The benefits and challenges of blockchain in healthcare supply chain management in KSA: A systematic review

Abstract

Background

Blockchain is a cutting-edge innovation being applied to offer innovative solutions in various fields, including healthcare. The healthcare industry uses blockchain networks to store and distribute patient data across hospitals, physicians, diagnostic labs, and pharmaceutical firms. Blockchain applications are essential in the healthcare industry for identifying crucial fallacies that might be fatal. The effectiveness, security, and transparency in exchanging medical data may thus be improved in the healthcare industry. This technology may also aid medical institutions in procuring information and analysing patient data.

Aim

To examine the published papers that discussed the ability of utilization and probable challenges of blockchain technology in KSA's healthcare supply chain management.

Methods

Until February 10, 2023, the prime databases: Pub Med, Science Direct, Scopus, Google Scholar, Web of science, Embase and The Cochrane Library were searched. Published studies (except case reports), commentaries, editorials, reviews, and meta-analysis reporting on the use of blockchain technology in healthcare supply chain management were included and a Preferred Reporting Items of systematic Reviews and Meta-analyses (PRISMA) flow diagram was used to present the process. To assess risk of bias and the quality of the included studies, the Joanna Briggs Institute's (JBI) critical evaluation tools were implemented.

Results

A total of 22 studies were included and most of them used blockchain in technology for ensuring transparency, security, and storage of electronic health or medical records. Patients benefited from seamless electronic health records provided by a multi-level blockchain eHealth system. It was observed that blockchain technology effectively addresses clinical trial misconduct, and its potential in this area is to boost data productivity for the healthcare sector. The distinctive data storage pattern of blockchain offers a high-security standard that potentially reduces concerns about data tampering. It provides flexibility, accountability, connection, and data access authentication. Blockchain helps the healthcare sector avoid certain risks and offers decentralized data protection. In our study, we observed that the most preferred network for integrating the healthcare authority, manufacturer, wholesaler, retailer, and service was Ethereum (ETH).

Conclusion

Healthcare policymakers should implement blockchain in Healthcare Supply Chain Management. Moreover, they need to be aware that the primary issues with blockchain technology in the healthcare industry are the lack of practical applications, the high rate of failed initiatives, and the requirement for collaboration between diverse stakeholders. However, there is a lack of studies on how to evaluate the acceptability and assist healthcare organisations in using blockchain.

Introduction

Blockchain is a novel technology with tremendous potential for the healthcare sector. The use of blockchain technology may help resolve the current interoperability issues in the healthcare industry. Blockchain enables secure exchange of health information among patients, medical professionals, and researchers.¹ Blockchains are decentralized, digitally distributed public ledgers that synchronize databases used to record transactions. This prevents a record from being changed retrospectively without changing any blocks subsequently. Because blockchains are fundamentally decentralized databases, the data has no single owner. By guaranteeing that the data is automatically updated, and identical copies are received, users collaborate to selectively add data to the blockchain. In healthcare, blockchain technology is used for health information interchange, patient data management, financial and insurance claims, supply chain management, biomedical device monitoring, clinical trials, and anti-counterfeiting of drugs, among others.2, 3, 4

The blockchain application was developed by Griggs and others for secure sensor-based remote patient monitoring.⁵ To simplify access and sharing of medical information, Siyal et al. suggested utilizing a Personal Health Record (PHR) for patients, based on a public blockchain.¹ Chen et al. suggested utilizing a blockchain-based cloud application for storing and exchanging patient healthcare data.⁶ Without the involvement of a middleman, patients can exchange and manage their medical records within this system. Wang et al. presented a blockchain-based artificial intelligence system to support physicians in reviewing the overall course of care and assist patients choose a treatment plan.⁷ Shen et al. proposed a MedChain architecture for secure data exchange during sessions, utilizing blockchain and cryptography approaches.⁸ In order to ensure the validity and privacy of exchanging personal healthcare data and electronic medical records, Jiang et al. devised BloCHIE, which is based on an off-chain approach.⁹ To mitigate the proliferation of counterfeit medicines, Uddin et al. (2021) addressed problems with product traceability in the pharmaceutical supply chain and outlined practical applications of blockchain technology for tracking and monitoring.¹⁰

