Application of Blockchain to Maintaining Patient Records in Electronic Health Record for Enhanced Privacy, Scalability, and Availability
Application of Blockchain to Maintaining Patient Records in Electronic Health Record for Enhanced Privacy, Scalability, and Availability
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DOI：
10.4258/hir.2020.26.1.3
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发表时间：
2020-01-01
影响因子：
2.9
通讯作者：
Ohyama, Nagaaki
中科院分区：
文献类型：
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作者：
Tith, Dara;Lee, Joong-Sun;Ohyama, Nagaaki
目的：电子病历(EHR)系统作为不同医院之间共享病历的一种有效手段，得到了越来越广泛的应用。然而，通过多个电子病历访问分散的患者数据仍然是一个挑战。我们的目标是建立一个系统，在电子病历中轻松访问患者记录，而不依赖于一个集中的监督系统。方法：应用联合区块链，利用Hyperledger Fabric构建一个分布式系统，整合现有的EHR。对等节点持有写有电子病历中患者记录地址的同一分类账。个别患者由当地证书颁发机构颁发的唯一证书来识别，这些证书在网络的一个渠道中相互协作。为了保护患者的隐私，我们在传输数据时使用代理重新加密方案。我们设计并实现了各种链码来处理网络成员组织商定的业务逻辑。结果：我们开发了一个原型系统来实现我们的概念，并测试了它的性能，包括链码逻辑。结果表明，我们的系统可以被医生用来查找患者的记录，并验证患者对访问数据的同意。患者还可以无缝地从其他医院接收他们过去的记录。访问日志以透明和不变的方式存储在用于审计目的的分类帐中。结论：我们的系统是可行和灵活的，具有可扩展性和可用性，以适应现有的EHR，以加强患者病历管理的安全性和隐私性。我们的研究有望为整合分散在医疗机构之间的病历提供一种有效的方法。
Objectives: Electronic Health Record (EHR) systems are increasingly used as an effective method to share patients' records among different hospitals. However, it is still a challenge to access scattered patient data through multiple EHRs. Our goal is to build a system to access patient records easily among EHRs without relying on a centralized supervisory system. Methods: We apply consortium blockchain to compose a distributed system using Hyperledger Fabric incorporating existent EHRs. Peer nodes hold the same ledger on which the address of a patient record in an EHR is written. Individual patients are identified by unique certificates issued by a local certificate authorities that collaborate with each other in a channel of the network. To protect a patient's privacy, we use a proxy re-encryption scheme when the data are transferred. We designed and implemented various chaincodes to handle business logic agreed by member organizations of the network. Results: We developed a prototype system to implement our concept and tested its performance including chaincode logic. The results demonstrated that our system can be used by doctors to find patient's records and verify patient's consent on access to the data. Patients also can seamlessly receive their past records from other hospitals. The access log is stored transparently and immutably in the ledger that is used for auditing purpose. Conclusions: Our system is feasible and flexible with scalability and availability in adapting to existing EHRs for strengthening security and privacy in managing patient records. Our research is expected to provide an effective method to integrate dispersed patient records among medical institutions.