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

A Systematic Literature Review for Blockchain-Based Healthcare Implementations

BACKGROUND

Healthcare information systems are hindered by delayed data sharing, privacy breaches, and lack of patient control over data. The growing need for secure, privacy-preserved access control interoperable in health informatics technology (HIT) systems appeals to solutions such as Blockchain (BC), which offers a decentralized, transparent, and immutable ledger architecture. However, its current adoption remains limited to conceptual or proofs-of-concept (PoCs), often relying on simulated datasets rather than validated real-world data or scenarios, necessitating further research into its pragmatic applications and their benchmarking.

OBJECTIVE

This systematic literature review (SLR) aims to analyze BC-based healthcare implementations by benchmarking peer-reviewed studies and turning PoCs or production insights into real-world applications and their evaluation metrics. Unlike prior SLRs focusing on proposed or conceptual models, simulations, or limited-scale deployments, this review focuses on validating practical BC real-world applications in healthcare settings beyond conceptual studies and PoCs.

METHODS

Adhering to PRISMA-2020 guidelines, we systematically searched five major databases (Scopus, Web of Science, PubMed, IEEE Xplore, and ScienceDirect) for high-precision relevant studies using MeSH terms related to BC in healthcare. The designed review protocol was registered with OSF, ensuring transparency in the review process, including study screening by independent reviewers, eligibility, quality assessment, and data extraction and synthesis.

RESULTS

In total, 82 original studies fully met the eligibility criteria and narratively reported BC-based healthcare implementations with validated evaluation outcomes. These studies highlight the current challenges addressed by BC in healthcare settings, providing both qualitative and quantitative data synthesis on its effectiveness.

CONCLUSIONS

BC-based healthcare implementations show both qualitative and quantitative effectiveness, with advancements in areas such as drug traceability (up to 100%) and fraud prevention (95% reduction). We also discussed the recent challenges of focusing more attention in this area, along with a discussion on the mythological consideration of our own work. Our future research should focus on addressing scalability, privacy-preservation, security, integration, and ethical frameworks for widespread BC adoption for data-driven healthcare.

Blockchain technology adoption in healthcare: an integrated model

Blockchain technology has gained significant attention in several sectors owing to its distributed ledger, decentralized nature, and cryptographic security. Despite its potential to reform the healthcare industry by providing a unified and secure system for health records, blockchain adoption remains limited. This study aimed to identify the factors influencing the intention to adopt blockchain in healthcare by focusing on healthcare providers. A theoretical model is proposed by integrating the Technological-Organizational-Environmental framework, Fit-Viability Model, and institutional theory. A quantitative approach was adopted and data were collected through an online survey of 199 hospitals to evaluate the model. The collected data were analysed using PLS-SEM. The results indicated that technology trust, information transparency, disintermediation, cost-effectiveness, top management support, organizational readiness, partner readiness, technology vendor support, fit, and viability significantly and positively influenced the intention to adopt blockchain-based Health Information Systems in hospitals. Conversely, coercive pressure from the government negatively affects adoption decisions. Moreover, the study found that the hospital ownership type did not moderate the relationship between the identified factors and blockchain adoption. This study provides valuable insights into the various factors that influence blockchain adoption in hospitals. The developed model offers guidelines for hospitals, blockchain providers, governments, and policymakers to devise strategies that promote implementation and encourage widespread adoption of blockchain in healthcare organizations.

Participant Evaluation of Blockchain-Enhanced Women's Health Research Apps: Mixed Methods Experimental Study

BACKGROUND

Blockchain technology has capabilities that can transform how sensitive personal health data are safeguarded, shared, and accessed in digital health research. Women's health data are considered especially sensitive, given the privacy and safety risks associated with their unauthorized disclosure. These risks may affect research participation. Using a privacy-by-design approach, we developed 2 app-based women's health research study prototypes for user evaluation and assessed how blockchain may impact participation.

OBJECTIVE

This study aims to seek the perspectives of women to understand whether applications of blockchain technology in app-based digital research would affect their decision to participate and contribute sensitive personal health data.

METHODS

A convergent, mixed methods, experimental design was used to evaluate participant perceptions and attitudes toward using 2 app-based women's health research study prototypes with blockchain features. Prototype A was based on the status quo ResearchKit framework and had extensive electronic informed consent, while prototype B minimized study onboarding requirements and had no informed consent; the mechanisms of how the contributed data flowed and were made pseudonymous were the same. User evaluations were carried out in February and March 2021 and consisted of a think-aloud protocol, a perception survey, and a semistructured interview. Findings were mapped to the technology acceptance model to guide interpretation.