Precision medicine and medical research could potentially advance with the advent of blockchain-based IT infrastructure. A decentralized, digital technology called blockchain creates a shared database for storing data. Its principal components comprise a distributed network, digital transactions, and a shared ledger. Participant nodes form the first layer, which work together to certify and validate digital transactions for the network, and store identical copies of each transaction. Records may be saved thanks to the second layer. The members administrating the algorithm verify these transactions and add new ones. The legitimacy of the additional transaction is confirmed when most participants agree. Once the data has been uploaded, no single person can approve or change it.^6,11

Blockchain saves the financial system by eliminating the need for a third party. Finally, yet importantly, blockchain technology enables access to a one-sided corruption-free health system for the poorest people on the planet. Digital data is verified and protected using encryption. Blocks are stored in chronological order and in a linear fashion. Research shows that the proposed method is viable. However, there are presently no blockchain or open standards implementations that utilize it.12, 13, 14 Information and communication technologies (ICT) are being used in eHealth to improve access to quality healthcare. The current systematic review aims to review studies that report on the benefits and challenges of blockchain technology in healthcare supply chain management in KSA. The outcome of this review may be used by governmental and non-governmental organizations in implementing a cost-effective, highly secure technology that may improve daily healthcare delivery in the country.

Materials and Methods

The guidelines cited in the PRISMA checklist (Preferred Reporting Items for Systematic Review and Meta-Analyzes) checklist were followed.¹⁵

Strategy for literature search

A thorough literature search was conducted in five different databases (The Cochrane Library, Google Scholar, Science Direct, Scopus, and Pub Med) from 2000 to 2022. Database searches were conducted using broad keywords (Blockchain technology OR Healthcare OR Supply Chain Management AND KSA), following which only research articles were retrieved and reviewed. Due to the limited number of peer-reviewed publications specifically focused on KSA, it was essential to include high-quality international studies to establish a comprehensive theoretical foundation and identify transferable insights and best practices.

Study selection

Following deduplication, the titles were screened, and potentially relevant articles were identified by analyzing the associated abstracts. Relevant studies, including abstracts and full texts, were reviewed independently. The study information was abstracted from the full texts of the articles included in the study.

Inclusion and exclusion criteria for selecting studies

The criteria for inclusion include published studies and reports on the use of blockchain technology in healthcare in various countries with particular focus on KSA. The following types of articles were excluded: interviews and news articles that were not peer-reviewed; articles that lack full-text access; publications whose main topic is not the application of blockchain technology in healthcare; duplicate papers; studies in languages other than English; retracted papers; studies that are incomplete, without findings. We also searched for pertinent papers in the reference lists of previous systematic reviews and meta-analyzes.

Data extraction and synthesis

The information was compiled by two independent reviewers from selected articles. A discussion helped to clarify any discrepancies. Data were extracted from each included study.

Study quality assessment

The Critical Appraisal Checklists for Studies formulated by the Joanna Briggs Institute (JBI) were used to assess the quality of the selected research and the potential for bias in the included studies.¹⁶ A “yes” score of 49 % or less indicated a high risk of bias, a score of 50 %–69 % indicated a moderate risk of bias, and a score of 70 % or more indicated a low risk. The selected studies were screened for their potential for bias before being categorized into low-risk, high-risk and studies that raised some questions all included studies were evaluated by two independent reviewers. Discussions and consensus were invoked to resolve the disagreements between the two independent reviewers. Most of the studies included in this analysis exhibited low to moderate risk of bias.

Results & discussion

Identification and description of included studies

A total of 1025 citations were extracted from various databases. This included 150 duplicate studies. The citations were sourced from different databases as follows: 137 from PubMed, 188 from Embase, 176 from Google Scholar, 233 from Science Direct, 10 from The Cochrane Library, 196 from Scopus, and 85 from the Web of Sciences. After an initial screening of the titles and an assessment of the abstracts of 875 papers, approximately 698 studies were excluded. Out of the initial pool, 177 papers met the criteria for a full-text review. After applying the exclusion criteria, 155 complete texts were eliminated, yielding 22 articles for the final qualitative analysis. The flowchart illustrates the method used to select the studies (see Figure 1). The characteristics of the included studies are listed in Table 1. A total of 22 studies were included, most of which utilized blockchain technology to ensure transparency, security, and storage of electronic health or medical records. Most studies had a low to moderate risk of bias, as indicated in the table (see Table 2).

Figure 1.

Selection of articles as per PRISMA guidelines.

Table 1.

Characteristic of included studies with their quality assessment using Joanna Briggs Institute (JBI) checklist.

