Table 3.

The evolutionary path of a blockchain–health care ecosystem: the IBM case.

Stage	Cooperative challenges	Competitive challenges
Birth	Stakeholders create new value propositions of blockchain-based ecosystems and define their roles when working with suppliers and customers Players seize opportunities Example: IBM blockchain–health care ecosystem	Protect ideas against competitors with similar offerings Pilot cases with similar features Examples: Change Healthcare’s Intelligent Healthcare Network with blockchain processes, Synaptic Health Alliance, and ProCredEx
Expansion	Bring new innovations (ie, products or services) to market to increase the market share or coverage Strategy: optimize platform functionality, absorb complementary health care members, and identify and address changing demands from customers	Compete with and defeat rival implementations Expand market share by establishing market or technical standards Strategy: build up technical or industrial standards and expand the adoption of blockchain-based applications
Leadership	Make future prospects and encourage partners to step forward Measure: integrate with other disrupting technologies (eg, machine learning, artificial intelligence, mobile and ubiquitous health, wearables, and internet of things)	Maintain bargaining power against ecosystem players Measures: keep customers satisfied and strengthen the customer relationship management; use backward integration, search multiple suppliers, increase profile, and conduct market education
Self-renewal or death	Cope with innovators to generate or seize new opportunities or be replaced by alternative paradigms	Build high levels of entry barriers and customer switching costs to prevent being replaced by alternative ecosystems