SAĞLIK EKOSİSTEMİNDE BLOKZİNCİRİ TEKNOLOJİSİNİN ROLÜ VE ÖNEMİ

Yıl 2021, Cilt: 24 Sayı: 4, 903 - 920, 27.12.2021

Ceren Türkdoğan Görgün , Arzu Kurşun

Öz

Blokzinciri teknolojisi, aracı bir kuruluş olmadan iki veya daha fazla taraf arasındaki işlemlerin güvenli, şeffaf, değiştirilemez bir şekilde doğrulanması, gerçekleştirilmesi ve depolanmasını sağlayan dağıtık bir defter teknolojisidir. Akıllı sözleşmelerin (smart contracts) gelişimi ile taraflar arasındaki yasal sözleşmelerin aracısız bir şekilde otomatik olarak doğrulanması ve işlerlik kazanması sağlanmış, blokzinciri teknolojisinin gıda, enerji, emlak, inşaat, otomotiv gibi pek çok sektörde kullanılır hale gelmesine yol açmıştır. Sağlık hizmetleri alanında ise blokzinciri teknolojisi sağlık ekosistemini temelden dönüştürme potansiyeli ile önem arz etmektedir. Bu çalışmada, blokzinciri teknolojisinin anlamı, yapısı, işleyişi, çeşitleri, kullanım alanları, akıllı kontratlar ve sağlık hizmetleri alanında blokzinciri teknolojisinin kullanım alanları güncel uygulama örnekleri eşliğinde paylaşılmıştır. Blokzinciri teknolojisinin sağlık hizmetleri alanında kullanımından yola çıkarak oluşan kişisel sağlık verilerinin hastaların izni ile doktorlar, klinik araştırmalar ve hassas tıp çalışmaları ile güvenli paylaşımı, aracısız işlemler sonucu idari süreçlerin optimizasyonu ve maliyetlerde azalma, tedarik zinciri yönetiminde bilgi güvenilirliğinin artışı ve ürünlerin izlenebilirliği sonucu ürün sahteciliğinin önlenmesi gibi pek çok avantajı da ele alınmıştır. Yapısal bir derleme şeklinde kurgulanan bu çalışma, araştırma verileri için ulusal ve uluslararası literatürde “blokzinciri teknolojisi”, “akıllı kontratlar” ve “sağlık hizmetlerinde blokzinciri teknolojisi” ile ilgili çalışmalar taranarak meydana getirilmiştir.

Anahtar Kelimeler

blokzinciri teknolojisi, akıllı kontratlar, sağlık hizmetlerinde veri güvenliği, dağınık defter teknolojisi, şeffaflık

THE ROLE AND IMPORTANCE OF BLOCKCHAIN TECHNOLOGY IN THE HEALTH ECOSYSTEM

Öz

Blockchain technology is a distributed ledger technology that enables transactions between two or more parties to be verified, executed and stored in a secure, transparent, immutable manner without an intermediary organization. With the development of smart contracts, legal contracts between the parties have been automatically verified and operated without intermediaries, leading to the use of blockchain technology in many sectors such as food, energy, real estate, construction, and automotive. In the field of healthcare, blockchain technology draws attention with its potential to fundamentally transform the health ecosystem. In this study, the meaning, structure, functioning, types, usage areas of blockchain technology, smart contracts and usage areas of blockchain technology in the field of health services are shared with current application examples. Many advantages such as the secured sharing of personal health data with doctors, clinical researches and precision medicine with the patient permission, optimization of administrative processes and cost reduction as a result of intermediary transactions, and prevention of product counterfeiting as a result of increasing information security and traceability of products in supply chain management, based on the use of blockchain technology in the field of health services were also discussed. This article, which was designed as a structural review, was created by scanning studies on "blockchain technology", "smart contracts" and "blockchain technology in health services" in the national and international literature.

