Journal of Modern Medical

Introduction
The emergence of Internet of Things (IoT) technology has improved the quality of patient care with remote patient monitoring. It is a network of sensors, including wearable and mobile sensors that record health-related data. It acts as a bridge between the sensors and remote servers and performs most of the data transfer and common services such as protocol conversion. It seems to be difficult to maintain data privacy in case of using IoT technology. Decentralized architecture can be used to solve this security problem. As an emerging technology, blockchain supports decentralized architecture and provides secure sharing of IoT network data and resources.
Considering the importance of implementing IoT and Blockchain technologies in health and the necessity of feasibility of each plan before implementation, this study aims to assess the technical, economic, managerial, educational and cultural infrastructures of blockchain and IoT technologies for implementation in hospitals affiliated to Tabriz University of Medical Sciences (TUMS) from the perspective of users.
Methods
This is a descriptive cross-sectional study that was conducted in 2020. The study population consisted of the personnel of health information management, medical informatics and health information technology of all hospitals of TUMS in Iran. Among hospitals, only 8 hospitals volunteered. The personnel familiar with the concepts of IoT and Blockchain and those who were willing to cooperate were included in the study. In this regard, 30 participated.
The data collection tool was a researcher-made questionnaire whose items were formulated based on relevant articles and the validity was confirmed by experts in health information management. to assess out content validity, a checklist was prepared and sent to 8 experts to determine the degree of simplicity, relevance and clarity of each item. The questionnaire had 42 items and 5 domains including technical infrastructure (13 questions), economic infrastructure (8 questions), managerial infrastructure (8 questions), educational infrastructure (5 questions), and cultural infrastructure (8 questions). The items were rated on a scale as 1=very low, 2= low, 3= moderate, 4=high, and 5=very high. After collecting data, they were entered into SPSS software, version 16 for analysis.
Results
In terms of technical domain, the following components were reported as very important: access to high-speed Internet in all clinical units, standardization of health and medical devices, the possibility of exchanging information between the systems of different units, equipping the hospitals’ online network with optical fiber, access to the required hardware such as sensors, integrated transfer of old systems and their setup based on the IoT technology, security in data collection and encryption by sensors, security of data stored on the database, analysis and needs assessment for designing system and software, development of encryption protocols in blockchain, and digital data management structure in blockchain. In terms of economic domain, the most important components for implementation of IoT technology were: The cost of installation and operation, the cost of maintaining the hardware and software, and the support by the government and sufficient investment. In terms of managerial domain, the most important components were: Managers’ inadequate understanding of information systems, the occurrence of the phenomenon of resistance to change in system administrators, and the support of senior managers. In terms of educational domain, providers’ awareness of the advantages of blockchain and IoT, providers’ willingness to acquire new skills, educating specialists and holding training courses for health service professionals were the most important components. Among the cultural components, only the component of structural changes had high importance for the implementation of Blockchain and IOT technology; the rest were of moderate importance.
Discussion
The purpose of this study was to investigate the necessary infrastructure for the implementation of IoT and Blockchain technologies in selected hospitals in Tabriz. By using the IoT technology, patients can easily see and be fully informed about their treatment process at any time and in any place. The IoT is considered a modern technology and its economic impact is many times greater than the impact of the Internet in different countries; like any other technology, it has its own challenges. Privacy is still a fundamental challenge. Blockchain-based approaches provide decentralized privacy and security.
The results showed that technical infrastructure was the most important factor for the implementation of IoT technology and Blockchain, followed by managerial and educational infrastructure which were more important than cultural and economic infrastructure. Among the 42 components that were investigated in this study, 26 components were perceived as very important including “security of data stored on the database”, “analysis and need assessment for designing system and software”, “possibility of exchanging information between the systems of different units”, “installation cost”, and “standardization of health and medical devices”. Paying attention to these components can facilitate the implementation of blockchain and IoT technology in hospitals of Iran.

Ethical Considerations
Compliance with ethical guidelines
This study has ethical approval from Tabriz University of Medical Sciences (Code: IR.TBZMED. REC.1399.498).

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors' contributions
Conceptualization: Elham Masserat, Zeinab Mohammadzadeh; Data analysis: Elham Masserat, Zeinab Mohammadzadeh, Fatemeh Mohammadi, Maryam Kamali; Data interpretation and preparing initial draft: Zeinab Mohammadzadeh, Elham Masserat; Data collection: , Fatemeh Mohammadi, Maryam Kamali; Writing-original draft, supervision, and editing & Review: Elham Masserat, Zeinab Mohammadzadeh, Fatemeh Mohammadi, Maryam Kamali.

Conflicts of interest
The authors declared no conflict of interest.

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