Blockchains in health information systems: A literature review on use cases and status of implementation of blockchains for electronic health records

Abstract

BACKGROUND: The careful management of health data is crucial due to its immense value and high sensitivity. Blockchain technologies can manage data in a trustworthy way. OBJECTIVE: The central aim is to identify the current state of blockchain technologies applied to Electronic Health Records (EHR) to identify common structures and functionalities. This common ground could be the starting point for defining clear global standards. METHODS: A systematic literature review is used. RESULTS: The benefits of enhancing the digitalization and cross-institutional accessibility of health data are undoubted. Four main application areas of blockchain for the EHR can be identified: storing, sharing, audit logging, and managing the identity of data accessors. Since on-chain transactions are slow and inefficient, most research promotes a hybrid approach for handling transactions as a combination of off-chain and on-chain approaches. CONCLUSIONS: Several approaches, frameworks, and models exist for applying blockchain technologies in the context of EHR. The research revealed that a) only a few concepts are already implemented, b) the existing system implementations are based on different backgrounds and technology stacks, and c) a lack of comprehensive and global standards and norms. All these factors are barriers to a broader usage of blockchain-based EHRs.