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Introduction
Medical technology has facilitated remarkable advances in various fields. With the development of healthcare technology, the quality of life and longevity of humans have improved. Interest in the exchange of medical information has also increased [1].
Currently, the medical records of patients are fragmented and stored in different hospitals. Fragmented medical records lead to several problems [2,3]. First, it is difficult for a doctor to check the medical records. Second, because not all medical records are accessible by every doctor, tests performed at another hospital may be duplicated. Third, although medical records can be digitally stored, patients or guardians copy and transport medical records to other hospitals using paper or compact disks (CDs). Fourth, the medical records stored in the hospital may be hacked or lost due to the hospital’s closure. Thus, there may be unnecessary damage and a waste of time and human resources.
Blockchain technology ensures data safety, reliability, integrity, and transparency by distributing and documenting data over a peer-to-peer network [4]. This technology is different from traditional methods that store transactions on a central server [5].
Different perspectives on the application of blockchain technology in the healthcare industry are presented in this paper. Currently, the proposed clinical application will help facilitate the exchange of medical records and will be applied to the Internet of Things (IoT) system to manage patients with chronic diseases such as diabetes [6-10].
Pediatrics is also a field with many subfields that can benefit from blockchain technology. This study aims to assess pediatricians’ thoughts and attitudes toward introducing blockchain technology into the medical field.
Methods
Ethical statements: This study was conducted according to the guidelines of the Declaration of Helsinki of 1975 and approved by the Institutional Review Board (IRB) of Yeungnam University Hospital (IRB No: YUMC 2019-04-041). At the time of receiving the questionnaire from the study participants, consent was obtained verbally, and a process was approved by the IRB.
1. Survey
Based on widely used theories concerning new technology acceptance, we investigated various factors related to using new technologies, such as blockchain, in our survey. In more detail, our study’s factors, such as expected performance and ease of use, theoretically stem from the technology acceptance model [11]. Intention, attitude, and perceived behavioral control of using blockchain for hospital work originate from the theory of planned behavior [12].
We conducted a questionnaire survey among pediatricians aged between 30 and 60 years. A paper questionnaire and Google questionnaire were used. Before the participants responded to the questionnaires (Supplementary material 1), they watched a video about blockchain medical applications. The authors do not have any associations or relationships with the company that produced the video [13].
The items that were used to measure intentions, attitudes toward using blockchain for hospital work, expected performance, ease of use, and perceived behavioral control were adopted from validated measures that were used in Venkatesh et al. [14]. Responses to each item were recorded on a scale that ranged from 1 (never agree) to 7 (completely agree). Higher scores were indicative of a higher degree of consent, whereas lower scores were indicative of a lower degree of consent.
The attitudes toward using blockchain technology to manage medical information were adapted from Venkatesh et al. [14] and Min and Kim [15]. Replies to these items were gauged on a 7-point scale, ranging from 1 (very negative) to 7 (very positive). Higher scores denoted more positivity, and lower scores indicated more negativity.
2. Statistical analysis
The collected data were analyzed using IBM SPSS ver. 25.0 (IBM Corp., Armonk, NY, USA). The demographic characteristics and attitudes of the medical doctors, stratified by their characteristics, were compared using the Mann-Whitney U-test. Statistical significance was denoted by p<0.05.
Results
1. Study population
A total of 23 pediatricians were enrolled in this study (Table 1). Most of them were in their 30s (n=16, 69.6%), five were in their 40s (21.7%), and two were in their 50s (8.7%). There were 10 men (43.5%) and 13 women (56.5%). The average career duration of the participants was 12±9 years (Table 1). Regarding the hospital type, two were primary hospitals (8.7%), five were secondary hospitals (21.7%), and one was tertiary hospital (65.2%). Regarding job titles, eight of the pediatricians were employed (34.8%), six were residents (26.1%), eight were university professors (34.8%), and one was allocated to the “other” category (4.3%).
2. Thoughts about the use and adoption of blockchain
The participants’ perspectives on the use and adoption of blockchain are shown in Table 2 and Fig. 1. The average score for the participants’ intentions to use blockchain technology was 4.0 to 4.6. Those working at tertiary hospitals provided slightly more positive answers about their attitudes toward blockchain technology.
Regarding the attitudes toward and perspectives on blockchain technology, the participants expressed only a few positive opinions about the use of blockchain for hospital work (4.3–4.7). Those working at tertiary hospitals provided slightly more positive answers related to the attitudes toward blockchain technology. However, those working in primary and secondary hospitals had slightly negative perspectives on applying blockchain technology to hospital work (p=0.018).
The expectations of the effectiveness of blockchain technology were generally neutral. The participants in tertiary hospitals had positive expectations. Those in tertiary hospitals believed that it would improve productivity, processing speed, quality, and convenience. Participants from primary and secondary hospitals expressed neutral opinions, but these were not statistically significant.
The participants expressed neutral opinions about the ease of using blockchain technology. Participants working in primary and secondary hospitals expressed slightly more negative views regarding the ease of use and learning curve of the technology.
All participants expressed relatively negative opinions of their environment when using blockchain technology. Participants from primary and secondary hospitals expressed more negative views than those from tertiary hospitals. They thought that the information technology resources necessary to use blockchain technology were insufficient and believed they lacked knowledge of blockchain technology. They also considered blockchain incompatible with the hospital work support system they were using.
3. Attitudes toward using blockchain technology to manage medical information
Regarding the benefits of blockchain technology, the most preferred was exchanging medical information between hospitals (Table 3, Fig. 2).