Reference	Year	Country	Block chain technology	Data type	Benefits	Challenges	Quality assessment
Saia et al.	2021	Italy	Public blockchain	Sensor data	Robust against network issues	Security risks	Low risk
Alshahrani et al.	2021	KSA	Public blockchain	Electronic health records Pharmaceutical supply chain	Improves security, reduces paper work and amplifies verification inefficiency	Implementation cost	Low risk
Pandey et al.	2020	Kenya	Public blockchain (AarogyaChain)	Electronic health records Clinical trial data	Management of pharmaceutical supply chain, clinical trial record management	Processing speed	Moderate risk
Tanwar et al.	2020	Brazil	Hyperledger Fabric platform	Electronic health records	Health information exchange	Implementation cost	Moderate risk
Alsufyani et al.	2020	KSA	Ethereum Hyperledger Fabric platform Private blockchain	Electronic health records	Improves autonomy, immutable and anonymity	Security risks Scalability	Moderate risk
Albahli et al.	2020	KSA	Public blockchain	Electronic health records	Smart healthcare system	Implementation cost	Moderate risk
Shuaib et al.	2019	KSA	Public blockchain Private blockchain Proof-of-work	Electronic health records	Personalized healthcare and tracking patients' data	Scalability	Moderate risk
Sylim et al.	2018	Philippines	Ethereum Hyperledger Fabric platform Public blockchain	Transaction records	Improved the traceability of falsified drugs	Simulated network needed	Moderate risk
Tseng et al.	2018	Taiwan	Gcoin platform Proof-of-work Private blockchain	Transaction records	Transparent drug transaction data	Implementation cost	Moderate risk
Griggs et al.	2018	USA	Ethereum Public blockchain Proof-of-concept	Sensor data	Automated patient monitoring	Inefficient data ingestion	Low risk
Rahman et al.	2018	KSA	Ethereum Hyperledger Fabric platform Private blockchain	Multimedia	Diagnosis data shared securely with mobile medical practitioners	Upload time	Low risk
Jo et al.	2018	Korea	Ethereum Proof-of-work Private blockchain	Sensor data	Ensured transparency, data security, and data storage	Security risks	Low risk
Saia	2018	Italy	Public blockchain	Sensor data	Ensured anonymity and immutability	Implementation cost	Moderate risk
Kuo et al.	2018	USA	Private blockchain	Electronic medical records	Enhanced privacy	Security risks	Low risk
Zhang et al.	2018	USA	Ethereum	Electronic health records	Access control and data integrity	Security risks Scalability	Low risk
Li et al.	2018	China	Ethereum	Electronic medical records	Data integrity	Security risks Scalability	Moderate risk
Benchoufi et al.	2017	France	Proof-of-concept	Clinical trial records	Improved the transparency and processing of data Traceability of the consent protocol	Lack of coherence	Low risk
Toyoda et al.	2017	Japan	Ethereum Proof-of-concept	Transaction records	Supply chain system for anti-counterfeits	Security risks	Low risk
Ichikawa et al.	2017	Japan	Hyperledger Fabric platform	Electronic health records Sensor data	Robust against network issues	Security risks	Low risk
Dorri et al.	2017	Australia	Public blockchain	Electronic health records Sensor data	Reduced validation time	Lack of transparency	Low risk
Saravanan et al.	2017	India	Ethereum	Remote patient monitoring	Access control	Security risks	Moderate risk
Nugent et al.	2016	UK	Ethereum	Clinical trial records	Improved the transparency of clinical trials Monitors and manages records	Scalability Implementation cost	Low risk

Table 2.

Blockchain benefits in health care.

