Blockchain technology in healthcare: A systematic review

Huma Saeed, Data curation , Methodology , Writing – original draft , 1 Hassaan Malik, Conceptualization , Data curation , Supervision , Writing – original draft , 1 , 2 , * Umair Bashir, Conceptualization , Formal analysis , Writing – review & editing , 1 Aiesha Ahmad, Conceptualization , Data curation , Formal analysis , Investigation , Methodology , Writing – original draft , 1 Shafia Riaz, Data curation , Funding acquisition , Methodology , 1 Maheen Ilyas, Conceptualization , Formal analysis , Methodology , Writing – original draft , 1 Wajahat Anwaar Bukhari, Data curation , Formal analysis , Writing – review & editing , 1 and Muhammad Imran Ali Khan, Conceptualization , Data curation , Resources 1

Huma Saeed

1 Department of Computer Science, National College of Business Administration & Economics Lahore, Multan, Pakistan

Hassaan Malik

1 Department of Computer Science, National College of Business Administration & Economics Lahore, Multan, Pakistan

2 Department of Computer Science, University of Management and Technology, Lahore, Pakistan

Umair Bashir

1 Department of Computer Science, National College of Business Administration & Economics Lahore, Multan, Pakistan

Aiesha Ahmad

1 Department of Computer Science, National College of Business Administration & Economics Lahore, Multan, Pakistan

Shafia Riaz

1 Department of Computer Science, National College of Business Administration & Economics Lahore, Multan, Pakistan

Maheen Ilyas

1 Department of Computer Science, National College of Business Administration & Economics Lahore, Multan, Pakistan

Wajahat Anwaar Bukhari

1 Department of Computer Science, National College of Business Administration & Economics Lahore, Multan, Pakistan

Muhammad Imran Ali Khan

1 Department of Computer Science, National College of Business Administration & Economics Lahore, Multan, Pakistan

1 Department of Computer Science, National College of Business Administration & Economics Lahore, Multan, Pakistan

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Abstract

Blockchain technology (BCT) has emerged in the last decade and added a lot of interest in the healthcare sector. The purpose of this systematic literature review (SLR) is to explore the potential paradigm shift in healthcare utilizing BCT. The study is compiled by reviewing research articles published in nine well-reputed venues such as IEEE Xplore, ACM Digital Library, Springs Link, Scopus, Taylor & Francis, Science Direct, PsycINFO, Ovid Medline, and MDPI between January 2016 to August 2021. A total of 1,192 research studies were identified out of which 51 articles were selected based on inclusion criteria for this SLR that presents the modern information on the recent implications and gaps in the use of BCT for enhancing the healthcare procedures. According to the outcomes, BCT is being applied to design the novel and advanced interventions to enrich the current protocol of managing, distributing, and processing clinical records and personal medical information. BCT is enduring the conceptual development in the healthcare domain, where it has summed up the substantial elements through better and enhanced efficiency, technological innovation, access control, data privacy, and security. A framework is developed to address the probable field where future researchers can add considerable value, such as data protection, system architecture, and regulatory compliance. Finally, this SLR concludes that the upcoming research can support the pervasive implementation of BCT to address the critical dilemmas related to health diagnostics, enhancing the patient healthcare process in remote monitoring or emergencies, data integrity, and avoiding fraud.

Introduction

Healthcare is a system that includes 3 main components: (i) Main suppliers of services for medical treatment, For instance, doctors, nurses, technicians, and hospital administrations (ii) Emergency related services [1–4], and (iii) Health and health-oriented service users, specific patients. In the current study, to encourage, preserve or restore the health of beneficiaries, we examine the health maintenance to include technology-based remotely controlling services increased by constituent service providers [5–9]. In the medical field, every year, there are more security and privacy breaches, in 2017, more than 300 breaches were reported, and up to 37 million records were affected during 2010–2017 [10, 11]. The growing digitization of medical care has advanced the acknowledgment of issues about secure storage, accessing of patients’ medical records, ownership, and medical data from associated sources [12–16]. Blockchain is recommended as a method of addressing critical issues faced by healthcare, for instance, protected sharing of health records and adherence to data privacy laws [17–19].