Anahtar Kelimeler

Blockchain technology, smart contracts, data security in healthcare, distributed ledger technology, transparency

Kaynakça

• Ahmad, R. W., Salah, K., Jayaraman, R., Yaqoob, I., Ellahham, S. & Omar, M. (2021). The role of blockchain technology in telehealth and telemedicine. International Journal of Medical Informatics, 148, 104399. doi:10.1016/j.ijmedinf.2021.104399
• Alkhaldi, N. (2020, Şubat 6). Blockchain in healthcare: Use cases for your practice. Itransition. https://www.itransition.com/blog/blockchain-in-healthcare
• Ande, R., Adebisi, B., Hammoudeh, M. & Saleem, J. (2019). Internet of things: Evolution and technologies from a security perspective. Sustainable Cities and Society, 54, 1-15.
• Angraal, S., Krumholz, H.M. & Schulz, W.L. (2017). Blockchain technology: Applications in health care. Circulation Cardiovascular Quality and Outcomes, 10(9), 1-3.
• Ante, L. (2021). Smart contracts on the blockchain - A bibliometric analysis and review. Telematics and Informatics, 57, 1-27.
• Benchoufi, M., Altman, D. & Ravaud, P. (2019). From clinical trials to highly trustable clinical trials: Blockchain in clinical trials, a game changer for improving transparency? Front. Blockchain, 2(23), 1-6.
• BIS Research (2018). Global blockchain in helthcare market. https://bisresearch.com/industry-report/global-blockchain-in-healthcare-market-2025.html.
• Buterin, V. (2013). Ethereum [White paper]. https://ethereum.org/en/whitepaper/
• Capece, G. & Lorenzi, F. (2020). Blockchain and healthcare: Opportunities and prospects for the EHR. Sustainability, 12, 9693.
• CB Insights (2021, Mart 3). Banking is only the beginning: 58 big industries blockchain could transform. https://www.cbinsights.com/research/industries-disrupted-blockchain/
• Chatterjee, K., Goharshady, A. & Velner, Y. (2018). Quantitative analysis of smart contracts. In Programming Languages and Systems, Amal Ahmed (Ed.) (pp. 739-767). Springer, Cham.
• Cong, L.W. & He, Z. (2019). Blockchain disruption and smart contracts. The Review of Financial Studies, 32 (5), 1754–1797,
• Corea, F. (2019). The convergence of AI and blockchain. In: Applied Artificial Intelligence: Where AI can be used in business (pp. 19-26). Springer, Cham.
• Duca, A.L., Bacciu, C. & Marchetti, A. (2017). How distributed ledgers can transform healthcare applications, Special Theme: Blockchain Engineering, Ercim News, 110, 25-26. https://eprints.sztaki.hu/9327/1/Bauer_42_3256036_ny.pdf#page=25
• Dagher, G. G., Mohler, J., Milojkovic, M., & Marella, P. B. (2018). Ancile: Privacy-preserving framework for access control and interoperability of electronic health records using blockchain technology. Sustainable Cities and Society, 39, 283–297.
• Dujak, D. & Sajter, D. (2019). Blockchain applications in supply chain. In SMART supply network (pp. 21-46). Springer, Cham.
• Engelhardt, M.A. (2017). Hitching healthcare to the chain: An introduction to blockchain technology in the healthcare sector. Technology Innovation Management Review, 7(10), 22–34.
• Farouk, A., Alahmadi, A., Ghose, S. & Mashatan, A. (2020). Blockchain platform for industrial healthcare: Vision and future opportunities. Computer Communications, 154, 223-235.
• Followmyvote. (2021). https://followmyvote.com/ Erişim Tarihi: 13.12.2021
• Gabison, G. (2016). Policy considerations for the blockchain technology public and private applications. SMU Sci. Tech. L. Rev., 19, 327. https://heinonline.org/HOL/LandingPage?handle=hein.journals/comlrtj19&div=19&id=&page=
• Greenspan, G. (2015). MultiChain private blockchain [White Paper]. http://www.multichain.com/download/MultiChain-White-Paper.pdf.
• Giordanengo A. (2019). Possible usages of smart contracts (blockchain) in healthcare and why no one is using them. Stud Health Technology and Information, 264, 596-600. doi: 10.3233/SHTI190292.
• Guardtime. (2021). https://guardtime.com/. Erişim Tarihi: 20.03.2021
• Healpoint.(2021). [White Paper], http://healpoint.io/ Erişim Tarihi: 13.12.2021
