Review

Blockchain and Healthcare: A Critical Analysis of Progress and

Challenges in the Last Five Years
Hamed Taherdoost 1,2,3

1 Department of Arts, Communications and Social Sciences, University Canada West,

Vancouver, BC V6B 1V9, Canada; [email protected] or [email protected]
2 Hamta Group|Hamta Business Corporation, Vancouver, BC V6E 1C9, Canada
3 Q Minded|Quark Minded Technology Inc., Vancouver, BC V6E 1C9, Canada

Abstract: Utilizing the fundamental characteristics of the decentralization, immutability, and trans-
parency of blockchain technology, the healthcare industry has made notable advancements in incor-
porating it over the past five years. This review examines the progress and challenges encountered
in this critical study by assessing 124 articles published by MDPI between 2018 and the current
date. Examining blockchain’s potential uses, like safe data exchange and interoperability in supply
chain management and electronic health records, provides exciting new directions for the future
of healthcare. Blockchain technology can greatly increase efficiency and cost-effectiveness by guar-
anteeing data integrity, protecting patient privacy, and reducing administrative procedures. This
paper objectively evaluates blockchain’s advancement in healthcare through a thorough analysis of
real-world applications and research projects. By highlighting both its advantages and disadvantages,
this analysis seeks to add to the continuing conversation about how blockchain will influence the
way healthcare is managed and delivered in the future.

Keywords: blockchain technology; healthcare industry; advancements; data integrity; patient privacy

1. Introduction
Citation: Taherdoost, H. Blockchain As our population ages, not only do we have a greater demand for healthcare, but also
and Healthcare: A Critical Analysis for increased productivity [1]. The aging population and the prevalence of chronic diseases
of Progress and Challenges in the have increased the focus on health and the quest for better medical care [2]. There is a shift
Last Five Years. Blockchains 2023, 1, in perspective away from traditional healthcare and toward patient-centered care. Recent
73–89. https://doi.org/10.3390/ years have seen a shift away from healthcare that focuses on the patient and the hospital,
blockchains1020006 toward healthcare that is more mobile and electronic; this shift has resulted in universal
healthcare [3].
Academic Editors: Keke Gai and
Liehuang Zhu
The industry is at the forefront. Healthcare organizations, equipped with the necessary
tools, are at the forefront of participating in the blockchain movement [4]. The health
Received: 15 August 2023 ecosystem’s primary focus is on patients, and its primary objective is to increase the security,
Revised: 6 November 2023 confidentiality, and portability of health information. The healthcare sector generates
Accepted: 6 November 2023 copious amounts of data, including patient records, data from clinical trials, billing, and
Published: 8 November 2023
research findings [5]. Securing all internet-connected medical devices is the biggest obstacle
to universal electronic healthcare [6].
Blockchain, a distributed, immutable, and powerful technology, is having profound
Copyright: © 2023 by the author.
effects on the healthcare industry [7]. The elimination of third-party middlemen is another
Licensee MDPI, Basel, Switzerland. useful feature of blockchain technology. These days, blockchain is used for more than only
This article is an open access article cryptocurrency transactions [8]. Since these problems are real ones, the healthcare manage-
distributed under the terms and ment system has social relevance [9]. The overarching goal is to boost happiness by solving
conditions of the Creative Commons actual health problems [3]. Healthcare information technology emerged as a result of the
Attribution (CC BY) license (https:// incorporation of computer science into healthcare, leading to significant improvements
creativecommons.org/licenses/by/ in medical care [10]. There are significant problems and gaps in the healthcare system,
4.0/). notwithstanding its progress [11].

Blockchains 2023, 1, 73–89. https://doi.org/10.3390/blockchains1020006 https://www.mdpi.com/journal/blockchains

Blockchains 2023, 1 74

Since its start with cryptocurrencies and continuing with the latest blockchain-based
application for industry 5.0 [12], blockchain technology has been deployed in a wide variety
of areas as part of the infrastructure of some firms that require transparency, integrity, and
reliability [13]. The applications of blockchain technology in healthcare extend far beyond
just patient records and include things like supply chain management and drug security, dis-
ease prediction, medicine traceability, insurance claims, and more. By automating formerly
laborious processes that relied on inefficient configurations and wasted time, blockchain
technology has fundamentally altered how things are implemented [14]. Blockchain’s
trustworthy environment and user-friendly network produce effective results that foster
confidence among parties [14,15].
In light of the rapidly evolving landscape, this paper draws upon reliable research and
current knowledge, primarily focusing on MDPI articles. Our collaborative effort delves
into the advantages and disadvantages of blockchain integration in healthcare, with the
aim of identifying potential areas for development and future research directions. It serves
as a resource for decision-makers, healthcare experts, and technology enthusiasts, offering
insights into the current state of blockchain in healthcare and its potential to reshape the
industry in the years ahead.

2. Background
2.1. Core Features and Characteristics
The potential for blockchain technology to completely overhaul the healthcare sector
has surfaced [16]. Blockchain is fundamentally a distributed, decentralized digital ledger
that securely and permanently records transactions [17]. In the healthcare industry, where
the confidentiality and security of patient data are crucial, this functionality is very use-
ful [18]. Blockchain technology assures that no single party has complete control over the
data by functioning on a peer-to-peer network [17,19]. This increases transparency and
lowers the possibility of data modification or unauthorized access [18]. Healthcare data is
protected by a crucial layer of security thanks to the immutability of blockchain records [17].
Since each transaction or item on the blockchain is cryptographically connected to the one
before it, updating historical data would require changing every block after it [16]. This
tamper-resistant quality protects medical data and critical information, greatly lowering
the possibility of fraud, and boosting patient confidence [18].
All network users have access to a complete transaction history, allowing for the
traceability of medical data, the authentication of products, and regulatory compliance [20].
Additionally, being able to audit and track data access improves accountability and fortifies
security against data breaches. The long-standing issue of sharing medical data among
various systems and stakeholders can be addressed with the help of blockchain’s inter-
operability features. Blockchain-based platforms can enable secure and seamless data
transmission, improving care coordination and minimizing redundant procedures, by
using standardized data formats and protocols.
Blockchain’s special ability, smart contracts, automates healthcare procedures. Among
other things, the processing of insurance claims, consent management, and supply chain
tracking can all be automated using these self-executing agreements with specified rules.
Smart contracts can streamline procedures, lower costs, and improve overall efficiency in
the healthcare ecosystem by removing the need for middlemen and manual interventions.
Despite its enormous promise, the implementation of blockchain in healthcare confronts
difficulties. Significant obstacles still need to be solved in the areas of scalability, regulatory
compliance, data protection, and interaction with current healthcare infrastructure [21].
However, continuous research and development in this field continue to look at novel ap-
proaches to deal with these difficulties as the fundamental traits and properties of blockchain
drive the goal of a more secure, effective, and patient-centric healthcare environment.
Blockchains 2023, 1, FOR PEER REVIEW 3

