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. 2021 Apr 13;23(4):e25094.
doi: 10.2196/25094.

Blockchain Personal Health Records: Systematic Review

Hao Sen Andrew Fang  1 , Teng Hwee Tan  2 , Yan Fang Cheryl Tan  3 , Chun Jin Marcus Tan  2
Affiliations

Blockchain Personal Health Records: Systematic Review

Hao Sen Andrew Fang et al. J Med Internet Res. .

Abstract

Background: Blockchain technology has the potential to enable more secure, transparent, and equitable data management. In the health care domain, it has been applied most frequently to electronic health records. In addition to securely managing data, blockchain has significant advantages in distributing data access, control, and ownership to end users. Due to this attribute, among others, the use of blockchain to power personal health records (PHRs) is especially appealing.

Objective: This review aims to examine the current landscape, design choices, limitations, and future directions of blockchain-based PHRs.

Methods: Adopting the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, a cross-disciplinary systematic review was performed in July 2020 on all eligible articles, including gray literature, from the following 8 databases: ACM, IEEE Xplore, MEDLINE, ScienceDirect, Scopus, SpringerLink, Web of Science, and Google Scholar. Three reviewers independently performed a full-text review and data abstraction using a standardized data collection form.

Results: A total of 58 articles met the inclusion criteria. In the review, we found that the blockchain PHR space has matured over the past 5 years, from purely conceptual ideas initially to an increasing trend of publications describing prototypes and even implementations. Although the eventual application of blockchain in PHRs is intended for the health care industry, the majority of the articles were found in engineering or computer science publications. Among the blockchain PHRs described, permissioned blockchains and off-chain storage were the most common design choices. Although 18 articles described a tethered blockchain PHR, all of them were at the conceptual stage.

Conclusions: This review revealed that although research interest in blockchain PHRs is increasing and that the space is maturing, this technology is still largely in the conceptual stage. Being the first systematic review on blockchain PHRs, this review should serve as a basis for future reviews to track the development of the space.

Keywords: blockchain; distributed ledger; electronic health records; personal health records; systematic review.

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Conflict of interest statement

Conflicts of Interest: The authors did not receive any funding for this work and declare no conflicts of interest. However, the authors would like to highlight that MT is the cofounder of MediLOT, which published one of the articles reviewed in this paper.

Figures

Figure 1
Figure 1
Illustration of how blocks of data are linked together in a blockchain through hashing. To add a new record (eg, Record #7) to the blockchain, this is first grouped with other records (Records #6, #8, and #9). The group of records is then combined with a hash key from the previous block (hash key 2) and then put through a hashing algorithm to produce a new hash key (hash key 3). The new records, along with hash keys 2 and 3, are now part of a new block (Block N+3) that has been added to the blockchain. This process continues as new records are added.
Figure 2
Figure 2
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) flow diagram of the article selection process. The title and author screen involved removing duplicate articles that had the same title and authors. The abstract screen involved reviewing article abstracts to remove review articles and those not related to blockchain and electronic health records. The full text screen involved reviewing the full articles to exclude those that did not meet the inclusion and exclusion criteria, and those whose full text was not available or in English. ACM: Association of Computing Machinery; EHR: electronic health record; IEEE: Institute of Electrical and Electronics Engineers; PHR: personal health record.
Figure 3
Figure 3
Trend of blockchain personal health record articles by interest group. The trend from 2019 to 2020 (represented by dashed lines) is a projection because only data from the first half of the year 2020 was available at the time of the search. Count refers to the number of articles published in that year.
Figure 4
Figure 4
Distribution of articles published by geography. The number of articles refers to the total number of articles selected for the final review.
Figure 5
Figure 5
Trend of blockchain personal health record articles by country. Only countries with 5 or more articles in the final review were plotted individually. The other countries were grouped under an Others category. The trend from 2019 to 2020 (represented by dashed lines) is a projection because only data from the first half of the year 2020 was available at the time of the search. Count refers to the number of articles published in that year.
Figure 6
Figure 6
Trend of blockchain personal health record maturity. Note that the trend from 2019 to 2020 (represented by dashed lines) is a projection because only data from the first half of the year 2020 was available at the time of search. Count refers to the number of articles published in that year (2018).
See this image and copyright information in PMC

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