JMIR Publications

ABSTRACT

Background:

In the era of big data, Artificial Intelligence (AI) and the Internet-of-Things (IoT), digital data has become essential for our day-to-day functions and in healthcare. The sensitive nature of healthcare data presents a number of privacy, security, interoperability, and reliability issues that are crucial to address in any healthcare data management system. However, most of the current healthcare systems are still facing major obstacles and are lacking in some of these areas. This is where the role of decentralized, secure, scalable databases, most notably blockchain, come in, addressing these requisites without compromising security, and therefore, gaining vast interest within the healthcare community. A blockchain is a cryptographic database (or ledger) that is stored, maintained and widely distributed using a large network of nodes, commonly computers, each of which stores a full replica of the data. A blockchain protocol is a set of pre-defined rules or procedures that govern how the nodes interact with the network, view, verify and add data to the ledger.

Objective:

In this article, we aim to explore the blockchain technology, its framework, current applications and integration with other innovations, as well as future opportunities in diverse aspects of healthcare and clinical research, in addition to shedding light on the future impact on the healthcare ecosystem. We also illustrate two case studies to instantiate the potential role of blockchains in healthcare.

Methods:

To identify related existing work, MeSH terms were used. The inclusion criteria included studies that were mainly healthcare/clinical research oriented, a proposed functional framework design as well as implementation and testing with data. Systematic review sources were PubMed/Medline and Cochrane library, in addition to a preliminary search of IEEE Xplore

Results:

Studies included demonstrated multiple framework designs as well as various implementations in healthcare including chronic disease diagnosis, management, monitoring and evaluation. We found that blockchains have also shown a lot of promising applications in clinical trials management such as smart contract application, participant-controlled data access, trustless protocols, and data validity. Electronic health records, patient-centered interoperability, remote patient monitoring, and clinical trials data management were found to be major areas for blockchain utilization, which can become a key catalyst for healthcare innovation.

Conclusions:

the potential benefits of blockchains are limitless; however concrete data on long term clinical outcomes based on blockchains powered and supplemented by AI and IoT is yet to be seen. Nonetheless, implementation of blockchains as a novel way to integrate Electronic health records (EHR) nationwide and to manage common clinical problems in an algorithmic fashion, has the potential of improving patient outcomes, healthcare experience as well as the overall health and well-being of individuals. Electronic health records, patient-centered interoperability, remote patient monitoring, and clinical trials data management are major areas for blockchain utilization, that can become a major catalyst for healthcare innovation.