Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Oct 5, 2018
Open Peer Review Period: Oct 9, 2018 - Dec 4, 2018
Date Accepted: Mar 30, 2019
(closed for review but you can still tweet)
Analysis of trade-offs in systems design of blockchain implementations in healthcare: A systematic review
ABSTRACT
Background:
A blockchain is a list of records that uses cryptography to make stored data immutable, and their use has recently been proposed for Electronic Medical Record systems (EMRs). This paper details a systematic review of “trade-offs” in blockchain that are relevant to EMRs.
Objective:
The review’s primary research question was: “What are the trade-offs involved in different blockchain designs that are relevant to the creation of blockchain-based electronic medical records systems?”
Methods:
7 databases were systematically searched for relevant articles between 1 Jan 2017 and 15 Jun 2018 using the Preferred Reporting Items for Systematic Reviews. Papers published from 1 Jan 2017 to 15 June 2018 were selected. Quality assessments of papers were performed using the ROBINS-I tool and the CASP tool. Database searches identified 2885 articles, of which 15 were ultimately included for analysis.
Results:
17 trade-offs were identified impacting the design, development and implementation of blockchain systems; these trade-offs are organised in themes including business, application, data and technology architecture.
Conclusions:
The key findings concluded: (1); multiple trade-offs can be managed adaptively to improve EMR utility. (2); multiple trade-offs involve improving the security of blockchain systems at the cost of other features, meaning EMR efficacy highly depends on data protection standards. (3); multiple trade-offs result in improved blockchain scalability. Consideration of these trade-offs will be important to the specific environment in which electronic medical records are being developed. The review also uses its findings to suggest useful design choices for a hypothetical NHS blockchain. Clinical Trial: International Prospective Register for Systematic Reviews (PROSPERO) number CRD42018096947.
Citation
Per the author's request the PDF is not available.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.