Deriving Key Architectural Features of FHIR-BlockChain Integration through the Qualitative Content Analysis

Abstract

Abstract Background: The blockchain has been highlighted its possibility as a technology to ensure immutability, transparency, and decentralization of data in information systems in various industries. Amongst the possibility of blockchain in the healthcare industry, one of the informatics areas that can leverage the benefits of using blockchain is healthcare information exchange while it is combined with the use of fast healthcare interoperability resources (FHIR).Objective: To investigate the key architectural features of FHIR and blockchain integration that provides the benefits of immutability of transaction data for a decentralized and secured healthcare information exchange framework.Materials and Methods: We conducted an in-depth, individual, semi-structured interview with four domain knowledge experts in the area of FHIR and medical blockchain. Our interview plan were qualified by the COREQ criteria (Consolidated Criteria for Reporting Qualitative Research), which is an analysis method the qualitative content analysis. We conducted the interview based on seven key questions and additional open discussion of technical, business, and legal aspects of the FHIR-blockchain implementations. The results of the interviews were recorded, summarized, and codified in a structured way. Results: The qualitative content analysis revealed the four types of FHIR-blockchain architectures for storing FHIR data and/or transaction and integrating FHIR and blockchain. The four FHIR-blockchain architectures compose of 1) the types of on-chain information from FHIR transactions to be stored inside blocks and 2) the features of the architectures and their possible use case scenarios. In addition to the characterization of the four FHIR-blockchain architectures, we discussed the topics; 1) potential legal issues, 2) justification of using blockchain in healthcare information exchange, and 3) practical implications and guideline of the architectures for implementation.Conclusion: Although FHIR-blockchain integration has been considered as a promising tool for decentralized and secured healthcare information exchange, it should be clarified as to how it aligned with business requirements. A detailed and/or tailored guidelines of implementation in the architectural, functional, and legal perspectives may need to be demonstrated by the benefits of using FHIR-blockchain integration.