The Potential of Blockchain Technology for Health Information Exchange: Experimental Study From Patients’ Perspectives

Abstract

Background Nowadays, a number of mechanisms and tools are being used by health care organizations and physicians to electronically exchange the personal health information of patients. The main objectives of different methods of health information exchange (HIE) are to reduce health care costs, minimize medical errors, and improve the coordination of interorganizational information exchange across health care entities. The main challenges associated with the common HIE systems are privacy concerns, security risks, low visibility of system transparency, and lack of patient control. Blockchain technology is likely to disrupt the current information exchange models utilized in the health care industry. Objective Little is known about patients’ perceptions and attitudes toward the implementation of blockchain-enabled HIE networks, and it is still not clear if patients (as one of the main HIE stakeholders) are likely to opt in to the applications of this technology in HIE initiatives. Thus, this study aimed at exploring the core value of blockchain technology in the health care industry from health care consumers’ views. Methods To recognize the potential applications of blockchain technology in health care practices, we designed 16 information exchange scenarios for controlled Web-based experiments. Overall, 2013 respondents participated in 16 Web-based experiments. Each experiment described an information exchange condition characterized by 4 exchange mechanisms (ie, direct, lookup, patient-centered, and blockchain), 2 types of health information (ie, sensitive vs nonsensitive), and 2 types of privacy policy (weak vs strong). Results The findings show that there are significant differences in patients’ perceptions of various exchange mechanisms with regard to patient privacy concern, trust in competency and integrity, opt-in intention, and willingness to share information. Interestingly, participants hold a favorable attitude toward the implementation of blockchain-based exchange mechanisms for privacy protection, coordination, and information exchange purposes. This study proposed the potentials and limitations of a blockchain-based attempt in the HIE context. Conclusions The results of this research should be of interest to both academics and practitioners. The findings propose potential limitations of a blockchain-based HIE that should be addressed by health care organizations to exchange personal health information in a secure and private manner. This study can contribute to the research in the blockchain area and enrich the literature on the use of blockchain in HIE efforts. Practitioners can also identify how to leverage the benefit of blockchain to promote HIE initiatives nationwide.

The Current State of Research, Challenges, and Future Research Directions of Blockchain Technology in Patient Care: Systematic Review

“…Most of the research reviewed focused on blockchain’s use to strengthen HIT security or patients’ privacy during health data exchange or access; 53% (37/70) papers focused on addressing patients’ lack of control over the privacy and security of their data [ 10 - 46 ], and 40% (28/70) papers addressed blockchain’s ability to prevent data tampering [ 10 , 12 , 21 , 25 , 33 , 34 , 37 , 38 , 40 - 44 , 46 - 60 ]. Data breaches were addressed in 37% (26/70) papers [ 15 , 18 , 19 , 22 , 24 , 29 , 31 , 32 , 34 , 36 - 38 , 43 , 44 , 54 , 56 - 66 ], 9% (6/70) papers mentioned malicious attacks (eg, impersonation) that blockchain could potentially resolve [ 17 , 34 , 44 , 56 , 60 , 67 ], and 4% (3/70) papers focused on how blockchain can preserve patients’ anonymity while third parties accessed their health and medical records for activities such as medical research [ 41 , 42 , 68 ].…”

“…The third category covers HIT’s alignment with the health organizations’ goals to achieve specific health care outcomes such as health care quality and system satisfaction; 10% (7/70) papers focused on addressing the inefficiency of current health systems, such as lengthy processing times and the inability to simultaneously process large data volumes [ 16 , 24 , 28 , 37 , 55 , 67 , 77 ]. With regard to the quality of patient care, quite often, missing or incorrect health data lead to repetitive lab tests or diagnostic errors, which can be detrimental to patients’ health; 9% (6/70) papers discussed how blockchain can reduce misdiagnosis and overtreatment [ 27 , 32 , 35 , 40 , 78 , 79 ]. Data dredging may occur in clinical trials where researchers may alter or omit data to achieve a statistically significant result in their experiments; 4% (3/70) papers addressed data dredging [ 32 , 52 , 70 ].…”

“…With regard to the quality of patient care, quite often, missing or incorrect health data lead to repetitive lab tests or diagnostic errors, which can be detrimental to patients’ health; 9% (6/70) papers discussed how blockchain can reduce misdiagnosis and overtreatment [ 27 , 32 , 35 , 40 , 78 , 79 ]. Data dredging may occur in clinical trials where researchers may alter or omit data to achieve a statistically significant result in their experiments; 4% (3/70) papers addressed data dredging [ 32 , 52 , 70 ]. Another issue is the lack of trust between stakeholders (patients, providers, and researchers) because of stakeholders’ capability to modify and edit health data, which may lead to errors.…”

Blockchain in Health Care: Hope or Hype?

“…Consequently, complex or computation-intense systems are not the best use cases for blockchain [ 18 ]. For health care information systems, performance, real-time communication, coordination, data sharing, and medical service availability are critical in life-threatening situations [ 55 ].…”

An Architecture and Management Platform for Blockchain-Based Personal Health Record Exchange: Development and Usability Study

“…This technology can improve data safety and remove privacy issues. Pouyan et al [ 8 ] stated that regarding the trust in health information exchange competency and exchange integrity, the blockchain architecture is more trustworthy than other exchange mechanisms for exchanging highly sensitive information.…”