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The recently developed blockchain technology uses a peer-to-peer network to distribute data to all participants for storage. This method enhances data safety, reliability, integrity, and transparency. To successfully introduce blockchain technology to medical data management, it is essential to obtain consent from medical doctors and patients.
The aim of this study was to examine medical doctors’ and patients’ attitudes toward the use of blockchain technology and interpret the findings within the framework of expectancy theory.
In this questionnaire survey, we examined medical doctors’ (n=90) and patients’ (n=90) attitudes toward the use of blockchain technology in the management and distribution of medical information. The questionnaire comprised 8 questions that assessed attitudes toward new means of managing and distributing medical information using blockchain technology. Responses were rated on a scale that ranged from 1 (very negative) to 7 (very positive).
Medical doctors (mean 3.7-5.0) reported significantly more negative attitudes than patients (mean 6.3-6.8). Furthermore, self-employed doctors reported more negative attitudes than employed doctors and university professors.
To successfully introduce blockchain technology to medical data management, it is necessary to promote positive attitudes toward this technology among medical doctors, especially self-employed doctors.
In addition to an increase in life expectancy and use of health care services, medical advances have also led to an exponential growth in the amount of patient medical information available [
The recently developed blockchain technology differs from the conventional method of data storage in a central server or specific institution. Specifically, it uses a peer-to-peer network that distributes the data to all participants for storage; these users are responsible for hosting and managing the data [
Recently, technology has gained a growing interest in the field of medicine [
However, the initial stages of introduction of blockchain technology to medical practice may involve challenges. Particularly, the introduction of blockchain technology to medical data management necessitates the fulfillment of 2 criteria: (1) it must solve technical problems, and (2) health care service providers (ie, medical doctors) and consumers (ie, patients) must consent to its use. According to expectancy theory [
The investigations were carried out following the rules of the Declaration of Helsinki of 1975. We conducted a questionnaire survey among practicing medical doctors who were between the ages of 30 and 49 years. Before the participants responded to the questionnaires, they viewed a video. The authors do not have any associations or relationships with the company that produced the video. In addition, a questionnaire survey was conducted among patients who were between the ages of 30 and 49 years. We think that the medical doctors under the age of 30 years are not experienced in the medical field enough to conduct this survey, and some doctors and patients over the age 49 years might find it difficult to understand blockchain technology. These participants were recruited from the lobby of a university hospital, and they provided consent before their participation in the survey.
The questionnaire comprised items that assessed attitudes toward new means of managing and distributing medical information using blockchain technology [
The items that were used to measure attitudes toward blockchain technology were adapted from a validated measure that has been used in previous studies, such as those that have been conducted by Venkatesh et al [
The item that was used to gauge the levels of medical doctors’ and patients’ previous knowledge about blockchain technology was adapted from a validated measure in a similar previous study by Bettman and Park [
The collected data were analyzed using SPSS Version 24.0 (IBM Corporation). The data were analyzed in 2 steps. In the first step, the demographic characteristics and attitudes of medical doctors and patients were compared using the Mann-Whitney
A total of 90 medical doctors from 16 different departments and 90 patients participated in this survey.
The results of the first step of data analysis revealed no significant differences in the demographic characteristics of medical doctors and patients (
Significance of the difference in the demographic characteristics of medical doctors and patients.
Demographic characteristics | Medical doctors (n=90) | Patients (n=90) | |
Age (years), 30s:40s, n | 62:28 | 60:30 | .75 |
Gender, male:female, n | 62:28 | 60:30 | .75 |
Level of prior knowledgea, mean (SD) | 3.0 (1.4) | 3.0 (1.5) | .69 |
aLevel of prior knowledge about blockchain technology was rated on a scale that ranged from 1 (Do not know it at all) to 7 (Know it very well). Higher scores are indicative of a higher level of prior knowledge about blockchain technology.
Distribution of medical doctors across the departments that they represented (N=90).
Department | Frequency, n (%) |
Rehabilitation and physical medicine | 27 (30) |
Pediatrics | 14 (16) |
Neurosurgery | 6 (7) |
Anesthesiology | 6 (7) |
Family medicine | 6 (7) |
General practice | 6 (7) |
Internal medicine | 5 (6) |
Orthopedics | 3 (3) |
Dermatology | 3 (3) |
Plastic surgery | 3 (3) |
Obstetrics and gynecology | 3 (3) |
Diagnostic medicine | 3 (3) |
Psychiatry | 2 (2) |
General surgery | 1 (1) |
Radiology | 1 (1) |
Radiation oncology | 1 (1) |
The emergent means for all items that measured attitudes toward blockchain technology (ie, >3.5) were indicative of positive attitudes among both medical doctors and patients (
Significance of the difference in attitudes toward the use of blockchain technology in the management of medical information between medical doctors and patients.
Blockchain technology application | Medical doctors, mean (SD) | Patients, mean (SD) | |
(1) Unlike traditional methods of medical data management, which bestow complete control over medical information to the hospital, blockchain technology allows a patient to choose the extent to which their medical information is stored, distributed, and managed. | 3.9 (1.9) | 6.4 (0.8) |
|
(2) Blockchain technology delivers each aspect of a patient’s medical information to medical doctors. | 4.4 (1.9) | 6.3 (0.9) |
|
(3) As blockchain technology renders it impossible for one to hack medical information, it enhances the security of patient medical information. | 4.4 (1.8) | 6.8 (0.5) |
|
(4) Blockchain technology prohibits anyone from revising a medical chart without patient consent once it has been created by a medical doctor. | 3.7 (1.9) | 6.4 (1.0) |
|
(5) Blockchain technology allows patients to access information anywhere and at any time. | 4.2 (1.9) | 6.7 (0.6) |
|
(6) As blockchain technology allows hospitals to exchange medical information, patients do not have to print medical charts on paper, copy imaging scans onto a CD, and submit them to another hospital. | 5.0 (1.9) | 6.8 (0.5) |
|
(7) As blockchain technology reduces the likelihood of patients being subjected to redundant medical examinations, it lowers health care costs and reduces the time that patients spend at a hospital. | 4.7 (2.0) | 6.8 (0.5) |
|
(8) Blockchain technology makes it possible for one to use standardized medical big data to enhance the precision and personalization of medical treatments. | 4.7 (2.0) | 6.7 (0.8) |
|
aValues in italics are significant at the .05 level of significance.
