Methods Inf Med 2020; 59(06): 193-204
DOI: 10.1055/s-0041-1727193
Original Article

Efficient Clinical Data Sharing Framework Based on Blockchain Technology

Karamo Kanagi
1   Institute of Information Management, National Chiao Tung University, Hsin-Chu City, Taiwan
,
Cooper Cheng-Yuan Ku
1   Institute of Information Management, National Chiao Tung University, Hsin-Chu City, Taiwan
,
Li-Kai Lin
1   Institute of Information Management, National Chiao Tung University, Hsin-Chu City, Taiwan
2   Division of Information Technology, Data Communications Branch, Chunghwa Telecom Inc., Taipei City, Taiwan
,
Wen-Huai Hsieh
3   Department of Information Management, National Chung Cheng University, Chia-Yi County, Taiwan
4   Department of Surgery, Ministry of Health and Welfare, Chang-Hua Hospital, Chang-Hua County, Taiwan
› Author Affiliations

Abstract

Background While electronic health records have been collected for many years in Taiwan, their interoperability across different health care providers has not been entirely achieved yet. The exchange of clinical data is still inefficient and time consuming.

Objectives This study proposes an efficient patient-centric framework based on the blockchain technology that makes clinical data accessible to patients and enable transparent, traceable, secure, and effective data sharing between physicians and other health care providers.

Methods Health care experts were interviewed for the study, and medical data were collected in collaboration with Ministry of Health and Welfare (MOHW) Chang-Hua hospital. The proposed framework was designed based on the detailed analysis of this information. The framework includes smart contracts in an Ethereum-based permissioned blockchain to secure and facilitate clinical data exchange among different parties such as hospitals, clinics, patients, and other stakeholders. In addition, the framework employs the Logical Observation Identifiers Names and Codes (LOINC) standard to ensure the interoperability and reuse of clinical data.

Results The prototype of the proposed framework was deployed in Chang-Hua hospital to demonstrate the sharing of health examination reports with many other clinics in suburban areas. The framework was found to reduce the average access time to patient health reports from the existing next-day service to a few seconds.

Conclusion The proposed framework can be adopted to achieve health record sharing among health care providers with higher efficiency and protected privacy compared to the system currently used in Taiwan based on the client–server architecture.



