications for the healthcare sector: Uses beyond Bitcoin

The year 2020 will always be remembered as a catastrophic year since the World Health Organization (WHO) declared COVID-19 (coronavirus) as a pandemic. The sudden emergence of the COVID-19 pandemic has exposed the drawbacks in our healthcare systems to handle public health emergencies. It is clear that implementing cutting-edge technology such as blockchain can aid in reducing the devastating effects of healthcare mishaps and promote efficient planning operations and resource deployment. In the healthcare sector, blockchain technology has the potential to improve clinical trial data management by minimizing regulatory approval delays and revitalizing communication between various parties in the supply chain, among other things. Furthermore, the propagation of misinformation has accelerated in recent years, and existing platforms lack the ability to verify the accuracy of data, resulting in public alarm and irrational behavior. As a result, building a blockchain-based tracking system is critical to ensuring that any data related to healthcare are collected in an accurate and trustworthy manner. Blockchain is a decentralized distributed ledger distribution technology that can make data processing, provenance, and authentication simpler and has the potential to disrupt healthcare. Blockchain is being actively explored in the health sector to optimize business processes, lower costs, improve patient quality, improve compliance, and make better use of data relevant to healthcare. Nevertheless, the need to ensure that blockchain design elements consider specific healthcare needs from the different viewpoints of clients, patients, providers, and regulators is crucial in determining whether blockchain will fulfill the excitement of a technology described as “revolutionary” and “disruptive.” In addition, blockchain approaches must also be attentive to the specific problems facing healthcare relative to other sectors of the economy, in response to the actual needs of healthcare stakeholders. There have been many proposed implementations of blockchain in the healthcare sector, such as electronic health record (EHR) systems. In this chapter, we review the motivations of inculcating blockchain in currently existing EHR systems. The content of this chapter is organized as follows. Section 1 discusses a brief introduction of blockchain along with the EHR system and the current implementation of blockchain in the medical industry. The second section provides a deeper insight into the importance of mobile health, remote monitoring, and the motivations for using blockchain-based EHR systems. The third section will cover the details of a patient-centered blockchain model along with its promising features. The development of the COVID-19 pandemic has created a slew of difficulties around the world. The use of blockchain technology is critical in developing a platform for effectively managing the COVID-19 pandemic. The lack of a precise mechanism to detect new infections and anticipate the coronavirus infection risk is the largest difficulty facing most nations. The numerous characteristics of blockchain technology, such as decentralization, transparency, and immutability, can aid in pandemic management by detecting breakouts early, expediting drug distribution, and safeguarding user privacy while undergoing treatment. In this chapter, we examine blockchain applications and potential in the fight against COVID-19, demonstrating that the proposed solution is cost-effective and assures data integrity, security, transparency, and traceability among stakeholders during the pandemic. The last section is the conclusion.

Exploring the COVID-19 Pandemic as a Catalyst for PHR App User Behavior Change in Taiwan: A Development and Usability Study

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.

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.

Leveraging Blockchain Technology for Informed Consent Process and Patient Engagement in a Clinical Trial Pilot

Objective

Despite the implementation of quality assurance procedures, current clinical trial management processes are time-consuming, costly, and often susceptible to error. This can result in limited trust, transparency, and process inefficiencies, without true patient empowerment. The objective of this study was to determine whether blockchain technology could enforce trust, transparency, and patient empowerment in the clinical trial data management process, while reducing trial cost.

Design

In this proof of concept pilot, we deployed a Hyperledger Fabric-based blockchain system in an active clinical trial setting to assess the impact of blockchain technology on mean monitoring visit time and cost, non-compliances, and user experience. Using a parallel study design, we compared differences between blockchain technology and standard methodology.

Results

A total of 12 trial participants, seven study coordinators and three clinical research associates across five sites participated in the pilot. Blockchain technology significantly reduces total mean monitoring visit time and cost versus standard trial management (475 to 7 min; P = 0.001; €722 to €10; P = 0.001 per participant/visit, respectively), while enhancing patient trust, transparency, and empowerment in 91, 82 and 63% of the patients, respectively. No difference in non-compliances as a marker of trial quality was detected.

Conclusion

Blockchain technology holds promise to improve patient-centricity and to reduce trial cost compared to conventional clinical trial management. The ability of this technology to improve trial quality warrants further investigation.

