Blockchain Technology in Healthcare: An Analysis of Strengths, Weaknesses, Opportunities, and Threats.

SUMMARY: The dawn of the crypto age has highlighted the potential of blockchain technology in an array of functions for multiple industries. Blockchain technology disrupts existing architecture by offering an efficient and decentralized data management platform. It provides a potential solution to current health information technology problems. The strengths of blockchain are interoperability, data accuracy, security, and transparency. Its weaknesses include a lack of standardization, accessibility, ownership, and change management. Applications in healthcare include revenue cycle management, physician credentialing, electronic health records, and supply chain management, although potential government regulation and internal attacks pose threats to its wider adoption.

Perceived Security Risk Based on Moderating Factors for Blockchain Technology Applications in Cloud Storage to Achieve Secure Healthcare Systems.

Due to the high amount of electronic health records, hospitals have prioritized data protection. Because it uses parallel computing and is distributed, the security of the cloud cannot be guaranteed. Because of the large number of e-health records, hospitals have made data security a major concern. The cloud's security cannot be guaranteed because it uses parallel processing and is distributed. The blockchain (BC) has been deployed in the cloud to preserve and secure medical data because it is particularly prone to security breaches and attacks such as forgery, manipulation, and privacy leaks. An overview of blockchain (BC) technology in cloud storage to improve healthcare system security can be obtained by reading this paper. First, we will look at the benefits and drawbacks of using a basic cloud storage system. After that, a brief overview of blockchain cloud storage technology will be offered. Many researches have focused on using blockchain technology in healthcare systems as a possible solution to the security concerns in healthcare, resulting in tighter and more advanced security requirements being provided. This survey could lead to a blockchain-based solution for the protection of cloud-outsourced healthcare data. Evaluation and comparison of the simulation tests of the offered blockchain technology-focused studies can demonstrate integrity verification with cloud storage and medical data, data interchange with reduced computational complexity, security, and privacy protection. Because of blockchain and IT, business warfare has emerged, and governments in the Middle East have embraced it. Thus, this research focused on the qualities that influence customers' interest in and approval of blockchain technology in cloud storage for healthcare system security and the aspects that increase people's knowledge of blockchain. One way to better understand how people feel about learning how to use blockchain technology in healthcare is through the United Theory of Acceptance and Use of Technology (UTAUT). A snowball sampling method was used to select respondents in an online poll to gather data about blockchain technology in Middle Eastern poor countries. A total of 443 randomly selected responses were tested using SPSS. Blockchain adoption has been shown to be influenced by anticipation, effort expectancy, social influence (SI), facilitation factors, personal innovativeness (PInn), and a perception of security risk (PSR). Blockchain adoption and acceptance were found to be influenced by anticipation, effort expectancy, social influence (SI), facilitating conditions, personal innovativeness (PInn), and perceived security risk (PSR) during the COVID-19 pandemic, as well as providing an overview of current trends in the field and issues pertaining to significance and compatibility.

Workshop RNDS: arquitetura e Infraestrutura da RNDS - 11/12/2020

Design and Application of Electronic Rehabilitation Medical Record (ERMR) Sharing Scheme Based on Blockchain Technology.

As the value of blockchain has been widely recognized, more and more industries are proposing their blockchain solutions, including the rehabilitation medical industry. Blockchain can play a powerful role in the field of rehabilitation medicine, bringing a new research idea to the management of rehabilitation medical data. The electronic rehabilitation medical record (ERMR) contains rich data dimensions, which can provide comprehensive and accurate information for assessing the health of patients, thereby enhancing the effect of rehabilitation treatment. This paper analyzed the data characteristics of ERMR and the application requirements of blockchain in rehabilitation medicine. Based on the basic principles of blockchain, the technical advantages of blockchain used in ERMR sharing have been studied. In addition, this paper designed a blockchain-based ERMR sharing scheme in detail, using the specific technologies of blockchain such as hybrid P2P network, block-chain data structure, asymmetric encryption algorithm, digital signature, and Raft consensus algorithm to achieve distributed storage, data security, privacy protection, data consistency, data traceability, and data ownership in the process of ERMR sharing. The research results of this paper have important practical significance for realizing the safe and efficient sharing of ERMR, and can provide important technical references for the management of rehabilitation medical data with broad application prospects.

Research on medical system based on blockchain technology.