• Healthcare Business Review (Kasım, 2020). How will blockchain affect medical billing and coding?. https://www.healthcarebusinessreview.com/news/how-will-blockchain-affect-medical-billing-and-coding-nwid-17.html
• IBM (2016). Healthcare rallies for blockchain: Keeping patients at the center. https://www.ibm.com/downloads/cas/BBRQK3WY
• IBM BlockchainPulse (2019, Aralık 16). Protect pharmaceutical product integrity with the pharmaceutical utility network. https://www.ibm.com/blogs/blockchain/2019/12/protect-pharmaceutical-product-integrity-with-the-pharmaceutical-utility-network/.
• Ioannidis, J.P. (2005). Why most published research findings are false. PLoS Med. 2:e124.
• Jayaraman, R., AlHammadi, F. & Simsekler, M.C.E. (2018, Aralık 16-19). Managing product recalls in healthcare supply chain [Conference presentation]. IEEE International Conference on Industrial Engineering and Engineering Management (IEEM), Bangkok, Thailand, 293–297.
• Katuwal, G.J., Pandey, S., Hennessey, M. & Lamichhane, B. (2018). Applications of blockchain in healthcare: Current land scape & challenges, arXiv:1812.02776.
• Kazmi, H. S. Z., Nazeer, F., Mubarak, S., Hameed, S., Basharat, A. & Javaid, N. (2019, Kasım 7-9). Trusted remote patient monitoring using blockchain-based smart contracts [Conference presentation]. International Conference on Broadband and Wireless Computing, Communicationand Applications. Springer. 765–776.
• Khezr, S., Moniruzzaman, M., Yassine, A. & Benlamri, R. (2019). Blockchain technology in healthcare: A comprehensive review and directions for future research. Applied sciences, 9(9), 1736.
• Khatoon, A., Verma, P., Southernwood, J., Massey, B. & Corcoran, P. (2019). Blockchain in energy efficiency: Potential applications and benefits. Energies, 12, 3317.
• KISSPatent (2020). The current state of blockchain patents. https://kisspatent.com/blockchain-patents-study. Erişim Tarihi: 20.03.2021
• Krawiec, RJ., Housman, D., White, M., Filipova M. & Tsai, L. (2016). Blockchain: Opportunities for health care. Deloitte. https://www2.deloitte.com/content/dam/Deloitte/us/Documents/public-sector/us-blockchain-opportunities-for-health-care.pdf (Erişim Tarihi: 20.03.2021)
• Kritikos M. (2018, Eylül). What if blockchain offered a way to reconcile privacy with transparency?. European Parliamentary Research Service. https://www.europarl.europa.eu/RegData/etudes/ATAG/2018/624254/EPRS_ATA(2018)624254_EN.pdf (Erişim Tarihi: 20.03.2021)
• Landerreche, E. & Stevens, M. (2018, Mayıs 8-9). On immutability of blockchains [Conference presentation]. In: W. Prinz & P. Hoschka (Eds.), Proceedings of the 1st ERCIM Blockchain Workshop, Reports of the European Society for Socially Embedded Technologies. DOI: 10.18420/blockchain2018_04
• Lin, J., Pipattanasomporn M. & Rahman, S. (2019, Şubat 19-20). Comparative analysis of blockchain-based smart contracts for solar electricity exchanges [Conference presentation]. IEEE Power & Energy Society Innovative Smart Grid Technologies Conference (ISGT), Washington, DC, USA, 1-5, doi:10.1109/ISGT.2019.8791632.
• Liu, S. (2020, Jun 9). Size of the blockchain technology market worldwide from 2018 to 2025. Statista, https://www.statista.com/statistics/647231/worldwide-blockchain-technology-market-size/ (Erişim Tarihi: 20.03.2021)
• Mannaro, K., Baralla, G., Pinna, A. & Ibba, S. (2018). A blockchain approach applied to a teledermatology platform in the sardinian region (Italy). Information, 9(2), 44.
• Mathieu, S., Boutron, I., Moher, D., Altman, D. G. & Ravaud, P. (2009). Comparison of registered and published primary outcomes in randomized controlled trials. JAMA, 302, 977–984.
• MBAC, Course 2: The medical billing process. https://www.medicalbillingandcodingonline.com/medical-coding-for-billers/. Erişim Tarihi: 23.02.2021
• Md Tech Review (2020, Şubat 12). How will blockchain affect medical billing and coding?, https://www.mdtechreview.com/news/how-will-blockchain-affect-medical-billing-and-coding--nwid-264.html.
• Medrec. (2021). What is medrec? https://medrec.media.mit.edu/. Erişim Tarihi: 13.12.2021