Blockchain and artificial intelligence technology in e-Health

Blockchain and artificial intelligence technologies are novel innovations in healthcare sector. Data on healthcare indices are collected from data published on Web of Sciences and other Google survey from various governing bodies. In this review, we focused on various aspects of blockchain and artificial intelligence and also discussed about integrating both technologies for making a significant difference in healthcare by promoting the implementation of a generalizable analytical technology that can be integrated into a more comprehensive risk management approach. This article has shown the various possibilities of creating reliable artificial intelligence models in e-Health using blockchain, which is an open network for the sharing and authorization of information. Healthcare professionals will have access to the blockchain to display the medical records of the patient, and AI uses a variety of proposed algorithms and decision-making capability, as well as large quantities of data. Thus, by integrating the latest advances of these technologies, the medical system will have improved service efficiency, reduced costs, and democratized healthcare. Blockchain enables the storage of cryptographic records, which AI needs.

Potential Uses of Blockchain Technology for Outcomes Research on Opioids

The scale and severity of the opioid epidemic call for innovative, multipronged solutions. Research and development is key to accelerate the discovery and evaluation of interventions that support pain and substance use disorder management. In parallel, the use and integration of blockchain technology within research networks holds the potential to address some of the unique challenges facing opioid research. This paper discusses the applications of blockchain technology and illustrates potential ways in which it could be applied to strengthen the validity of outcomes research on the opioid epidemic. We reviewed published and gray literature to identify useful applications of blockchain, specifically those that address the challenges faced by opioid research networks and programs. We then convened a panel of experts to discuss the strengths, limitations, and feasibility of each application. Blockchain has the potential to address some of the issues surrounding health data management, including data availability, data sharing and interoperability, and privacy and security. We identified five primary applications of blockchain to opioids: clinical trials and pharmaceutical research, incentivizing data donation and behavior change, secure exchange and management of e-prescriptions, supply chain management, and secondary use of clinical data for research and public health surveillance. The published literature was limited, leading us to rely on gray literature, which was also limited in its discussion of the technical aspects of implementation. The technical expert panel provided additional context and an assessment of feasibility that was lacking in the literature. Research on opioid use and misuse is challenging because of disparate data stored across different systems, data and system interoperability issues, and legal requirements. These areas must be navigated to make data accessible, timely, and useful to researchers. Blockchain technologies have the potential to act as a facilitator in this process, offering a more efficient, secure, and privacy-preserving solution for data exchange. Among the 5 primary applications, we found that clinical trial research, supply chain management, and secondary use of data had the most examples in practice and the potential effectiveness of blockchain. More discussions and studies should focus on addressing technical questions concerning scalability and tackling practical concerns such as cost, standards, and governance around the implementation of blockchain in health care. Policy concerns related to balancing the need for data accessibility that also protects patient privacy and autonomy in revoking consent should also be examined.

A Blockchain and Artificial Intelligence-Based, Patient-Centric Healthcare System for Combating the COVID-19 Pandemic: Opportunities and Applications

The world is facing multiple healthcare challenges because of the emergence of the COVID-19 (coronavirus) pandemic. The pandemic has exposed the limitations of handling public healthcare emergencies using existing digital healthcare technologies. Thus, the COVID-19 situation has forced research institutes and countries to rethink healthcare delivery solutions to ensure continuity of services while people stay at home and practice social distancing. Recently, several researchers have focused on disruptive technologies, such as blockchain and artificial intelligence (AI), to improve the digital healthcare workflow during COVID-19. Blockchain could combat pandemics by enabling decentralized healthcare data sharing, protecting users' privacy, providing data empowerment, and ensuring reliable data management during outbreak tracking. In addition, AI provides intelligent computer-aided solutions by analyzing a patient's medical images and symptoms caused by coronavirus for efficient treatments, future outbreak prediction, and drug manufacturing. Integrating both blockchain and AI could transform the existing healthcare ecosystem by democratizing and optimizing clinical workflows. In this article, we begin with an overview of digital healthcare services and problems that have arisen during the COVID-19 pandemic. Next, we conceptually propose a decentralized, patient-centric healthcare framework based on blockchain and AI to mitigate COVID-19 challenges. Then, we explore the significant applications of integrated blockchain and AI technologies to augment existing public healthcare strategies for tackling COVID-19. Finally, we highlight the challenges and implications for future research within a patient-centric paradigm.