ABSTRACT: Medical data sharing, anti-tampering, and leakage prevention have always been severe problems that plagued the pharmaceutical industry. When a patient is referred, he often cannot provide information about previous visits because the medical information of each hospital cannot be shared in most cases, but only through Medical records, test sheets, and other easily lost paper information are used to share some medical information. At the same time, patient medical information is easily leaked, and the medical information provided in the event of a medical dispute cannot guarantee authenticity and impartiality. This article designs a consortium medical blockchain system based on a Possible Byzantine Fault Tolerance algorithm. This system is a medical system that is maintained and shared by multiple nodes and can prevent medical data from being tampered with or leaked. It can be used to solve these medical problems. Compared with the existing medical blockchain system, this system has certain advantages and better applicability.

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.

A Blockchain-Based Consent Platform for Active Assisted Living: Modeling Study and Conceptual Framework.

BACKGROUND: Recent advancements in active assisted living (AAL) technologies allow older adults to age well in place. However, sensing technologies increase the complexity of data collection points, making it difficult for users to consent to data collection. One possible solution for improving transparency in the consent management process is the use of blockchain, an immutable and timestamped ledger. OBJECTIVE: This study aims to provide a conceptual framework based on technology aimed at mitigating trust issues in the consent management process. METHODS: The consent management process was modeled using established methodologies to obtain a mapping of trust issues. This mapping was then used to develop a conceptual framework based on previous monitoring and surveillance architectures for connected devices. RESULTS: In this paper, we present a model that maps trust issues in the informed consent process; a conceptual framework capable of providing all the necessary underlining technologies, components, and functionalities required to develop applications capable of managing the process of informed consent for AAL, powered by blockchain technology to ensure transparency; and a diagram showing an instantiation of the framework with entities comprising the participants in the blockchain network, suggesting possible technologies that can be used. CONCLUSIONS: Our conceptual framework provides all the components and technologies that are required to enhance the informed consent process. Blockchain technology can help overcome several privacy challenges and mitigate trust issues that are currently present in the consent management process of data collection involving AAL technologies.

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

BACKGROUND: Although the electronic health record system adoption rate has reached 96% in the United States, implementation and usage of health information exchange (HIE) is still lagging behind. Blockchain has come into the spotlight as a technology to solve this problem. However, there have been no studies assessing the perspectives of different stakeholders regarding blockchain-based patient-centered HIE. OBJECTIVE: The objective of this study was to analyze the awareness among patients, health care professionals, and information technology developers toward blockchain-based HIE, and compare their different perspectives related to the platform using a qualitative research methodology. METHODS: In this qualitative study, we applied grounded theory and the Promoting Action on Research Implementation in the Health Service (PARiHS) framework. We interviewed 7 patients, 7 physicians, and 7 developers, for a total of 21 interviewees. RESULTS: Regarding the leakage of health information, the patient group did not have concerns in contrast to the physician and developer groups. Physicians were particularly concerned about the fact that errors in the data cannot be easily fixed due to the nature of blockchain technology. Patients were not against the idea of providing information for clinical trials or research institutions. They wished to be provided with the results of clinical research rather than being compensated for providing data. The developers emphasized that blockchain must be technically mature before it can be applied to the health care scene, and standards of medical information to be exchanged must first be established. CONCLUSIONS: The three groups' perceptions of blockchain were generally positive about the idea of patients having the control of sharing their own health information. However, they were skeptical about the cooperation among various institutions and implementation for data standardization in the establishment process, in addition to how the service will be employed in practice. Taking these factors into consideration during planning, development, and operation of a platform will contribute to establishing practical treatment plans and tracking in a more convenient manner for both patients and physicians. Furthermore, it will help expand the related research and health management industry based on blockchain.

Reducing Alert Fatigue by Sharing Low-Level Alerts With Patients and Enhancing Collaborative Decision Making Using Blockchain Technology: Scoping Review and Proposed Framework (MedAlert).

BACKGROUND: Clinical decision support (CDS) is a tool that helps clinicians in decision making by generating clinical alerts to supplement their previous knowledge and experience. However, CDS generates a high volume of irrelevant alerts, resulting in alert fatigue among clinicians. Alert fatigue is the mental state of alerts consuming too much time and mental energy, which often results in relevant alerts being overridden unjustifiably, along with clinically irrelevant ones. Consequently, clinicians become less responsive to important alerts, which opens the door to medication errors. OBJECTIVE: This study aims to explore how a blockchain-based solution can reduce alert fatigue through collaborative alert sharing in the health sector, thus improving overall health care quality for both patients and clinicians. METHODS: We have designed a 4-step approach to answer this research question. First, we identified five potential challenges based on the published literature through a scoping review. Second, a framework is designed to reduce alert fatigue by addressing the identified challenges with different digital components. Third, an evaluation is made by comparing MedAlert with other proposed solutions. Finally, the limitations and future work are also discussed. RESULTS: Of the 341 academic papers collected, 8 were selected and analyzed. MedAlert securely distributes low-level (nonlife-threatening) clinical alerts to patients, enabling a collaborative clinical decision. Among the solutions in our framework, Hyperledger (private permissioned blockchain) and BankID (federated digital identity management) have been selected to overcome challenges such as data integrity, user identity, and privacy issues. CONCLUSIONS: MedAlert can reduce alert fatigue by attracting the attention of patients and clinicians, instead of solely reducing the total number of alerts. MedAlert offers other advantages, such as ensuring a higher degree of patient privacy and faster transaction times compared with other frameworks. This framework may not be suitable for elderly patients who are not technology savvy or in-patients. Future work in validating this framework based on real health care scenarios is needed to provide the performance evaluations of MedAlert and thus gain support for the better development of this idea.