RESULTS

We recruited 16 representative female participants from 175 respondents. User evaluations revealed that while participants considered prototype B easier to use on intuitive navigation (theme 1) of specified tasks and comprehension (theme 2) of research procedures, prototype A trended toward being perceived more favorably than prototype B across most perception survey constructs, with an overall lower level of privacy concern (mean [SD]: 2.22 [1.10] vs 2.95 [1.29]) and perceived privacy risk (2.92 [1.46] vs 3.64 [1.73]) and higher level of perceived privacy (5.21 [1.26] vs 4.79 [1.47]), trust (5.46 [1.19] vs 4.76 [1.27]), and usability (67.81 [21.77] vs 64.84 [23.69]). Prototype B was perceived more favorably than prototype A with perceived control (4.92 [1.32] vs 4.89 [1.29]) and perceived ownership (5.18 [0.59] vs 5.01 [0.96]). These constructs, except for perceived ownership, were significantly correlated with behavioral intention to use the app (P<.05). Participants perceived the usefulness of these prototypes in relation to the value of research study to women's health field (theme 3), the value of research study to self (theme 4), and the value of blockchain features for participation (theme 5).

CONCLUSIONS

This study provides nuanced insights into how blockchain applications in app-based research remain secondary in value to participants' expectations of health research, and hence their intention to participate and contribute data. However, with impending data privacy and security concerns, it remains prudent to understand how to best integrate blockchain technology in digital health research infrastructure.

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.

Utilizing Blockchain Technology for Healthcare and Biomedical Research: A Review

Blockchain is a decentralized, secure, and immutable public ledger that offers significant benefits over conventional centralized systems by preventing data breaches and cyber-attacks. It has a great potential to improve data security, privacy, and interoperability in healthcare and biomedical research. This review discusses the basic principles and the historical evolution of blockchain and evaluates the implications of blockchain for the existing healthcare infrastructure. It also highlights blockchain technology's advantages in electronic health records, supply chain management, clinical trials, and telemedicine. However, this technology faces several hurdles, including regulatory issues, technical complexity, and economic costs, which suggest a gradual adoption over time. In addition, the review emphasizes its ability to ensure data integrity, enhance collaboration, and protect intellectual property in biomedical research. This review shows that blockchain can enhance healthcare data management by providing secure, efficient, and patient-centric solutions. Furthermore, it also discusses the implications of blockchain for the future of healthcare and biomedical research and suggests that ongoing research and interdisciplinary approaches are essential for overcoming current barriers and realizing the full potential of this technology. Future research should focus on developing privacy-preserving hybrid data storage solutions that comply with international laws and regulations, thus enhancing the sustainability and scalability of this technology in healthcare.

The Use of Blockchain Technology in Public Health: Lessons Learned

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

A review of big data technology and its application in cancer care

The development of modern medical devices and information technology has led to a rapid growth in the amount of data available for health protection information, with the concept of medical big data emerging globally, along with significant advances in cancer care relying on data-driven approaches. However, outstanding issues such as fragmented data governance, low-quality data specification, and data lock-in still make sharing challenging. Big data technology provides solutions for managing massive heterogeneous data while combining artificial intelligence (AI) techniques such as machine learning (ML) and deep learning (DL) to better mine the intrinsic connections between data. This paper surveys and organizes recent articles on big data technology and its applications in cancer, dividing them into three different types to outline their primary content and summarize their critical role in assisting cancer care. It then examines the latest research directions in big data technology in cancer and evaluates the current state of development of each type of application. Finally, current challenges and opportunities are discussed, and recommendations are made for the further integration of big data technology into the medical industry in the future.

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

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

Artificial Intelligence for Personalized Perioperative Medicine

The development of artificial intelligence (AI) is disruptive and unstoppable, also in medicine. Because of the enormous quantity of data recorded during continuous monitoring and the peculiarity of our specialty where stratification and mitigation risk are some of the core aspects, anesthesiology and postoperative intensive care are fertile fields where new technologies find ample room for expansion. Recently, research efforts have focused on the development of a holistic technology that globally embraces the entire perioperative period rather than a fragmented approach where AI is developed to carry out specific tasks. This could potentially revolutionize the perioperative medicine we know today. In fact, AI will be able to expand clinician's ability to interpret, adapt, and ultimately act in a complex reality with facets that are too complex to be managed all at the same time and in a holistic manner. With the support of new tools, as healthcare professionals we have the moral obligation to govern this transition, allowing an ethical and sustainable development of these technologies and avoiding being overwhelmed by them. We should welcome this transhumanist tension which does not aim at the replacement of human capabilities or even at the integration of these but rather at the expansion of a "single intelligence".

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).

MediLinker: a blockchain-based decentralized health information management platform for patient-centric healthcare

Patients' control over how their health information is stored has been an ongoing issue in health informatics. Currently, most patients' health information is stored in centralized but siloed health information systems of healthcare institutions, rarely connected to or interoperable with other institutions outside of their specific health system. This centralized approach to the storage of health information is susceptible to breaches, though it can be mitigated using technology that allows for decentralized access. One promising technology that offers the possibility of decentralization, data protection, and interoperability is blockchain. In 2019, our interdisciplinary team from the University of Texas at Austin's Dell Medical School, School of Information, Department of Electrical and Computer Engineering, and Information Technology Services developed MediLinker-a blockchain-based decentralized health information management platform for patient-centric healthcare. This paper provides an overview of MediLinker and outlines its ongoing and future development and implementation. Overall, this paper contributes insights into the opportunities and challenges in developing and implementing blockchain-based technologies in healthcare.