• Mettler, M. (2016, Eylül 14-17). Blockchain technology in healthcare: The revolution starts here [Conference presentation]. IEEE 18th International Conference on e-Health Networking, Applications and Services (Healthcom), Munich, Germany, 1-3, doi: 10.1109/HealthCom.2016.7749510.
• Nakamoto, S. (2008). Bitcoin: A peer-to-peer electronic cash system [White Paper]. https://bitcoin.org/bitcoin.pdf
• Narayanaswami, C., Nooyi, R., Raghavan, S.G. & Viswanathan, R. (2019). Blockchain anchored supply chain automation. IBM Journal of Research and Development, 63, 7(11).
• Niranjanamurthy, M., Nithya, B.N. & Jagannatha, S. (2019). Analysis of blockchain technology: pros, cons and SWOT. Cluster Comput, 22 (6), 14743–14757.
• Omar, I, Jayaraman, R, Salah, K. & Simsekler M. (2019, Kasım 3-7). Exploiting ethereum smart contracts for clinical trial management [Conference presentation]. ACS 16th international conference on computer systems and applications (AICCSA). IEEE, Abu Dhabi, United Arab Emirates, 1–6
• Omohundro, S. (2014). Cryptocurrencies, smart contracts, and artificial intelligence. AI Matters, 1(2), 19–21.
• Ozercan, H.I., Ileri, A.M., Ayday, E. & Alkan, C. (2018). Realizing the potential of blockchain technologies in genomics. GenomeRes, 28 (9), 1255–1263.
• Pandey, P. & Litoriya, R. (2020). Implementing healthcare services on a large scale: challenges and remedies based on blockchain technology. Health Policy Technol, 9, 69–78.
• Peterson, K., Deeduvanu, R., Kanjamala, P. & Boles, K. (2016). A blockchain-based approach to health information exchange networks. Mayo Clinics. https://www.healthit.gov/sites/default/files/12-55-blockchain-based-approach-final.pdf
• Prisco, G. (2016, Nisan 26). The Blockchain for Healthcare: Gem launches gem health network with philips blockchain lab. Bitcoine Magazine. https://bitcoinmagazine.com/business/the-blockchain-for-heathcare-gem-launches-gem-health-network-with-philips-blockchain-lab-1461674938#:~:text=Gem%2C%20a%20provider%20of%20enterprise,Philips%2C%20is%20the%20first%20major
• PwC (2018). Global blockchain survey. https://www.pwc.com/jg/en/publications/blockchain-is-here-next-move.pdf
• PwC (2020a). 23rd annual global CEO survey. https://www.pwc.com.tr/ceo-survey
• PwC (2020b). Time for trust. report. https://bitcoinke.io/wp-content/uploads/2020/10/Time-for-Trust-PwC-October-2020.pdf?x63648
• Rabah, K.V.O. (2017). Challenges & opportunities for blockchain powered healthcare systems: A review. Mara Res. J. Med. Health Sci. 1, 45–52.
• Raikwar, M., Mazumdar, S., Ruj, S., Sen Gupta, S., Chattopadhyay A. & Lam, K. (2018, Şubat 26-28). A blockchain framework for insurance processes [Conference presentation]. 9th IFIP International Conference on New Technologies, Mobility and Security (NTMS), Paris, France. 1-4. doi: 10.1109/NTMS.2018.8328731.
• Reynolds, J., Rezgui, Y. & Hippolyte, J.L. (2017). Upscaling energy control from building to districts: Current limitations and future perspectives. Sustainable Cities and Society, 35, 816–829.
• Scorringe, M. (2019). More than Medicine: Pharmaceutical industry collaborations with the UK NHS. In: Ratten V., Jones P., Braga V., Marques C. (eds) Sustainable Entrepreneurship. Contributions to Management Science. Springer, Cham. https://doi.org/10.1007/978-3-030-12342-0_7.
• Shabani, M. (2019). Blockchain-based platforms for genomic data sharing: a decentralized approach in response to the governance problems? J. Am. Med. Inform. Assoc, 26 (1),76–80.
• Sharma, S. (2020, Mayıs 5). 16 Amazing Examples of How Blockchain Technology is Revolutionizing Everyday Life. Classic Informatics. https://www.classicinformatics.com/blog/blockchain-technology-applications
• Shelter Zoom (2021). https://shelterzoom.com/ Erişim Tarihi: 13.12.2021
• Shivom (2018, Ekim 12). Blockchain can be the catalyst for a revolution in precision medicine. https://medium.com/projectshivom/blockchain-can-be-the-catalyst-for-a-revolution-in-precision-medicine-d55e1e810262
