What the healthcare sector’s experience of blockchain reveals about its real transformative potential: a cross-disciplinary analysis

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Background: Academic literature highlights the potential benefits of blockchain to transform healthcare, focusing on its potential seamlessly and securely to integrate existing ‘data silos’ while enabling patients to exercise automated, fine-grained control over access to their Electronic Health Records (EHRs). Yet no serious scholarly attempt has been made to assess the extent to which these technologies have in fact been applied to real-world healthcare contexts.

Objective: The primary aim of this paper is to critically investigate the healthcare sector’s actual engagement and experience of blockchain technologies to date to assess the extent to which the potential for blockchain technologies to transform healthcare highlighted in academic literature is likely to be realised in healthcare practice.

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

Results: Healthcare organisations 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. Yet blockchain technology is yet to be implemented at scale in healthcare, remaining largely in its infancy. These early experiences of blockchain technologies have demonstrated blockchain’s potential to generate meaningful value to healthcare by facilitating data sharing between organisations in circumstances where computational trust can overcome a lack of social trust that might otherwise prevent valuable cooperation. Although there are genuine prospects of utilising blockchain to bring about positive transformation in healthcare, the successful development of blockchain for healthcare applications face a number of very significant, multi-dimensional and highly complex challenges. Early experience suggests that blockchain is unlikely to rapidly and radically revolutionise healthcare.

Conclusions: The successful development of blockchain for healthcare applications face numerous significant, multi-dimensional and complex challenges which will not be easily overcome, suggesting that blockchain technologies are unlikely to revolutionise healthcare in the near future

Bibliographic note

Final Version of Record not yet available as of 23/09/2021.


Original languageEnglish
JournalJournal of Medical Internet Research
Publication statusAccepted/In press - 3 Apr 2021