The Potential of Blockchain Technology for Health Information Exchange: Experimental Study From Patients' Perspectives.

Pouyan Esmaeilzadeh,Tala Mirzaei

doi:10.2196/14184

Abstract

BackgroundNowadays, a number of mechanisms and tools are being used by health care organizations and physicians to electronically exchange the personal health information of patients. The main objectives of different methods of health information exchange (HIE) are to reduce health care costs, minimize medical errors, and improve the coordination of interorganizational information exchange across health care entities. The main challenges associated with the common HIE systems are privacy concerns, security risks, low visibility of system transparency, and lack of patient control. Blockchain technology is likely to disrupt the current information exchange models utilized in the health care industry.ObjectiveLittle is known about patients’ perceptions and attitudes toward the implementation of blockchain-enabled HIE networks, and it is still not clear if patients (as one of the main HIE stakeholders) are likely to opt in to the applications of this technology in HIE initiatives. Thus, this study aimed at exploring the core value of blockchain technology in the health care industry from health care consumers’ views.MethodsTo recognize the potential applications of blockchain technology in health care practices, we designed 16 information exchange scenarios for controlled Web-based experiments. Overall, 2013 respondents participated in 16 Web-based experiments. Each experiment described an information exchange condition characterized by 4 exchange mechanisms (ie, direct, lookup, patient-centered, and blockchain), 2 types of health information (ie, sensitive vs nonsensitive), and 2 types of privacy policy (weak vs strong).ResultsThe findings show that there are significant differences in patients’ perceptions of various exchange mechanisms with regard to patient privacy concern, trust in competency and integrity, opt-in intention, and willingness to share information. Interestingly, participants hold a favorable attitude toward the implementation of blockchain-based exchange mechanisms for privacy protection, coordination, and information exchange purposes. This study proposed the potentials and limitations of a blockchain-based attempt in the HIE context.ConclusionsThe results of this research should be of interest to both academics and practitioners. The findings propose potential limitations of a blockchain-based HIE that should be addressed by health care organizations to exchange personal health information in a secure and private manner. This study can contribute to the research in the blockchain area and enrich the literature on the use of blockchain in HIE efforts. Practitioners can also identify how to leverage the benefit of blockchain to promote HIE initiatives nationwide.

Highlights

Health Information Exchange ModelsIndividuals usually seek health care services from several providers who may practice in either affiliated or unaffiliated institutions
The findings propose potential limitations of a blockchain-based health information exchange (HIE) that should be addressed by health care organizations to exchange personal health information in a secure and private manner
We used IBM SPSS Statistics 24 to perform analysis of variance (ANOVA) to examine whether the 16 groups are significantly different by our main outcome variables: privacy concerns, opt-in intention, trust in competency, trust in integrity, willingness to share information, and perceived benefits

Summary

Introduction

Health Information Exchange ModelsIndividuals usually seek health care services from several providers who may practice in either affiliated or unaffiliated institutions. A provider can share encrypted patient medical records with a known recipient [6] This exchange model facilitates point-to-point data exchange in which the sender is aware of the recipient’s identity and patients’ medical records can be exchanged directly from one health care organization to another via widely adopted email protocols. Direct exchange initiatives, which are principally based on trust between providers, incorporate medical records into the recipient’s electronic health record (EHR) system or clinical inbox in a secure network governed by health care entities. The direct model is able to improve communication and coordination among health care organizations involved in providing treatments by securely exchanging identifiable information of patients. Blockchain technology is likely to disrupt the current information exchange models utilized in the health care industry

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