Blockchain for COVID-19: a comprehensive review

The rampant and sudden outbreak of the SARS-CoV-2 coronavirus also called COVID-19 and its uncontrollable spread have led to a global crisis. COVID-19 is a highly contagious disease and the only way to fight with it is to follow social distancing and Non-Pharmaceutical Interventions (NPIs). Moreover, this virus is increasing exponentially day-by-day and a huge amount of data from this disease is also generated at the fast pace. So, there is a need to store, manage, and analyze this huge amount of data efficiently to get meaningful insights from it, which further helps medical professionals to tackle this global pandemic situation. Moreover, this data is to be passed through an open channel, i.e., the Internet, which opens the doors for the intruders to perform some malicious activities. Blockchain (BC) emerges as a technology that can manage the data in an efficient, transparent manner and also preserve the privacy of all the stakeholders. It can also aid in transaction authorization and verification in the supply chain or payments. Motivated by these facts, in this paper, we present a comprehensive review on the adoption of BC to tackle COVID-19 situations. We also present a case study on BC-based digital vaccine passports and analyzed its complexity. Finally, we analyzed the research challenges and future directions in this emerging area.

A Permissioned Blockchain-Based Clinical Trial Service Platform to Improve Trial Data Transparency

The clinical research faces numerous challenges, from patient enrollment to data privacy concerns and regulatory requirements to spiraling costs. Blockchain technology has the potential to overcome these challenges, thus making clinical trials transparent and enhancing public trust in a fair and open process with all stakeholders because of its distinct features such as data immutability and transparency. This paper proposes a permissioned blockchain platform to ensure clinical data transparency and provides secure clinical trial-related solutions. We explore the core functionalities of blockchain applied to clinical trials and illustrate its general principle concretely. These clinical trial operations are automated using the smart contract, which ensures traceability, prevents a posteriori reconstruction, and securely automates the clinical trial. A web-based user interface is also implemented to visualize the data from the blockchain and ease the interaction with the blockchain network. A proof of concept is implemented on Hyperledger Fabric in the case study of clinical management for multiple clinical trials to demonstrate the designed approach's feasibility. Lastly, the experiment results demonstrate the efficiency and usability of the proposed platform.

ESR white paper: blockchain and medical imaging

Blockchain can be thought of as a distributed database allowing tracing of the origin of data, and who has manipulated a given data set in the past. Medical applications of blockchain technology are emerging. Blockchain has many potential applications in medical imaging, typically making use of the tracking of radiological or clinical data. Clinical applications of blockchain technology include the documentation of the contribution of different "authors" including AI algorithms to multipart reports, the documentation of the use of AI algorithms towards the diagnosis, the possibility to enhance the accessibility of relevant information in electronic medical records, and a better control of users over their personal health records. Applications of blockchain in research include a better traceability of image data within clinical trials, a better traceability of the contributions of image and annotation data for the training of AI algorithms, thus enhancing privacy and fairness, and potentially make imaging data for AI available in larger quantities. Blockchain also allows for dynamic consenting and has the potential to empower patients and giving them a better control who has accessed their health data. There are also many potential applications of blockchain technology for administrative purposes, like keeping track of learning achievements or the surveillance of medical devices. This article gives a brief introduction in the basic technology and terminology of blockchain technology and concentrates on the potential applications of blockchain in medical imaging.

Data sharing: using blockchain and decentralized data technologies to unlock the potential of artificial intelligence: What can assisted reproduction learn from other areas of medicine?

The extension of blockchain use for nonfinancial domains has revealed opportunities to the health care sector that answer the need for efficient and effective data and information exchanges in a secure and transparent manner. Blockchain is relatively novel in health care and particularly for data analytics, although there are examples of improvements achieved. We provide a systematic review of blockchain uses within the health care industry, with a particular focus on the in vitro fertilization (IVF) field. Blockchain technology in the fertility sector, including data sharing collaborations compliant with ethical data handling within confines of international law, allows for large-scale prospective cohort studies to proceed at an international scale. Other opportunities include gamete donation and matching, consent sharing, and shared resources between different clinics.

