Electronic health records and blockchain interoperability requirements: a scoping review

OBJECTIVE: The purpose of this study was to conduct a scoping review of publications that explored blockchain technology in the context of interoperability and challenges of electronic health record (EHR) implementations. We synthesize the literature regarding standards and security, specifically regulation, regulatory operability, and conformance to standards. We review open practitioner questions that were not addressed in the studies as directions for further research. MATERIALS AND METHODS: We conducted a literature search in the OVID databases (Medline and Embase) on terms blockchain, implementation, interoperability, EHRs, security, and standards. The search resulted in 152 nonduplicate, peer-reviewed manuscripts, of which 15 were relevant to our objective and included for synthesis. RESULTS: Based on the search results, we analyzed the adoption of blockchain technology in the healthcare systems and challenges to EHR implementation of blockchain. From the synthesized research, we categorized and reported compelling factors of blockchain for EHR integration using current knowledge on blockchain research standardization and architectural challenges. DISCUSSION: Our research showed promise in implementing blockchain technology associated with EHRs, especially with Health Information Exchanges. The studies relevant for both EHR (n = 5) and blockchain (n = 10) reported compelling factors and limitations of the architecture. Security (n = 4) and interoperability (n = 4) features were reported as compelling requirements with lingering challenges. Standardization literature (n = 3) reported implementation challenges. CONCLUSION: This study shows promise in implementing blockchain technology within EHR systems. The adoption is increasing; however, multiple implementation challenges remain from architectural perspectives (eg, scalability and performance), to security challenges (eg, legal requirements), and standard perspectives including patient-matching problems.