Table 10 Listing of constructs, definitions, anecdotal evidence, and count for perceived concerns of blockchain-based HIEs
Axial Codes (Constructs) | Definition | Sample Quotes | Count |
|---|---|---|---|
Lack of knowledge about blockchain technology | The extent to which healthcare providers may not be aware of blockchain applications in healthcare and why they could be useful | “Most of my colleagues don’t know what blockchain is… and how it can be used in healthcare practices.” | 34 |
Implementation issues | The extent to which healthcare organizations may not have required resources and effective planning to integrate blockchain into routine healthcare practices | “Some managers are terrified by technical issues, time, cost, training, and value-added of blockchain projects.” | 32 |
Regulatory issues | The extent to which physicians believe that using blockchain-based HIE is not fully regulated | “I don’t think blockchain applications are completely regulated in the healthcare space and still need laws to support it.” | 30 |
Selection decision | The extent to which selecting blockchain platforms in healthcare is challenging when there are various alternatives (i.e., outsourced, in-house) | “Many outside providers can design blockchain-based exchange methods, but some managers believe they need to develop blockchain platforms in-house.” | 27 |
Feasibility issues | The extent to which blockchain projects may not be a feasible effort from organizational perspectives | “I think blockchain integration is not a feasible endeavor for healthcare managers; that’s why many of them do not support these kinds of projects.” | 25 |
Lack of collaboration among various stakeholders | The extent to which various stakeholders may not be willing to collaborate in blockchain-based HIE | “A number of entities got to collaborate in blockchain HIE, such as patients…. I am not sure if all agree on the role of patients in transactions.” | 23 |
Blockchain model types | The extent to which healthcare providers may not deploy the right blockchain models (among various architectures) which is suitable in the healthcare domain (e.g., public, private, hybrid, federated) | “There are some blockchain architectures, but it is challenging to realize which one could be the most secure model with a robust infrastructure for information exchange in healthcare.” | 21 |
Complicated system | The extent to which using blockchain may not be free of effort for users | “Technological foundations of the blockchain and smart contracts do not seem to be easy.” | 18 |
Network effects | The extent to which competitors (such as large healthcare organizations) may not adopt blockchain | “We are scared that we are the only one [27] adopted blockchain… as a matter of fact, competitors' responses are not clear.” | 15 |
Lack of trust in blockchain technology | The extent to which healthcare providers believe that blockchain may not be a trustworthy, reliable, and error-free technology | “I think blockchain is still a new technology, still unstable and not scalable.” | 12 |