Transparency	Due to the immutability of the recorded data, blockchain is a more transparent system. A transaction that has been confirmed and recorded on a blockchain cannot be removed or changed after that point since the system is immutable.
Decentralization	Given the dispersed players in healthcare, a decentralized management system is required. Blockchain has the potential to become the decentralized foundation for health data management, giving all stakeholders regulated access to consistent health data without the need for a central authority to oversee global health data.
Data integrity	Data integrity is guaranteed via blockchain. Greater security and data integrity are made possible by the distribution of patient records and the immutability of the data. It makes sure there is no centralised authority that might be exposed to security threats.
Automation	Smart contracts enable the automation of several processes that would otherwise need substantial labour resources. Human mistake and judgement are eliminated. By automating specific actions, it lowers transaction costs and eliminates some costs. It leads to increased productivity, cost savings, and a decrease in human error.
Cost saving	It is argued that blockchain can significantly reduce expenses and increase efficiency due to the fact that it is designed to function as a decentralised database. It reduces transaction expenses.
Security & privacy	The blockchain's core value is security. Blockchain offers highly sophisticated security and encryption features. It offers encryption techniques that lessen any security lapses. On-chain and off-chain storage are both acceptable depending on how sensitive the data is.
Enabling platform	With the use of blockchain technology, several cutting-edge technologies, like wearables, smart contracts, big data analytics, and artificial intelligence, may be used more effectively.
Efficiency	The efficiency of operations and technology is increased by blockchain. Because blockchain offers immutable, distributed record-keeping that is verified by community consensus, efficiency is attained. Data reconciliation between all of these parties is no longer necessary, which helps save time and money.
Interoperability	The system's capacity to be decentralised enhances interoperability. Blockchain simplifies access control for the transmission of health information, gives patients more control over their personal health data, and ensures the safe transfer of patient records.
Complete health record	Blockchain technologies can be used to construct a permanent and comprehensive patient health record.
Patient-Centred	While healthcare professionals under the present EHR have complete ownership of those information, patients have the right to control their health records. By including people in their own treatment, it improves patient-centred healthcare.
Ownership of health data	Patients should own and have access and control over their private data. Patients should be able to identify instances of data misuse and demand assurances that third parties won't exploit their health information. These requirements can be satisfied by blockchain thanks to its strong cryptographic protocols and precisely defined smart contracts.

Findings

The current review found that blockchain technology is open, trustworthy, and more responsive to sudden changes than closed and patented software.¹⁷ Moreover, blockchain technology offers low-cost, high computing power on standard hardware because it has been developed using open standards from various vendors. They are based on industry best practices in that they are easy to use and do not require complicated point-to-point data integration.18, 19, 20 Additionally, patients, healthcare organizations, and researchers can contribute their accurate data instantly. Several companies and public institutions have adopted and evaluated this technology as a secure and effective solution. Unlike cloud-based systems, blockchain provides several advantages in terms of security, flexibility, affordability, and reliability. So compared to the high cost and lack of security of cloud computing, blockchain technology appears to be a far better option. For example, in these systems, no data can be viewed by outsiders as the individual nodes only keep encrypted medical records, which helps both patients and clinicians to protect their private information from unwanted intrusions.⁹

Leslie Lamport created the fundamental ideas of blockchain technology in the late 1980s and early 1990s. Afterward, in 2008, Satoshi Nakamoto initiated the digital currency Bitcoin using a digital ledger technology. The blockchain is built on cryptocurrencies such as Bitcoin, Litecoin, and Ethereum. To track transactions, they work with a distributed ledger.⁴ Blockchain is essentially a decentralized node network for data storage with enormous technological potential to secure sensitive data throughout the system. Automation enables the secure and private transfer of sensitive information. It is the best option for keeping all relevant records securely in one place. Blockchain also makes processes faster and more efficient.²¹

Blockchain may lead to a significant shift in the healthcare sector. The organizational structure of the healthcare sector is also on the verge of shifting to a patient-centric strategy that focuses on two crucial aspects: continuous access to appropriate treatment resources. Healthcare organizations can use blockchain technology to provide quality medical facilities and the necessary patient care. The technology could also help manage the lengthy and tedious process of sharing health information, which is a high cost in healthcare. This technology also enables broad public participation in wellness and health research, which in turn could improve treatment options for many populations. A single central database serves as a management tool for the entire healthcare system and all organizations.^22,23

The problem aspects in population health management have so far been data sharing, data privacy, and interoperability. For this specific problem, blockchain technology is trustworthy. Appropriate use of this technology enhances interoperability, real-time updating, integrity, data exchange, access, and security. Secondly, data security is also a major concern, especially in the context of wearable technology and personalized care. Patients and healthcare professionals need a convenient and reliable means to gather, transfer, and consult data over networks without having to worry about security. Security of electronic data management, medical records, digitalized tracking, interoperability, and management of different genotypes are some technical and critical aspects used to utilize and create blockchain technology.²⁴