A Blockchain-Enabled Framework for mHealth Systems

Presently modern technology makes a significant contribution to the transition from traditional healthcare to smart healthcare systems. Mobile health (mHealth) uses advances in wearable sensors, telecommunications and the Internet of Things (IoT) to propose a new healthcare concept centered on the patient. Patients' real-time remote continuous health monitoring, remote diagnosis, treatment, and therapy is possible in an mHealth system. However, major limitations include the transparency, security, and privacy of health data. One possible solution to this is the use of blockchain technologies, which have found numerous applications in the healthcare domain mainly due to theirs features such as decentralization (no central authority is needed), immutability, traceability, and transparency. We propose an mHealth system that uses a private blockchain based on the Ethereum platform, where wearable sensors can communicate with a smart device (a smartphone or smart tablet) that uses a peer-to-peer hypermedia protocol, the InterPlanetary File System (IPFS), for the distributed storage of health-related data. Smart contracts are used to create data queries, to access patient data by healthcare providers, to record diagnostic, treatment, and therapy, and to send alerts to patients and medical professionals.

Security Aspects of Blockchain Technology Intended for Industrial Applications

Blockchain technology plays a significant role in the industrial development. Many industries can potentially benefit from the innovations blockchain decentralization technology and privacy protocols offer with regard to securing, data access, auditing and managing transactions within digital platforms. Blockchain is based on distributed and secure decentralized protocols in which there is no single authority, and no single point of control; the data blocks are generated, added, and validated by the nodes of the network themselves. This article provides insights into the current developments within blockchain technology and explores its ability to revolutionize the multiple industrial application areas such as supply chain industry, Internet of Things (IoT), healthcare, governance, finance and manufacturing. It investigates and provides insights into the security issues and threats related to the blockchain implementations by assessing the research through a systematic literature review. This article proposes possible solutions in detail for enhancing the security of the blockchain for industrial applications along with significant directions for future explorations. The study further suggests how in recent years the adoption of blockchain technology by multiple industrial sectors has gained momentum while in the finance sector it is touching new heights day by day.

Vpassport: A Digital Architecture to Support Social Restart during the SARS-CoV-2 Pandemic

As a consequence of the Sars-CoV-2 pandemic, the causative agent of the COVID-19 coronavirus, the world is currently witnessing profound changes in everyday life. The infection and the resulting death number forecasts generate an increasing threat to the lives of people and the economics of countries. As the acute phase of the pandemic ends, the greatest challenge that most governments are currently undergoing is the lack of tools to certify the immunity status of citizens and the related infection risk of the spread of the COVID-19 virus. To mitigate this challenge, this study proposes an innovative approach to implement a set of IT tools, here named VPassport, that assist large-scale test execution/result management in a distributed way and store the results of all tests made through all channels in a blockchain under country authority control. The proposed approach aims to produce an effective system able to support governments, health authorities, and citizens to take informed decisions on which services and social activities can be accessed respecting policies and rules set by the authorities. This aims to allow a controlled restart of the activities of the country, giving to all citizens the possibility to manage their immunity tests while allowing the authorities to manage the reopening of services and social activities. The proposed model helps in managing this phase and, therefore, the resulting outcome can be used to authorize possible behaviors (e.g., going to the office, production plants, public transportation, theaters, cinemas, etc.). The knowledge of being infected or not in a secure and not modifiable way that can be shown in a simple way, accessible to all, will be the real change in managing the coexistence with the virus until a vaccine will be available for all people.

An Overview of Existing Publications and Most Relevant Projects/Platforms on the Use of Blockchain in Medicine and Neurology

Background

Blockchain is a new methodology involving a data structure with list of records, called blocks, which are linked using cryptography. The aim of the review is to overview the existing publication, projects, and platforms on the use of blockchain in Medicine and Neurology.

Methods

We searched the bibliographic database of MEDLINE and BASE. We also accessed ICObench, Coinmarketcap, and Mobihealthnews databases to explore upcoming, ongoing, and ended projects.

Results

In medicine, there are many projects related to health care, disease prevention, and promotion of healthy life style. In neurology, only one project looks promising: Neuro, an ongoing scientific-technical project uniting scientists, engineers, and programmers for development of new architectures and algorithms of neural networks. Bibliographic searches found 117 publications on Medline and 203 publications on BASE referring to the use of blockchain technology in medicine. Most of them are presented as reviews (narrative, systematic, or minireview), opinions and hypotheses, commentaries, or perspectives. As for Neurology, only one publication refers to the use of blockchain, specifically to Parkinson’s disease.

