The benefits and threats of blockchain technology in healthcare: A scoping review.

Blockchain technology enables new ways of organizing economic activities, reduces costs and time associated with intermediaries, and strengthens the trust in an ecosystem of actors. The impact of this seminal technology is reflected by an upcoming research stream and various firms that examine the potential uses of blockchain technology. While there are promising use cases of this new technology, research and practice are still in their infancy about altering existing and creating new business models. We develop a taxonomy of blockchain business models based on 99 blockchain ventures to explore the impact of blockchain technology on business models. As a result, we identify five archetypal patterns, which enhance our understanding of how blockchain technology affects existing and creates new business models. We propose to use these results to discover further patterns fueled by blockchain technology and illustrate how firms can use blockchain technology to innovate their business models.

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The impact of blockchain technology on business models – a taxonomy and archetypal patterns

Background: Blockchain offers a promising new distributed technology to address the challenges of data standardization, system interoperability, security, privacy, and accessibility of medical records.
Objective: The purpose of this review is to assess the research on the use of blockchain technology for patient care and the associated challenges and to provide a research agenda for future research.
Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We queried the Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, Excerpta Medica dataBASE (EMBASE), and Web of Science databases for peer-reviewed research articles published up to December 2019 that examined the implementation of blockchain technology in health care settings. We identified 800 articles from which we selected 70 empirical research articles for a detailed review.
Results: Blockchain-based patient care applications include medical information systems, personal health records, mobile health and telemedicine, data preservation systems and social networks, health information exchanges and remote monitoring systems, and medical research systems. These blockchain-based health care applications may improve patient engagement and empowerment, improve health care provider access to information, and enhance the use of health care information for medical research.
Conclusions: Blockchain health information technology (HIT) provides benefits such as ensuring data privacy and security of health data, facilitating interoperability of heterogeneous HIT systems, and improving the quality of health care outcomes. However, barriers to using blockchain technology to build HIT include security and privacy vulnerabilities, user resistance, high computing power requirements and implementation costs, inefficient consensus algorithms, and challenges of integrating blockchain with existing HIT. With 51% of the research focused on medical information systems such as electronic health record and electronic medical record, and 53% of the research focused on data security and privacy issues, this review shows that HIT research is primarily focused on the use of blockchain technologies to address the current challenges HIT faces. Although Blockchain presents significant potential for disrupting health care, most ideas are in their infancy.

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

Considering today’s lifestyle, people just sleep forgetting the benefits sleep provides to the human body. Smart-Yoga Pillow (SaYoPillow) is proposed to help in understanding the relationship between stress and sleep and to fully materialize the idea of “Smart-Sleeping” by proposing an edge device. An edge processor with a model analyzing the physiological changes that occur during sleep along with the sleeping habits is proposed. Based on these changes during sleep, stress prediction for the following day is proposed. The secure transfer of the analyzed stress data along with the average physiological changes to the IoT cloud for storage is implemented. A secure transfer of any data from the cloud to any third party applications is also proposed. A user interface is provided allowing the user to control the data accessibility and visibility. SaYoPillow is novel, with security features as well as consideration of sleeping habits for stress reduction, with an accuracy of up to 96%.

SaYoPillow: Blockchain-Integrated Privacy-Assured IoMT Framework for Stress Management Considering Sleeping Habits

The widespread application of the Hyperledger Fabric platform and the timeliness requirement of transactions on the platform necessitate the effective performance evaluation of transaction processing. The existing evaluation researches on Hyperledger Fabric ignored transaction endorsement failure (due to transaction endorsing duration timeout) and/or ignored block timeout. This paper considers these two timeout constraints and develops a hierarchical model for Hyperledger Fabric v1.4 transaction process from the time when transactions are submitted by clients until the completion of validating/committing transactions as a block. Formulas for calculating performance measures, including platform throughput, transaction rejection probability and mean transaction response delay, are derived. Extensive numerical analysis and simulations are carried out to verify the approximate accuracy of the model and formulas. Moreover, numerical analysis is applied to illustrate the impact of various parameters on performance measures.

Performance analysis of Hyperledger Fabric platform: A hierarchical model approach

Background Data security issues still constitute the main reason for the sluggish dissemination of electronic health records (EHRs). Given that blockchain technology offers the possibility to verify transactions through a decentralized network, it may serve as a solution to secure health-related data. Therefore, we have identified stakeholder-specific requirements and propose a blockchain-based architecture for EHRs, while referring to the already existing scientific discussions on the potential of blockchain for use in EHRs. Objective This study aimed to introduce blockchain technology for EHRs, based on identifying stakeholders and systematically eliciting their requirements, and to discuss the key benefits (KBs) and key challenges (KCs) of blockchain technology in the context of EHRs. Methods The blockchain-based architecture was developed in the framework of the design science research paradigm. The requirements were identified using a structured literature review and interviews with nine health care experts. Subsequently, the proposed architecture was evaluated using 4 workshops with 15 participants. Results We identified three major EHR stakeholder groups and 34 respective requirements. On this basis, we developed a five-layer architecture. The subsequent evaluation of the artifact was followed by the discussion of 12 KBs and 12 KCs of a blockchain-based architecture for EHRs. To address the KCs, we derived five recommendations for action for science and practice. Conclusions Our findings indicate that blockchain technology offers considerable potential to advance EHRs. Improvements to currently available EHR solutions are expected, for instance, in the areas of data security, traceability, and automation by smart contracts. Future research could examine the patient's acceptance of blockchain-based EHRs and cost-benefit analyses.

