Blockchain Technology in the Healthcare Sector Discussion Paper

1.0 Introduction

The advent of technology has enabled the development and enhancement of service provision in nearly all sectors, including health. New technologies, for instance, big data and the Internet of Things, have proved core to healthcare innovation and in supporting the designing and execution of a “smart healthcare system” (Du et al., 2021). The concept of smart healthcare adopts a system that relies on “cloud data” as the principal and one that unites electronic medical records (EHRs), EHRs archives, and medical Internet of Things (IoT) by exploiting IoT, technologies exchange, and data transmission to support clinical and health service execution and delivery through enhanced management. Currently, the “smart healthcare” sector is on a rapid trajectory though it faces significant challenges associated with information and system security. Miraz & Donald (2018) claims that technology is the fourth stage of the industrial revolution. With blockchain having the characteristics of anonymity, decentralization, security, and auditability Zhang et al. (2018), it eliminates the challenge of the system and information security. The combination of smart healthcare and blockchain can lessen the weak points of traditional “smart healthcare” regarding data security, information sharing, and data privacy, consequently optimizing the patient-centered smart healthcare systems, besides helping to develop a chain of multiparty medical stakeholders. The applicability of blockchain technology in the healthcare sector is the overall purpose of this analysis. A literature review on the management of electronic health records, which has been a challenge to the provision of quality care as well as on the effective adoption of comprehensive and patient-centered care, will be conducted with special attention to MedRec.

2.0 Background

In the healthcare sector, there is a progressive shift towards comprehensive and one that is also yet patient-centric. Patient-centered care refers to providing care that is responsive to and cognizant of a patient’s preferences, needs, and values; hence the approach emphasizes that a patient’s values should direct all medical decisions (Blount, 2019). A patient-centric approach necessitates the inclusion of multi-disciplinary teams as well as solid corporation between patients and their healthcare providers. Blockchain Technology in the Healthcare Sector Discussion Paper Though the principal goal of any patient-centric care plan is enhancing patient health outcomes, healthcare providers similarly gain from the care approach through higher staff morale and productivity, enhanced patient satisfaction ratings, and declined overall care costs, among other benefits.

On its part, the concept of comprehensiveness in healthcare links to the scope of offered services and the whole-person clinical approach. Haggerty et al. (2011) define comprehensive healthcare as providing services that meet most of the patient’s healthcare needs. Additionally, the whole-person care concept denoted the extent to which a healthcare provider draws out and recognizes a patient’s physical, social, and emotional health and considers the community context in the patient’s care.

While the concepts of patient-centered and comprehensive care are attractive and gaining strong recognition in healthcare, their adoption and implementation are highly constrained by various challenges (Sullivan, 2016). The issue of patient records sharing is highly limiting for various reasons, including data protection laws concerned with the security of personal data. This is even though for the patient-centered and comprehensive care concepts to work effectively, patient records must be easily accessible. With blockchain having the characteristics of anonymity, decentralization, security, and auditability (Zhang et al., 2018), there is a possibility of finally addressing the already identified challenge of information and system security. Healthcare is seeing the progressive entry of blockchain-based systems, including MedRec, PokitDok, Patientory, Chronicled, Guardtime, and Medicalchain.

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MedRec adopts the blockchain technology approach, consequently helping to decentralize the management of patient Electronic Health Records (EHRs). The system’s design allows patients a watertight, absolute log and access to their medical information across healthcare institutions and providers. Leveraging distinctive blockchain attributes, MedRec controls authentication, patient data retrieval, real-time tracking of existing records, data modification, and data sharing. The system can manage patients’ records without centralized data repositories since, through a modular system design, it can join with providers’ current local data storage systems solutions, consequently guaranteeing interoperable data exchange between the patients and the data sources.

3.0 Research Questions

Azaria et al. (2016).

• What is the blockchain structure applied to EMRs?

Bhattacharya et al. (2017).

• How can blockchain be exploited to optimize healthcare outcomes?

