Table 9 Open codes for perceived concerns associated with using blockchain in HIEs

Familiarity, knowledge, exposure, understanding, insights about the system

Awareness

Outsourcing, outsourced platforms, in-house, third-party supplier, system design phase, contracting with a vendor, designer contract, contract with an outside provider

Selection decision

Regulatory issues, unclear rules and regulations, lack of regulatory guidelines, lack of supporting laws, not regulated area, not aligned with HIPAA regulation privacy compliance metrics

Regulations and laws

Not doable projects, not feasible efforts, lack of support from managers, not aligned with hospital strategic directions, not backed by healthcare organizations' policymakers

Feasibility

Involvement of various entities, collaboration issues, patient roles, needs for a strong network of relationships, communications issues among different beneficiaries

Stakeholders participation

Blockchain architectures, public or private models, authority agency, various platforms, model conflicts, right model in healthcare, different model structures, different verification procedures, consensus algorithm

Blockchain model types

Resource allocations, workflow changes, installing a new system, integrating blockchain into healthcare, system installation, network infrastructure, implementation duration, implementation cost

Implementation

Lack of adoption in the market, competitors' adoption, other providers' acceptance, not popular in the market yet, challenge with the widespread adoption of blockchain, state of blockchain adoption

Industry traction

Lack of technical trust, untrustworthy technical underpinning, technological immaturity, unreliable foundation, technology in its infancy, instability, unscalable, errors

Trust in technology

Not easy to use, complicated foundations, confusing protocols, difficult platforms

Complexity