Background: Blockchain and distributed ledger technology is a disruptive force in healthcare. Methods: This article provides a globally relevant, interdisciplinary perspective intended to aid disparate group of actors, participants, and users that represent the diverse stakeholders of an increasingly complex and technologically reliant healthcare system. Domain expertise reinforced by literature published via industry, technical, and academic venues was used to inform these perspectives. Results: Key characteristics of blockchain and distributed ledger technology are highlighted and framed for a readership ranging from healthcare executive to policy makers to researchers. Antecedent application of blockchain in the financial sector is explored followed by the technical, security, and interoperability considerations specific to healthcare. Conclusion: Blockchain remains an emerging technology both fraught with unanticipated challenges and the promise of unrealized potential in healthcare. Keywords: Blockchain, Healthcare, Innovation, Adoption, Global, Interoperability

BACKGROUND Healthcare is undergoing a transformation worldwide1. In many developed countries, mature but antiqued national healthcare services are being burdened with a growing aging population, changes in payment reforms, worker shortage and rising costs2. Combined with a surge in innovative technologies like Artificial Intelligence (AI)3 and blockchain4 which can help with automating medical record mining to provide a more accurate diagnosis5 or reduce errors in medical practice6 by providing accurate and tailored treatment while reducing the financial burden, today’s healthcare systems are ready for change. After success in industries like financial services7 and retail8, if blockchain can be scaled and moved into the mainstream in healthcare, it can help alleviate the many concerns with security and privacy of health data and help stitch together a longitudinal history of health data that is fragmented and locked away in multiple silos today. Sophisticated use of blockchain technology will contribute to improving health outcomes, improved health care quality, and lower health care costs – the three overarching aims that the U.S. is striving to achieve (also known as the “Triple aim”)9. OBJECTIVE This paper aims to provide a primer on blockchain technology, and implementation considerations for blockchain at healthcare institutions. METHODS Systematic literature survey, conversation with experts. RESULTS After extensive research and interviews, we developed a primer and high level implementation guide for healthcare systems exploring the use of blockchain technology. CONCLUSIONS The use of blockchain technology in healthcare is at a promising stage in development but Blockchain-based applications are yet to be demonstrated as a viable platform for exchanging and reviewing information. Healthcare systems should be cautiously optimistic regarding the potential of blockchain and do a thorough business and technical diligence that is driven by targeted use cases (s) to be successful.

ObjectiveThis article aims to provide a primer on blockchain technology and implementation considerations for blockchain at healthcare institutions.ResultsAfter research and interviews, we developed a primer and a high-level implementation guide for healthcare systems exploring the use of blockchain technology.ConclusionsThe use of blockchain technology in health care is at a promising stage in development but blockchain-based applications are yet to be demonstrated as a viable platform for exchanging and reviewing information. Healthcare systems should be cautiously optimistic regarding the potential of blockchain and do a thorough business and technical diligence that is driven by targeted use cases to be successful.