Du et al. (2021)

• Who constitutes smart healthcare stakeholders, and what are their shared goals and mutual trading relationships from the stakeholders’ outlook?
• How should smart healthcare systems be designed to guarantee safety and effectiveness?

Gosh et al. (2023)

• What is the current literature’s standpoint concerning the adoption of blockchain in the healthcare industry?
• In which healthcare areas is the blockchain being employed?
• What are the limitations of blockchain adoption in healthcare?
• What healthcare aspects are in the future likely to benefit from the adoption of blockchain technology?

Haleem et al. (2021)

• What are the significant needs in healthcare that necessitate the need for blockchain technology?
• What is the potential of blockchain technology in enabling a global healthcare culture?
• How can blockchain technology contribute to the revival of healthcare services?
• What is the “Unified Work-Flow Process” of blockchain technology implementation in healthcare services provision?
• What are the core applications of blockchain in healthcare?

Noh et al. (2017)

• What strategies can be used to guarantee data security in EHRs sharing systems?

OECD (2020)

• What does blockchain technology denote, and what are its benefits and limitations?
• What are blockchain technology’s rising and future uses in the health sector?
• What are the policy considerations for deploying blockchain technology in the health sector?

Saeed et al. (2022)

• What is the leading structure of blockchain applications in the healthcare sector?
• What are the core healthcare areas where blockchain technology has been employed?
• What are the current issues and limitations identified in past studies in the healthcare sectors employing blockchain technology?
• What healthcare avenues are likely to benefit from the employment of blockchain technology?

4.0 Methodology

Azaria et al. (2016)

In this descriptive study, the authors evaluate MedRec’s effectiveness in managing EMHRs. Through a case research approach, the authors attempt to justify why MedRec is an appropriate and suitable system for managing EMHRs.

Bhattacharya et al. (2017)

A case study research approach is adopted in this study. The researchers examined the “Blockchain-Based Deep Learning as-a-Service (BinDaaS) framework” to identify how it combines” blockchain technology” and “deep-learning techniques” to share EHRs across healthcare users. Blockchain Technology in the Healthcare Sector Discussion Pape

Du et al. (2021)

This study employed a qualitative method to analyze ten identified need gaps in healthcare. The study widely employs the “decision making trial,” “fuzzy set theory,” as well as “evaluation laboratory (DEMATEL),” and “interpretive structural modeling (ISM)” to measure the relationship between factors and explain the correlation between diverse levels, showing the pressure trail of blockchain on the development of “smart healthcare.”

Gosh et al. (2023)

This study adopted the qualitative research method, where a systematic review of the literature was conducted. Through the CASP Systematic Review Checklist, the researchers identified 144 past studies for the final analysis.

Haleem et al. (2021)

Through a qualitative research approach, the study established and explicated some fourteen primary executions of blockchain in healthcare.

Noh et al. (2017)

Noh et al. (2017) adopted the case study methodology in their study. The researchers examined the cloud-based data-sharing system, consequently comparing its efficiency against the blockchain-based system.

OECD (2020)

The policy paper adopted the interview method for its data collection, where experts/policymakers were asked to respond to the questions; to what extent is blockchain essential to maintain the integrity of transactions in the healthcare sector? Do the costs and benefits of blockchain technology compare positively against substitute technologies, for instance, the traditional, centrally-managed database?

Saeed et al. (2022)

The study employed the systematic literature review method. Accordingly, 51 studies were chosen to demonstrate the effects of each research question in the study.

5.0 Data Analysis.

Du et al. (2021) made four observations regarding the hierarchy and interdependence of stakeholders in a smart healthcare system. First, the upper-level blueprint consists of the medical record and staff management and is the key influencer of the need for the system. Secondly, they observed that particular applications of blockchain technology in the “smart healthcare” system are primarily wedged around the smart aspects that depend on medical records management through significantly inhibited by the “smart healthcare” system; therefore, blockchain optimization is core to system improvement. Third, external and internal oversight, insurance, and governance within the sector play a definite role in the system’s development and safeguard stakeholders’ interests. Adopting the smart healthcare system under the blockchain should therefore be designed on the foundation of the stakeholder, information, and transaction layers.

