IEEE J Biomed Health Inform. 2020 Aug;24(8):2169-2176. doi: 10.1109/JBHI.2020.2993072. Epub 2020 May 8.
Health Information Exchange (HIE) exhibits remarkable benefits for patient care such as improving healthcare quality and expediting coordinated care. The Office of the National Coordinator (ONC) for Health Information Technology is seeking patient-centric HIE designs that shift data ownership from providers to patients. There are multiple barriers to patient-centric HIE in the current system, such as security and privacy concerns, data inconsistency, timely access to the right records across multiple healthcare facilities. After investigating the current workflow of HIE, this paper provides a feasible solution to these challenges by utilizing the unique features of blockchain, a distributed ledger technology which is considered "unhackable". Utilizing the smart contract feature, which is a programmable self-executing protocol running on a blockchain, we developed a blockchain model to protect data security and patients' privacy, ensure data provenance, and provide patients full control of their health records. By personalizing data segmentation and an "allowed list" for clinicians to access their data, this design achieves patient-centric HIE. We conducted a large-scale simulation of this patient-centric HIE process and quantitatively evaluated the model's feasibility, stability, security, and robustness.
健康信息交换 (HIE) 为患者护理带来了显著的益处，例如提高医疗质量和加快协调护理。国家卫生信息技术协调员办公室 (ONC) 正在寻求以患者为中心的 HIE 设计，将数据所有权从提供者转移给患者。在当前系统中，以患者为中心的 HIE 存在多个障碍，例如安全和隐私问题、数据不一致、在多个医疗机构及时访问正确的记录。在调查 HIE 的当前工作流程后，本文通过利用区块链的独特功能提供了一个可行的解决方案，区块链是一种分布式账本技术，被认为是“无法破解”的。利用智能合约功能，这是在区块链上运行的可编程自执行协议，我们开发了一个区块链模型来保护数据安全和患者隐私，确保数据来源，并为患者提供对其健康记录的完全控制。通过个性化数据分段和临床医生访问其数据的“允许列表”，实现以患者为中心的 HIE。我们对这个以患者为中心的 HIE 过程进行了大规模模拟，并对模型的可行性、稳定性、安全性和鲁棒性进行了定量评估。
