On the exploitation of the blockchain technology in the healthcare sector: A systematic review

Highlights

• Blockchain technology in the health sector.

• Smart, secure, and transparent management of Electronic Health Records.

• Blockchain-based strategies to support research activities in the health sector.

Abstract

The blockchain is a disruptive technology born in the last few years, which possible applications in different domains are being extensively studied. In this context, healthcare appears to be a very attractive application domain for the blockchain because, due to its characteristics, it can provide the necessary guarantees on the secure processing, sharing and management of sensitive patient data. In this paper, we perform a systematic review of the literature on the adoption of the blockchain technology in healthcare, focusing on applications implemented in real contexts. Our goal is to investigate the current state of the art in this specific field, emphasizing limitations and possible future developments.

Publications extracted from Scopus, PubMed and Web of Science that satisfy some predetermined search criteria were collected by means of appropriate queries. These papers were analyzed and classified into five main categories, based on the specific sub-domain on which the applications were projected.

The performed analysis highlighted that research activities are currently focused on data security and on the implementation of electronic health records through the Blockchain. On the other hand, some other areas are still under-explored, including that related to IoT or to the implementation of automated diagnosis systems.

Introduction

In 2008, Satoshi Nakamoto proposed a solution to the double spending problem (Nakamoto, 2008), that refers to the possibility of spending a digital currency multiple times, due to its inherent ease to be duplicated. Nakamoto’s innovative idea was to use the blockchain, and proposed the specific blockchain nowadays known as Bitcoin, together with its native cryptocurrency.

A blockchain is a database of sequential blocks containing transactions, distributed in a peer-to-peer network, where each node of the network owns its own copy. The Bitcoin blockchain, like other blockchains subsequently proposed, is public. The main advantages of public blockchains are the transparency, the immutability, the traceability and, therefore, the reliability of the stored data. These characteristics make the blockchain applicable in many contexts besides the storage and verification of cryptocurrency transactions.

One of the most interesting applications of the blockchain technology, on which companies and researchers are focusing their efforts, is that of the healthcare. In this context, research activities are being conducted on the design of proper processes to share data, such as records, reports and images, between healthcare institutions without involving third parties that may possibly alter it (Rakic, 2018). Other lines of research include archiving patient health data (Shahnaz et al., 2019), enforcing transparency and verifiability of medical experiments (Bell et al., 2018), and supporting the traceability of drugs to prevent counterfeiting issues (Kuo et al., 2017).

In this scenario, the goal of our work is to perform a systematic review of blockchain applications in healthcare that have been proposed in the literature and/or have been actually implemented in real contexts. The motivations of this work live in the need of assessing the current state of the art, outlining challenges and opportunities, as well limitations of current solutions, in order to pave the way for future research activities in this field.

Existing works in the literature have been selected using the PubMed PubReminer tool,¹ focusing on Scopus, PubMed, and Web of Science, using blockchain as a seed keyword in the title of the articles. We refined the set of identified paper by eliminating duplicates (since copies of the same article can be found in different repositories), and by removing papers without an abstract, a DOI, or keywords provided by the authors. This step was followed by a manual selection based on the abstracts and/or the full content of the articles. In particular, a paper has been included in this review if it describes an application in the healthcare sector that is actually implemented, even through a small prototype. Therefore, papers describing purely theoretical ideas were excluded. This manual selection led to a total of 64 articles, that were subsequently been categorized into research areas, in order to provide researchers with some clues about the challenges, the opportunities and the gaps for which further research activities are needed. The details of the methodology adopted to refine the query are reported in Section 4.

The rest of the paper is organized as follows: Section 2 provides a brief introduction on the blockchain technology; in Section 3, we describe the specific challenges arising while adopting the blockchain for healthcare applications, briefly review existing surveys, and outline the contribution of this paper; in Section 4, we define the methodology we followed to conduct our systematic review; in Section 5 we discuss the outcome of our review, specifically focusing on the identified categories; in Section 6, we outline possible research directions; finally, Section 7 concludes the paper and outline some possible future work.