Technological advancement has made daily life more convenient. For example, the administrative, socio-economic, and political circumstances of some nations influence how technology changes in the medical industry. In addition, technology developed using multiple platforms, such as e-health, m-health, and telemedicine provides simultaneous sharing of health information with patients, clinics, healthcare professionals, the research community, and government organizations.²⁵ For instance, through a series of project calls launched by the health ministry, the significance of these cutting-edge innovative methods to enhance healthcare services in the Kingdom of Saudi Arabia (KSA) is underlined. The Saudi government launched the Vision 2030 initiative which is a bold but achievable plan for a nation with ambitions. The government of the Kingdom launched the National Transformation Plan (NTP) to enhance capabilities and achieve the goals of Vision 2030. The aim of the NTP is to establish the groundwork and pave the way for the achievement of the Vision 2030 goals. The government is also attempting to enhance the healthcare system by commercializing and privatizing it.²⁶

Use of blockchains in healthcare

MIRACL, a C library that enables the security of blockchain communication, was used by Albahli and his collaborators.²⁷ This library implements multi-precision numbers, data types, and cryptography. Any blockchain for healthcare that facilitates research institutes to advance medical research must be accessible to the public. The blockchain data includes information on medications, reports, photos, and health records. An index similar to a card, is suggested for organizing the data stored in the blockchain. The information on the card contains the precise location of the respective patient data. The transactions are processed in encrypted blocks. All medical history information is stored in the healthcare blockchain. All frequently used searches are handled via different types of metadata. The information may be received from hospital departments, laboratories, sensors, or even the patient themselves.^11,28

In that token, numerous hospitals are participating in different blockchain-based projects that have been proposed. Indeed, the applications and benefits of blockchain in auditing, accounting, and business administration have been discussed by Secinaro and others.²⁴ Another well-known examples of the use of a private blockchain for monitoring individual clinical data is the Healthcare Data Gateway (HDG) platform developed by Siyal et al. (2017) to exchange healthcare records in a secure way. Pandey and Litoriya presented the DASH application, which is based on blockchain technology.¹

Introducing measures tailored to patient populations, such as medications, effective delivery methods, and shifting provider reimbursement away from intensity and volume of services towards value and quality, can compromise the true capacity of the healthcare system and the issues that already exist, according to a study by Al Shahrani and colleagues.⁶ In addition to reducing paperwork and increasing inefficient verification, blockchain has been shown to help improve secure management on a variety of levels. While there is a short-term inverse relationship between cost expenditure and the use of blockchain technology, the authors assert that the long-term relationship is positive. Lack of collaboration and economic disparity were identified as the main barriers to the adoption of blockchain technology in the KSA pharmaceutical industry, according to the perceptions of healthcare executives and internet access.

Benefits of blockchain in healthcare management

Blockchain is a promising technology that offers creative possibilities when it is used in the health sector. The recent advancements in blockchain technology within the logistics sector have emphasized the advantages it offers to the healthcare industry. Blockchain is used to maintain health data, carry out clinical studies, keep track of patients, display information, improve security, and promote transparency. The hospital's financial statements are updated while the time and cost of data translation is minimized through this technology. In healthcare and medicine, blockchain applications can accurately detect important and even dangerous errors. Blockchain is essential for processing trial duplicates to improve medical outcomes.²⁹

Blockchain adoption and challenges in healthcare management

Even though blockchain offers several advantages that can help organizations achieve their objectives, its implementation is fraught with difficulties. On the way to transforming the business, implementation and use of blockchain technology may encounter certain difficulties from government, organizations, and society. Despite the acceptance of blockchain technology by the healthcare industry, there are still certain issues that need to be resolved. The biggest problem with using this cutting-edge technology in hospitals is the lack of competence. Blockchain applications are still in the early stages, but technological studies and analysis must continue. Contemporary blockchain applications must adapt to the specific technological limitations and constraints that blockchain technology entails. Moreover, Nagasubramanian (2020) points out the problems of management, storage, and scalability. Data maintenance for each patient cannot be done securely.³⁰ Table 3 outlines some of these challenges.

Table 3.

Blockchain Adoption Challenges and Considerations.

