RESEARCH PROPOSAL BLOCKCHAIN IN HEALTHCARE 1

Research Proposal: Blockchain in HIM

HIMP4430 – Fundamentals of Research

Challenges of Implementation of Blockchain in Canadian Healthcare system

Introduction

Blockchain technology has been revolutionary in terms of streamlining processes and costs in

every field of study. The success of Bitcoin (digital currency) is a prime example. Blockchain

can be explained in the simplest terms as a data structure or a chain of records, where

information/transactions is stored in blocks which is secure, transparent and decentralized.

Implementation of blockchain in healthcare is suggested to improve interoperability, facilitate

HIE and ensure privacy and security of PHI, all areas of study in health information

management. Blockchain implementation is becoming ever so important with the most recent

data breach of Lifelabs, which affected 15 million Canadians, which led to a class action lawsuit

being filed in Toronto for $1.14 billion. Advantages of its implementation in healthcare is

advocated by cybersecurity experts and relevant stakeholders addressing problems like data

security in clinical trials, and drug traceability preventing counterfeiting and duplicate orders of

drugs. Healthcare is highly underrepresented in terms of blockchain implementation/use cases in

Canada, only 0.3% (ICTC, 2019).

Objective

The Canadian publicly funded healthcare system- Medicare, is an intricately complex organism.

The huge volumes of patient data generated has led to slow/ineffective data exchanges between

stakeholders. This has led to a drop in health outcomes, in terms of affordability, value and time

taken to achieve the outcome. At present, patient information is stored on hospital or individual

databases. The sharing of records and knowledge distribution between physicians, payers and
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stakeholders is still a cumbersome process, due to issues like lack of standardized patient

records, operational errors, trust and security threats. In summary, there is a need to better

understand the constraints leading to successful implementation of blockchain in healthcare.

The goal of the research is to identify key constraints for underuse of blockchain in health

information management. The objective of the current study is to provide a conceptual

framework for identifying and resolving challenges for lack of blockchain implementation in the

Canadian healthcare system. The result of this study will be valuable to the industry stakeholders

to develop a framework for better practice and tools for blockchain implementation in health

information management.

Literature review

A preliminary literature review shows that past studies are primarily focused on blockchain

implementation in finance, fintech, and information and communications technology. Limited

progress has been made on identifying and classifying various constraints according to their

characteristics in a comprehensive manner, specifically for healthcare. What is missing from the

past studies is a comprehensive and structured approach in identifying constraints involving all

the stakeholders of the complex Canadian healthcare ecosystem.

Proposed Method

Aim of the research is to identify challenges to implementation of blockchain in health

information management in Canada. The primary method will be literature review and interviews

with industry leaders and government leaders. Literature reviews will focus on cases where

blockchain is implemented in healthcare in other countries. (E.g. Blockchain used by Estonian

government for patient data, pilot projects in USA, and other use cases of blockchain in

healthcare). Interviews with experts in blockchain technology, health information management

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(CHIM leaders), healthcare (physicians, clinical professionals), government authorities (health

authority officials, information governance, security and privacy officials). The goal of the

interviews is to identify challenges according to these industry leaders in relation to

implementation and to try and amalgamate a list of challenges that can be tackled by all the

stakeholders together. The study will last from March 2020 to December 2020. Experts will be

identified from various electronic channels (online publications, official websites, etc.) Emails

will be sent out to the experts of the fields of study mentioned above. Once they have consented

to the interview, they will be asked if they permit the use of their name and job title for

publishing of the study. If they do not consent, it will be respected and only general titles (e.g. an

industry leader) will be used in the publication. Appropriate gratitude packages will be presented

to the participants of the interviews. All interview transcripts will be verified with the

interviewee before publication along with the literature reviews. The research will be conducted

by a team of HIM professionals where every individual will be given specific task to perform,

e.g. identification of research articles for literature review, collect and assimilate information

from the existing literature for the research publication, contact interviewees for the interview

consent, schedule and process. Once the research has been completed, the intention is to publish

in a medical technology journal or through an organization that would fund the study. (E.g.

CHIMA).

Discussion

Blockchain implementation in Canadian healthcare has the potential to bring a paradigm shift in

health information management. Blockchain technology will deal with information governance,

privacy and security regulations along with other government compliance standards. It will also
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involve HIM expertise regarding data standardization; especially in EHRs, population health data

management, etc. along with medical, computer science and cybersecurity expertise.

Conclusion

Blockchain is viewed as a “one stop shop” for all problems related to medical data. That cannot

be said for sure, as enough research has not been done to validate the claim. While it has solved a

lot of similar issues highlighted earlier, in fields other than healthcare, it is unclear as to how

those advantages of blockchain fit in with challenges yet to be discovered/considered by all

relevant stakeholders. There have been many use cases of blockchain implementation in other

fields of study like finance and technology. Its use in healthcare has its skeptics, mainly because

of standardization issues, unclear compliance standards and acceptance issues by relevant

stakeholders. By conducting a thorough research involving all the stakeholders of the system, a

template can be made by this exercise so that challenges in blockchain implementation can be

identified and appropriate stakeholders can work on addressing the issues with the support of

stakeholders of the entire ecosystem. This will lead to a better structure for patient data which in

turn will cascade into a better system providing timely, efficient cost-effective value for care to

the Canadian population.

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References

Carpio, L. (2018, March 21). Blockchain in Healthcare: Complex Challenges, Overshadowed by

the Hype, Need to be Overcome. Retrieved from

https://www.dataart.com.ar/news/blockchain-in-healthcare-complex-challenges-

overshadowed-by-the-hype-need-to-be-overcome/

Dimitrov D. V. (2019). Blockchain Applications for Healthcare Data Management. Healthcare

informatics research, 25(1), 51–56. doi:10.4258/hir.2019.25.1.51

Hamoni, R; McLaughlin, R; and Rice, F (November 2019). Building Canadian Consensus: Our

Maturing Blockchain Ecosystem. Information and Communications Technology Council

(ICTC). Ottawa, Canada.

Ikeda, S. (2020, January 6). Lifelabs Data Breach, the Largest Ever in Canada, May Cost the

Company Over $1 Billion in Class-Action Lawsuit. Retrieved from

https://www.cpomagazine.com/cyber-security/lifelabs-data-breach-the-largest-ever-in-

canada-may-cost-the-company-over-1-billion-in-class-action-lawsuit/

Mire, S. (2019, July 17). What Are The Challenges To Blockchain Adoption In Healthcare? 10

Experts Share Their Insights. Retrieved from https://www.disruptordaily.com/blockchain-

adoption-challenges-healthcare/

Wolfond, G. 2017. A Blockchain Ecosystem for Digital Identity: Improving Service Delivery in

Canada's Public and Private Sectors. Technology Innovation Management Review, 7(10):

35–40. http://doi.org/10.22215/timreview/1112