Blockchain in Healthcare Today <p><strong>Blockchain in Healthcare Today (BHTY) </strong>is the world’s first peer reviewed open access journal that amplifies and disseminates distributed ledger technology research and innovations in the healthcare information systems, clinical computing, network technologies and biomedical sciences.<em> </em>Fields of interest include utility for data integrity, privacy preservation, health information systems interoperability, permissioned security for health data, clinical support and clinical trials management, supply chain management, revenue cycle automation, cost and impact, and the integration of AI and machine learning tools in this emerging specialty field of research.</p> <p>The preeminent international journal is published on a continuous basis to accelerate sharing rigorously vetted theoretical and experiential knowledge required for a global multi-disciplinary ecosystem. A world-class peer review board endeavors to offer rapid peer review and includes constructive commentary to strengthen work.</p> Partners in Digital Health, 241 Hamilton Avenue, Suite 21 Stamford, CT 06902, USA en-US Blockchain in Healthcare Today 2573-8240 <p><span style="color: #4b7d92;">Auth</span><span style="color: #4b7d92;">ors retain copyright of their work, with first publication rights granted to Blockchain in Healthcare Today (BHTY). Read the full <a href="">Copyright Statement</a>.</span></p> <p> </p> <p> </p> Health Datasets as Assets: Blockchain-Based Valuation and Transaction Methods <p>There is increasing recognition that health-oriented datasets could be regarded as intangible assets: distinct assets with future economic benefits but without physical properties. While health-oriented datasets—particularly health records—are ascribed monetary value on the black market, there are few established methods for assessing value for legitimate research and business purposes.</p> <p>The emergence of blockchain has created new commerce opportunities for transferring assets without intermediaries. Therefore, blockchain is proposed as a medium by which research datasets could be transacted to provide future value. Blockchain methodologies also offer security, auditability, and transparency to authorized individuals for verifying transactions. The authors will share data valuation methodologies consistent with accounting principles and include discussions of black market valuation of health data. Further, this article describes blockchain-based methods of managing real-time payment/micropayment strategies.</p> Wendy M. Charles Brooke M. Delgado Copyright (c) 2022 Dr. Wendy M. Charles, Brooke Delgado 2022-03-22 2022-03-22 10.30953/bhty.v5.185 Decentralized Identity Management for E-Health Applications: State-of-the-Art and Guidance for Future Work <p><strong>Background: </strong>The increasing usage of various online services requires an efficient digital identity management approach. Unfortunately, the original Internet protocols were not designed with built-in identity management, which creates challenges related to privacy, security, and usability. Thereis an increasing concern regarding the management of these sensitive data in the society, who have access to it and where it is stored. Blockchain technology can, potentially offer a secure solution to address this problem, in a decentralized manner without any centralized authority. This is of importance for e-health services where the patient and the healthcare provider often are required toprove their identity. Blockchain technology can be utilized for creating digital identities and make themanagement of those identities easier, giving a higher degree of control to the user than what current solutions offer. It can be used for creating a digital identity on the blockchain, making it easier to manage for individuals and entities, giving them greater control over who has their personal in-formation and how they handle it, and it could be utilized to create a higher degree of trust andsecurity to e-health applications.</p> <p><strong>Objective </strong>The aim of this research work is to review the state-of-the- art regarding blockchain-based decentralized identity management for healthcare applications. Based on this summary, we provide a viewpoint on how blockchain-based decentralized identity frameworks couldbe utilized for virtualized healthcare applications.</p> <p><strong>Method </strong>This research has applied a scoping, semi-systematic review approach to summarize thestate-of-the-art. Included identity management systems were evaluated based on seven criteria:Autonomy, Authority, Availability, Approval, Confidentiality, Tenacity and Interoperability <strong>Results</strong>Seven blockchain-based identity management systems were included and evaluated in this work:These include solutions built with Ethereum, Hyperledger Indy, Hyperledger Fabric, Hedera andSovrin &nbsp;blockchains.</p> <p><strong>Conclusion </strong>Digital identity management is crucial for virtual healthcare. Decentralized identity management for healthcare purposes is currently being explored, both in academia and the private sector. More work is needed with the aim to improve the efficiency of current DIM solutions and to fully understand what technical frameworks are best suited for e-health applications.