• Siwicki, B. (2019, Ekim 16). How blockchain can protect telemedicine programs. Healthcare IT News. https://www.healthcareitnews.com/news/how-blockchain-can-protect-telemedicine-programs
• Sylim, P., Liu, F., Marcelo, A. & Fontelo, P. (2018). Blockchain technology for detecting falsified and substandard drugs in distribution: Pharmaceutical supply chain intervention. JMIR Res. Protoc. 7(9), e10163.
• Szabo, N. (1997). Formalizing and securing relationships on public networks. First Monday, 2(9).
• Tang, P.C., Ash, J.S., Bates, D.W., Overhage, J.M. & Sands, D.Z. (2006). Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. J. Am. Med. Inform. Assoc, 13 (2), 121–126.
• Tanwar, S., Parekh, K. & Evans, R. (2020). Blockchain-based electronic healthcare record system for healthcare 4.0 applications. Journal of Information Security and Applications, 50, 102407.
• Taylor, P. (2016, Nisan 27). Applying bxlockchain technology to medicine traceability. Securing Industry. https://www.securingindustry.com/pharmaceuticals/applying-blockchain-technology-to-medicine-traceability/s40/a2766/#.YGHm_kgzZaq
• Tendulkar, S., Rodrigues, A., Patel, K. & Dalvi, H. (2020). System to fight counterfeit drugs. In: Advanced computing technologies and applications. Algorithms for intelligent systems. Springer, 465–470.
• Terzi, S. & Stamelos, I. (2018). Software process improvement and capability determination. In Stamelos, I., O'Connor, R.V., Rout, T.& Dorling, A. (Eds). Permissioned blockchains and smart contracts into agile software processes (355–362). https://link.springer.com/chapter/10.1007/978-3-030-00623-5_26
• Todaro, J.M. (2018). Overview of MedCredits. http://medcredits.io/team/
• Toyoda, K., Mathiopoulos, P. T., Sasase, I., & Ohtsuki, T. (2017). A novel blockchain-based product ownership management system (POMS) for anti-counterfeits in the post supply chain. IEEE access, 5, 17465-17477.
• Unnithan, C., Houghton, A., Anema, A. & Lemieux, V. (2020). Essentials of blockchain technology (Chapman&Hall CRC Big Data Series, CRC Press), Blockchain in global health-an appraisal of current and future applications, Chapter: 9. Taylor and Francis LLC.
• Wang, S., Yuan, Y., Wang, X., Li, J., Qin R. & Wang, F. (2018 June 30-July 1). An overview of smart contract: Architecture, applications, and future trends [Conference presentation]. IEEE Intelligent Vehicles Symposium (IV), Changshu, China, 108-113. doi:10.1109/IVS.2018.8500488.
• WHO (2017, Kasım 28). 1 in 10 medical products in developing countries is substandard or falsified, https://www.who.int/news/item/28-11-2017-1-in-10-medical-products-in-developing-countries-is-substandard-or-falsified
• Wright, C.S. (2019). Bitcoin: A peer-to-peer electronic cash system. SSRN Electronic Journal, 1-9. doi:10.2139/ssrn.3440802
• Wood, G. (2014). Ethereum yellow paper. https://gavwood.com/paper.pdf
• Yang, R., Yu, F. R., Si, P., Yang Z. & Zhang, Y. (2019). Integrated blockchain and edge computing systems: A survey, some research issues and challenges. IEEE Communications Surveys & Tutorials, 21 (2), 1508-1532.
• Yaqoob, I., Salah, K., Jayaraman, R. & Al-Hammadi, Y. (2021). Blockchain for healthcare data management: opportunities, challenges, and future recommendations. Neural Comput & Applic. https://doi.org/10.1007/s00521-020-05519-w
• Zhang, P., Schmidt, D.C., White, J. & Lenz, G. (2018). Blockchain technology use cases in healthcare, Advances in computers, 111, 1–41.
• Zhao, H., Zhang, Y., Peng, Y. & Xu, R. (2017, March 22-24). Lightweight backup and efficient recovery scheme for health blockchain keys [Conference presentation]. IEEE 13th International Symposium on Autonomous Decentralized System (ISADS), Bangkok, pp. 229-234, doi: 10.1109/ISADS.2017.22.
• Zhenag, Z., Dai, H.-N., Tang, M. & Chen, X. (2019). Blockchain and trustworthy systems. First International Conference, BlockSys, Springer.
• Zheng, Z., Xie, S., Dai, H.N., Chen, X. & Wang, H. (2018). Blockchain challenges and opportunities: A survey. Int. J. Web Grid Serv., 14 (4) 352–375.