Publication History

Received: 02 October 2020

Accepted: 02 February 2021

Article published online:
12 May 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Guo R, Shi H, Zhao Q, Zheng D. Secure attribute-based signature scheme with multiple authorities for blockchain in electronic health records systems. IEEE Access 2018; 6: 11676-11686
  • 2 Wulff A, Montag S, Marschollek M, Jack T. Clinical decision-support systems for detection of systemic inflammatory response syndrome, sepsis, and septic shock in critically ill patients: a systematic review. Methods Inf Med 2019; 58 (S02): e43-e57
  • 3 Lin MC, Vreeman DJ, McDonald CJ, Huff SM. Auditing consistency and usefulness of LOINC use among three large institutions - using version spaces for grouping LOINC codes. J Biomed Inform 2012; 45 (04) 658-666
  • 4 Durojaiye AB, Puett LL, Levin S. et al. Linking electronic health record and trauma registry data: assessing the value of probabilistic linkage. Methods Inf Med 2018; 57 (05,06): 261-269
  • 5 Shrier AA, Chang A, Diakun-Thibault N. et al. Blockchain and health IT: algorithms, privacy, and data. White paper. Accessed february 25, 2021 at: https://www.healthit.gov/sites/default/files/1-78-blockchainandhealthitalgorithmsprivacydata_whitepaper.pdf
  • 6 Jian WS, Wen HC, Scholl J. et al. The Taiwanese method for providing patients data from multiple hospital EHR systems. J Biomed Inform 2011; 44 (02) 326-332
  • 7 Li YCJ, Yen JC, Chiu WT, Jian WS, Syed-Abdul S, Hsu MH. Building a national electronic medical record exchange system - experiences in Taiwan. Comput Methods Programs Biomed 2015; 121 (01) 14-20
  • 8 Bhattacharya P, Tanwar S, Bodke U, Tyagi S, Kumar N. BinDaaS: blockchain-based deep-learning as-a-service in healthcare 4.0 applications. IEEE/ACM Transact Netw Sci Engineer 2019. Doi: 10.1109/TNSE.2019.2961932
  • 9 Tanwar S, Parekh K, Evans R. Blockchain-based electronic healthcare record system for Healthcare 4.0 applications. J Inform Secur Appl 2020; 50: 102-407
  • 10 Hathaliya JJ, Tanwar S, Tyagi S, Kumar N. Securing electronics healthcare records in Healthcare 4.0: A biometric-based approach. Comput Electr Eng 2019; 76: 398-410
  • 11 Nakamoto S. Bitcoin: a peer-to-peer electronic cash system. Accessed August 5, 2019 at: http://bitcoin.org/bitcoin.pdf
  • 12 Akram SV, Malik PK, Singh R, Anita G, Tanwar S. Adoption of blockchain technology in various realms: opportunities and challenges. Security Privacy 2020; 3 (05) e109
  • 13 Hölbl M, Kompara M, Kamisalic A, Nemec ZL. A systematic review of the use of blockchain in healthcare. Symmetry (Basel) 2018; 10: 470
  • 14 Tanwar S, Bhatia Q, Patel P, Kumari A, Singh PK, Hong WC. Machine learning adoption in blockchain-based smart applications: the challenges, and a way forward. IEEE Access 2020; 8: 474-488
  • 15 Linn LA, Koo MB. Blockchain for health data and its potential use in health it and health care related research. Accessed August 15, 2020 at: https://www.healthit.gov/sites/default/files/11-74-ablockchainforhealthcare.pdf
  • 16 Hathaliya J, Sharma P, Tanwar S, Gupta R. . Blockchain-based remote patient monitoring in Healthcare 4.0. Paper presented at IEEE 9th International Conference on Advanced Computing (IACC); December 13–14,2019; Tiruchirappalli, India
  • 17 Buterin V. Ethereum white paper: a next generation smart contract and decentralized application platform, 2013. Accessed February 25, 2021 at: https://ethereum.org/en/whitepaper/
  • 18 Szabo N. Smart contracts: Building blocks for digital markets. Accessed February 25, 2021 at: https://www.fon.hum.uva.nl/rob/Courses/InformationInSpeech/CDROM/Literature/LOTwinterschool2006/szabo.best.vwh.net/smart_contracts_2.html
  • 19 Sadiku MNO, Eze KG, Musa SM. Smart contracts: a primer. J Sci Eng Res 2018; 5 (05) 538-541
  • 20 Katuwal GJ, Pandey S, Hennessey M, Lamichhane B. Applications of blockchain in healthcare: current landscape & challenges. Accessed February 25, 2021 at: https://arxiv.org/pdf/1812.02776.pdf
  • 21 Regenstrief Institute. LOINC Development. Accessed July 19, 2019 at: https://loinc.org/about/loinc-development/
  • 22 McDonald CJ, Huff SM, Suico JG. et al. LOINC, a universal standard for identifying laboratory observations: a 5-year update. Clin Chem 2003; 49 (04) 624-633
  • 23 Lin MC, Vreeman DJ, Huff SM. Investigating the semantic interoperability of laboratory data exchanged using LOINC codes in three large institutions. AMIA Annu Symp Proc 2011; 2011: 805-814
  • 24 Dubovitskaya A, Xu Z, Ryu S, Schumacher M, Wang F. Secure and trustable electronic medical records sharing using blockchain. AMIA Annu Symp Proc 2017; 2017: 650-659
  • 25 Azaria A, Ekblaw A, Vieira T, Lippman A. Medrec: Using blockchain for medical data access and permission management. Published at 2nd International Conference on Open and Big Data (OBD). August 22–24,2016; Vienna, Austria
  • 26 Vora J, Nayyar A, Tanwar S. et al. BHEEM: A blockchain-based framework for securing electronic health records, paper presented at IEEE Globecom Workshops. December 9–13,2018; Abu Dhabi, United Arab Emirates
  • 27 Zhang P, White J, Schmidt DC, Lenz G, Rosenbloom ST. FHIRchain: applying blockchain to securely and scalably share clinical data. Comput Struct Biotechnol J 2018; 16: 267-278
  • 28 Peterson KJ, Deeduvanu R, Kanjamala P, Mayo K. A blockchain-based approach to health information exchange networks. Accessed August 17, 2019 at: https://www.semanticscholar.org/paper/A-Blockchain-Based-Approach-to-Health-Information-Peterson-Deeduvanu/c1b189c81b6fda71a471adec11cfe72f6067c1ad
  • 29 Gupta R, Shukla A, Mehta P. et al. VAHAK: A blockchain-based outdoor delivery scheme using UAV for Healthcare 4.0 services. Paper presented at IEEE INFOCOM 2020— IEEE Conference on Computer Communications Workshops (INFOCOM WKSHPS). July 6–9,2020; Toronto, ON, Canada
  • 30 Osmov V, Kurbanniyazov A, Hussain R, Oracevic A, Kazmi SMA, Hussain F. On the blockchain-based general-purpose public key infrastructure. Paper presented at IEEE/ACS 16th International Conference on Computer Systems and Applications (AICCSA) 2019; November 3–7,2019; Abu Dhabi, United Arab Emirates
  • 31 De Angelis S, Aniello L, Baldoni R, Lombardi F, Margheri A, Sassone V. PBFT vs proof-of-authority: applying the CAP theorem to permissioned blockchain, 2017. Accessed July 9, 2020 at: https://eprints.soton.ac.uk/415083/2/itasec18_main.pdf
  • 32 Martínez VG, Encinas LH, Ávila CS. A survey of the elliptic curve integrated encryption scheme. J Comput Sci Eng 2010; 2 (02) 7-13
  • 33 Thyvalikakath TP, Duncan WD, Siddiqui Z. et al; National Dental PBRN Collaborative Group. Leveraging electronic dental record data for clinical research in the national dental PBRN practices. Appl Clin Inform 2020; 11 (02) 305-314