fundamental traits and properties of blockchain drive the goal of a more secure, effective,
Blockchains 2023, 1
and patient-centric healthcare environment. 75

2.2. Employing Blockchain in Healthcare

Blockchain technology implementation in the healthcare industry has many benefits,
2.2. Employing Blockchain in Healthcare
including improved data security, interoperability, and simplified data management [22].
To doBlockchain technology
this, it is needed to firstimplementation
pinpoint the precise in theuse
healthcare industry
cases where has many
blockchain can benefits,
provide
including improved data security, interoperability, and simplified
value. These applications cover managing medical records, monitoring the medical sup- data management [22].
To do this, it is needed to first pinpoint the precise use cases where blockchain
ply chain, sharing data from clinical trials and research, processing healthcare payments, can provide
value. These applications cover managing medical records, monitoring the medical supply
and integrating data from internet of things (IoT) devices. Once the use cases have been
chain, sharing data from clinical trials and research, processing healthcare payments,
established, choosing the best blockchain platform is essential, taking into account ele-
and integrating data from internet of things (IoT) devices. Once the use cases have been
ments like scalability, privacy needs, and consensus techniques.
established, choosing the best blockchain platform is essential, taking into account elements
Strong data privacy and permission management methods are crucial due to the sen-
like scalability, privacy needs, and consensus techniques.
sitivity of healthcare data and the requirement for compliance with tight standards. Im-
Strong data privacy and permission management methods are crucial due to the
plementations of blockchain need to follow privacy regulations and provide impenetrable
sensitivity of healthcare data and the requirement for compliance with tight standards. Im-
consent management to guarantee that patient data is only accessible with the appropriate
plementations of blockchain need to follow privacy regulations and provide impenetrable
authorization. Smart contracts are extremely helpful in the healthcare industry for activi-
consent management to guarantee that patient data is only accessible with the appropriate
ties like processing insurance claims and managing data access rights [23] since they play
authorization. Smart contracts are extremely helpful in the healthcare industry for activities
a vital
like role in automating
processing insurance procedures
claims and and transactions
managing based rights
data access on specified rules
[23] since [24].play a
they
vital role in automating procedures and transactions based on specified rules [24]. with
Given that the majority of enterprises have legacy systems in place, integration
existing
Givenhealthcare
that the systems
majorityisofessential.
enterprises Whilehavechallenging, a smooth
legacy systems integration
in place, is essen-
integration with
tial for a successful shift to blockchain technology [25]. Another crucial choice
existing healthcare systems is essential. While challenging, a smooth integration is essential depends on
the chosen blockchain platform and the healthcare use case [26], such
for a successful shift to blockchain technology [25]. Another crucial choice depends on as whether to em-
ploychosen
the proof of work (PoW)
blockchain or proof
platform andof stake (PoS). Before
the healthcare use implementing
case [26], suchblockchain
as whether tech-
to
nology in a real-world healthcare setting, thorough testing and
employ proof of work (PoW) or proof of stake (PoS). Before implementing blockchain compliance checks are es-
sential to guarantee
technology data integrity,
in a real-world healthcare security,
setting,and adherence
thorough to legal
testing standards. Finally,
and compliance checks are af-
ter implementation,
essential to guarantee it is crucial
data to maintain
integrity, security,monitoring and improvement
and adherence to address
to legal standards. any
Finally,
problems
after that may emerge
implementation, and enhance
it is crucial the functioning
to maintain monitoringof theimprovement
and system. Figure to 1address
representsany
the step-by-step process of implementing blockchain technology in
problems that may emerge and enhance the functioning of the system. Figure 1 represents the healthcare indus-
try. step-by-step process of implementing blockchain technology in the healthcare industry.
the

Figure 1. Implementation of blockchain in the healthcare

healthcare system.
system.

2.3. Benefits and

2.3. Benefits and Potential Applications in
Potential Applications in Healthcare
Healthcare
Blockchain
Blockchain technology has numerous advantages
technology has numerous and prospective
advantages and prospective uses
uses that
that could
could
completely transform the way healthcare is delivered and managed, and how patients fare.
completely transform the way healthcare is delivered and managed, and how patients
The unmatched data security and privacy capabilities of blockchain technology are among
fare. The unmatched data security and privacy capabilities of blockchain technology are
its most important benefits for the healthcare industry. Blockchain ensures that patient
among its most important benefits for the healthcare industry. Blockchain ensures that
data is secure and tamper-resistant by using a decentralized and immutable ledger. This
patient data is secure and tamper-resistant by using a decentralized and immutable
lowers the possibility of data breaches and illegal access, fostering more confidence in the
healthcare system.
Acheiving interoperability between various systems and stakeholders has been a
major difficulty in the healthcare industry [27]. This problem is resolved by the open and
standardized data exchange protocols offered by blockchain technology [28]. Healthcare
organizations may safely exchange patient information in real time, allowing for seamless
Blockchains 2023, 1 76