However, medical doctors reported significantly more negative attitudes than patients across all items (mean 3.7-5.0;
The results of the second step of data analysis revealed no significant difference in the demographic characteristics of self-employed and employed doctors and university professors (
Self-employed doctors reported significantly more negative attitudes than employed doctors and university professors on the following two items (
Significance of the difference in the demographic characteristics of self-employed and employed doctors and university professors.
Demographic characteristics | Self-employed doctors (n=14) | Employed doctors (n=54) | University professors (n=22) | |
Age (years), 30s:40s, n | 7:7 | 13:41 | 14:8 | .15 |
Gender, male:female, n | 12:2 | 36:18 | 14:8 | .32 |
Level of prior knowledgea, mean (SD) | 3.1 (1.5) | 3.0 (1.5) | 2.8 (1.4) | .74 |
aLevel of prior knowledge about blockchain technology was rated on a scale that ranged from 1 (
Significance of the difference in attitudes toward new methods of managing medical information using blockchain technology among self-employed doctors, employed doctors, and university professors.
Blockchain technology application | Self-employed doctors, mean (SD) | Employed doctors, mean (SD) | University professors, mean (SD) | |
(1) Unlike traditional methods of medical data management, which bestow complete control over medical information to the hospital, blockchain technology allows a patient to choose the extent to which their medical information is stored, distributed, and managed. | 3.0 (1.9) | 4.0 (1.9) | 4.4 (1.7) | .09 |
(2) Blockchain technology delivers each aspect of a patient’s medical information to medical doctors. | 3.5 (2.4) | 4.5 (1.9) | 4.8 (1.6) | .10 |
(3) As blockchain technology renders it impossible for one to hack medical information, it enhances the security of patient medical information. | 4.5 (2.0) | 4.4 (1.8) | 4.5 (1.8) | >.99 |
(4) Blockchain technology prohibits anyone from revising a medical chart without patient consent once it has been created by a medical doctor. | 3.1 (1.9) | 3.9 (2.1) | 3.5 (1.5) | .42 |
(5) Blockchain technology allows patients to access information anywhere and at any time. | 3.3 (2.1) | 4.3(1.9) | 4.7 (1.6) | .07 |
(6) As blockchain technology allows hospitals to exchange medical information, patients do not have to print medical charts on paper, copy imaging scans onto a CD, and submit them to another hospital. | 3.5 (2.4) | 5.2 (1.8) | 5.4 (1.3) |
|
(7) As blockchain technology reduces the likelihood of patients being subjected to redundant medical examinations, it lowers health care costs and reduces the time that patients spend at a hospital. | 2.9 (2.4) | 5.0 (1.9) | 5.1 (1.7) |
|
(8) Blockchain technology makes it possible for one to use standardized medical big data to enhance the precision and personalization of medical treatments. | 3.8 (2.4) | 4.9 (2.0) | 5.0 (1.9) | .14 |
aMean item score for self-employed doctors < mean item score for employed doctors and university professors.
bValues in italics are significant at the .05 level of significance.
This study examined medical doctors’ and patients’ attitudes toward new methods of managing and distributing medical information using blockchain technology. The major findings of this study can be summarized into 3 points. First, medical doctors reported significantly more negative attitudes than patients across all items that measured attitudes toward the application of blockchain technology to the management and distribution of medical information (
The 3 major findings of this study can be interpreted within the framework of the expectancy theory of psychological motivation [
The third finding of this study suggests that patients hold very favorable attitudes toward the use of blockchain technology. This may be because of the fact that the application of blockchain technology to medical data management will yield outcomes that are beneficial rather than harmful to patients. Expectancy theory suggests that people cognitively analyze the gains and losses of behaviors in which they intend to engage [
The 3 major findings of this study, which are consistent with the premises of expectancy theory [
At present, many companies worldwide are researching the means by which blockchain technology can be introduced to the health care sector [
In this study, we ascertained the extent to which the attitudes of medical doctors and patients are favorable toward the use of blockchain technology in the management and distribution of medical information. We found that medical doctors reported more negative attitudes than patients. Therefore, to introduce blockchain technology to medical data management, it is necessary to alleviate the concerns that medical doctors (especially self-employed doctors) have about the use of blockchain technology. Our study has some limitations. First, we did not examine the specific factors that lead to negative and positive attitudes toward the use of blockchain technology in medical data management. Second, diverse age groups were not represented in the study sample. Third, the number of doctors working in a specific department (physical medicine and rehabilitation) is disproportionately high. Fourth, the number of included subjects was relatively small. Fourth, a qualitative analysis method, such as a qualitative survey, can be effectively used to clearly show medical doctors’ and patients’ attitudes toward blockchain technology. However, we analyzed them by using only the quantitative analysis method using a questionnaire-based survey. Future studies that address these limitations will be able to enrich the present findings.
National Research Foundation
The 2017 Yeungnam University Research Grant supported this work. The National Research Foundation of Korea (NRF) Grant (NRF-2019R1F1A1061348) supported this work.
None declared.