The health care sector’s experience of blockchain: a cross-disciplinary investigation of its real transformative potential

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Academic literature highlights blockchain’s potential to transform health care, particularly by seamlessly and securely integrating existing data silos while enabling patients to exercise automated, fine-grained control over access to their electronic health records. However, no serious scholarly attempt has been made to assess how these technologies have in fact been applied to real-world health care contexts.

The primary aim of this paper is to assess whether blockchain’s theoretical potential to deliver transformative benefits to health care is likely to become a reality by undertaking a critical investigation of the health care sector’s actual experience of blockchain technologies to date.

This mixed methods study entailed a series of iterative, in-depth, theoretically oriented, desk-based investigations and 2 focus group investigations. It builds on the findings of a companion research study documenting real-world engagement with blockchain technologies in health care. Data were sourced from academic and gray literature from multiple disciplinary perspectives concerned with the configuration, design, and functionality of blockchain technologies. The analysis proceeded in 3 stages. First, it undertook a qualitative investigation of observed patterns of blockchain for health care engagement to identify the application domains, data-sharing problems, and the challenges encountered to date. Second, it critically compared these experiences with claims about blockchain’s potential benefits in health care. Third, it developed a theoretical account of challenges that arise in implementing blockchain in health care contexts, thus providing a firmer foundation for appraising its future prospects in health care.

Health care organizations have actively experimented with blockchain technologies since 2016 and have demonstrated proof of concept for several applications (use cases) primarily concerned with administrative data and to facilitate medical research by enabling algorithmic models to be trained on multiple disparately located sets of patient data in a secure, privacy-preserving manner. However, blockchain technology is yet to be implemented at scale in health care, remaining largely in its infancy. These early experiences have demonstrated blockchain’s potential to generate meaningful value to health care by facilitating data sharing between organizations in circumstances where computational trust can overcome a lack of social trust that might otherwise prevent valuable cooperation. Although there are genuine prospects of using blockchain to bring about positive transformations in health care, the successful development of blockchain for health care applications faces a number of very significant, multidimensional, and highly complex challenges. Early experience suggests that blockchain is unlikely to rapidly and radically revolutionize health care.

The successful development of blockchain for health care applications faces numerous significant, multidimensional, and complex challenges that will not be easily overcome, suggesting that blockchain technologies are unlikely to revolutionize health care in the near future.
Original languageEnglish
Article numbere24109
JournalJournal of Medical Internet Research
Issue number12
Publication statusPublished - 20 Dec 2021

Bibliographical note

Funding Information:
The author gratefully acknowledges funding support from the Wellcome Trust, grant reference number: 210337/Z/18/Z, “Regulating healthcare through blockchain: Mapping the legal, ethical, technical and governance challenges.” The author is grateful for the research and administrative assistance provided by Immaculate Motsi-Omoijiade and Alexander Kharlamov and for the editing and proofreading assistance provided by PhD candidate Nathalie Smuha. The author is also indebted to those who participated in the focus group meetings convened for the purposes of this study, including John Halamka for his support and encouragement. Special thanks are due to colleagues who kindly read and commented on earlier drafts: Atina Krajewska, Muireann Quigley, Natalie Pankova, Barbara Prainsack, and Mark Taylor. All errors remain the author’s own. Further information about the project is available on the web [186].

Publisher Copyright:
© Karen Yeung. Originally published in the Journal of Medical Internet Research (, 20.12.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.


  • Blockchain
  • Computer security
  • Data sharing
  • Electronic health record
  • Health information management
  • Health information systems
  • Health services administration
  • Mobile phone
  • Privacy of patient data

ASJC Scopus subject areas

  • Health Informatics


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