Implementing healthcare services on a large scale: Challenges and remedies based on blockchain technology

The accessibility of electronic healthcare data is necessary for effective treatment, policy decisions, and healthcare information exchange. Due to the intangibility of digital data, healthcare information is also prone to privacy-breach and security attacks. Further, the importance of immutability and privacy of healthcare data becomes colossal when a nationwide healthcare and wellness scheme is planned to be implemented. Providing quality healthcare services to such an enormous population size is challenging and requires proper technological infrastructure. The cooperation from the society is equally important to lay such a copious architecture on which the healthcare services should seamlessly run. Objective: To assess the social and technical challenges that lie ahead in implementing large-scale comprehensive healthcare services and suggest a technology-intervening solution to serve the society at large. Method: This study considers India's National Health Policy (2017) initiatives. The social and technical hurdles in implementation of the schemes are discussed, and AarogyaChain, a Blockchain technology-based solution is proposed to eliminate the health policy implementation hiccups. Result: We find that the scalability is a primary concern in implementing healthcare services on blockchain at such a large scale. We experimented by creating a blockchain and found that the system throughput is a function of the number of special nodes called ordering nodes, and a trade-off is required to balance between time-to-commit and system's fault tolerance. Conclusion: Blockchain provides a secure and transparent system of integrated healthcare services that keeps patients at the center and provides for corruption intolerant and efficient implementation of nationwide health-insurance programs. (C) 2020 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved.