Blockchain Technology Applications for Improving Quality of Electronic Healthcare System

Improving the efficiency and sustainability of Canada’s healthcare system is currently being prioritized by the federal government. In order to achieve this, government and non-government stakeholder collaboration will be required to improve integration, universality, and equity for all populations throughout the country. Although technological innovations pose certain risks, investing in health technologies plays a major role in improving service delivery and cost-saving within healthcare. Canada has historically had a relatively low use of electronic medical records (EMR’s) in comparison to other high-income countries - which appears to be partially due to inefficiencies within the fragmented systems throughout Canada. Improving the current EMR infrastructure has the potential to save our country substantial amounts of money, improve information transfer for patients and practitioners, and enhance the overall quality of medical care Canadian citizens receive. There has been mention of developing a national EMR strategy by various organizations, including the Canadian Medical Association. Blockchain technology appears to have many desired characteristics for developing a comprehensive national EMR strategy to support the needs of our universal healthcare system. This is due to the fact that it is a secure platform to store huge amounts of information and make data transfers between a diverse group of stakeholders. It is believed that blockchain can provide a unique framework upon which a national data system can be built.

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Big data in the healthcare system: a synergy with artificial intelligence and blockchain technology

Journal of Integrative Bioinformatics ◽

10.1515/jib-2020-0035 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Reyes-González Juan Pablo ◽

Díaz-Peregrino Roberto ◽

Soto-Ulloa Victor ◽

Galvan-Remigio Isabel ◽

Castillo Paul ◽

...

Keyword(s):

Artificial Intelligence ◽

Big Data ◽

Healthcare System ◽

Medical Doctors ◽

Blockchain Technology ◽

System A ◽

Healthcare Professions ◽

State Of Art ◽

Digital Anatomy

Abstract In the last decades big data has facilitating and improving our daily duties in the medical research and clinical fields; the strategy to get to this point is understanding how to organize and analyze the data in order to accomplish the final goal that is improving healthcare system, in terms of cost and benefits, quality of life and outcome patient. The main objective of this review is to illustrate the state-of-art of big data in healthcare, its features and architecture. We also would like to demonstrate the different application and principal mechanisms of big data in the latest technologies known as blockchain and artificial intelligence, recognizing their benefits and limitations. Perhaps, medical education and digital anatomy are unexplored fields that might be profitable to investigate as we are proposing. The healthcare system can be revolutionized using these different technologies. Thus, we are explaining the basis of these systems focused to the medical arena in order to encourage medical doctors, nurses, biotechnologies and other healthcare professions to be involved and create a more efficient and efficacy system.

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MedShard: Electronic Health Record Sharing Using Blockchain Sharding

Sustainability ◽

10.3390/su13115889 ◽

2021 ◽

Vol 13 (11) ◽

pp. 5889

Author(s):

Faiza Hashim ◽

Khaled Shuaib ◽

Farag Sallabi

Keyword(s):

Healthcare System ◽

Small Groups ◽

Network Performance ◽

Communication Overhead ◽

Privacy And Security ◽

Health Records ◽

Medical Practitioners ◽

Blockchain Technology ◽

Simulation Results ◽

Electronic Health

Electronic health records (EHRs) are important assets of the healthcare system and should be shared among medical practitioners to improve the accuracy and efficiency of diagnosis. Blockchain technology has been investigated and adopted in healthcare as a solution for EHR sharing while preserving privacy and security. Blockchain can revolutionize the healthcare system by providing a decentralized, distributed, immutable, and secure architecture. However, scalability has always been a bottleneck in blockchain networks due to the consensus mechanism and ledger replication to all network participants. Sharding helps address this issue by artificially partitioning the network into small groups termed shards and processing transactions parallelly while running consensus within each shard with a subset of blockchain nodes. Although this technique helps resolve issues related to scalability, cross-shard communication overhead can degrade network performance. This study proposes a transaction-based sharding technique wherein shards are formed on the basis of a patient’s previously visited health entities. Simulation results show that the proposed technique outperforms standard-based healthcare blockchain techniques in terms of the number of appointments processed, consensus latency, and throughput. The proposed technique eliminates cross-shard communication by forming complete shards based on “the need to participate” nodes per patient.

