IEEE Consumer Electronics Magazine - July/August 2023 - 29

them. Moreover, the number of experts in the field
of blockchain in general and NFTs, in particular, is
considered very small.12 Therefore, adopting this
technology on a large scale while proving its efficiency
and efficacy is still very challenging.
Storage Requirements
Healthcare involves an enormous number of
transactions and interactions among its participants.
Therefore, this can lead to congestion in the
blockchain network, which causes long confirmation
times and high transaction fees.Moreover, the
content of the NFT needs a specialized decentralized
storage system to accommodate a large number
of files that need to be stored. For example,
when a whole genome is sequenced, the produced
file size is around 138 GB,13 which is very large
compared to what the blockchain is designed to
accommodate. Therefore, work around these limitationsmust
be done. For example, large-sized files
can be stored off-chain to free up space and avoid
congestion, and only a hash of that file is stored
on-chain. This technique is commonly used with
InterPlanetary File System (IPFS). However, this
leads to another issue, which is the immutability of
the off-chain stored content. Even though the
NFT's unique address and ID will stay the same,
the real content could be lost if the off-chain storage
no longer has it.
Lack of Regulation Framework
The decentralized nature of blockchain makes
it very challenging for centralized authorities to
impose regulations on the applications or solutions
that are built on it. Given that healthcare
applications, in general, involve sensitive information
about patients, the need for regulations
and audits becomes indispensable.
Privacy
In healthcare, the privacy of patients' information
must be maintained based on the standards
defined by the HIPAA and GDPR.27 Therefore, the
developed smart contracts and NFTs must not
store any sensitive or personal information of the
patients on the blockchain.
Scalability
Scalability is one of the key challenges. It
refers to the ability of the blockchain to provide
July/August 2023
TABLE 2. Possible solutions for NFTs challenges.
Challenge
Solution
Interoperability
with legacy systems
Smart contracts
vulnerabilities
Lack of NFTs
technical experts
Storage
requirements
Lack of regulation
framework
Privacy
Scalability
Cost
Leveraging oracle networks
Performing extensive auditing
and testing
Conducting pilot programs
and workshops
Using incentive-based
decentralized storage
solutions
Establishing and
implementing regulatory
standards
Irreversible encryption
Utilizing on-chain and offchain
scaling solutions
Using private blockchains
high transactional throughput. In order to
achieve high adoption for the use of NFTs in
healthcare, the underlying blockchain that is
handling the transactions must be scalable.
Cost
Performing transactions and interacting with
smart contracts to update the state of the blockchain
requires gas fees. These fees are paid using
the native currency of the blockchain, which is
Ether. Gas fees are determined based on the congestion
of the blockchain network, which means
they can be volatile and unpredictable. Moreover,
theprice of Etheritselfplays aroleinestimating
the total cost of transactions, and given that the
price of Ether is volatile, it adds more complexity
in predicting the cost of transactions.
ADDRESSING NFT CHALLENGES IN
HEALTHCARE
In this section, we suggest solutions to the NFT
adoption challenges as can be seen in Table 2. First,
integrating blockchain or NFTs with the existing legacy
systems can be extremely challenging. This is
because smart contracts are executed on the blockchain
in a deterministic manner, which means
that transactions are executed exactly as written.
Therefore, establishing trust with legacy systems
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IEEE Consumer Electronics Magazine - July/August 2023

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