Discussion

Among the problems related to medicine, there is the lack of information on the patient’s clinical history that could allow accurate diagnosis and treatment. The possibility of having a register based on blockchain technology could help doctors in many ways, including patient management, choosing and monitoring treatments, and standardization of clinical trials.

Conclusion

The use of the blockchain technology in medicine has been repetitively proposed to solve different problems. In this article, we highlight the possible benefits of this technology, with attention to Neurology. Blockchain use can lead to quantifiable benefits in the treatment of neurodegenerative diseases, especially in clinical trials that can fail because of an incorrect patient recruitment.

The HealthChain Blockchain for Electronic Health Records: Development Study

Background

Health care professionals are required to maintain accurate health records of patients. Furthermore, these records should be shared across different health care organizations for professionals to have a complete review of medical history and avoid missing important information. Nowadays, health care providers use electronic health records (EHRs) as a key to the implementation of these goals and delivery of quality care. However, there are technical and legal hurdles that prevent the adoption of these systems, such as concerns about performance and privacy issues.

Objective

This study aimed to build and evaluate an experimental blockchain for EHRs, named HealthChain, which overcomes the disadvantages of traditional EHR systems.

Methods

HealthChain is built based on consortium blockchain technology. Specifically, three organizations, namely hospitals, insurance providers, and governmental agencies, form a consortium that operates under a governance model, which enforces the business logic agreed by all participants. Every peer node hosts an instance of the distributed ledger consisting of EHRs and an instance of chaincode regulating the permissions of participants. Designated orderers establish consensus on the order of EHRs and then disseminate blocks to peers.

Results

HealthChain achieves functional and nonfunctional requirements. It can store EHRs in a distributed ledger and share them among different participants. Moreover, it demonstrates superior features, such as privacy preservation, security, and high throughput. These are the main reasons why HealthChain is proposed.

Conclusions

Consortium blockchain technology can help to build new EHR systems and solve the problems that prevent the adoption of traditional systems.

Blockchain for COVID-19: Review, Opportunities, and a Trusted Tracking System

The sudden development of the COVID-19 pandemic has exposed the limitations in modern healthcare systems to handle public health emergencies. It is evident that adopting innovative technologies such as blockchain can help in effective planning operations and resource deployments. Blockchain technology can play an important role in the healthcare sector, such as improved clinical trial data management by reducing delays in regulatory approvals, and streamline the communication between diverse stakeholders of the supply chain, etc. Moreover, the spread of misinformation has intensely increased during the outbreak, and existing platforms lack the ability to validate the authenticity of data, leading to public panic and irrational behavior. Thus, developing a blockchain-based tracking system is important to ensure that the information received by the public and government agencies is reliable and trustworthy. In this paper, we review various blockchain applications and opportunities in combating the COVID-19 pandemic and develop a tracking system for the COVID-19 data collected from various external sources. We propose, implement, and evaluate a blockchain-based system using Ethereum smart contracts and oracles to track reported data related to the number of new cases, deaths, and recovered cases obtained from trusted sources. We present detailed algorithms that capture the interactions between stakeholders in the network. We present security analysis and the cost incurred by the stakeholders, and we highlight the challenges and future directions of our work. Our work demonstrates that the proposed solution is economically feasible and ensures data integrity, security, transparency, data traceability among stakeholders.

Ensuring protocol compliance and data transparency in clinical trials using Blockchain smart contracts

Background

Clinical Trials (CTs) help in testing and validating the safety and efficacy of newly discovered drugs on specific patient population cohorts. However, these trials usually experience many challenges, such as extensive time frames, high financial cost, regulatory and administrative barriers, and insufficient workforce. In addition, CTs face several data management challenges pertaining to protocol compliance, patient enrollment, transparency, traceability, data integrity, and selective reporting. Blockchain can potentially address such challenges because of its intrinsic features and properties. Although existing literature broadly discusses the applicability of blockchain-based solutions for CTs, only a few studies present their working proof-of-concept.