care coordination and a reduction in the number of tests and procedures that need to be
repeated. Because of interoperability, healthcare professionals can make better judgments
and provide patients with more thorough and effective care.
The integration of blockchain technology has enormous potential benefits for electronic
health records (EHRs). Blockchain technology can be used to make EHRs into a unified
and impenetrable system. Authorized healthcare practitioners can quickly access medical
records stored on the blockchain, assuring accurate and current patient information during
medical treatment. A more accurate diagnosis, individualized treatment strategies, and
ultimately better patient outcomes may result from this simplified access to patient data.
The management of supply chains, notably in the pharmaceutical sector, is another
prospective use of blockchain in healthcare [29]. Transparency and traceability are improved
by blockchain’s capability to follow the distribution of medications and medical equipment
from the maker to the final consumer. This supports patient safety and confidence in the
healthcare system by ensuring the authenticity and integrity of medications while also
assisting in the fight against the growth of counterfeit drugs.
Blockchain technology can also have a big impact on managing research data and
clinical trials. Researchers can use the transparent and auditable ledger of a blockchain to
check the accuracy of trial outcomes and guarantee protocol adherence. Medical break-
throughs are ultimately accelerated by the immutability of data stored on the blockchain,
which improves the reproducibility and legitimacy of study findings [30].
Blockchain-based smart contracts have the potential to transform other industries as
well, including health insurance and claims processing [31]. Smart contract automation
of claim settlements lowers administrative loads and avoids errors, resulting in a more
effective and economical insurance system. Additionally, blockchain can give patients more
control over their personal information by enabling them to manage their medical data and
consent through smart contracts.
Despite these promising uses, problems with scalability, legal compliance, and system
integration continue. Blockchain technology is continuing to advance, overcoming these
challenges and advancing the healthcare sector toward a more secure, effective, and patient-
focused future. Blockchain technology is expected to have a revolutionary impact on
healthcare as it develops, transforming how healthcare data is maintained, shared, and
used to improve patient care and general public health.

2.4. Evaluation of Improved Efficiency and Cost-Effectiveness

Blockchain accelerates administrative procedures by utilizing its decentralized and
tamper-proof ledger system, doing away with the need for middlemen and manual record
reconciliation [32]. Smart contracts can automate processes like patient registration, billing,
and insurance claim processing, which speeds up decision-making and improves collabo-
ration among healthcare providers [33]. This improves patient care while simultaneously
saving time.
Blockchain’s interoperability features enable smooth data sharing between various
healthcare organizations and systems [34,35]. Secure data exchange improves care coordi-
nation and lowers medical errors with patients, caregivers, and other authorized parties.
Repetitive tests and treatments can be reduced with better patient access to their medical
records, which lowers costs for both patients and healthcare providers. Moreover, efficiency
and cost-effectiveness are further enhanced by blockchain’s ability to revolutionize supply
chain management [36,37]. Counterfeit goods can be found and supply chain integrity
ensured by tracking medications and medical equipment on the blockchain [38]. This open-
ness not only increases patient safety but also lessens financial losses brought on by recalled
goods and fake goods. Table 1 provides a comprehensive analysis of the potential impact of
implementing blockchain technology in the healthcare industry. It examines various aspects
of healthcare operations, comparing traditional systems to blockchain-based systems.
Blockchains 2023, 1 77

Table 1. Blockchain in healthcare: evaluating improved efficiency, cost-effectiveness, and challenges.

Aspect Traditional System Blockchain System Challenges/Limitations Reference

High security via
Limited security, data Regulatory complexity,
Data Security/Privacy cryptographic [16]
breaches possible. private key management
algorithms.
Data silos, Shared, standardized,
Interoperability Integration challenges [39]
incompatible formats. transparent data access.
Centralized data, Immutable ledger,
Data Integrity Scalability concerns [40]
tampering risks. reduced errors.
Manual verification, Efficient smart
Claims Processing Transition challenges [41]
time-consuming. contract validation.
Lack of transparency Traceable supply
Supply Chain Management Onboarding difficulties. [42]
in tracing. chain data.
Limited access to Decentralized data Data privacy,
Medical Research [43]
diverse datasets. sharing with consent. compliance challenges
Inadequate counterfeit Unique identifiers,
Counterfeit Drugs Detection Adoption hurdles [44]
drug identification. history tracking.
Manual audits, Transparent, auditable Privacy vs.
Auditability/Compliance [45]
compliance issues. blockchain records. transparency balance
Increased costs due Direct peer-to-
Cost of Intermediaries Stakeholder trust transition [46]
to intermediaries. peer transactions.

3. Methodology
To examine the development and difficulties of blockchain adoption in the healthcare
industry during the past five years, this study used a mixed-methods methodology. A re-
view of research papers on blockchain technology in healthcare that have been published in
MDPI journals was performed. “Medical” or “Health” or “Healthcare” AND “Blockchain”
were the keywords. The search encompassed the past five years (2018–19 July 2023) to
ensure that the study included the most recent and relevant information.
The first search produced 158 papers. After screening based on criteria, 124 articles
were selected to review. A variety of adoption-related metrics for blockchain technology in
healthcare were gathered and examined. These comprise the number of articles started,
the number of implementations that were successful, and the growth pattern during the
previous five years.
Limitations:
• The study might be constrained by the data and published studies on blockchain in
healthcare that are currently available, particularly for certain locations or particu-
lar applications;
• Because blockchain technology and healthcare are both quickly growing fields, it may
be difficult to keep up with the most recent advances;
• Examining studies within the context of MDPI publishers.
Providing a comprehensive overview of the progress and challenges in integrating
blockchain technology into the healthcare industry, this study aimed to offer valuable
insights for stakeholders. This approach leveraged the well-established benefits of con-
ducting reviews in swiftly evolving fields, ensuring the synthesis of pertinent evidence.
The purpose of this study’s conclusions was to provide insightful information that will
help stakeholders, decision-makers, and researchers make informed judgments about the
potential applications of blockchain technology in healthcare.

4. Analysis of Current State

Blockchain technology’s current situation in the healthcare industry indicates both
tremendous advancements and enduring difficulties. Several initiatives and projects have
 will help stakeholders, decision-makers, and researchers make informed judgments about
the potential applications of blockchain technology in healthcare.