Towards developing a secure medical image sharing system based on zero trust principles and blockchain technology.

BACKGROUND: Data security has been a critical topic of research and discussion since the onset of data sharing in e-health systems. Although digitalization of data has increased efficiency and speed, it has also made data vulnerable to cyber attacks. Medical records in particular seem to be the regular victims of hackers. Several data breach incidents throughout history have warranted the invention of security measures against these threats. Although various security procedures like firewalls, virtual private networks, encryption, etc are present, a mix of these approaches are required for maximum security in medical image and data sharing. METHODS: Relatively new, blockchain has become an effective tool for safeguarding sensitive information. However, to ensure overall protection of medical data (images), security measures have to be taken at each step, from the beginning, during and even after transmission of medical images which is ensured by zero trust security model. In this research, a number of studies that deal with these two concepts were studied and a decentralized and trustless framework was proposed by combining these two concepts for secured medical data and image transfer and storage. RESULTS: Research output suggested blockchain technology ensures data integrity by maintaining an audit trail of every transaction while zero trust principles make sure the medical data is encrypted and only authenticated users and devices interact with the network. Thus the proposed model solves a lot of vulnerabilities related to data security. CONCLUSIONS: A system to combat medical/health data vulnerabilities has been proposed. The system makes use of the immutability of blockchain, the additional security of zero trust principles, and the scalability of off chain data storage using Inter Planetary File Systems (IPFS). The adoption of this system suggests to enhance the security of medical or health data transmission.

Proposed Implementation of Blockchain in British Columbia's Health Care Data Management.

BACKGROUND: There are several challenges such as information silos and lack of interoperability with the current electronic medical record (EMR) infrastructure in the Canadian health care system. These challenges can be alleviated by implementing a blockchain-based health care data management solution. OBJECTIVE: This study aims to provide a detailed overview of the current health data management infrastructure in British Columbia for identifying some of the gaps and inefficiencies in the Canadian health care data management system. We explored whether blockchain is a viable option for bridging the existing gaps in EMR solutions in British Columbia's health care system. METHODS: We constructed the British Columbia health care data infrastructure and health information flow based on publicly available information and in partnership with an industry expert familiar with the health systems information technology network of British Columbia's Provincial Health Services Authorities. Information flow gaps, inconsistencies, and inefficiencies were the target of our analyses. RESULTS: We found that hospitals and clinics have several choices for managing electronic records of health care information, such as different EMR software or cloud-based data management, and that the system development, implementation, and operations for EMRs are carried out by the private sector. As of 2013, EMR adoption in British Columbia was at 80% across all hospitals and the process of entering medical information into EMR systems in British Columbia could have a lag of up to 1 month. During this lag period, disease progression updates are continually written on physical paper charts and not immediately updated in the system, creating a continuous lag period and increasing the probability of errors and disjointed notes. The current major stumbling block for health care data management is interoperability resulting from the use of a wide range of unique information systems by different health care facilities. CONCLUSIONS: Our analysis of British Columbia's health care data management revealed several challenges, including information silos, the potential for medical errors, the general unwillingness of parties within the health care system to trust and share data, and the potential for security breaches and operational issues in the current EMR infrastructure. A blockchain-based solution has the highest potential in solving most of the challenges in managing health care data in British Columbia and other Canadian provinces.

Combating Health Care Fraud and Abuse: Conceptualization and Prototyping Study of a Blockchain Antifraud Framework.

