JMIR Publications

ABSTRACT

Background:

Blockchain-based (BC) health information exchange (HIE) has received increased attention in healthcare research and practice over the last years. It enables the sharing of patient information across healthcare organizations, provides higher levels of data confidentiality and security, and reduces time and costs in collaborative medical decision-making. To make informed decisions on the implementation of BC-based HIE in practice and to fully understand the implications of its use for patient care, it is important to gain insights into patient perceptions of and interactions with BC-based HIE.

Objective:

The objective of this study was to assess patient perceptions and evaluate their feedback for the iterative development of a BC-based HIE mobile application.

Methods:

We employed user-centered design in three phases, using both qualitative and quantitative methods to collect patient perceptions of BC-based HIE. First, we enquired about patient requirements with a structured questionnaire, followed by semi-structured interviews to collect feedback on mock-ups for a BC-based HIE mobile application. Last, we conducted a survey to evaluate the BC-based HIE mobile application with the technology acceptance model (TAM), the system usability scale (SUS), and open feedback.

Results:

Our findings support that patients have a high intention to use the BC-based functions that enable them to define, track, and revoke access to their health data per healthcare facility and service provider. Patients rated the four key functionalities (connection with providers, document sharing, a health diary, and a healthcare service provider search) as both useful and easy to use. The overall SUS of the BC-based HIE mobile application improved over the three phases up to 77.34 showing a good overall usability. The open feedback showed that patients’ perceived usefulness of a BC-based HIE mobile application is especially influenced by three factors: The acceleration of the process of data sharing, patient-centered access control, and the alignment with the respective healthcare settings. Moreover, patients’ perceived ease of use of a BC-based HIE mobile application is impacted by further three factors: The intuitiveness of the interaction, an aesthetic and functional design, and individual differences such as age or literacy with document management systems.

Conclusions:

The evaluation demonstrates that patients are inclined to use BC-based HIE to manage their health data, as it empowers them to control which healthcare providers or individuals can access their information. To foster the use of a BC-based HIE mobile application, the application should allow patients to effortlessly establish connections with healthcare providers, offer an overview of all patient data, and enable patients to share medical documents individually via the application.