# Blockchain Technology in Healthcare: A Comprehensive Review and Directions for Future Research
## 4 Supply Chain Management  
SCM is designed to include best practices of the industry to streamline the entire delivery processes from ordering to supply [101; 102]. SCM is a challenging prospect in healthcare; with scattered ordering settings of medical supplies, drugs and critical resources, there is inherit risk of compromising the supply chain process that might directly impact patients' safety [103; 104]. According to a study by the World Health Organization (WHO) [105], more than 100,000 people die in Africa due to improper dosing from counterfeited drugs ordered from not known or trusted vendors. In addition to product and drug counterfeiting, lacking product registry and packaging errors in a healthcare facility may disrupt the entire SCM [106]. Blockchain is particularly key monitoring technology for tapping into the whole process of drugs and medical products movement [107]. Since all transactions are recorded ontothe ledger, and every node in the blockchain maintains a record of the transaction, it is easy to verify the origin of the drug, the vendor and the distributor instantly. Furthermore, the distributed ledger of the blockchain allows healthcare officials and physician to check and authenticate the credentials of suppliers [108]. With better insight into the supply chain through proper and timely authentication process, pharmacies and healthcare providers will be able to ensure that the flow of authentic drugs continues to reach those patients who need it the most. In this regard, blockchain technology holds a great promise for establishing a trusted network of vendors that allow healthcare administrators to guard patients from disreputable suppliers. Furthermore, blockchain technology promises significant enhancement on demand forecasting, data provenance, fraud prevention, and transaction. Figure 4 illustrates a pharmaceutical SCM process using blockchain technology.
* Step-1: A block is created upon the invention of a new medicine or medical care which includes patent protection and a long process of clinical trials. This information is recorded in the digital ledger as a form of transaction.
* Step-2: Once the clinical trial is successful, the patent is sent to the manufacturing plant for test prototype and mass production. Every product has its own unique identity that is integrated with another transaction or block in the blockchain including other relevant information.
* Step-3: Once the mass production along with packaging is finished, medicine is gathered in a warehouse for future distribution. Information such as, time, lot number, barcode, expiry date are included in the blockchain.
* Step-4: Transportation information is also included in the blockchain which may include time out from one warehouse (IN) to other, mode of transportation, authorized agent, and other information.
* Step-5: A third-party distribution network is normally responsible for distributing drugs and medical supplies to healthcare providers or retailers. A warehouse (OUT) for each third party is used for this purpose from where all distribution endpoints are linked. A separate transaction is also integrated into the blockchain.
* Step-6: Care providers such as hospitals, or clinics need to provide information, for example, batch number, lot number, product owner, expired date to authenticate, and prevent counterfeit. This is also included in the blockchain.
* Step-7: The actions taken by a retailer are similar to Step-6.
* Step-8: Patients are encouraged to determine authenticity throughout the whole process as blockchain supply chain offers transparent information for verification to potential buyers.