</p> Abylay Satybaldy Anton Hasselgren Mariusz Nowostawski Copyright (c) 2022 Anton Hasselgren, Abylay Satybaldy, Mariusz Nowostawski 2022-03-14 2022-03-14 10.30953/bhty.v5.195 Improving Transitions of Care: Designing a Blockchain Application for Patient Identity Management <p><strong>Background: </strong>The current healthcare ecosystem in the United States is plagued by inefficiencies in transitions of patient care between healthcare providers due in large part to a lack of interoperability among the many electronic medical record (EMR) systems that exist today. Both providers and patients experience significant frustration due to the negative effects of increased costs, unnecessary administrative burden, and duplication of services that occur because of data fragmentation in the system. Blockchain technology provides a solution to mitigate or eliminate these gaps by allowing for healthcare information exchange that is distributed, auditable, immutable, and respectful of patient autonomy. Our multidisciplinary team identified key tasks required for a transition of care to design and develop a blockchain application, MediLinker, that served as a patient-centric identity management system to address the issues of data fragmentation ultimately allowing for the delivery of high value care.</p> <p>&nbsp;</p> <p><strong>Methods:</strong> The MediLinker application was evaluated for its ability to accomplish various key tasks needed for a successful transition of patient care in an outpatient setting. Our team created twenty unique patient use cases covering a diversity of medical needs and social circumstances that were played out by participants who were asked to perform various tasks as they received case across a simulated healthcare ecosystem composed of four clinics, a research institution, and other ancillary public services. Tasks included, but were not limited to, clinic enrollment, verification of identity, medication reconciliation, sharing insurance and billing information, and updating demographic information. With this iteration of MediLinker, we specifically focused on the functionality of Guardianship and patient revocation of healthcare information. Additionally, throughout the simulation we surveyed participant perceptions regarding the use of MediLinker and blockchain technology to better ascertain comfortability and usability of the application.</p> <p>&nbsp;</p> <p><strong>Results: </strong>Quantitative evaluation of simulation results revealed that MediLinker was able to successfully accomplish all seven clinical scenarios tested across the twenty patient use cases. MediLinker successfully achieved its goal of patient-centered interoperability as participants transitioned their simulated healthcare data, including COVID-19 vaccination status and current medications, across the four clinic sites and research institution. In addition to completing all key tasks designated, all eligible participants were able to enroll with and subsequently revoke data access with our simulated research site. A high degree of data accuracy was noted with most errors occurring due to inaccurate data entry from user input. Our qualitative analysis of user perceptions indicated that comfortability and trust with blockchain technology, such as MediLinker, grew with increased education and exposure to such technology.</p> <p>&nbsp;</p> <p><strong>Conclusion: </strong>The ubiquitous problem of data fragmentation in our current healthcare ecosystem has placed considerable strain on providers and patients alike. Blockchain applications for health identity management, such as MediLinker, provide a viable solution to stem the inefficiencies that exist today. The interoperability that MediLinker provided across our simulated healthcare system has the potential to improve transitions of care by sharing key aspects of healthcare information in a timely, secure, and patent-centric fashion allowing for the delivery of consistent personalized high-value care. Blockchain technologies appear to face similar challenges to widespread adoption as other novel interventions, namely recognition, trust, and usability. Further development and scaling are required for such technology to realize its full potential in the real-world and transform the practice of modern healthcare.</p> Mustafa Abdul-Moheeth Muhammad Usman Daniel Toshio Harrell Anjum Khurshid Copyright (c) 2022 Mustafa Abdul-Moheeth, Muhammad Usman, Daniel Toshio Harrell, Anjum Khurshid 2022-03-14 2022-03-14 10.30953/bhty.v5.200 Technical Design and Development of a Self-Sovereign Identity Management Platform for Patient-Centric Healthcare Using Blockchain Technology <p><strong>Objective: </strong>Clinical data in the United States is highly fragmented, stored in numerous different databases, and are defined by service providers or clinical specialties rather than by individuals or their families. As a result, linking or aggregating a complete record for a patient is a major technological, legal, and operational challenge. One factor that has made clinical data integration so difficult to achieve is the lack of a universal ID for everyone. This leads to other related problems of having to prove identity at each interaction with the health system and providing basic information about demographics, insurance, payment, and medical conditions repeatedly. Traditional solutions that require complex governance, expensive technology, and risks to privacy and security of the data have failed to solve this interoperability problem adequately. We describe the technical design decisions of a patient-centric decentralized health identity management system using blockchain technology, called MediLinker, to address some of these challenges.</p> <p><strong>Design: </strong>Our multi-disciplinary research group developed and implemented an identity wallet, that uses blockchain technology to manage verifiable credentials issued by healthcare clinics, banks, and insurance companies. To manage patient’s self-sovereign identity, we leveraged the Hyperledger Indy blockchain framework to store patient’s decentralized identifiers (DIDs) and the schemas or format for each credential type. In contrast, the credentials containing patient data are stored “off-ledger” in each person’s wallet and accessible via a computer or smartphone. We used Hyperledger Aries as a middleware layer (API) to connect Hyperledger Indy with the front-end, which was developed using a JavaScript framework, ReactJS (Web Application) and React Native (iOS Application).