4. Analysis of Current State

Blockchains 2023, 1 Blockchain technology’s current situation in the healthcare industry indicates 78 both
tremendous advancements and enduring difficulties. Several initiatives and projects have
been launched during the past five years to investigate the potential of blockchain to rev-
olutionize healthcare
been launched operations
during the past five and
yearsaddress pressing
to investigate concerns.ofHowever,
the potential blockchainsome chal-
to revo-
lutionize
lenges needhealthcare operations
to be carefully and address
overcome before pressing concerns.can
the technology However, some
be fully challenges
integrated.
needAccording
to be carefully
to theovercome
numberbefore the technology
of publications can be in
published fully integrated.
respected journals like MDPI
According to the number of publications published in respected
during the past five years (Figure 2), there has been a consistent and significant journals like MDPI
increase
during the past five years (Figure 2), there has been a consistent and significant
in research interest. With only three articles published in 2018 and a steady increase increase
to 21
in research
articles interest.
in 2021, With only
the pattern three articles
of research published
publications in 2018
points to aand a steady
healthy increaseIntopar-
trajectory.
21 articles in 2021, the pattern of research publications points to a healthy trajectory. In
ticular, the year 2022 saw a notable acceleration with 47 publications, demonstrating the
particular, the year 2022 saw a notable acceleration with 47 publications, demonstrating
expanding understanding of blockchain’s potential in resolving healthcare issues. The
the expanding understanding of blockchain’s potential in resolving healthcare issues. The
output of research did, however, see a modest decline in 2023, which is clear given that
output of research did, however, see a modest decline in 2023, which is clear given that the
the year
year hashas
not not yet ended.
yet ended.

50 47

45

40

35

30
25
25
21
20 18

15
10
10

5 3

0
2017 2018 2019 2020 2021 2022 2023 2024

Figure 2. Number of MDPI articles.

Figure 2. Number of MDPI articles.
A greater emphasis is being placed on blockchain as a workable solution for many
A greater
healthcare emphasis
concerns, is being
as seen by theplaced oninblockchain
increase as a workable
research publications solution
in 2022. for many
Numerous
healthcare concerns, as seen by the increase in research publications in 2022.
topics are covered in these articles, including the management of electronic health records, Numerous
topics are covered
the tracking of the in thesechain,
supply articles, including
patient the management
permission of electronic
and data sharing, health records,
interoperability, and
the
datatracking of the supply chain, patient permission and data sharing, interoperability,
protection.
and data
Overprotection.
the past five years, Blockchain technology has garnered considerable interest and
research
Overactivity
the pastin the
fivehealthcare sector, as evidenced
years, Blockchain technology byhas
the garnered
publicationconsiderable
trends in various
interest
MDPI
and journals
research (Figurein3).
activity theWith 35 published
healthcare sector,articles, “Sensors”
as evidenced is the
by the most prominent
publication trends in
journal MDPI
various platform, reflecting
journals a strong
(Figure emphasis
3). With on the use
35 published of sensors
articles, in blockchain-based
“Sensors” is the most prom-
healthcare applications, such as ubiquitous health devices and
inent journal platform, reflecting a strong emphasis on the use of sensors remote patient monitoring.
in blockchain-
Following
based closely applications,
healthcare with 24 and 17 articles,
such “Electronics”
as ubiquitous and devices
health “Appliedand Sciences”
remotelikely
patient
cover a broad range of topics, including blockchain-based electronic health record sys-
tems, secure data sharing, and medical device integration. There is a growing interest in
investigating blockchain’s potential to revolutionize healthcare by improving data security,
interoperability, and patient-centric care, as evidenced by these publications.
 monitoring. Following closely with 24 and 17 articles, “Electronics” and “Applied Sci-
ences” likely cover a broad range of topics, including blockchain-based electronic health
record systems, secure data sharing, and medical device integration. There is a growing
interest in investigating blockchain’s potential to revolutionize healthcare by improving
Blockchains 2023, 1 data security, interoperability, and patient-centric care, as evidenced by these publica-
79
tions.

