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Design Choices and Trade-Offs in Health Care Blockchain Implementations: Systematic Review

BACKGROUND: A blockchain is a list of records that uses cryptography to make stored data immutable; their use has recently been proposed for electronic medical record (EMR) systems. This paper details a systematic review of trade-offs in blockchain technologies that are relevant to EMRs. Trade-offs...

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Autores principales: O'Donoghue, Odhran, Vazirani, Anuraag A, Brindley, David, Meinert, Edward
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6533871/
https://www.ncbi.nlm.nih.gov/pubmed/31094344
http://dx.doi.org/10.2196/12426
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author O'Donoghue, Odhran
Vazirani, Anuraag A
Brindley, David
Meinert, Edward
author_facet O'Donoghue, Odhran
Vazirani, Anuraag A
Brindley, David
Meinert, Edward
author_sort O'Donoghue, Odhran
collection PubMed
description BACKGROUND: A blockchain is a list of records that uses cryptography to make stored data immutable; their use has recently been proposed for electronic medical record (EMR) systems. This paper details a systematic review of trade-offs in blockchain technologies that are relevant to EMRs. Trade-offs are defined as “a compromise between two desirable but incompatible features.” OBJECTIVE: This review’s primary research question was: “What are the trade-offs involved in different blockchain designs that are relevant to the creation of blockchain-based electronic medical records systems?” METHODS: Seven databases were systematically searched for relevant articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Papers published from January 1, 2017 to June 15, 2018 were selected. Quality assessments of papers were performed using the Risk Of Bias In Non-randomized Studies—of Interventions (ROBINS-I) tool and the Critical Assessment Skills Programme (CASP) tool. Database searches identified 2885 articles, of which 15 were ultimately included for analysis. RESULTS: A total of 17 trade-offs were identified impacting the design, development, and implementation of blockchain systems; these trade-offs are organized into themes, including business, application, data, and technology architecture. CONCLUSIONS: The key findings concluded the following: (1) multiple trade-offs can be managed adaptively to improve EMR utility; (2) multiple trade-offs involve improving the security of blockchain systems at the cost of other features, meaning EMR efficacy highly depends on data protection standards; and (3) multiple trade-offs result in improved blockchain scalability. Consideration of these trade-offs will be important to the specific environment in which electronic medical records are being developed. This review also uses its findings to suggest useful design choices for a hypothetical National Health Service blockchain. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/10994
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spelling pubmed-65338712019-06-07 Design Choices and Trade-Offs in Health Care Blockchain Implementations: Systematic Review O'Donoghue, Odhran Vazirani, Anuraag A Brindley, David Meinert, Edward J Med Internet Res Review BACKGROUND: A blockchain is a list of records that uses cryptography to make stored data immutable; their use has recently been proposed for electronic medical record (EMR) systems. This paper details a systematic review of trade-offs in blockchain technologies that are relevant to EMRs. Trade-offs are defined as “a compromise between two desirable but incompatible features.” OBJECTIVE: This review’s primary research question was: “What are the trade-offs involved in different blockchain designs that are relevant to the creation of blockchain-based electronic medical records systems?” METHODS: Seven databases were systematically searched for relevant articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Papers published from January 1, 2017 to June 15, 2018 were selected. Quality assessments of papers were performed using the Risk Of Bias In Non-randomized Studies—of Interventions (ROBINS-I) tool and the Critical Assessment Skills Programme (CASP) tool. Database searches identified 2885 articles, of which 15 were ultimately included for analysis. RESULTS: A total of 17 trade-offs were identified impacting the design, development, and implementation of blockchain systems; these trade-offs are organized into themes, including business, application, data, and technology architecture. CONCLUSIONS: The key findings concluded the following: (1) multiple trade-offs can be managed adaptively to improve EMR utility; (2) multiple trade-offs involve improving the security of blockchain systems at the cost of other features, meaning EMR efficacy highly depends on data protection standards; and (3) multiple trade-offs result in improved blockchain scalability. Consideration of these trade-offs will be important to the specific environment in which electronic medical records are being developed. This review also uses its findings to suggest useful design choices for a hypothetical National Health Service blockchain. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/10994 JMIR Publications 2019-05-10 /pmc/articles/PMC6533871/ /pubmed/31094344 http://dx.doi.org/10.2196/12426 Text en ©Odhran O'Donoghue, Anuraag A Vazirani, David Brindley, Edward Meinert. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 10.05.2019. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), 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 http://www.jmir.org/, as well as this copyright and license information must be included.
spellingShingle Review
O'Donoghue, Odhran
Vazirani, Anuraag A
Brindley, David
Meinert, Edward
Design Choices and Trade-Offs in Health Care Blockchain Implementations: Systematic Review
title Design Choices and Trade-Offs in Health Care Blockchain Implementations: Systematic Review
title_full Design Choices and Trade-Offs in Health Care Blockchain Implementations: Systematic Review
title_fullStr Design Choices and Trade-Offs in Health Care Blockchain Implementations: Systematic Review
title_full_unstemmed Design Choices and Trade-Offs in Health Care Blockchain Implementations: Systematic Review
title_short Design Choices and Trade-Offs in Health Care Blockchain Implementations: Systematic Review
title_sort design choices and trade-offs in health care blockchain implementations: systematic review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6533871/
https://www.ncbi.nlm.nih.gov/pubmed/31094344
http://dx.doi.org/10.2196/12426
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