Informatics in Medicine Unlocked (Jan 2021)
A simulation-based AHP approach to analyze the scalability of EHR systems using blockchain technology in healthcare institutions
Abstract
Objective: Since their introduction, blockchain applications have been numerous and varied, allowing for the resolution of many issues previously considered insurmountable. In the field of health records management, the storing of electronic health records (EHRs) has been one of the topics of greatest interest to academics, though its implementation using blockchain technology has not been without flaws. Therefore, the objective of this research is to select the blockchain protocol that provides the best performance given the scalability issue in the implementation of a BT-based EHR system in a high-priority healthcare institution (HP–HI). Methods: To achieve this objective, a discrete-event simulation tool and the AHP technique are both combined, to model the selected blockchain protocols and to analyze the output data. Results: Ethereum protocol emerges as the platform with the best overall performance for the HP-HI under consideration. This result is based on a rigorous analysis of three blockchain protocols–Ethereum, Dogecoin and Bitcoin–and five criteria to evaluate the scalability in BT-based EHR systems: sent transactions, received transactions, failed transactions, nodes, and cost. This research is the first practical study to assess the implementation of BT-based EHR systems in the context of the Colombian health system. This research also integrates a general evaluation framework that can be replicated to other similar HCs. Conclusions: In light of the scalability problem studied, Ethereum protocol is consistently the most appropriate blockchain solution for the selected HP-HI. This result is in line with previous research on BT-based EHR systems. The problem-solving integrated approach discussed in this research can also be replicated to other similar HCs to improve their performance against pandemics such as COVID-19.