BACKGROUND: An estimated US $2.6 billion loss is attributed to health care fraud and abuse. With traditional health care claims verification and reimbursement, the health care provider submits a claim after rendering services to a patient, which is then verified and reimbursed by the payer. However, this process leaves out a critical stakeholder: the patient for whom the services are actually rendered. This lack of patient participation introduces a risk of fraud and abuse. Blockchain technology enables secure data management with transparency, which could mitigate this risk of health care fraud and abuse. OBJECTIVE: The aim of this study is to develop a framework using blockchain to record claims data and transactions in an immutable format and to enable the patient to act as a validating node to help detect and prevent health care fraud and abuse. METHODS: We developed a health care fraud and abuse blockchain technical framework and prototype using key blockchain tools and application layers including consensus algorithms, smart contracts, tokens, and governance based on digital identity on the Ethereum platform (Ethereum Foundation). RESULTS: Our technical framework maps to the claims adjudication process and focuses on Medicare claims, with the US Centers for Medicare and Medicaid Services (CMS) as the central authority. A prototype of the framework system was developed using the blockchain platform Ethereum (Ethereum Foundation), with its design features, workflow, smart contract functions, system architecture, and software implementation outlined. The software stack used to build the system consisted of a front-end user interface framework, a back-end processing server, and a blockchain network. React was used for the user interface framework, and NodeJS and an Express server were used for the back-end processing server; Solidity was the smart contract language used to interact with a local Ethereum blockchain network. CONCLUSIONS: The proposed framework and the initial prototype have the potential to improve the health care claims process by using blockchain technology for secure data storage and consensus mechanisms, which make the claims adjudication process more patient-centric for the purposes of identifying and preventing health care fraud and abuse. Future work will focus on the use of synthetic or historic CMS claims data to assess the real-world viability of the framework.

Blockchain technology applications to postmarket surveillance of medical devices.

INTRODUCTION: The amount of mandatory data that needs to be analyzed as part of a medical device postmarket surveillance (PMS) system has grown exponentially in recent times. This is a consequence of increasingly demanding and complex regulatory requirements from Health Authorities, aimed at a better understanding of the medical device safety evaluation. Proactive approaches to PMS processes are becoming more necessary as regulators increase the scrutiny of device safety. New technologies have been explored to address some of the challenges associated with this changing regulatory environment. AREAS COVERED: This paper focuses on the different technical aspects of blockchain and how this new technology has the potential to support the ongoing efforts to improve the PMS system for medical devices. EXPERT OPINION: To address these challenges, we suggest to generate a private PMS data permissioned blockchain with a proof-of-authority consensus mechanism, to which only a restricted number of designated and audited participants have authorization to validate transactions and add them to the PMS data blockchain ledger. Blockchain has the potential to support a more efficient approach, which could offer many advantages to the different stakeholders involved in the PMS process, such as supporting with new regulatory initiatives.

Adoption of Blockchain in Health Care.

This study aims to review current issues regarding the application of blockchain technology in health care. We illustrated the various ways in which blockchain can solve current health care issues in three main arenas: data exchange, contracts, and supply chain management. This paper presents several current and projected uses of blockchain technology in the health care industry. We predicted which of these applications are likely to be adopted quickly and provided a supply chain example of tracking the transportation of organs for transplantation.

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

BACKGROUND: Blockchain technology is leveraging its innovative potential in various sectors and its transformation of business-related processes has drawn much attention. Topics of research interest have focused on medical and health care applications, while research implications have generally concluded in system design, literature reviews, and case studies. However, a general overview and knowledge about the impact on the health care ecosystem is limited. OBJECTIVE: This paper explores a potential paradigm shift and ecosystem evolution in health care utilizing blockchain technology. METHODS: A literature review with a case study on a pioneering initiative was conducted. With a systematic life cycle analysis, this study sheds light on the evolutionary development of blockchain in health care scenarios and its interactive relationship among stakeholders. RESULTS: Four stages-birth, expansion, leadership, and self-renewal or death-in the life cycle of the business ecosystem were explored to elucidate the evolving trajectories of blockchain-based health care implementation. Focused impacts on the traditional health care industry are highlighted within each stage to further support the potential health care paradigm shift in the future. CONCLUSIONS: This paper enriches the existing body of literature in this field by illustrating the potential of blockchain in fulfilling stakeholders' needs and elucidating the phenomenon of coevolution within the health care ecosystem. Blockchain not only catalyzes the interactions among players but also facilitates the formation of the ecosystem life cycle. The collaborative network linked by blockchain may play a critical role on value creation, transfer, and sharing among the health care community. Future efforts may focus on empirical or case studies to validate the proposed evolution of the health care ecosystem.

Developing a Mobile App for Monitoring Medical Record Changes Using Blockchain: Development and Usability Study.