Methods

We propose a blockchain-based framework for CT data management, using Ethereum smart contracts, which employs IPFS as the file storage system to automate processes and information exchange among CT stakeholders. CT documents stored in the IPFS are difficult to tamper with as they are given unique cryptographic hashes. We present algorithms that capture various stages of CT data management. We develop the Ethereum smart contract using Remix IDE that is validated under different scenarios.

Results

The proposed framework results are advantageous to all stakeholders ensuring transparency, data integrity, and protocol compliance. Although the proposed solution is tested on the Ethereum blockchain platform, it can be deployed in private blockchain networks using their native smart contract technologies. We make our smart contract code publicly available on Github.

Conclusions

We conclude that the proposed framework can be highly effective in ensuring that the trial abides by the protocol and the functions are executed only by the stakeholders who are given permission. It also assures data integrity and promotes transparency and traceability of information among stakeholders.

Is code law? Current legal and technical adoption issues and remedies for blockchain-enabled smart contracts

Blockchain technology has enabled so-called smart contracts between different parties on a decentralized network. These self-enforceable and self-executable computerized contracts could initiate a fundamental paradigm shift in the understanding and functioning of our legal practices. Opportunities for their application are increasingly understood, and numerous tests of feasibility have been completed. However, only very few use cases have yet been implemented at scale. This article—as the first of its kind—comprehensively analyzes the underlying challenges and locates a key reason for the slow adoption in the discrepancy between legal requirements and IT capabilities. Our work combines a wide range of academic sources and interviews with 30 domain experts from IT, the legal domain and private industry. First, we establish that smart contracts still fall within the boundaries of the general legal framework. We then systematically dissect current shortcomings of smart contracts on three distinct levels, namely, (1) how smart contracts are likely to cause conflicts with existing laws, (2) how smart contracts are intrinsically limited on an individual contract level and (3) how they are impeded by their current technical design. Across those levels, we dissect 20 distinct issues concerning the current implementation of smart contracts for which we derive potential remedies. We further outline implications for policy-makers as well as IT management, and examine how information systems research can play an important role in advancing smart contracts. Finally, we show how managerial and organizational issues might represent an ongoing challenge for the widespread adoption of smart contracts.

Applications of blockchain in ensuring the security and privacy of electronic health record systems: A survey

Due to the popularity of blockchain, there have been many proposed applications of blockchain in the healthcare sector, such as electronic health record (EHR) systems. Therefore, in this paper we perform a systematic literature review of blockchain approaches designed for EHR systems, focusing only on the security and privacy aspects. As part of the review, we introduce relevant background knowledge relating to both EHR systems and blockchain, prior to investigating the (potential) applications of blockchain in EHR systems. We also identify a number of research challenges and opportunities.

Blockchain in Healthcare

Blockchain, an immutable ledger or database shared by peers in a network, is comprised of records of events or transactions that are appended chronologically. Introduced via Bitcoin to the world, blockchain is increasingly being accepted and adopted in different industries and for diverse use cases. Among key industries, health care offers several significant opportunities for applying blockchain conceptualization. Chief areas for health care blockchain applications include electronic medical records management, pharmaceutical supply chain management, biomedical research and education, remote patient monitoring, health insurance claim processing, and health data analytics. Even so, applying blockchain concepts in health care is not without challenges, including interoperability, security-privacy, scalability-speed, and stakeholders' engagement issues. While these challenges may militate against blockchain applications in health care, there are possible countermeasures and implementation techniques, which if adhered to, can reasonably contain many aspects of such challenges.

An Architecture and Management Platform for Blockchain-Based Personal Health Record Exchange: Development and Usability Study

BACKGROUND

Personal health record (PHR) security, correctness, and protection are essential for health and medical services. Blockchain architecture can provide efficient data retrieval and security requirements. Exchangeable PHRs and the self-management of patient health can offer many benefits to traditional medical services by allowing people to manage their own health records for disease prevention, prediction, and control while reducing resource burdens on the health care infrastructure and improving population health and quality of life.

OBJECTIVE

This study aimed to build a blockchain-based architecture for an international health record exchange platform to ensure health record confidentiality, integrity, and availability for health management and used Health Level 7 Fast Healthcare Interoperability Resource international standards as the data format that could allow international, cross-institutional, and patient/doctor exchanges of PHRs.