Scalability	The scalability issue with blockchain deployment in healthcare is one of the main worries. With time and the increased use of contemporary technology, the transaction volume and amount of clinical data grow tremendously. One option may be to store data both on-chain and off-chain.
Privacy	The blockchain's distributed architecture creates a conflict between privacy and openness. As each public key's balance and the values of all transactions are available to everyone, some writers contend that blockchain cannot ensure transactional privacy. To increase security and privacy, on-chain and off-chain storage is allowed depending on how sensitive the data is.
Cost	The implementation and use of the blockchain to manage and share patient records is associated with a variety of costs, including the initial outlay, the cost of joining the network, the cost of resolving issues with standardisation, the cost of operation, the cost of data sharing, the cost of adhering to legal requirements, and the cost of maintenance. When all transactions are replicated and broadcast, there will be an increase in computing and network costs as well as power usage.
Technology immaturity	Moreover, because blockchain is a young technology, its present models may be hard to scale, poorly understood, and untested in mission-critical applications.
Clarity and support of stakeholders	The motivations of the stakeholders who appear to be driving the adoption of blockchain technology are unclear, as is the support of numerous influential stakeholders.
Incentives	Lack of financial incentives to construct and participate in a big network blockchain solution is another issue preventing the mainstream adoption of blockchain.
Skills	The abilities necessary to create and maintain the blockchain are insufficient.
Regulatory constraint	Another aspect to take into account is the blockchain's regulatory unpredictability. The degree to which the blockchain complies with current security and privacy laws is regulated. Furthermore, it is challenging to foresee the technology's regulatory future because to its youth and immaturity.
Awareness	The potential for blockchain technology to disrupt the healthcare system and address many of the current healthcare issues should be understood by all levels of the healthcare organisations, from top management to IT departments.
Standardization	The adoption of multiple standards by EHR systems makes data interchange more difficult. Due to the lack of mutually accepted standards across suppliers and customers and the fact that many blockchain providers do not provide software that is interoperable, standardisation necessitates specific considerations throughout the deployment process.

After a thorough analysis of the literature, it was found that big data and blockchain technology have penetrated the supply chain and can completely transform the Saudi Arabian network. Blockchain research for healthcare administration is expanding but needs to be explored further. Other areas where blockchain applications are being utilized include oncology, biological research to save DNA, detecting healthcare insurance fraud, combating counterfeit prescriptions, maintaining medications records, and managing the healthcare supply chain of pharmaceuticals.

Furthermore, blockchain technology has the capacity to improve outcomes for patients and the healthcare system. Accountability, integrity, transparency, confidentiality, and reliability are the five guiding principles of blockchain technology, and each study included in the systematic review addressed at least one of these principles. Ethereum (ETH), Hyper-ledger Fabric, ETH with FileCoin, IBM Hyper-ledger Fabric, InterPlanetary File System (IPFS), open source blockchain, and an “in-house” blockchain technology were the most widely used blockchain platforms. According to the studies we reviewed, ETH was the preferred pre-blockchain platform, perhaps because of its open-source status and cross-industry focus that enables decentralized applications.³¹

Healthcare organizations are under mounting pressure to improve their profitability and manage their rising supply chain costs. As a result, there is a pressing demand for efficient supply chain management in the healthcare industry. To reduce costs, avoid waste and ensure the availability of critical medical supplies, effective supply chain management is crucial. Prioritizing and testing methods to leverage the complementary benefits of public and private sector supply chains is important as countries in the region work towards universal health coverage. Resilience and capacity building are crucial for enhancing health outcomes. A strong supply chain is essential for all public health operations and activities. Also protecting public health and promoting equitable growth are vital for maintaining socio-economic stability in low- and middle-income countries (LMICs), especially in fragile environments. Risk management is also important to health supply chains, closing gaps in the availability and quality of commodities, and promoting inclusive growth are necessary steps to achieve these goals.

Blockchain adoptions: some examples

Estonia is a pioneer in the introduction of blockchain technology at national level. It has used blockchain to secure judicial, legislative, security and commercial code systems, as well as health records. This has significantly improved data integrity, reduced bureaucracy and increased the effectiveness of public services.³² In 2020, India's Ministry of Health launched the CSIR National Healthcare Supply Chain Portal “Aarogyapath” to integrate suppliers, manufacturers, and consumers in the real-time availability of vital medical supplies.³³ PharmEasy, a web-based pharmacy, acquired Aknamed, an Indian healthcare supply chain management platform, in September 2021. The company offers a supply chain platform that enables hospitals to streamline, optimize and track their purchases and consumption using cloud-based technology.³⁴ The government of United Arab Emirates (UAE) has introduced the Emirates Blockchain Strategy 2021 with the aim of using blockchain technology to transfer 50 % of government transactions. The introduction of blockchain has reduced paperwork, brought savings and increased the effectiveness of government transactions. The e-Procurement platform was launched by Bridge Medical GPO at Arab Health 2022 in January 2022. JAGGAER, a provider of supply management systems, developed the software platform. By using this software, healthcare providers in the UAE were able to apply best practices for supply chain management and procurement.³⁵