With blockchain technology, when a patient visits another hospital, there is no need to print out the chart from the prior hospital or transfer image information to a CD and deliver it to the new hospital, thereby facilitating the exchange of medical information between the hospitals. Blockchain technology can reduce repetitive tests, thus reducing patient treatment costs and shortening treatment time. Blockchain technology makes it possible to use standardized medical big data for precision medical care and customized medical care.
In addition, the participants found that blockchain technology reduced repetitive examinations, medical expenses, and treatment hours, and it facilitated the use of standardized medical big data. However, the participants expressed neutral opinions about the inability to modify medical records without patient consent, patients managing medical information by themselves, the transmission of all patient medical information to medical staff, and patient access to medical records at any time.
4. Necessity and feasibility of blockchain technology related to hospital business
All participants expressed positive opinions about the need for services that could be implemented through blockchain. Regarding the feasibility of the services that could be implemented through blockchain, positive views were expressed for all services other than patient-centered medical data management services, about which the participants expressed a neutral opinion (Table 4). There were no differences according to the hospital type.
Discussion
This study aimed to clarify the opinions and attitudes of pediatricians related to the adoption of blockchain technology in the medical field. The study findings revealed that pediatricians expressed only a few positive opinions about blockchain, and pediatricians working in tertiary medical institutions were found to have more positive attitudes toward this technology. Pediatricians working in primary and secondary hospitals expressed neutral opinions about blockchain technology and somewhat negative opinions about its introduction into hospitals.
In our previous study, medical doctors demonstrated significantly more negative attitudes toward blockchain technology than did patients [2]. Furthermore, self-employed doctors demonstrated more negative attitudes than employed doctors and university professors [2]. We attempted to understand these findings using the expectancy theory of psychological motivation [18,19], which suggests that people are motivated to pursue positive outcomes and avoid adverse effects.
Blockchain technology has various applications in pediatrics. Even simple invasive procedures such as obtaining blood samples are often difficult to perform in infants. Using blockchain technology to deliver medical information can lower medical expenses and lessen the inconvenience for children by eliminating redundant examinations.
Children may have to move frequently, sometimes against their will, depending on the circumstances of their parents. Therefore, it is highly possible that finding past records will be difficult. Although a system where the government manages vaccination records has been introduced in Korea, medical records other than vaccination records should be checked by relying on the memory of the guardian.
With blockchain technology, patients do not need to maintain their medical records. Instead of waiting to receive medical information from the guardian of a child, the hospital staff can access the medical history because the technology allows the transmission of the appropriate medical information. Additionally, there is no risk of record loss or distortion. It is essential to share the medical records of patients across different hospitals following their wishes; this is also important for the security of personal data.
In a study of medical record keeping in a summer camp setting by Kaufman et al. [20], approximately one-fifth of school-aged children were found to spend their time at residential summer camps in the United States. Many of these children had chronic medical conditions. In such a situation, the delivery of medical information for the special pediatric settings of a healthcare provider is said to be necessary. The study noted that standard software for documenting summer camp healthcare practice was needed, along with network and technical support. The delivery of medical records using blockchain technology with the approval of an authorized guardian may be helpful in this field.
The Korea Disease Control and Prevention Agency manages Korea’s national immunization program, and vaccinations can be checked online [21,22]. Since a child’s vaccination record is maintained from birth, this information is a good starting point for applying blockchain technology in the medical field. The immunization registration management information system may contain various errors that occurred during data entry. Owing to the nature of blockchain technology, access and modification are possible only with the individual patient’s consent, and a potential solution needs to be formulated.
The study findings revealed that pediatricians in tertiary hospitals expressed more positive views about blockchain technology than those in primary and secondary hospitals. A previous study reported similar results for doctors who were not pediatricians [2], which was not related to their direct compensation; there is relatively limited information about individual income levels. The availability of information technology support in tertiary hospitals also could have led to more positive answers.
In the future, the integration of blockchain technology with the medical record systems of pediatric and adolescent patients may be preceded by a pilot project that prioritizes pediatricians in tertiary hospitals. Blockchain technology has various applications in pediatric healthcare management. First, it can be used to deliver medical information securely, transparently, and cost-effectively. For example, it can be used for a national vaccination schedule registry. Blockchain technology can also facilitate a national interoperability framework, eliminate the need to manage different immunization records for each hospital, and lower the overall cost of vaccinations in the country. Second, blockchain technology can be helpful in conducting clinical trials involving children with rare hereditary diseases. Third, blockchain can be used for data sharing without compromising or leaking personal information in big data collected by a monitoring device—a wearable device that continuously monitors medical parameters using the IoT network.
After the coronavirus disease 2019 (COVID-19) outbreak, telemedicine use has increased dramatically in the United States [23]. Telemedicine sessions increased by 683% between March and April 2020. In response to COVID-19, the virtual urgent care system has expanded. Considering the increasing attention given to “untact” technology after COVID-19, the use of blockchain technology for medical record management has garnered interest.
In addition, blockchain technology plays a role as a means of delivering medical information, but digitalization of medical care, telemedicine, and smooth information delivery cannot be fully realized with only blockchain. To use medical blockchain technology, preliminary work such as standardization of medical databases will be required. The standardization of different medical databases for each hospital will facilitate the activation of information sharing between hospitals, which will require policy support from the government.
The limitations of this study are that the survey population was small, and patient and guardian surveys were not obtained. It seems that additional large-scale surveys are needed in this area.
It appears that there is adequate scope for the application of blockchain technology to pediatric healthcare management. With the introduction of blockchain technology to the medical industry, the technology, cost, policies, and the perception of market participants are important. We hope that the reported perceptions of pediatricians, who are important market participants in the introduction of blockchain to the medical industry, will help stimulate active discussions on the introduction of blockchain technology to the field of pediatrics in the future.
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