</p> <p><strong>Results: </strong>MediLinker allows users to store their personal data on digital wallets, which they control. It uses decentralized trusted identity using Hyperledger Indy and Hyperledger Aries. Patients use MediLinker to register and share their information securely and in a trusted system with healthcare and other service providers. Each MediLinker wallet can have six credential types: Health ID with patient demographics, insurance, medication list including COVID-19 vaccination status, credit card, medical power of attorney (MPOA) for guardians of pediatric or geriatric patients, and research consent. The system allows for in-person and remote granting and revoking of such permissions for care, research, or other purposes without repeatedly requiring physical identity documents or enrollment information.</p> <p><strong>Conclusion: </strong>We have successfully developed and tested a blockchain-based technical architecture, described in this paper, as an identity management system that may be operationalized and scaled for future implementation to improve patient experience and control over their personal information.</p> Daniel Toshio Harrell Muhammad Usman Ladd Hanson Mustafa Abdul-Moheeth Ishav Desai Jahnavi Shriram Eliel de Oliveira John Robert Bautista Eric T. Meyer Anjum Khurshid Copyright (c) 2022 Daniel Toshio Harrell, Muhammad Usman, Ladd Hanson, Mustafa Abdul-Moheeth, Ishav Desai, Jahnavi Shriram, Eliel de Oliveira, John Robert Bautista, Eric T. Meyer, Anjum Khurshid 2022-04-22 2022-04-22 10.30953/bhty.v5.196 Clinical, Organizational and Regulatory, and Ethical and Social (CORES) Issues and Recommendations on Blockchain Deployment for Healthcare: Evidence From Experts <p>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.<br>Method: 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.<br>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.<br>Conclusion: 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.</p> John Robert Bautista Muhammad Usman Daniel Toshio Harrell Eric Meyer Anjum Khurshid Copyright (c) 2022 John Robert Bautista, Muhammad Usman, Daniel Toshio Harrell, Eric Meyer, Anjum Khurshid 2022-03-14 2022-03-14 10.30953/bhty.v5.199 Applicability of Blockchain-Based Implementation for Risk Management in Healthcare Projects <p>Hospitals provide diverse tasks essential for the delivery of patient care and are comprised of many functional units. This makes healthcare construction projects 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 illustrates the process, benefits, and limitations of adopting blockchain technology for collaborative risk management in healthcare projects.</p> <p>&nbsp;</p> In Bae Chung Carlos Caldas Copyright (c) 2022 In Bae Chung, Carlos Caldas 2022-03-14 2022-03-14 10.30953/bhty.v5.191 Securing the Chain of Custody and Integrity of Data in a Global North-South Partnership to Monitor the Quality of Essential Medicines <p>Substandard and falsified (SF) pharmaceuticals account for an estimated 10% of the pharmaceutical supply chain in low- and middle-income countries (LMICs), where a lack of regulatory and laboratory resources limits the ability to conduct effective post-market surveillance and allows SF products to penetrate the supply chain. The Distributed Pharmaceutical Analysis Laboratory (DPAL) was established in 2014 to expand testing of pharmaceutical dosage forms sourced from LMICs; DPAL is an alliance of academic institutions throughout the United States and abroad that provides high quality, validated chemical analysis of pharmaceutical dosage forms sourced from partners in LMICs. Results from analysis are reported to relevant regulatory agencies and are used to inform purchasing decisions made by in-country stakeholders. As the DPAL program has expanded to testing more than 1000 pharmaceutical dosage forms annually, challenges have surfaced regarding data management and sample tracking. Here, we describe a pilot project between DPAL and ARTiFACTs that applies blockchain to organize and manage key data generated during the DPAL workflow, including a sample’s progress through the workflow, its physical location, provenance of metadata, and lab reputability. Recording time and date stamps with this data will create a permanent and verifiable chain-of-custody for samples. This secure, distributed ledger will be linked to an easy-to-use dashboard, allowing stakeholders to view results and experimental details for each sample in real time and verify the integrity of DPAL analysis data. Introducing this blockchain-based system as a pilot will allow us to test the technology with real users analyzing real samples. Feedback from users will be recorded and necessary adjustments will be made to the system before the implementation of blockchain across all DPAL sites. Anticipated benefits of implementing blockchain for managing DPAL data include efficient management for routing work, increasing throughput, creating a chain of custody for samples and their data in alignment with the distributed nature of DPAL, and using the analysis results to detect patterns of quality within and across brands of products and develop enhanced sampling techniques and best practices.&nbsp;</p> Kathleen Hayes Natalie Meyers Christopher Sweet Ayenew Ashenef Tim Johann Marya Lieberman David Kochalko Copyright (c) 2022 Kathleen Hayes, Natalie Meyers, Christopher Sweet, Ayenew Ashenef, Tim Johann, Marya Lieberman, David Kochalko 2022-03-22 2022-03-22 10.30953/bhty.v5.230