BACKGROUND: Although we are living in an era of transparency, medical documents are often still difficult to access. Blockchain technology allows records to be both immutable and transparent. OBJECTIVE: Using blockchain technology, the aim of this study was to develop a medical document monitoring system that informs patients of changes to their medical documents. We then examined whether patients can effectively verify the monitoring of their primary care clinical medical records in a system based on blockchain technology. METHODS: We enrolled participants who visited two primary care clinics in Korea. Three substudies were performed: (1) a survey of the recognition of blockchain medical records changes and the digital literacy of participants; (2) an observational study on participants using the blockchain-based mobile alert app; and (3) a usability survey study. The participants' medical documents were profiled with HL7 Fast Healthcare Interoperability Resources, hashed, and transacted to the blockchain. The app checked the changes in the documents by querying the blockchain. RESULTS: A total of 70 participants were enrolled in this study. Considering their recognition of changes to their medical records, participants tended to not allow these changes. Participants also generally expressed a desire for a medical record monitoring system. Concerning digital literacy, most questions were answered with "good," indicating fair digital literacy. In the second survey, only 44 participants-those who logged into the app more than once and used the app for more than 28 days-were included in the analysis to determine whether they exhibited usage patterns. The app was accessed a mean of 5.1 (SD 2.6) times for 33.6 (SD 10.0) days. The mean System Usability Scale score was 63.21 (SD 25.06), which indicated satisfactory usability. CONCLUSIONS: Patients showed great interest in a blockchain-based system to monitor changes in their medical records. The blockchain system is useful for informing patients of changes in their records via the app without uploading the medical record itself to the network. This ensures the transparency of medical records as well as patient empowerment.

ACTION-EHR: Patient-Centric Blockchain-Based Electronic Health Record Data Management for Cancer Care.

BACKGROUND: With increased specialization of health care services and high levels of patient mobility, accessing health care services across multiple hospitals or clinics has become very common for diagnosis and treatment, particularly for patients with chronic diseases such as cancer. With informed knowledge of a patient's history, physicians can make prompt clinical decisions for smarter, safer, and more efficient care. However, due to the privacy and high sensitivity of electronic health records (EHR), most EHR data sharing still happens through fax or mail due to the lack of systematic infrastructure support for secure, trustable health data sharing, which can also cause major delays in patient care. OBJECTIVE: Our goal was to develop a system that will facilitate secure, trustable management, sharing, and aggregation of EHR data. Our patient-centric system allows patients to manage their own health records across multiple hospitals. The system will ensure patient privacy protection and guarantee security with respect to the requirements for health care data management, including the access control policy specified by the patient. METHODS: We propose a permissioned blockchain-based system for EHR data sharing and integration. Each hospital will provide a blockchain node integrated with its own EHR system to form the blockchain network. A web-based interface will be used for patients and doctors to initiate EHR sharing transactions. We take a hybrid data management approach, where only management metadata will be stored on the chain. Actual EHR data, on the other hand, will be encrypted and stored off-chain in Health Insurance Portability and Accountability Act-compliant cloud-based storage. The system uses public key infrastructure-based asymmetric encryption and digital signatures to secure shared EHR data. RESULTS: In collaboration with Stony Brook University Hospital, we developed ACTION-EHR, a system for patient-centric, blockchain-based EHR data sharing and management for patient care, in particular radiation treatment for cancer. The prototype was built on Hyperledger Fabric, an open-source, permissioned blockchain framework. Data sharing transactions were implemented using chaincode and exposed as representational state transfer application programming interfaces used for the web portal for patients and users. The HL7 Fast Healthcare Interoperability Resources standard was adopted to represent shared EHR data, making it easy to interface with hospital EHR systems and integrate a patient's EHR data. We tested the system in a distributed environment at Stony Brook University using deidentified patient data. CONCLUSIONS: We studied and developed the critical technology components to enable patient-centric, blockchain-based EHR sharing to support cancer care. The prototype demonstrated the feasibility of our approach as well as some of the major challenges. The next step will be a pilot study with health care providers in both the United States and Switzerland. Our work provides an exemplar testbed to build next-generation EHR sharing infrastructures.

Blockchain in Health Care: Hope or Hype?

There has been an increasing interest in blockchain technology from the health care sector in the last couple of years. The value proposition for using blockchain technology in the health care sector is to share sensitive patient data among health care entities securely and to empower patients. Blockchain technology allows patients to have an active role in developing and updating their own patient data. However, is blockchain technology really the silver bullet it seems to be? With this paper, we aim to understand the benefits and challenges of blockchain technology in the health care sector. We discuss innovation and security implications concerning blockchain technology in health care. Furthermore, we show that there is a need for more use cases to ensure the secure sharing of data within the health care sector. In our opinion, blockchain technology will not solve the issues encountered by the health care sector; in fact, it may raise more issues than it will solve.