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Cited by 828Blockchain Technology Applications and SecurityElectronic Health Records SystemsBlockchain Technology in Education and Learning

Blockchain Technology for Healthcare: Facilitating the Transition to Patient-Driven Interoperability

Open access
Gordon, William J., Catalini, Christian·2018·Computational and Structural Biotechnology Journal
DOI 10.1016/j.csbj.2018.06.003PMC PMC6068317
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Abstract

Interoperability in healthcare has traditionally been focused around data exchange between business entities, for example, different hospital systems. However, there has been a recent push towards patient-driven interoperability, in which health data exchange is patient-mediated and patient-driven. Patient-centered interoperability, however, brings with it new challenges and requirements around security and privacy, technology, incentives, and governance that must be addressed for this type of data sharing to succeed at scale. In this paper, we look at how blockchain technology might facilitate this transition through five mechanisms: (1) digital access rules, (2) data aggregation, (3) data liquidity, (4) patient identity, and (5) data immutability. We then look at barriers to blockchain-enabled patient-driven interoperability, specifically clinical data transaction volume, privacy and security, patient engagement, and incentives. We conclude by noting that while patient-driving interoperability is an exciting trend in healthcare, given these challenges, it remains to be seen whether blockchain can facilitate the transition from institution-centric to patient-centric data sharing.

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Crossref · 10.1016/j.csbj.2018.06.003

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  • Conventional access control strategies require external key authorities with PKI, which can be extremely complex and usually demands expensive resources to achieve secure EHRs sharing.

    “First, the designs of conventional access control strategies [14]-[16] require external key authorities with a Public Key Infrastructure (PKI), which can be extremely complex and usually demands expensive resources to achieve secure EHRs sharing [25].”

    From Blockchain for Secure EHRs Sharing of Mobile Cloud Based E-Health Systems (2019) · cites this paper as [25]

    The “Interoperability: Current State” section describes institutional EHR exchange as operationally challenging, with complex patient matching and repeated authentication. “Reducing the Cost of Verification and Networking” identifies security, authentication, and network costs. Neither passage says conventional access control requires external key authorities with PKI or that those requirements usually demand expensive resources. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Conventional access control systems mainly rely on a predefined point of access, a centralized cloud server, which can lead to a central point of failure for e-health networks.

    “More importantly, conventional access control systems mainly rely on a predefined point of access, i.e. a centralized cloud server, and this can lead to the central point of failure for e-health networks [25].”

    From Blockchain for Secure EHRs Sharing of Mobile Cloud Based E-Health Systems (2019) · cites this paper as [25]

    In “Blockchain's Role in Patient-Driven Interoperability” (page unavailable), the paper says permission to release clinical data is typically controlled by the data silo owner. It does not say conventional access control mainly relies on a centralized cloud server or that such a server creates a single point of failure for e-health networks. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • EACMS is a Hyperledger Composer based blockchain application that alleviates the problems of traditional emergency access with an architecture that is extensible and scalable.

    “Our system is a hyperledger composer [19] based Blockchain application that alleviates these problems with an architecture that allows our system to be both extensible and scalable: a blockchain based EACMS, off chain data storage and a patient-centered mobile and web interface.”

    From EACMS: Emergency Access Control Management System for Personal Health Record Based on Blockchain (2019) · cites this paper as [19]

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Research works printed but not linked: 4

  1. [2]Henry J. Pylypchuk Y. Searcy T. Patel V. Adoption of electronic health record systems among U.S. Non-Federal Acute Care Hospitals ONC Data Brief 35 2016 2008-2015 https://dashboard.healthit.gov/evaluations/data-briefs/non-federal-acute-care-hospital-ehr-adoption-2008-2015.php 40127322
  2. [10]Julia Adler-Milstein. Moving past the EHR interoperability blame game. N Engl J Catal n.d. https://catalyst.nejm.org/ehr-interoperability-blame-game/ (accessed March 28, 2018).
  3. [13]Gordon W.J. Wright A. Landman A. Blockchain Technology in Health Care: Decoding the hype NEJM Catal 2017 https://catalyst.nejm.org/decoding-blockchain-technology-health/
  4. [27]Centers for Medicare & Medicaid Services (CMS) HHS Medicare and medicaid programs; electronic health record incentive program—Stage 3 and modifications to meaningful use in 2015 through 2017 2015 26477064

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Authors
Gordon, W. J., & Catalini, C.
Affiliations
  • Brigham and Women's Hospital (US)
  • National Bureau of Economic Research (US)
Corresponding author
Gordon, William J.
ORCID
Venue
Computational and Structural Biotechnology Journal
Publisher
American Association for the Advancement of Science (AAAS)
Published
2018-01
Volume
16
Pages
224-230
ISSN
2001-0370 (ISSN-L)
DOI
10.1016/j.csbj.2018.06.003
PMC
PMC6068317
OpenAlex
W2810476200
Cited by
828
References
34
Citations by year
2026: 52 · 2025: 80 · 2024: 94 · 2023: 126 · 2022: 151 · 2021: 135 · 2020: 112 · 2019: 78
FWCI
15.04
Type
journal article
Language
en
Open access
Licence
Locations
  • Computational and Structural Biotechnology Journal (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • DSpace@MIT (Massachusetts Institute of Technology) (submittedVersion, cc-by-nc)
Topics
  • Physical Sciences › Computer Science › Information Systems › Blockchain Technology Applications and Security
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Physical Sciences › Computer Science › Information Systems › Blockchain Technology in Education and Learning
Keywords
blockchain, health data sharing, data privacy, data security, patient identity, data immutability, data aggregation, patient engagement, incentives, governance, barriers to adoption

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