Blockchain Technology in Healthcare: Readiness of Different Types of Stakeholders

With the advent of the Digital Transformation, Healthcare Systems have switched from paper to electronic health records (EMR). However, there are few critical issues related to data governance (e.g., transparency of data, traceability, immutability, privacy and security) that need to be addressed in the upcoming years. Blockchain (BT) is a decentralized digital ledger and an innovative technology with the potential to address such issues. A pivotal role when implementing a blockchain-based solution, in healthcare as in other fields, is played by the stakeholders involved in the digitalization process, and in their respective readiness, that can be defined as the availability and capacity of the various stakeholders to adopt the new technology, both individually and collectively. Readiness represents a factor that affects the correct implementation of blockchain-based solutions and is commonly declined in the literature by means of different dimensions: motivational readiness, engagement readiness, technological readiness and structural readiness. Readiness is particularly important for those stakeholders who are nodes of the blockchain network, as they have the fundamental role of keeping and exchanging the information necessary for its operations. However, in the literature we have not encountered any work analyzing the differences between stakeholders that are nodes and those that are not-nodes of the BT network, not only in terms of type but also in readiness. This work aims at identifying what is the difference between the readiness dimensions of stakeholder-nodes respects stakeholders-non-nodes in BT-based projects applied to EMR and how readiness impacts blockchain-based projects, especially when it concerns the stakeholders that are nodes of the BT network and those that are not. The chosen methodology is the multiple case studies; three different projects have been selected that use BT in different ways to manage EMRs. Through semi-structured interviews, it was possible to identify the stakeholders interested in these projects, determine which of these represent nodes of the network and which non-nodes, and identify the different dimensions of readiness that characterize them.