Blockchain in Healthcare: Opportunities, Challenges, and Possible Solutions

Blockchain in Healthcare: Opportunities, Challenges, and Possible Solutions

Cornelius Chidubem Agbo (University of Ontario Institute of Technology, Canada) and Qusay H. Mahmoud (University of Ontario Institute of Technology, Canada)
DOI: 10.4018/IJHISI.2020070105


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.
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1. Introduction

In advocating personalized and proactive care, healthcare services today must leverage the knowledge hidden in massive data that are generated from various medical monitoring devices and patient medical records (PMRs). The transformation of data into knowledge is the hallmark of modern medicine. Such knowledge offers significant potentials to be utilized for promoting personalized treatments (Shae & Tsai, 2018) and for early disease detection in predictive analytics (Agbo, Mahmoud & Eklund, 2018a; 2018b). Yet, efforts to derive knowledge out of data may be futile if these data are siloed in different databases with little or no interoperable capabilities; moreover, such data may be stored in formats that make data sharing difficult. Also, the collected data may be incomplete, unreliable or potentially compromised (Mettler, 2016). Meanwhile, access to the medical data by the healthcare stakeholders must still be controlled, as the security and privacy of patient data must be protected. Hence, modern healthcare services must be designed to be collaborative, open and transparent, without compromising the integrity of the data or the privacy of patients, the ultimate owners and providers of these data.

Current health data management solutions do not sufficiently address many of these critical data requirements. For example, PMRs are usually held by healthcare providers such as hospitals without the patients having full access to the data (Engelhardt, 2017). Accordingly, patients cannot examine their medical data or even share these with new providers to create a complete medical history. This made it difficult for new healthcare providers to construct a patient's medical history. They sometimes rely on a patient's recollection of their medical history by querying the patient. Yet, this approach is rudimentary and may not result in a complete medical history as the patient may have forgotten details of his past medications and/or may not be able to recount them comprehensively due to lack of knowing proper medical terminologies. Incomplete medical history, as stated earlier, will make it impossible to realize the full potentials of the emerging database technologies for health care. It may also affect the provider's ability to conduct accurate diagnosis and to proffer the right medical intervention. To facilitate the creation and sharing of the complete medical history of patients, care providers should be able to collaborate and exchange patients’ information among each other.

With cloud computing (CC), healthcare providers, including hospitals, now make use of patient portals (PP) to connect and exchange data among themselves and with patients. Even so, the cloud-assisted health data exchange environment has drawbacks with respect to data security and privacy. First, hosting patients' data on the cloud exposes them to security vulnerabilities, which could result in data loss or manipulation. Although there exist countermeasures such as cryptographic techniques, which can be employed to protect the data on the cloud, the fact that the cloud storage is centralized still retains some vulnerabilities, for example, the ransomware attack (McCarthy, 2016). Second, to safeguard patient privacy, the patients themselves must be involved and actively participate in the creation, management and sharing of their personal medical data (Kitson, Marshall, Bassett & Zeitz, 2013). Patient-centric medical data management ensures that patients have access to their complete medical history and can decide when, how and with whom to (or not to) share the data.

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