A Blockchain Framework for Patient-Centered Health Records and Exchange (HealthChain): Evaluation and Proof-of-Concept Study
A Blockchain Framework for Patient-Centered Health Records and Exchange (HealthChain): Evaluation and Proof-of-Concept Study
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DOI：
10.2196/13592
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发表时间：
2019-08-30
影响因子：
7.4
通讯作者：
Zeng, Xiaoming
中科院分区：
文献类型：
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作者：
Hylock, Ray Hales;Zeng, Xiaoming
背景：区块链有可能颠覆当前患者数据获取、积累、贡献、交换和控制的模式。利用互操作性标准、智能合约和加密身份，患者能够安全地与医疗服务提供者交换数据并规范访问权限。由此产生的全面、纵向的医疗记录可以显著提高针对个人和人群的患者医疗成本效益和质量。
目的：本研究提出了HealthChain，一种新型的以患者为中心的区块链框架。其目的是在安全、互操作的环境中促进患者参与、数据管理以及对所积累信息的规范传播。提出了一种混合区块链来支持不可篡改的日志记录和可编辑的患者数据块。患者数据通过医疗信息交换标准第7层快速医疗互操作性资源（Health Level - 7 Fast Healthcare Interoperability Resources）生成和交换，从而允许与兼容系统无缝传输。此外，患者会收到公钥和私钥对形式的加密身份。公钥存储在区块链中，适用于保障和验证交易。再者，设想的系统使用代理重加密（PRE）通过可撤销的智能合约共享信息，确保隐私和保密性。最后，提出了一些代理重加密的改进措施以提高性能和安全性。
方法：该框架的制定是为了解决区块链在医疗保健领域应用的关键障碍，即信息安全、互操作性、数据完整性、身份验证和可扩展性。它通过对4种模式的操作支持16种配置。开发了一个开源的概念验证工具来评估新型患者数据块组件和系统配置的性能。为了展示所提出框架的实用性并评估资源消耗，在涉及不同数量现有和导入记录的各种场景下，对16种配置中的每一种都进行了广泛测试。
结果：结果表明有几种明显的高性能、低带宽配置，尽管它们在加密方面不是最强的。在最强的模型中，预期的累积记录大小被证明会影响选择。尽管最有效的算法最终因用户而异，但使用静态密钥的高级加密标准（Advanced Encryption Standard）加密数据、增量服务器存储且无额外服务器端加密的方式速度最快且带宽需求最低，而使用动态密钥的代理重加密数据、增量服务器存储且有额外服务器端加密的方式在最强配置中性能最佳。
结论：区块链是一种强大且可行的技术，可用于以患者为中心的健康信息访问和交换。通过将结构化、互操作的设计与通过智能合约共享的患者积累和生成的数据集成到一个普遍可访问的区块链中，HealthChain为患者和医疗服务提供者提供了获取一致且全面的医疗记录的途径。所解决的挑战包括数据安全、互操作性、数据块存储以及患者管理的数据访问，并且出现了几种配置，在速度和安全性方面值得进一步考虑。
Background: Blockchain has the potential to disrupt the current modes of patient data access, accumulation, contribution, exchange, and control. Using interoperability standards, smart contracts, and cryptographic identities, patients can securely exchange data with providers and regulate access. The resulting comprehensive, longitudinal medical records can significantly improve the cost and quality of patient care for individuals and populations alike.Objective: This work presents HealthChain, a novel patient-centered blockchain framework. The intent is to bolster patient engagement, data curation, and regulated dissemination of accumulated information in a secure, interoperable environment. A mixed-block blockchain is proposed to support immutable logging and redactable patient blocks. Patient data are generated and exchanged through Health Level-7 Fast Healthcare Interoperability Resources, allowing seamless transfer with compliant systems. In addition, patients receive cryptographic identities in the form of public and private key pairs. Public keys are stored in the blockchain and are suitable for securing and verifying transactions. Furthermore, the envisaged system uses proxy re-encryption (PRE) to share information through revocable, smart contracts, ensuring the preservation of privacy and confidentiality. Finally, several PRE improvements are offered to enhance performance and security.Methods: The framework was formulated to address key barriers to blockchain adoption in health care, namely, information security, interoperability, data integrity, identity validation, and scalability. It supports 16 configurations through the manipulation of 4 modes. An open-source, proof-of-concept tool was developed to evaluate the performance of the novel patient block components and system configurations. To demonstrate the utility of the proposed framework and evaluate resource consumption, extensive testing was performed on each of the 16 configurations over a variety of scenarios involving a variable number of existing and imported records.Results: The results indicate several clear high-performing, low-bandwidth configurations, although they are not the strongest cryptographically. Of the strongest models, one's anticipated cumulative record size is shown to influence the selection. Although the most efficient algorithm is ultimately user specific, Advanced Encryption Standard-encrypted data with static keys, incremental server storage, and no additional server-side encryption are the fastest and least bandwidth intensive, whereas proxy re-encrypted data with dynamic keys, incremental server storage, and additional server-side encryption are the best performing of the strongest configurations.Conclusions: Blockchain is a potent and viable technology for patient-centered access to and exchange of health information. By integrating a structured, interoperable design with patient-accumulated and generated data shared through smart contracts into a universally accessible blockchain, HealthChain presents patients and providers with access to consistent and comprehensive medical records. Challenges addressed include data security, interoperability, block storage, and patient-administered data access, with several configurations emerging for further consideration regarding speed and security.