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Clinical, behavioural and social factors associated with racial disparities in COVID-19 patients from an integrated healthcare system in Georgia: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-044052 ◽

2021 ◽

Vol 11 (5) ◽

pp. e044052

Author(s):

Felipe Lobelo ◽

Alan Bienvenida ◽

Serena Leung ◽

Armand Mbanya ◽

Elizabeth Leslie ◽

...

Keyword(s):

Quality Of Care ◽

Racial Disparities ◽

Clinical Outcomes ◽

Healthcare System ◽

Retrospective Cohort ◽

Chronic Obstructive ◽

Integrated Healthcare ◽

Icu Admission ◽

Hospitalised Patients

ObjectivesTo identify sociodemographic, clinical and behavioural drivers of racial disparities and their association with clinical outcomes among Kaiser Permanente Georgia (KPGA) members with COVID-19.DesignRetrospective cohort of patients with COVID-19 seen from 3 March to 29 October 2020. We described the distribution of underlying comorbidities, quality of care metrics, demographic and social determinants of health (SDOH) indicators across race groups. We also described clinical outcomes in hospitalised patients including length of stay, intensive care unit (ICU) admission, readmission and mortality. We performed multivariable analyses for hospitalisation risk among all patients with COVID-19 and stratifyied by race and sex.SettingKPGA, an integrated healthcare system.Participants5712 patients who all had laboratory-confirmed COVID-19. Of them, 57.8% were female, 58.4% black, 29.5% white, 8.5% Hispanic and 3.6% Asian.ResultsBlack patients had the highest proportions of living in neighborhoods under the federal poverty line (12.4%) and in more deprived locations (neighbourhood deprivation index=0.4). Overall, 14.4% (n=827) of this cohort was hospitalised. Asian patients had the highest rates of ICU admission (53.1%) and mechanical ventilation (21.9%). Among all patients, Hispanics (adjusted 1.60, 95% CI (1.08, 2.37)), blacks (1.43 (1.13, 1.83)), age in years (1.03 (1.02, 1.04)) and living in a zip code with high unemployment (1.08 (1.03, 1.13)) were associated with higher odds of hospitalisation. COVID-19 patients with chronic obstructive pulmonary disease (2.59 (1.67, 4.02)), chronic heart failure (1.79 (1.31, 2.45)), immunocompromised (1.77 (1.16, 2.70)), with glycated haemoglobin >8% (1.68 (1.19, 2.38)), depression (1.60 (1.24, 2.06)), hypertension (1.5 (1.21, 1.87)) and physical inactivity (1.25 (1.03, 1.51)) had higher odds of hospitalisation.ConclusionsBlack and Hispanic KPGA patients were at higher odds of hospitalisation, but not mortality, compared with other race groups. Beyond previously reported sociodemographics and comorbidities, factors such as quality of care, lifestyle behaviours and SDOH indicators should be considered when designing and implementing interventions to reduce COVID-19 racial disparities.

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The impact of sex, gender and healthcare system on quality of care among young adults with acute myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.3175 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