40
35
35

30
Number of Articles

24
25

20 17
15
11
10 7
5
5 3 3 3 2 2 1 1 1 1 1 1 1 1 1 1 1 1
0

Journal

Figure 3. Distribution of MDPI journals in the case of blockchain application in the medical industry.
Figure 3. Distribution of MDPI journals in the case of blockchain application in the medical industry.
Eleven articles published in the journal “Sustainability” demonstrate the importance
Eleven articles
of sustainability andpublished in the journal
environmental concerns “Sustainability”
in healthcare.demonstrate
Researchersthe areimportance
eager to in-
of sustainability
vestigate and environmental
how blockchain technology concerns in healthcare.
can contribute Researchers
to sustainable are eager
healthcare to in-
solutions,
vestigate
includinghow blockchain
supply technology and
chain transparency can contribute to sustainable
waste reduction. healthcare
Furthermore, solutions,
“Healthcare” as
including
a specialized supply chaincontains
journal transparency
seven and waste
articles reduction.
wholly devotedFurthermore,
to blockchain “Healthcare”
in the health- as
acare domain, demonstrating
specialized journal contains the seven
topic’s articles
niche appeal.
whollyThe remaining
devoted journals, including
to blockchain in the
“IJERPH”, domain,
healthcare “Future Internet”,
demonstrating “Computers”,
the topic’s“Symmetry”,
niche appeal.“Information”,
The remainingand “Cryptog-
journals, in-
raphy”, “IJERPH”,
cluding among others, haveInternet”,
“Future also contributed to the body
“Computers”, of knowledge
“Symmetry”, in this field
“Information”, by
and
publishing between
“Cryptography”, one others,
among and fivehave articles
also highlighting
contributed to thethe
diverse
body aspects and potential
of knowledge in this
applications
field of blockchain
by publishing betweeninone theandhealthcare industry.
five articles highlighting the diverse aspects and po-
tentialThe increasingofnumber
applications blockchainof scholarly articles published
in the healthcare industry.in various fields over the past
five The
years increasing number of scholarly articles published intechnology
demonstrates the current condition of blockchain various fieldsin the
over healthcare
the past
industry (Figure 4). Engineering emerged as the discipline with
five years demonstrates the current condition of blockchain technology in the healthcarethe most articles, totaling
82, indicating a strong interest in investigating how blockchain can
industry (Figure 4). Engineering emerged as the discipline with the most articles, totaling be applied to various
engineering
82, indicatingaspects
a strongininterest
the healthcare industry.how
in investigating These applications
blockchain can may include
be applied tosecuring
various
medical devices,
engineering aspectsassuring
in the data integrity
healthcare in medical
industry. records,
These and optimizing
applications may include supply chains
securing
in the healthcare industry.
medical devices, assuring data integrity in medical records, and optimizing supply chains
in theEnvironmental
healthcare industry. and earth sciences and computer science and mathematics, with 72
and Environmental
63 articles, respectively,
and earthfollowed
sciences and closely behind.science
computer This suggests that researchers
and mathematics, with 72 in
these fields are increasingly recognizing the potential of blockchain
and 63 articles, respectively, followed closely behind. This suggests that researchers in technology to resolve
healthcare-related
these environmental
fields are increasingly recognizingchallenges, such asoftracing
the potential the provenance
blockchain technology of to medical
resolve
products and facilitating
healthcare-related the secure
environmental exchangesuch
challenges, of dataas between
tracing thehealthcare
provenance providers.
of medicalSim-
ilarly, in chemistry and materials science and physical sciences,
products and facilitating the secure exchange of data between healthcare providers. Sim- with 58 and 48 articles,
there is a great deal of interest in improving the traceability of pharmaceutical products
ilarly, in chemistry and materials science and physical sciences, with 58 and 48 articles,
and ensuring the authenticity of medical equipment and materials.
In the context of life sciences and healthcare-specific disciplines, the quantity of articles
indicates a growing interest, albeit at a lower level than in other disciplines. 22 articles
were devoted to biology and life sciences, 16 to public health and healthcare, and 15 to
medicine and pharmacology. This indicates that researchers in these disciplines recognize
blockchain’s potential to enhance healthcare data management, patient privacy, and medical
research. While business and economics and social sciences, arts, and humanities had
relatively fewer articles, with 14 and 12 publications, respectively, this may indicate a
growing interest in investigating the economic and societal implications of blockchain
Blockchains 2023, 1, FOR PEER REVIEW 8
Blockchains 2023, 1 80

there is a great deal of interest in improving the traceability of pharmaceutical products

implementation in healthcare, including cost-effectiveness, patient empowerment, and
and ensuring the authenticity of medical equipment and materials.
ethical considerations.

Figure
Figure 4. Topic
4. Topic distribution
distribution for blockchain
for blockchain applications
applications in theinmedical
the medical industry.
industry

The healthcare industry is being revolutionized by blockchain technology, which offers

In the context of life sciences and healthcare-specific disciplines, the quantity of arti-
a variety of prospective applications. The expedient sharing and management of healthcare
cles indicates a growing interest, albeit at a lower level than in other disciplines. 22 articles
data is a primary focus. The immutable and transparent ledger system of blockchain has
were devoted to biology and life sciences, 16 to public health and healthcare, and 15 to
enabled the development of platforms that facilitate secure and seamless data sharing
medicine and pharmacology. This indicates that researchers in these disciplines recognize
among healthcare providers. Whether it’s enhancing the transmission of DNA sequencing
blockchain’s potential to enhance healthcare data management, patient privacy, and med-
data, expediting the administration of electronic health records, or ensuring the integrity of
ical research. While business and economics and social sciences, arts, and humanities had
drug supply chains within smart hospitals, blockchain solutions are improving the security
relatively fewer articles, with 14 and 12 publications, respectively, this may indicate a
and accessibility of medical information.
growing interest in investigating the economic and societal implications of blockchain im-
Privacy and security are of the utmost importance in healthcare, and blockchain
plementation
is up to inthehealthcare,
task. Thisincluding cost-effectiveness,
theme examines innovativepatient empowerment,
approaches and ethi-
to protecting sensitive
cal considerations.
patient information. From privacy-preserving techniques and encryption techniques to
The healthcare industry
comprehensive is beingframeworks,
access control revolutionized by blockchain
blockchain technology,
provides which of- for
a solid foundation
fers athe
variety of prospective applications. The expedient sharing and
development of secure healthcare systems. These developments foster a more reliable management of
healthcare data isenvironment
and secure a primary focus. The immutable
for medical and transparent
data management ledger system
by nurturing of block-
trust and ensuring
chaincompliance
has enabled the development
with stringent regulations.of platforms that facilitate secure and seamless data
sharing among healthcare of
The combination providers. Whether it’sand
artificial intelligence enhancing
blockchainthe represents
transmission a newof DNA
frontier in
sequencing data, expediting the administration of electronic health records, or
the innovation of healthcare. This category explores the relationship between artificial intelli- ensuring
the integrity of drug supply
gence algorithms chains within
and blockchain smartwith
technology, hospitals, blockchain
applications spanning solutions are im- diag-
from medical
proving the
nosis security
and digitaland accessibility
twinning of medical
to IoT device information.
authentication. By combining the analytical power
Privacy andintelligence
of artificial security are of the
with the utmost importance
data integrity in healthcare,
and transparency of and blockchain
blockchain, is
healthcare
up tosystems
the task.are
This theme examines
becoming innovative
more intelligent and approaches to protecting
capable, facilitating informedsensitive patient
decision-making
information. From privacy-preserving
and enhancing patient care. techniques and encryption techniques to compre-
hensive access control frameworks, blockchain provides a solid foundation for the devel-
opment5. Discussion
of secure healthcare systems. These developments foster a more reliable and se-
cure environment for medical of
The implementation data management
blockchain by nurturing
technology trust and
in healthcare ensuringfrom
is examined compli-
a variety
ance of
with stringent
angles in thisregulations.
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Blockchains 2023, 1 81

health information, artificial intelligence (AI), and blockchain are covered. By ensuring
data integrity, enhancing patient privacy, enabling secure and decentralized health records
management, and facilitating creative responses to healthcare concerns, these articles
demonstrate how blockchain technology has the potential to change healthcare.