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Several studies also widely observed that blockchain technology is essential in addressing critical dilemmas in healthcare, including diagnostics, enhancing healthcare, data integrity, and fraud avoidance (Saeed et al., 2022). Similarly, Haleem et al. (2021) argued that blockchain plays a fundamental role in handling fraud in the sector by citing the potential it offers concerning improving data efficiency. They further observed that blockchain helped eliminate the fear of data manipulation and support a distinctive data storage model with a tight security level (Noh et al., 2017). The study identified authentication, interconnection, versatility, and accountability as the primary attributes of a blockchain technology-based system, a similar observation to that of Gosh et al. (2023). However, Goshen et al. (2023) noted that most of the applications of the technology were largely in documentation; hence it is relatively limited.

Concerning data security, Bhattacharyan et al. (2019) argue that confidentiality, privacy, and data consistency are paramount in health care. Therefore there is a need to develop reliable security measures such as the Blockchain-Based Deep Learning as-a-Service (BinDaaS), which integrates blockchain and deep-learning techniques for data sharing and has proved to be highly efficient compared to traditional data protection systems and approaches. In a policy paper, OECD (2020) proposed that blockchain is fit for purpose in the healthcare sector but must be critically assessed for compliance with the law and data governance frameworks. Besides, extensive user awareness education should be adopted to facilitate its use and acceptance. In this regard, Azaria et al. (2016) conclude that MedRec, a blockchain-based healthcare system, effectively facilitates the surfacing of data economics, feeding big data to enable healthcare stakeholders to make appropriate choices under a safe yet accessible EHRs system.

6.0 Conclusions

The selected studies and policy papers raise relevant issues/questions regarding the application of blockchain technology in the healthcare sector. The researchers could obtain verifiable results through effective research methods, qualitative and quantitative, as well as specific research approaches such as case studies, interviews, and systematic literature review. This can be justified by the similar deductions made for similar themes, including the capability of blockchain technology to enhance patient data safety when sharing over various internet-based systems. Depending on the research question, the studies differed in methodology but significantly made similar conclusions with the application of blockchain technology in the healthcare sector. However, the studies were limited in a range of ways, mainly due to little literature on blockchain technology in sectors other than finance. Further, only a handful of blockchain-based systems are applicable in the health sector to compare. Therefore, as an innovation in the sector, there is a need to expand research to understand where it can be effectively applied and mitigate any emerging challenges.

References List

Azaria, A., Ekblaw, A., Vieira, T., & Lippman, A. (2016). MedRec: Using Blockchain for Medical Data Access and Permission Management. 2016 2^nd International Conference on Open and Big Data. Massachusetts Institute of Technology Cambridge, MA

Bhattacharya, P., Tanwar, S., Bodkhe, U., Tyagi, S., & Kumar, N. (2021). Bindaas: Blockchain-based deep-learning as-a-service in Healthcare 4.0 applications. IEEE Transactions on Network Science and Engineering, 8(2), 1242–1255. https://doi.org/10.1109/tnse.2019.2961932

Blount, A. (2019). Getting to patient-centered care. Patient-Centered Primary Care, pp. 1–15. https://doi.org/10.1007/978-3-030-17645-7_1

Du, X., Chen, B., Ma, M., & Zhang, Y. (2021). Research on blockchain application in smart healthcare: Constructing a hierarchical framework. Journal of Healthcare Engineering, 2021, 1–13. https://doi.org/10.1155/2021/6698122

Ghosh, P.K.; Chakraborty, A.; Hasan, M.; Rashid, K.; Siddique, A.H. (2023). Blockchain Application in Healthcare Systems: A Review. Systems11 (38). 1-44. https://doi.org/10.3390/systems11010038

Blockchain Technology in the Healthcare Sector Discussion Paper