Beyond the Hype: What Blockchain Can—and Cannot Yet—Deliver for Digital Health

A new peer-reviewed study co-authored by MindSkiller founder Professor Gary Galambos examines nearly 900 studies to ask a deceptively simple question: is blockchain actually improving digital health governance, or are we still mostly building prototypes? 

Digital health is becoming extraordinarily powerful.

Electronic health records, telehealth, remote monitoring, wearable devices and artificial intelligence are creating unprecedented opportunities to collect, analyse and exchange health information. But as our ability to use health data expands, an equally important question becomes harder to answer:

Who controls that data, who is allowed to access it, how is consent managed, and how can patients and clinicians know that what happens to the data is transparent and accountable? 

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These are not simply cybersecurity problems. They are problems of digital health governance.

That is the focus of a newly published peer-reviewed paper in the Journal of Medical Internet Research (JMIR) , “Blockchain for Digital Health Governance: Evidence Gap Map and Scoping Review.” The paper was published on 7 October 2026 and includes Professor Gary Galambos, founder of MindSkiller's parent company Dr Egg Pty Ltd, among its authors.

The study provides an unusually large overview of where blockchain and distributed ledger technology (DLT) currently sit within healthcare—and its conclusions are both encouraging and sobering.

Why might blockchain matter in healthcare?

Blockchain is commonly associated with cryptocurrency. But that is not the role examined in this research.

In healthcare, its potentially more interesting function is as a governance layer.

Rather than putting a patient's medical record itself onto a blockchain, a distributed ledger can potentially provide a tamper-evident record of things such as permissions, consent decisions, identity, access events, provenance and transactions. The underlying identifiable health information can remain securely stored elsewhere.

Think of it less as a new filing cabinet for medical records and more as a potentially trustworthy digital record of who was allowed to do what, with which information, when and under what authority.

That distinction is important.

As healthcare becomes increasingly distributed between hospitals, private clinicians, researchers, digital platforms, diagnostic services, patients and AI-enabled technologies, governance can no longer always depend upon a single organisation controlling everything.

The study found that blockchain/DLT has consequently been investigated for functions including privacy and security, interoperability and data sharing, access control, data integrity, identity and authentication, auditability, AI and data governance, provenance, compliance and consent management.

An enormous literature—but very little real-world implementation

Perhaps the most striking finding from the research is the scale of the gap between technical experimentation and real-world healthcare implementation.

The review included 892 peer-reviewed studies.

Of these:

• 418 were proof-of-concept or prototype studies;
• 455 involved simulations or benchmarked evaluations;
• just 18 reported pilot or usability-tested implementations; and
• only one was classified as an operational real-world deployment.

In other words, blockchain in healthcare has generated a remarkable amount of research activity—but comparatively little evidence that these technologies have made the transition into sustained clinical or healthcare-system use.

The authors describe this as a fundamental gap between technical possibility and implemented governance. A system can work technically without necessarily being usable, trusted, scalable, sustainable or appropriate for real-world healthcare.

That is an important lesson for digital health more broadly.

Innovation is not demonstrated simply because a technology can be built. 

Ultimately, it must improve something that matters.

Where is blockchain being investigated?

The evidence was spread across six major areas of healthcare.

Electronic health records and health-information exchange represented the largest field, with 372 studies, followed by telemedicine, distributed care and IoT-enabled remote monitoring with 250 studies.

Other areas included clinical decision support and smart healthcare, public-health surveillance and certification, clinical trials and research governance, and health-data marketplaces.

Across these applications, however, a common pattern emerged.

Blockchain was generally not being used to store identifiable clinical information. Instead, it was being explored as a coordination and verification layer supporting access-control logs, consent records, authentication, auditability, provenance, integrity and interoperability.

This may ultimately prove to be one of the most useful ways to think about blockchain in healthcare.

From "blockchain healthcare" to trusted digital health ecosystems

At MindSkiller, this question is particularly relevant.

The future of digital mental healthcare is unlikely to consist of a single application operating in isolation. Increasingly, care can involve patients, clinicians, hospitals, outcome-measure platforms, telehealth, research systems, AI-enabled tools and other digital technologies.

As these ecosystems become richer, the challenge is no longer simply: Can these technologies communicate? 

We also need to ask: Can they communicate in a way that is transparent, permissioned, accountable and worthy of patients' trust? 

The study suggests that distributed ledger technologies could have a role here—particularly when multiple organisations or actors need to exchange, authorise, validate or audit information without relying entirely upon a single central authority.

Potential settings include cross-institutional health-information exchange, multicentre research, genomic databases, biobanks and patient-mediated data sharing.

But importantly, the paper does not argue that blockchain should automatically be used.

Quite the opposite.

Blockchain is not the answer to every digital-health problem

One of the most important conclusions of the review is that blockchain should not become a technology looking for a problem.

Where healthcare systems are already centralised and trusted, conventional databases, federated architectures, secure access controls and audit logs may achieve the same objectives with substantially less complexity.

Blockchain/DLT may be most useful where governance itself is distributed—where there are multiple institutions, distributed authority, relatively low baseline trust or particularly strong requirements for independent verification and auditability.

And technology cannot solve every governance problem.

A blockchain might reliably record that consent was given or withdrawn, for example. It cannot establish that the patient truly understood that consent, nor can it resolve questions of ethics, power, regulation, data ownership or institutional accountability.

As the authors argue, governance therefore needs to be designed around the whole sociotechnical system—not the ledger alone.

The next phase needs evidence, not more hype

This may be the paper's most important message.

After years of prototypes and technical demonstrations, the field needs to move toward implementation science and comparative evaluation.

Instead of asking simply whether blockchain can be incorporated into healthcare, researchers and developers should be asking whether it produces measurable improvements in: Consent traceability, transparency, accountability, access control, interoperability, administrative efficiency, user trust, cost-effectiveness and long-term sustainability. 

And crucially, blockchain-enabled systems need to be compared with conventional alternatives.

Otherwise, technological novelty risks being mistaken for clinical or organisational value.

Why this matters for MindSkiller

For MindSkiller, the significance of this research extends beyond blockchain itself.

Our broader interest is in how digital technology can support healthcare while maintaining patient agency, privacy, transparency, trust and accountable clinical governance.

As digital mental healthcare increasingly incorporates AI, personalised interventions, longitudinal outcome measurement and research, these questions will only become more important.

The future may involve highly interconnected digital-health ecosystems in which patients can understand and control permissions around their information; researchers can establish provenance and integrity; clinicians can confidently exchange information across services; and access and consent events can be transparently audited.

Blockchain may ultimately form part of the infrastructure supporting that future.

But this review suggests that the responsible position today is neither to dismiss blockchain nor to promote it uncritically.

It is to test it.

The paper concludes that blockchain/DLT should ultimately be judged by its contribution to governance performance—not by its technological novelty. The real question is whether these systems can make healthcare data access more accountable, consent more transparent, data exchange more trustworthy and collaboration across organisations more reliable.

That is also a useful principle for digital health innovation generally.

The technology is not the destination. Better, safer and more trustworthy healthcare is. 

About the research 

Blockchain for Digital Health Governance: Evidence Gap Map and Scoping Review was authored by Sarina Yaghobian, Nina Sulkowski, Gary Galambos, Linda Scarazzini, Nicolas Maloumian and Stephane Verhaeghe and published in the Journal of Medical Internet Research , Volume 28, 2026.

A/Professor Gary Galambos is a psychiatrist and the founder of Dr Egg Pty Ltd, the company behind MindSkiller. He contributed to validation and review and editing of the published manuscript.