5.1. Blockchain Applications in Medical Informatics and Healthcare

A promising answer in several areas of medical informatics and healthcare has
emerged: blockchain technology. Studies by Lee et al. [47] and Hölbl et al. [48] shed
light on the potential uses and difficulties of putting blockchain into use in the healthcare
sector. While the latter provides a thorough overview of current blockchain use cases in
healthcare, highlighting the influence on data management and patient privacy, the former
examines how blockchain may rapidly and securely transport DNA sequencing data.
Additionally, studies by Shen et al. [49] and Yang et al. [50] offer creative approaches
to safe and cooperative data exchange among healthcare professionals. MedChain makes
use of the decentralized nature of blockchain to speed up data access, while proof-of-
familiarity introduces a privacy-preserving system to aid in reliable medical judgment.
Studies by Khatoon [23] and Capece and Lorenzi [51] also look into the use of smart
contracts and blockchain-based EHR platforms to enhance patient data accessibility and
healthcare management.
Additional studies, such as the study by Ejaz et al. [52] and Park et al. [53] concen-
trate on improving healthcare service delivery and data security. The former uses proxy
re-encryption for secure data sharing among numerous healthcare providers, while the
latter connects blockchain with edge computing to create low-latency healthcare apps.
Ali et al. [54] and Lee et al. [55] also address data privacy and regulatory compliance by
integrating secure access frameworks and chaotic maps in blockchain transactions.

5.2. Blockchain and IoT in Healthcare

The integration of blockchain and IoT in healthcare is the subject of several research
studies, demonstrating the disruptive potential of this pairing. For instance, Jo et al. [56]
suggest a hybrid blockchain and IoT network to track the condition of underground
structures in healthcare facilities while assuring data security and real-time structural
health monitoring. Dwivedi et al. [57] focus on developing a decentralized and privacy-
preserving healthcare blockchain that is especially suited for IoT applications, enabling
secure communication and data sharing while maintaining patient confidentiality. A study
by Fernández-Caramés et al. [58] also looks into the fusion of blockchain, IoT, and fog
computing to create a continuous glucose monitoring system for diabetes patients that
enables real-time data insights and patient engagement.
Access control approaches and techniques are suggested in several research articles
for protecting healthcare data within the IoT environment. For instance, the paper by
Figueroa et al. [59] proposes an attribute-based access control model for healthcare en-
vironments using blockchain and IoT technology, ensuring data security and controlled
access based on predefined attributes. For secure communication in medical cyber-physical
systems, Shu et al. [60] suggest an effective certificateless aggregate signature scheme
for blockchain-based medical cyber-physical systems. Additionally, Satamraju and B [61]
present a proof-of-concept demonstrating the efficient integration of IoT devices with
blockchain technology in healthcare, focusing on scalability and data integrity.
The possibility of blockchain-enabled healthcare workflows within federated hospital
IoT clouds is explored in several research studies. As an illustration, Celesti et al. [62]
suggest a blockchain-based healthcare workflow to enable effective and secure data sharing
among medical laboratories in federated hospital IoT clouds, benefiting telemedicine and
patient care. Furthermore, Bai et al. [63] present a healthcare identity system based on
Fabric blockchain and zero-knowledge proofs, ensuring secure and private interactions
within the IoT-based healthcare ecosystem. Additionally, Rana et al. [64] focus on devel-
oping a decentralized access control model using blockchain and AI to guarantee secure
Blockchains 2023, 1 82

interoperability of healthcare systems within the IoT infrastructure, facilitating seamless

data exchange while enforcing stringent access control policies.
Several studies propose blockchain-based trust mechanisms to overcome security
issues in IoT-based healthcare systems. For instance, Ali et al. [65] describe a blockchain-
based trust mechanism that uses fuzzy logic to identify Sybil attacks and improve the
reliability of IoT devices and data. The article by Kerrison et al. [66] also examines the
application of blockchain and IoT in rural healthcare settings, utilizing hybrid-channel
communication with digital twinning to enhance healthcare services and data exchange in
remote areas. Additionally, Albakri and Alqahtani [67] present a smart healthcare system
combining IoT, blockchain, metaheuristics, and deep learning models to improve patient
monitoring, diagnosis, and treatment while also optimizing resource allocation.
The possibilities of blockchain-enabled federated learning in healthcare and its effect
on at-home health monitoring are also shown in study studies. To ensure privacy-preserving
data analysis and training models, Farooq et al. [68] studied federated learning in the
context of in-home health monitoring. This empowers patients to take an active role in their
treatment. In addition, Ali et al. [69] explore how these three technologies are combined in
healthcare to promote immersive experiences, open AI-driven decision-making, and secure
patient data management. These research articles demonstrate how combining blockchain
with IoT has the potential to transform healthcare delivery by guaranteeing data security,
interoperability, and scalability and improving patient outcomes.