V Raparelli ◽

L Pilote ◽

H Behlouli ◽

J Dziura ◽

H Bueno ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Young Adults ◽

Quality Of Care ◽

Healthcare System ◽

Quality Indicators ◽

Funding Source ◽

Post Discharge ◽

Single Payer

Abstract Background The quality of care among young adults with acute myocardial infarction (AMI) may be related to biological sex, psycho-socio-cultural (gender) determinants or healthcare system-level factors. Purpose To examine whether sex, gender, and the type of healthcare system influence the quality of AMI care among young adults. Methods A total of 4,564 AMI young adults (<55 years) (59% women, 47 years, 66% US) were analyzed from the VIRGO and GENESIS-PRAXY studies consisting of single-payer (Canada, Spain) versus multipayer (US) systems. For each patient treated in each system we calculated a quality of care score (QCS) for pre-AMI (1-year pre admission), in-hospital, and post-AMI (1-year post discharge) phases of care (number of quality indicators received divided by the total number [range=0–100%], with higher scores indicating better quality). Ordinal logistic or linear regression models, and 2-way interactions between sex, gender and healthcare system were tested. Results Women in the multipayer system had the highest risk factor burden. Across the phases of care for AMI, 20% of quality indicators were missed in both sexes. High stress, earner status, and social support were associated with a higher QCS in the pre-AMI phase, whereas only employment and earner status were associated with QCS in all other phases. In the pre-AMI phase, women had higher QCS than men, mainly in the single-payer system (adjusted-OR=1.85, 95% CI 1.46,2.35 vs. 1.07, 95% CI 0.84,1.36, P-interaction= 0.002). Regardless of sex, only employment status had a greater effect in the multipayer system (adjusted-OR=0.59, 95% CI 0.44,0.78 vs 1.13, 95% CI 0.89,1.44, P-interaction <0.001). In the in-hospital phase, women had a lower QCS than men, especially in the multipayer system (adjusted-mean-difference: −2.48, 95% CI-3.87, −1.08). Employment was associated with a higher QCS (2.0, 95% CI 0.9–3.17, P-interaction >0.05). Finally, in the post-AMI phase, men and women had a lower QCS, predominantly in the multipayer system. However, primary earners had higher QCS regardless of system. Conclusion Sex, gender, and healthcare system affected the quality of care after AMI. Women had a poorer in-hospital than men and both women and men had suboptimal post-discharge care. Being unemployed lowered the quality of care, more so in the multipayer system. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health and Research (CIHR)

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Quality of care for people with multimorbidity: a focus group study with patients and their relatives

BMJ Open ◽

10.1136/bmjopen-2020-047025 ◽

2021 ◽

Vol 11 (6) ◽

pp. e047025

Author(s):

Nadine Janis Pohontsch ◽

Josefine Schulze ◽

Charlotte Hoeflich ◽

Katharina Glassen ◽

Amanda Breckner ◽

...

Keyword(s):

Quality Of Care ◽

Focus Groups ◽

Healthcare System ◽

Qualitative Content Analysis ◽

Coordinated Care ◽

Treatment Standards ◽

Focus Group Study ◽

Treatment Regimens ◽

Quality Aspects

BackgroundPrevalence of people with multimorbidity rises. Multimorbidity constitutes a challenge to the healthcare system, and treatment of patients with multimorbidity is prone to high-quality variations. Currently, no set of quality indicators (QIs) exists to assess quality of care, let alone incorporating the patient perspective. We therefore aim to identify aspects of quality of care relevant to the patients’ perspective and match them to a literature-based set of QIs.MethodsWe conducted eight focus groups with patients with multimorbidity and three focus groups with patients’ relatives using a semistructured guide. Data were analysed using Kuckartz’s qualitative content analysis. We derived deductive categories from the literature, added inductive categories (new quality aspects) and translated them into QI.ResultsWe created four new QIs based on the quality aspects relevant to patients/relatives. Two QIs (patient education/self-management, regular updates of medication plans) were consented by an expert panel, while two others were not (periodical check-ups, general practitioner-coordinated care). Half of the literature-based QIs, for example, assessment of biopsychosocial support needs, were supported by participants’ accounts, while more technical domains regarding assessment and treatment regimens were not addressed in the focus groups.ConclusionWe show that focus groups with patients and relatives adding relevant aspects in QI development should be incorporated by default in QI development processes and constitute a reasonable addition to traditional QI development. Our QI set constitutes a framework for assessing the quality of care in the German healthcare system. It will facilitate implementation of treatment standards and increase the use of existing guidelines, hereby helping to reduce overuse, underuse and misuse of healthcare resources in the treatment of patients with multimorbidity.Trial registration numberGerman clinical trials registry (DRKS00015718), Pre-Results.

