Blockchain in healthcare today最新文献

Hospitals provide diverse tasks essential for the delivery of patient care and are comprised of many functional units. This makes healthcare projects in construction highly complex among other types of building projects due to the specific regulations, multiple functions it must provide, complicated mechanical and electrical systems, and so on. This complexity embodies potential risk events during its construction, which not only influences the completion of the project but can impact the patients' safety and health conditions even after the project is finished. To prevent such outcomes, risk management is a crucial process that can identify, evaluate, and properly mitigate risks along the project lifecycle. A key aspect of risk management is that it requires the interaction and contribution from multiple stakeholders of the project. Various frameworks and tools that enable collaborative management of risks among multiple stakeholders have been developed in the past. However, the developed frameworks are not suitable in the sense that it does not protect the confidentiality of individual inputs from the stakeholders. Moreover, these frameworks are centralized systems, which can bring issues related to the security and transparency of the information that is being stored. Blockchain technology is an emergent distributed ledger technology (DLT) that can provide solutions to the listed problems found in centralized systems. It is a novel system that records information on a decentralized, distributed ledger, where transactions are constantly duplicated and updated. This study explores the applicability of blockchain technology for healthcare risk management. The key functional elements of blockchain that can resolve the challenges faced by prior risk management frameworks have been identified and discussed. Based on the discussions, a conceptual information management model for managing healthcare project risks on a blockchain has been conceived. The development of the initial prototype has been explained. The research study illustrates the process, benefits, and limitations of adopting the blockchain technology for collaborative risk management in healthcare projects.

Objective: While existing research by our team has demonstrated the feasibility of building a decentralized identity management application ("MediLinker") for health information, there are implementation issues related to testing such blockchain-based health applications in real-world clinical settings. In this study, we identified clinical, organizational and regulatory, and ethical and social (CORES) issues, including recommendations, associated with deploying MediLinker, and blockchain in general, for clinical testing.

Methods: CORES issues and recommendations were identified through a focus group with 11 academic, industry, and government experts on March 26, 2021. They were grouped according to their expertise: clinical care (n = 4), organizational and regulatory concerns (n = 4), and ethical and social issues (n = 3). The focus group was conducted via Zoom in which experts were briefed about the study aims, formed into breakout groups to identify key issues based on their group's expertise, and reconvened to share identified issues with other groups and to discuss potential recommendations to address such issues. The focus group was video recorded and transcribed. The resulting transcriptions and meeting notes were imported to MAXQDA 2018 for thematic analysis.

Results: Clinical experts identified issues that concern the clinical system, clinical administrators, clinicians, and patients. Organizational and regulatory experts emphasized issues on accountability, compliance, and legal safeguards. Ethics and social-context experts raised issues on trust, transparency, digital divide, and health-related digital autonomy. Accordingly, experts proposed six recommendations that could address most of the identified issues: (1) design interfaces based on patient preferences, (2) ensure testing with diverse populations, (3) ensure compliance with existing policies, (4) present potential positive outcomes to top management, (5) maintain clinical workflow, and (6) increase the public's awareness of blockchain.

Conclusions: This study identified a myriad of CORES issues associated with deploying MediLinker in clinical settings. Moreover, the study also uncovered several recommendations that could address such issues. The findings raise awareness on CORES issues that should be considered when designing, developing, and deploying blockchain for healthcare. Further, the findings provide additional insights into the development of MediLinker from a prototype to a minimum viable product for clinical testing. Future studies can use CORES as a socio-technical model to identify issues and recommendations associated with deploying health information technologies in clinical settings.

During the COVID-19 pandemic, we witnessed how sharing of biological and biomedical data facilitated researchers, medical practitioners, and policymakers to tackle the pandemic on a global scale. Despite the growing use of electronic health records (EHRs) by medical practitioners and wearable digital gadgets by individuals, 80% of health and medical data remain unused, adding little value to the work of researchers and medical practitioners. Legislative constraints related to health data sharing, centralized siloed design of traditional data management systems, and most importantly, lack of incentivization models are thought to be the underpinning bottlenecks for sharing health data. With the advent of the General Data Protection Regulation (GDPR) of the European Union (EU) and the development of technologies like blockchain and distributed ledger technologies (DLTs), it is now possible to create a new paradigm of data sharing by changing the incentivization model from current authoritative or altruistic form to a shared economic model where financial incentivization will be the main driver for data sharing. This can be achieved by setting up a digital health data marketplace (DHDM). Here, we review papers that proposed technical models or implemented frameworks that use blockchain-like technologies for health data. We seek to understand and compare different technical challenges associated with implementing and optimizing the DHDM operation outlined in these articles. We also examine legal limitations in the context of the EU and other countries such as the USA to accommodate any compliance requirement for such a marketplace. Last but not least, we review papers that investigated the short-, medium-, and long-term socioeconomic impact of such a marketplace on a wide range of stakeholders.