The applicability of scarcity, originality, and transaction tracking characteristics of the dermatological industry and non-fungible token

BACKGROUND

The K-beauty industry has entered the global market and encompasses the global economy. In the future, it is necessary to recognize the need for rapid recognition and application of digital technologies such as non-fungible token (NFT) in a continuously changing and shared society.

OBJECTIVES

This literature review presents various examples of ways to increase the value of beauty brands according to the latest digital trends. The potential value of blockchain technology was reviewed while understanding the current usage status of NFT.

METHODS

As of July 2022, NFT's brand application cases can be confirmed, and comparisons and cases can be applied to how much it can contribute to the rise in the value of beauty brands in the future. The 41 references were finally selected using PRISMA flow diagram.

RESULTS

In a rapidly changing time, the beauty industry pays attention to the NFT market that can develop economically. Therefore, the parts that various industries are preemptively trying were prepared by confirming the cases.

CONCLUSION

The beauty industry should pay attention to the NFT market, which is an issue, and by creating a brand with scarcity value, it can apply economic activities in the beauty industry to the trend by releasing products that both consumers and sellers can satisfy.

Low Power Blockchained E-Vote Platform for University Environment

With the onset of the COVID-19 pandemic and the succession of its waves, the transmission of this disease and the number of deaths caused by it have been increasing. Despite the various vaccines, the COVID-19 virus is still contagious and dangerous for affected people. One of the remedies to this is precaution, and particularly social distancing. In the same vein, this paper proposes a remote voting system, which has to be secure, anonymous, irreversible, accessible, and simple to use. It therefore allows voters to have the possibility to vote for their candidate without having to perform the operation on site. This system will be used for university elections and particularly for student elections. We propose a platform based on a decentralized system. This system will use two blockchains communicating with each other: the public Ethereum blockchain and the private Quorum blockchain. The private blockchain will be institution-specific. All these blockchains send the necessary data to the public blockchain which manages different data related to the universities and the ministry. This system enables using encrypted data with the SHA-256 algorithm to have both security and information security. Motivated by the high energy consumption of blockchain and by the performance improvements in low-power, a test is performed on a low-power embedded platform Raspberry PI4 showing the possibility to use the Blockchain with limited resources.

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.

Addressing the Challenges of Electronic Health Records Using Blockchain and IPFS

Electronic Health Records (EHR) are the healthcare sector's core digital strategy meant to improve the quality of care provided to patients. Despite the benefits afforded by this digital transformation initiative, adoption among healthcare organizations has been slower than desired. The sheer volume and sensitive nature of patient records compel these organizations to exercise a healthy amount of caution in implementing EHR. Cyberattacks have also increased the risks associated with non-optimal EHR implementations. An influx of high-profile data breaches has plagued the sector during the COVID-19 pandemic, which put the spotlight on EHR cybersecurity. One objective of this research project is to aid the acceleration of EHR adoption. Another objective is to ensure the robustness of the system to resist malicious attacks. For the former, a systematic review was used to unearth all the possible causes why the adoption of EHR has been anemic. In this paper, sixty-five existing proposed EHR solutions were analyzed and it was found that there are fourteen major challenges that need to be addressed to reduce friction and risk for health organizations. These were privacy, security, confidentiality, interoperability, access control, scalability, authentication, accessibility, availability, data storage, data ownership, data validity, data integrity, and ease of use. We propose EHRChain, a new framework that tackles all the listed challenges simultaneously to address the first objective while also being designed to achieve the second objective. It is enabled by dual-blockchains based on Hyperledger Sawtooth to allow patient data decentralization via a consortium blockchain and IPFS for distributed data storage.

A Review of Blockchain Technology Applications in Ambient Assisted Living

The adoption of remote assisted care was accelerated by the COVID-19 pandemic. This type of system acquires data from various sensors, runs analytics to understand people’s activities, behavior, and living problems, and disseminates information with healthcare stakeholders to support timely follow-up and intervention. Blockchain technology may offer good technical solutions for tackling Internet of Things monitoring, data management, interventions, and privacy concerns in ambient assisted living applications. Even though the integration of blockchain technology with assisted care is still at the beginning, it has the potential to change the health and care processes through a secure transfer of patient data, better integration of care services, or by increasing coordination and awareness across the continuum of care. The motivation of this paper is to systematically review and organize these elements according to the main problems addressed. To the best of our knowledge, there are no studies conducted that address the solutions for integrating blockchain technology with ambient assisted living systems. To conduct the review, we have followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology with clear criteria for including and excluding papers, allowing the reader to effortlessly gain insights into the current state-of-the-art research in the field. The results highlight the advantages and open issues that would require increased attention from the research community in the coming years. As for directions for further research, we have identified data sharing and integration of care paths with blockchain, storage, and transactional costs, personalization of data disclosure paths, interoperability with legacy care systems, legal issues, and digital rights management.