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Towards a Stakeholder-Oriented Blockchain-Based Architecture for Electronic Health Records: Design Science Research Study

Start-ups in the blockchain context generate millions by means of initial coin offerings (ICOs). Many of these crowdfunding endeavours are very successful, others are not. However, despite the increasing investments in ICOs, there is still neither sufficient theoretical knowledge nor a comprehensive understanding of the different types of business models and the implications for these token-based ecosystems. Scientific research equally lacks a thorough understanding of the different business model forms and their influence on collaboration in token-based economies. We bridge this gap by presenting a taxonomy of real-world blockchain-based start-ups. For this taxonomy, we used 195 start-ups and performed a cluster-analysis in order to identify three different archetypes and thus gain a deeper understanding. Our taxonomy and the archetypes can equally be seen as strategic guidance for practitioners as well as a starting point for future research concerning the token-based business models.

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Understanding token-based ecosystems – a taxonomy of blockchain-based business models of start-ups

Towards a Business Model Taxonomy of Startups in the Finance Sector using Blockchain.

In the course of digitization in healthcare, personal health records (PHRs) are handled as a key solution. Despite the indisputable benefits, the adoption of PHRs is hampered by data security and data privacy concerns. Blockchain technology offers promising potential to address these issues by enabling secure transactions of sensitive data. With regards to PHRs, the blockchain can be used to manage the access to health-related data. Besides existing generic PHR architectures, we systematically identified issues for the healthcare sector that need to be considered for the development of a PHR. We subsequently derived eight meta-requirements that were consolidated into three design principles. Within a 1-year design science research project, we developed the blockchain-secured PHR prototype, OSHealthRec, and evaluated the system in four evaluation cycles. The findings of our research are twofold. On the one hand, we contribute to the design knowledge base by presenting three design principles. On the other hand, we present the development of a real, operational blockchain-secured PHR and the findings from its continuous evaluation, which may serve as useful advice for further solutions.

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Generating design knowledge for blockchain-based access control to personal health records

BACKGROUND: This article investigates the research problem of digital solutions to overcome the pandemic, more closely examining the limited effectiveness and scope of the governmental COVID-19 tracing apps, using the German COVID-19 tracing app (Corona-Warn-App) as an example. A well-designed and effective instrument in the technological toolbox is of utmost importance to overcome the pandemic. METHOD: A multi-methodological design science research approach was applied. In three development and evaluation cycles, we presented, prototyped, and tested user-centered ideas of functional and design improvement. The applied procedure contains (1) a survey featuring 1993 participants from Germany for evaluating the current app, (2) a gathering of recommendations from epidemiologists and from a focus group discussion with IT and health experts identifying relevant functional requirements, and (3) an online survey combined with testing our prototype with 53 participants to evaluate the enhanced tracing app. RESULTS: This contribution presents 14 identified issues of the German COVID-19 tracing app, six meta-requirements, and three design principles for COVID-19 tracing apps and future pandemic apps (e.g., more user involvement and transparency). Using an interactive prototype, this study presents an extended pandemic app, containing 13 potential front-end (i.e., information on the regional infection situation, education and health literacy, crowd and event notification) and six potential back-end functional requirements (i.e., ongoing modification of risk score calculation, indoor versus outdoor). In addition, a user story approach for the COVID-19 tracing app was derived from the findings, supporting a holistic development approach. CONCLUSION: Throughout this study, practical relevant findings can be directly transferred to the German and other international COVID-19 tracing applications. Moreover, we apply our findings to crisis management theory-particularly pandemic-related apps-and derive interdisciplinary learnings. It might be recommendable for the involved decision-makers and stakeholders to forego classic application management and switch to using an agile setup, which allows for a more flexible reaction to upcoming changes. It is even more important for governments to have a well-established, flexible, design-oriented process for creating and adapting technology to handle a crisis, as this pandemic will not be the last one.

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Jan Heinrich Beinke

Papers

Towards a Stakeholder-Oriented Blockchain-Based Architecture for Electronic Health Records: Design Science Research Study

Understanding token-based ecosystems – a taxonomy of blockchain-based business models of start-ups

Towards a Business Model Taxonomy of Startups in the Finance Sector using Blockchain.

Generating design knowledge for blockchain-based access control to personal health records

Learnings from the design and acceptance of the German COVID-19 tracing app for IS-driven crisis management: a design science research.