5.3. Privacy and Security in Healthcare Blockchain Systems

The use of blockchain technology in healthcare in recent years has highlighted the
importance of privacy and security while handling sensitive patient data. Many books
on the topic provide insight into various methods and frameworks for guaranteeing data
security, privacy, and exchange. The idea of healthcare blockchain systems with privacy
protection is one approach being looked at. Studies by Ali et al. [69] and Hu et al. [70]
highlight how important it is to protect patient privacy through effective and secure data-
sharing mechanisms. These simplified methods that rely on encryption try to balance data
security and accessibility.
The papers emphasize the importance of creating secure blockchain-based healthcare
systems, which are of similar importance. The papers Butt et al. [71] and Ali et al. [54]
highlight the use of blockchain technology to create a secure platform that cannot be
tampered with or compromised for the exchange of medical records. The need for thorough
security measures in managing healthcare data and protecting against cyber threats is also
highlighted by articles by Farahat et al. [72] and Islam et al. [73].
The COVID-19 epidemic has highlighted the value of blockchain in healthcare even
more. Blockchain technology can address healthcare issues during a worldwide crisis, as
evidenced by articles like by Fusco et al. [74] and Egala et al. [75]. Although these papers
might not specifically mention security or privacy, the use of blockchain in pandemic
management suggests a greater emphasis on data security and reliability. Another field
of research involves the application of blockchain to cutting-edge technologies like deep
learning and the internet of medical things (IoMT). In smart healthcare applications incor-
porating IoMT, studies by Albakri and Alqahtani [67] imply the usage of blockchain to
improve security. These headings highlight how healthcare systems are always changing as
cutting-edge technology combines to produce more reliable and secure solutions. Table 2
summarizes key findings and contributions from each paper related to the implementation
of blockchain solutions in healthcare.
Blockchains 2023, 1 83

Table 2. Analysis of papers on efficiency in healthcare blockchain systems.

Platform Efficiency for Health Management Key Findings/Contributions Study

Permissioned Enhanced data integrity Proposed an integrity model for secure [76]
eHealth data.
Protected data sharing Implemented lightweight message sharing [77]
for privacy.
Decentralized Controlled access to records Developed an access control scheme for [78]
secure sharing.
Improved record sharing Proposed a mechanism for the secure sharing [71]
of records.
Strengthened data security Introduced a secure blockchain model [72]
for healthcare.
Enhanced emergency data access Created a framework for secret data sharing [79]
in emergencies.
Secured data transmission Ensured secure transmission of electronic [80]
health records.
Trustworthy healthcare system Developed a trustworthy system for [73]
healthcare management.
Improved access to EHRs Introduced a secure framework for [54]
accessing EHRs.
Symmetric Privacy-preserving data sharing Implemented a privacy-preserving [70]
data-sharing system.
Hybrid-Channel Enhanced rural healthcare Enabled hybrid-channel communication for [66]
rural healthcare.
Metaheuristics Efficient healthcare systems Utilized metaheuristics for efficient [67]
healthcare systems.
Patient-Centric Patient-centric healthcare Proposed key requirements for [81]
patient-centric healthcare.
Enhanced healthcare assistance Developed a secure smart healthcare [75]
assisting system.
Efficient contact tracing Implemented blockchain-based health [82]
passports and contact tracing.
Streamlined asthma healthcare Designed a consortium framework for [83]
asthma healthcare.

5.4. Blockchain and the Management of Medical Data

The creation of a cutting-edge EMR integrity management system based on a spe-
cific blockchain platform within hospitals is one such possibility. This strategy improves
confidence and data dependability by ensuring the security and authenticity of Electronic
Medical Records (EMRs) [84]. For collaborative healthcare, effective data sharing is essen-
tial, and MedChain provides a solution by utilizing blockchain to make data exchange
simple and secure [49]. Furthermore, as illustrated by a cutting-edge medical blockchain
model, blockchain is essential in addressing drug supply chain integrity within smart
hospitals. To improve patient safety and regulatory compliance, this concept establishes
transparency and traceability in drug-related information [85]. Smart contracts are estab-
lished using a blockchain-based system that automates predefined rules and agreements
among multiple stakeholders to optimize healthcare management [23].
A secure end-to-end data security approach for exchanging personal health records is
made possible by the combination of completely homomorphic encryption with blockchain,
protecting sensitive data while encouraging data collaboration [86]. To improve data secu-
rity and secrecy, proxy re-encryption is also investigated in a safe outsourced blockchain-
based medical data exchange system [53]. A blockchain-based method for preserving
healthcare data that complies with HIPAA laws uses extended chaotic maps to meet
privacy and security standards [55].
Blockchains 2023, 1 84

Dual-channel blockchain architecture based on Hyperledger Fabric is suggested for

electronic health record (EHR) administration to scale up medical data management while
guaranteeing effectiveness and security [87]. Access control and privacy are elevated even
higher in blockchain-based systems with biometric authentication [87]. These security
measures are essential for maintaining the accuracy and privacy of medical data across the
whole blockchain-based healthcare ecosystem.
Finally, blockchain technology is combined with Cyber Safeguard safeguards to create
a decentralized, reliable healthcare administration system. In the era of Industry 4.0, this
integration strengthens the system against future cyber threats [73]. To promote interoper-
ability, share EHRs among healthcare providers, and improve patient care, HealthBlock
offers a collaborative platform [88]. A lightweight blockchain system leveraging practi-
cal Byzantine fault tolerance (PBFT) consensus is developed in the pursuit of a safe and
effective healthcare application [89].

5.5. Blockchain and AI in Healthcare

Blockchain and AI are two game-changing technologies that have the potential to
completely disrupt the healthcare sector. The incorporation of these technologies to address
diverse difficulties in healthcare systems is explored in several research articles. The first
group of articles focuses on the integration of blockchain with artificial neural networks
(ANN) to improve the management and analysis of individual health records [90]. This
research seeks to protect the integrity and privacy of private medical data by fusing
the pattern recognition abilities of AI with the data security and transparency offered
by blockchain.
The idea of metaverse technology, which builds immersive virtual environments and
integrates AI and blockchain for medical diagnosis and treatment, is covered in a different
set of articles [69,91]. This strategy can enhance patient care, give healthcare workers
reliable and precise insights, and guarantee data security thanks to blockchain’s immutable
ledger. Additionally, researchers investigate the use of blockchain and federated learning
to offer in-home health monitoring [68]. The analysis of dispersed healthcare data sources
is made possible by this combination, which guarantees that AI models may develop and
evolve without compromising data privacy.
These papers also provide insight into how decentralized data management and access
control enabled by blockchain might improve outdated healthcare systems [92]. Trans-
parency and security offered by blockchains improve interoperability between healthcare
stakeholders, empowering patients and enabling effective care delivery. Large amounts
of dispersed healthcare data can be examined with the help of AI integration, producing
insightful findings and individualized care.
Despite the tremendous potential of combining blockchain and AI in healthcare,
difficulties still exist. It is important to address scalability, legal compliance, and seamless
system interaction [93]. Nevertheless, current studies and innovations in this area show
an increased interest in using these technologies to improve patient care, diagnosis, and
management of healthcare data.

