Blockchain Personal Health Records: Systematic Review (Preprint)

Abstract

BACKGROUND Blockchain technology has the potential to enable more secure, transparent and equitable data management. In the healthcare domain, it has been most frequently applied to electronic health records (EHRs). Apart from securely managing data, blockchain also has a significant advantage of distributing data access, control and ownership to the end-users. This attribute, among others, makes it especially appealing when used to power personal health records (PHRs). OBJECTIVE In this review, we aim to examine the current landscape, design choices and limitations of blockchain-based PHRs. METHODS Adopting the PRISMA guidelines, a cross-discipline systematic review was performed in July 2020 on all eligible articles, including grey literature, from the following eight 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 58 articles fulfilled the inclusion criteria. The review found that the blockchain PHR space has been maturing over the past five years, from purely conceptual ideas initially to an increasing trend of publications describing prototypes and even implementations. Although the eventual PHR application is purposed for the healthcare industry, majority of the articles came from Engineering or Computer Science publications. Among the blockchain PHRs described, permissioned blockchains and off-chain storage were the more common design choices. While eighteen articles described a tethered blockchain PHR, all of these were at the conceptual stage. CONCLUSIONS This review revealed that research interest in using blockchain for PHRs is increasing and that the space is maturing. With further experimentation, this trend will very likely lead to breakthroughs to address existing limitations which could ultimately accelerate the adoption of blockchain PHRs.