Purpose The purpose of this paper is to describe the application of soft systems methodology (SSM) to address the problematic situation of low opt-in rates for Precision Health-Care (PHC). Design/methodology/approach The design logic is that when trust is enhanced and compliance is better assured, participants such as patients and their doctors would be more likely to share their medical data and diagnosis for the purpose of precision modeling. Findings The authors present the findings of an empirical study that confronts the design challenge of increasing participant opt-in to a PHC repository of Electronic Medical Records and genetic sequencing. Guided by SSM, the authors formulate design rules for the establishment of a trust-less platform for PHC which incorporates key principles of transparency, traceability and immutability. Research limitations/implications The SSM approach has been criticized for its lack of “rigour” and “replicability”. This is a fallacy in understanding its purpose – theory exploration rather than theory confirmation. Moreover, it is unlikely that quantitative modeling yields any clearer an understanding of complex, socio-technical systems. Practical implications The application of Blockchain, a platform for distributed ledgers, and associated technologies present a feasible approach for resolving the problematic situation of low opt-in rates. Social implications A consequence of low participation is the weak recall and precision of descriptive, predictive and prescriptive analytic models. Factors such as cyber-crime, data violation and the potential for misuse of genetic and medical records have led to a lack of trust from key stakeholders – accessors, participants, miners and regulators – to varying degrees. Originality/value The application of Blockchain as a trust-enabling platform in the domain of an emerging eco-system such as precision health is novel and pioneering.

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BACKGROUND The current digital health context is incapable of supporting the future need for data security and storage in digital health services. It requires implementing a robust, interoperable, and scalable data storage and security solution to address this future need. Blockchain is an emerging information technology that can support this industry's timely needs. Therefore, a clear foundational understanding of Blockchain affordances for digital health is significant to harness its full potential. OBJECTIVE Objective: This paper presents a comprehensive review of Blockchain affordances for digital health. The review aims to: 1) identify the perceived Blockchain affordances and 2) explore the recent Blockchain research in digital health (actualized). METHODS We applied the Systematic Literature Review (SLR) methodology to review the literature extant. Furthermore, we applied the affordance theory lens to define and defend our findings on Blockchain affordances. RESULTS A total of 3627 relevant papers have been identified and analysed in this review study. Of these, 90 were probed deeply. Our analysis identified 14 Blockchain affordances (Access control, Interoperability, Security, Tamper-resistance, Traceability, Anonymity, Data Provenance, Identity, Immutability, Integrity, Privacy, Transparency, and Trust) which are perceived and actualized in digital health. Our study also discovered several constraints in Blockchain implementation such as security and privacy, interoperability, scalability, and infrastructural support that requires further research attention. CONCLUSIONS We believe this study will guide further Blockchain research in the digital health domain and informatively contribute to eliminating (decreasing) the dark side of digital health and improving (increasing) the bright side for the future.

Bangladesh received the United Nations Award for DigitalHealth Development in 2011. Inspired by the recognition, the country has launched several digital health initiatives over the last decade. However, despite achievements in expanding information and communication technologies, recent studies show that current digital health services are difficult to use, fail to meet user needs, are subject to threats in data privacy and security, lack a robust digital infrastructure, and do not benefit from a cohesive policy and regulatory environment. As the country currently deals with the post‐COVID‐19 consequences, it is high time for its healthcare policymakers to address these challenges and take the necessary actions to establish a people‐centered framework for digital health service design and operations. In this commentary, we proposed a design framework for digital health services that address these ongoing challenges in the digital health services of Bangladesh. We believe the proposed framework stands to help Bangladesh and other coutnries attain sustainability.