5.6. Blockchain and Health Supply Chain Management

Healthcare supply chain management has been transformed by blockchain technology,
which addresses a variety of issues faced by the sector. One noteworthy contribution is a
revolutionary medical blockchain model designed exclusively for managing the integrity
of the drug supply chain in a smart hospital setting [85]. By assuring the secure recording
and tracking of pharmaceutical items throughout their lifecycle, this method increases
traceability and authenticity, lowers the risk of counterfeit pharmaceuticals, and improves
patient safety.
Another study evaluates the value of blockchain technology in supply chains for lux-
ury goods, food, and healthcare from a broader viewpoint [94]. This analysis demonstrates
how blockchain technology has the potential to improve authenticity, traceability, and
Blockchains 2023, 1 85

transparency in healthcare supply chains, giving stakeholders the information they need to
decide whether to implement it and what kind of return on investment to expect. Addition-
ally, a distributed information hiding system built on a blockchain solves the crucial issue
of data privacy in medical supply chains [95]. Sensitive medical data is protected by using
smart contracts and advanced cryptography techniques, which enable authorized parties
to access some information while preventing unauthorized access.
Healthcare-Chain is a comprehensive solution that combines blockchain technology
with Industry 4.0 technologies like IoT devices, AI, and cybersecurity measures to build
a decentralized and reliable system for managing the healthcare supply chain [73]. The
efficiency of the supply chain is increased because of the smooth data gathering and
analysis made possible by this integrated method, which also guarantees data validity,
integrity, and safe data exchange across stakeholders. These research papers collectively
contribute to improving the reliability, security, and effectiveness of healthcare supply
chains by incorporating blockchain’s transparency, data immutability, and privacy features.
In turn, this benefits patients, healthcare providers, and other stakeholders involved in the
management of medical products and data.

5.7. Challenges
The potential of blockchain technology to improve data management, privacy, and
security has attracted considerable attention in the healthcare sector. However, there are
several obstacles to its acceptance. The diversity of healthcare data is one of the main
obstacles [48,62]. Electronic health records and medical photographs are just two examples
of the sources of structured and unstructured healthcare data, which calls for a standardized
approach for effective integration and storage on the blockchain. Another significant
challenge is the protection of patient privacy and data security, as highlighted in studies
by Yang et al. [50] and Fu et al. [77]. While immutability and openness are guaranteed
by blockchain, it needs to also ensure that private, sensitive health information is only
accessible to those who are allowed to view it. Additionally, it is important to ensure
interoperability between various healthcare systems and devices, as discussed in studies
by Figueroa et al. [59] and Kerrison et al. [66]. Robust interoperability solutions are needed
for seamless data sharing and communication between the various healthcare providers
and systems.
Another key problem is scalability, as demonstrated by Ngabo et al. [96] and Islam et al. [73].
The blockchain network needs to be able to accommodate increasing transaction rates with-
out affecting performance as the number of healthcare data grows. The highly regulated
healthcare sector further emphasizes the importance of regulatory compliance in studies by
Jamil [85] and Fusco et al. [74]. For blockchain deployments to be compliant with stringent
data protection laws like HIPAA and GDPR, careful design and compliance mechanisms
are needed.
According to the studies by Sonkamble et al. [80] and Ismail and Materwala [97]
integrating blockchain technology with the current healthcare infrastructure is a difficult
task. Since many healthcare facilities currently have legacy systems in place, meticulous
preparation is necessary to ensure seamless transfer and backward compatibility. Addition-
ally, as discussed in studies by Jo et al. [56] and Ahmed et al. [98] addressing the energy
consumption concerns of blockchain technology, particularly proof-of-work consensus, is
crucial. Healthcare firms need to consider green and energy-efficient blockchain solutions.

6. Conclusions and Future Directions

The key characteristics, potential advantages, and applications of blockchain technol-
ogy in the healthcare sector have been highlighted during the past five years through a
critical review of its development and difficulties. Blockchain holds promise for changing
healthcare by enabling safe data management, interoperability, and patient-centric treat-
ment thanks to its decentralized, unchangeable, and transparent nature. The system has
a wide range of possible uses, including improving supply chain management, avoiding
Blockchains 2023, 1 86

fraud, and managing clinical trials and medical data. The assessment of increased efficacy
and efficiency has demonstrated appreciable advancement, showing improved data protec-
tion, streamlined procedures, and possible cost savings in healthcare operations. To fully
realize the potential of blockchain, however, issues including interoperability, regulatory
issues, scalability, and standards must be resolved. Collaboration between healthcare pro-
fessionals, policymakers, technologists, and patients is necessary for successful integration.
Blockchain technology has the potential to lead to a revolutionary change in healthcare,
ushering in a period of enhanced data security, interoperability, and ultimately better
patient care.
While the review has provided valuable insights into blockchain’s current and prospec-
tive impact on healthcare, broader research directions are required to completely compre-
hend the technology’s adaptability. Exploration of how blockchain can intersect with
emergent disciplines such as AI and machine learning to enable secure data exchange
and transparent AI algorithm validation is needed in the future. In addition, investigating
causal inference in healthcare data, blockchain’s applications in unique environments such
as underwater IoT, and its potential in the aerospace, airspace, and finance industries can
yield insightful information. Future research can demonstrate the multifaceted nature of
blockchain technology by incorporating these diverse domains, thereby fostering collabora-
tion among stakeholders and resulting in transformative changes not only in the healthcare
sector but also in other industries.

Funding: This research received no external funding.

Data Availability Statement: Not applicable.
Conflicts of Interest: The author declares no conflict of interest.

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