Georgia has used blockchain technology to confirm property-related government transactions, boosting the security and responsiveness of services related to real estate transactions. Due to the blockchain's public ledger, fraud is considerably decreased, and transparency is guaranteed. Singapore's Monetary Authority has been investigating blockchain for the clearing and settlement of payments and securities under its Project Ubin. This project has the potential to make financial operations more efficient and less risky. The blockchain-based land registration system has completed a trial run at Sweden's Landmäteriet. By providing a single, trusted source of truth, the system improves the security and efficiency of land transactions. The present system used by the Australian Securities Exchange (ASX) to manage the clearing and settlement of equity transactions and track shareholdings is being replaced by a blockchain-based system. This will improve security, save costs, and streamline the procedure.³⁶

However, the management of the healthcare supply chain in KSA faces difficulties, such as the need for temperature-sensitive storage and shipping of certain medical products due to the local environment. In addition, maintaining access to necessary medicines and medical supplies, especially in remote areas, is crucial to tackling inequalities in healthcare. In 2023–2024, the supply chain and logistics sector in KSA is set for significant change. The evolution of the industry will be influenced by the interplay of technology, sustainability, changing consumer tastes, and the dynamics of international commerce. In the future, successful companies will be those that embrace digitalization, automation, sustainability, and supply chain management methods that can adapt to changing consumer needs and trade regulations. The supply chain and logistics sector in KSA faces an exciting and revolutionary future as the Kingdom maintains its position as a major participant in the world of commerce.

Conclusion

Blockchain technology has made new and advanced possibilities in addressing the significant challenges of data protection, integrity, and security in the healthcare sector. Patients can easily access electronic health data through a multi-layered blockchain eHealth system. Through integrated encryption and decentralization technology, blockchain offers innovative applications in healthcare industry. It promotes the commercialization of healthcare data, improves interoperability between healthcare facilities, aids in the development of anti-counterfeiting technologies and enhances the security of electronic health records. This technology would significantly improve the way doctors and patients access and utilize clinical records, and ultimately transforming the delivery of healthcare. This technology is expected to address patient records, improve interoperability, prevent data breaches, streamline processes, control medications and prescriptions, and monitor the supply chain. Countries such as the United States, Estonia, and China have demonstrated practical blockchain applications that contribute to streamlined processes, efficient medication tracking, and improved transparency in supply chains.

Blockchain technology has made new and advanced possibilities in addressing the significant challenges of data protection, integrity, and security in the healthcare sector. Patients can easily access electronic health data through a multi-layered blockchain eHealth system. Through integrated encryption and decentralization technology, blockchain offers innovative applications in healthcare industry. It promotes the commercialization of healthcare data, improves interoperability between healthcare facilities, aids in the development of anti-counterfeiting technologies and enhances the security of electronic health records. This technology would significantly improve the way doctors and patients access and utilize clinical records, and ultimately transforming the delivery of healthcare. This technology is expected to address patient records, improve interoperability, prevent data breaches, streamline processes, control medications and prescriptions, and monitor the supply chain. Countries such as the United States, Estonia, and China have demonstrated practical blockchain applications that contribute to streamlined processes, efficient medication tracking, and improved transparency in supply chains.

In contrast, KSA is still in the early stages of blockchain adoption within its healthcare system. There is limited empirical evidence or documented implementation of blockchain solutions specifically within KSA's healthcare supply chain. Therefore, Healthcare policymakers should implement blockchain in Healthcare Supply Chain Management. However, they need to be cautious about the primary issues with blockchain technology in the healthcare industry which include, the lack of practical applications, the high rate of failed initiatives, and the requirement for collaboration between diverse stakeholders. However, there is a dearth of studies in how to evaluate the acceptability and assist healthcare organisations in using blockchain.

Author contributions

All the authors contributed equally to preparing this manuscript. All authors have critically reviewed and approved the final draft and are responsible for the content and similarity index of the manuscript.

Ethical approval

Not applicable as this study is a systematic review of published articles. It did not entail data collection from humans or animals.

Source of funding

There was no funding obtained to conduct this research.

Conflict of interest

There was no conflict of interest reported by the authors.