Blockchain is a particular type of database that can be managed by the network of authenticated members or nodes [13] and stores immutable information blocks that can be strongly exchanged without interference by third parties [10]. With cryptographic signatures and the use of consensus algorithms which are implemented as key enablers in their application, data is stored and registered [20]. The capability of preserving data is a major aim for using the BCT particularly in healthcare [21], which is subject to massive sharing and dissemination of a significant amount of data [7]. In different stages, the development of blockchain technology, as well as its application in various contexts, had been materialized. The first phase of blockchain development was focused on cryptocurrencies, while the second focused on the use of smart contracts in industries like real estate and finance [11, 22]. The 3rd generation of evolution concentrated on employing blockchain in non-financial areas including government, culture [23], and healthcare space [22, 24]. Also, powered by revolutionary technical features such as data immutability [25], with the introduction of artificial intelligence, blockchain technology is having its 4th generation of evolution [26]. This asserted diversity in Blockchain’s application spectrum can be attributed to its ability to build decentralized [27] and trustless transaction environments [28]. As blockchain can tackle serious issues, such as automated claim authentication [9] and public health management [29], the healthcare sector is a prime choice for the application of blockchain technology [30–32]. This technology allows patients to keep personal data and determine with whom this can be shared, thus resolving current data ownership, and sharing issues [28, 33]. At the same time, it allows recorded data to be integrated, modified, shared safely, and retrieved on time by relevant authorities using consensus protocols [31]. This is a significant benefit of the use of this technology in the healthcare system, as existing procedures need third parties to store the data [10]. Finally, because of possible human error, blockchain could potentially add accountability to data management processes [34] further decreasing the risks of mishandling or misusing recorded data [31]. Given the optimistic connotations of the effects of blockchain on social and business change, in contrast to previously defined expectations, it appears to be a discussion regarding its basic and derived advantages. A recent study indicates that while organizations will make substantial investments in the future in adopting blockchain-based technology due to a widespread perception that the advantages could be over-hype, they will probably accept a cautiously pragmatic approach [35]. It can be said that this technology has yet to fulfill its expectations [36], a fact that can be due to the prevalent adoption of block chain, particularly about regulatory barriers, to certain challenges [31]. The general public and specific users, for instance, patients or physicians are not acquainted with the way blockchain works, the technological features, or its advantages for data processing is another significant obstacle in promulgating the implementation of blockchain [35]. Suggest that it may take a considerable time for this technology to establish all anticipated stages of business transformation mainly because of the organizational, social, and implementation challenges, for example, security issues or governance reasons [22, 31]. This could also be exacerbated by general confusion regarding the use of blockchain regarding legal enforcement and regulations of the government. Current research focuses on supporting blockchain operational growth and speed-up its prevalence by overcoming these barriers.

However, previous studies have made little attempt to comprehensively summarize the existing knowledge by using SLRs [9–13]. For example, bibliometric techniques were used by [10] to provide a summary of blockchain research patterns and components related to the implementation of blockchain in the field of healthcare. In [9] the different blockchain platforms have been developed to deploy blockchain in healthcare. The study [11] addressed different examples of the implementation in the healthcare of blockchain technology, the problems, and their potential solutions. In diverse contexts where this technology was implemented [12], addressed design choices and tradeoffs made by the researchers. The research studies of [13, 14] have discussed the Blockchain-based applications throughout numerous industries and addressed many contexts of use for this technology in a broad manner. Recently [14] reviewed 39 studies to present an overview on common channels and other areas where blockchain technology is utilized for healthcare enhancement. Although these systematic literature reviews have a contribution to the extent of knowledge, their emphasis has been mainly on synthesizing or delineating blockchain technology patterns and areas [10, 11, 13, 14, 16]. However, researchers will get benefit from a concentrated discussion on the implications of its adoption [15], along with concrete obstacles and areas for progress for advancing the field, due to the reach and diversity of previous blockchain studies [11]. Through assimilating existing information and describing focus areas that require considerable academic attention, review-based research will assist in meeting these needs [11, 16–19]. As a result of this necessity, we perform an SLR on the blockchain technology application. This SLR presents a valuable overview of ongoing research, gaps in current knowledge, and future avenues of research as well. The contribution of this study is in two ways, this research adds to the emerging blockchain literature in healthcare. First regarding their implementation areas, restrictions, and recommendations, it offers an advanced and thematically ordered classification of previous literature. Second, we propose a synthesizing process according to the results of the SLR to detail possible topics that need academic attention to further update the existing body of literature.

The present study is organized as follows: In Section 2, we provide a thorough description of the research method utilized to search, screen, and select the literature. In Section 3, we present relevant review works that have been conducted in the field of health care using blockchain technology and discuss all the papers that have been selected, focusing on their main findings, and highlighting research gaps for future research. Finally, in Section 4we conclude this study.

Methodology

SLRs always provide a thorough understanding of literature as it presents a complete and systematized review meeting all standard protocols in it [18, 37–39]. SLRs also help in the understanding of current information gaps and, as a result, the discovery of potential research avenues [19].

Research questions

We conduct this SLR by addressing the following research questions (RQs).