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Need to Intervene: An Exploratory Study of Nurses’ Experiences With Patienthood

Journal of Patient Experience ◽

10.1177/2374373521998846 ◽

2021 ◽

Vol 8 ◽

pp. 237437352199884

Author(s):

Marian A O Cohen ◽

Jim McQuaid ◽

Ruth Remington

Keyword(s):

Patient Satisfaction ◽

Quality Of Care ◽

Healthcare System ◽

Family Caregiver ◽

Exploratory Study ◽

Medical Personnel ◽

Healthcare Personnel ◽

Coordination Of Care ◽

Professional Perspective

Much has been written about the patient experience, but there is little information about experiences of providers as patients. Since lay patients and providers have differing perspectives and expectations, it is important to identify those elements shared by those in each group and those that diverge. This study identified experiences of nurses as being a patient or a family caregiver of a patient as well as identified assessments of the healthcare system by nurses. An exploratory study using a self-administered electronic questionnaire with a group of registered nurses was conducted. Assessments of the system by responders were positive when addressing quality of care, interactions among healthcare personnel, and interactions with patients. However, when discussing their experiences as patient, nurses reported they encountered problems with coordination of care, responses of medical personnel, attention to details of care, and responses to their attempts to become more involved. Results confirm issues raised by patients who are not medical experts in patient satisfaction studies. Adding a professional perspective highlights where problems with the healthcare system lie.

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Blockchain technology applications for Industry 4.0: A literature-based review

Blockchain: Research and Applications ◽

10.1016/j.bcra.2021.100027 ◽

2021 ◽

pp. 100027

Author(s):

Mohd Javaid ◽

Abid Haleem ◽

Ravi Pratap Singh ◽

Shahbaz Khan ◽

Rajiv Suman

Keyword(s):

Industry 4.0 ◽

Blockchain Technology ◽

Technology Applications

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Blockchain Encryption on Student Academic Transcripts using a Smart Contract

Journal of Educational Science and Technology (EST) ◽

10.26858/est.v0i0.19386 ◽

2021 ◽

Author(s):

Primasatria Edastama ◽

Ninda Lutfiani ◽

Qurotul Aini ◽

Suryari Purnama ◽

Isabella Yaumil Annisa

Keyword(s):

Data Storage ◽

Storage System ◽

Digital Data ◽

Decentralized System ◽

Blockchain Technology ◽

Educational Environments ◽

The World ◽

Technology Applications ◽

E Learning ◽

Data Storage System

As an innovation in the world of computers, blockchain has many benefits and is also widely applied in the world of education. Blockchain itself has many advantages, especially in the world of education. Blockchain is a digital data storage system that consists of many servers (multiserver). In this Blockchain technology, data created by one server can be replicated and verified by another server. By using this technology with a decentralized system and strong cryptography and can help colleges or universities to build infrastructure in the archive storage of transcripts, diplomas, and diplomas. Usage One of the blockchain technology applications in education is iBC, namely the e-learning Blockchain Certificate, book copyright, and also e-Portfolios. iBC or e-learning Blockchain Certificate is a tool designed to create, verify and also issue blockchain certificates. As has been supported by the IBC to create certificates that are globally verified and stored in a decentralized manner. Here will be presented use cases that are relevant in the use of Blockchain technology in educational environments, especially data processing in universities and we also try to design an IBC based on blockchain technology that can be used to support transparency and accountability of colleges or universities in issuing diplomas and grades.

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Who is a “Senior”? Looking for a definition in the healthcare system

Working with Older People ◽

10.1108/wwop-06-2021-0027 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Monica Consolandi

Keyword(s):

Quality Of Life ◽

Health Care ◽

Healthcare System ◽

Health Care System ◽

Design Methodology ◽

Social Role ◽

Content Type ◽

The Core ◽

Starting Point

Purpose Seniors are nowadays at the core of important reflections to understand both how to ensure them a proper quality of life and better recognize their social role, providing them services and proper health care to value them as persons and resources. This paper aims to find a through definition about who is a senior, in the author’s opinion the starting point to help them flourishing. Design/methodology/approach As an example of definitions, an online dictionary and two geriatric text-books are quoted, highlighting qualities and rights referred to seniors especially in the delicate context of the health-care system. Findings The lack of a commonly shared perspective on this delicate kind of patient entails the difficulty to reach a coherent and satisfying definition about who a senior is. Originality/value The lack of a commonly shared definition leads to inevitable misunderstandings and could explain the arduousness of considering seniors in all their aspects. Further investigations are suggested.

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