METHODS

The PHR architecture in this study comprised 2 main components. The first component was the PHR management platform, on which users could upload PHRs, view their record content, authorize PHR exchanges with doctors or other medical health care providers, and check their block information. When a PHR was uploaded, the hash value of the PHR would be calculated by the SHA-256 algorithm and the PHR would be encrypted by the Rivest-Shamir-Adleman encryption mechanism before being transferred to a secure database. The second component was the blockchain exchange architecture, which was based on Ethereum to create a private chain. Proof of authority, which delivers transactions through a consensus mechanism based on identity, was used for consensus. The hash value was calculated based on the previous hash value, block content, and timestamp by a hash function.

RESULTS

The PHR blockchain architecture constructed in this study is an effective method for the management and utilization of PHRs. The platform has been deployed in Southeast Asian countries via the Asia eHealth Information Network (AeHIN) and has become the first PHR management platform for cross-region medical data exchange.

CONCLUSIONS

Some systems have shown that blockchain technology has great potential for electronic health record applications. This study combined different types of data storage modes to effectively solve the problems of PHR data security, storage, and transmission and proposed a hybrid blockchain and data security approach to enable effective international PHR exchange. By partnering with the AeHIN and making use of the network's regional reach and expert pool, the platform could be deployed and promoted successfully. In the future, the PHR platform could be utilized for the purpose of precision and individual medicine in a cross-country manner because of the platform's provision of a secure and efficient PHR sharing and management architecture, making it a reasonable base for future data collection sources and the data analytics needed for precision medicine.

Data Validation and Verification Using Blockchain in a Clinical Trial for Breast Cancer: Regulatory Sandbox

Background

The integrity of data in a clinical trial is essential, but the current data management process is too complex and highly labor-intensive. As a result, clinical trials are prone to consuming a lot of budget and time, and there is a risk for human-induced error and data falsification. Blockchain technology has the potential to address some of these challenges.

Objective

The aim of the study was to validate a system that enables the security of medical data in a clinical trial using blockchain technology.

Methods

We have developed a blockchain-based data management system for clinical trials and tested the system through a clinical trial for breast cancer. The project was conducted to demonstrate clinical data management using blockchain technology under the regulatory sandbox enabled by the Japanese Cabinet Office.

Results

We verified and validated the data in the clinical trial using the validation protocol and tested its resilience to data tampering. The robustness of the system was also proven by survival with zero downtime for clinical data registration during a Amazon Web Services disruption event in the Tokyo region on August 23, 2019.

Conclusions

We show that our system can improve clinical trial data management, enhance trust in the clinical research process, and ease regulator burden. The system will contribute to the sustainability of health care services through the optimization of cost for clinical trials.

A survey on blockchain-based platforms for IoT use-cases

The Internet of Things (IoT) has recently emerged as an innovative technology capable of empowering various areas such as healthcare, agriculture, smart cities, smart homes and supply chain with real-time and state-of-the-art sensing capabilities. Due to the underlying potential of this technology, it already saw exponential growth in a wide variety of use-cases in multiple application domains. As researchers around the globe continue to investigate its aptitudes, a collective agreement is that to get the best out of this technology and to harness its full potential, IoT needs to sit upon a flexible network architecture with strong support for security, privacy and trust. On the other hand, blockchain (BC) technology has recently come into prominence as a breakthrough technology with the potential to deliver some valuable properties such as resiliency, support for integrity, anonymity, decentralization and autonomous control. Several BC platforms are proposed that may be suitable for different use-cases, including IoT applications. In such, the possibility to integrate the IoT and BC technology is seen as a potential solution to address some crucial issues. However, to achieve this, there must be a clear understanding of the requirements of different IoT applications and the suitability of a BC platform for a particular application satisfying its underlying requirements. This paper aims to achieve this goal by describing an evaluation framework which can be utilized to select a suitable BC platform for a given IoT application.

Blockchain for Digital Health: Prospects and Challenges

An open distributed ledger system, blockchain records digital transactions and offers the potential to disruptively transform the way we conduct biomedical research, provide health care, and perform economic transactions. This expert review provides the overarching background, key definitions, prospects and socio-technical challenges at the intersection of blockchain and digital health. In addition, we discuss the tenets of next-generation technology policy for blockchain, drawing from the field of responsible innovation.