ACTION-EHR: Patient-Centric Blockchain-Based Electronic Health Record Data Management for Cancer Care
ACTION-EHR: Patient-Centric Blockchain-Based Electronic Health Record Data Management for Cancer Care
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DOI：
10.2196/13598
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发表时间：
2020-08-21
影响因子：
7.4
通讯作者：
Wang, Fusheng
中科院分区：
文献类型：
--
作者：
Dubovitskaya, Alevtina;Baig, Furqan;Wang, Fusheng
背景：随着医疗服务专业化程度的提高和患者流动性的提高，跨多家医院或诊所获得医疗服务在诊断和治疗中变得非常普遍，特别是对患有癌症等慢性病的患者。通过对患者病史的知情了解，医生可以迅速做出临床决策，从而实现更智能、更安全、更高效的护理。然而，由于电子病历的隐私性和高度敏感性，大多数电子病历数据的共享仍然通过传真或邮件进行，这是因为缺乏系统的基础设施来支持安全、可信的健康数据共享，这也会导致患者护理的严重延误。目标：我们的目标是开发一个能够促进安全、可信的管理、共享和聚合的系统。我们以患者为中心的系统允许患者跨多家医院管理自己的健康记录。该系统将针对医疗数据管理的需求，包括患者指定的访问控制策略，确保患者隐私保护和安全。方法：我们提出了一种允许的基于区块链的电子病历数据共享和集成系统。每家医院将提供一个区块链节点，与自己的EHR系统相结合，形成区块链网络。患者和医生将使用基于网络的界面来发起电子病历共享交易。我们采用混合数据管理方法，链上只存储管理元数据，而实际的EHR数据将被加密并离链存储在符合《医疗保险可携带性和责任法案》的云存储中。该系统使用基于公钥基础设施的非对称加密和数字签名来保护共享的电子病历数据。结果：我们与石溪大学医院合作，开发了ACTION-EHR系统，用于以患者为中心、基于区块链的电子病历数据共享和管理，用于患者护理，特别是癌症放射治疗。原型构建在Hyperledger Fabric上，Hyperledger Fabric是一个开源的、允许的区块链框架。数据共享事务使用链码实现，并公开为用于患者和用户的Web门户的代表性状态转移应用程序编程接口。采用HL7快速医疗互操作性资源标准来表示共享的EHR数据，使得与医院EHR系统的接口和集成患者的EHR数据变得容易。我们在石溪大学的分布式环境中使用识别的患者数据测试了该系统。结论：我们研究和开发了关键技术组件，以实现以患者为中心的、基于区块链的EHR共享，以支持癌症护理。原型展示了我们方法的可行性以及一些主要挑战。下一步将是在美国和瑞士的医疗保健提供者中进行一项试点研究。我们的工作为构建下一代电子病历共享基础设施提供了一个示范试验台。
Background: With increased specialization of health care services and high levels of patient mobility, accessing health care services across multiple hospitals or clinics has become very common for diagnosis and treatment, particularly for patients with chronic diseases such as cancer. With informed knowledge of a patient's history, physicians can make prompt clinical decisions for smarter, safer, and more efficient care. However, due to the privacy and high sensitivity of electronic health records (EHR), most EHR data sharing still happens through fax or mail due to the lack of systematic infrastructure support for secure, trustable health data sharing, which can also cause major delays in patient care.Objective: Our goal was to develop a system that will facilitate secure, trustable management, sharing, and aggregation of EHR data. Our patient-centric system allows patients to manage their own health records across multiple hospitals. The system will ensure patient privacy protection and guarantee security with respect to the requirements for health care data management, including the access control policy specified by the patient.Methods: We propose a permissioned blockchain-based system for EHR data sharing and integration. Each hospital will provide a blockchain node integrated with its own EHR system to form the blockchain network. A web-based interface will be used for patients and doctors to initiate EHR sharing transactions. We take a hybrid data management approach, where only management metadata will be stored on the chain Actual EHR data, on the other hand, will be encrypted and stored off-chain in Health Insurance Portability and Accountability Act-compliant cloud-based storage. The system uses public key infrastructure-based asymmetric encryption and digital signatures to secure shared EHR data.Results: In collaboration with Stony Brook University Hospital, we developed ACTION-EHR, a system for patient-centric, blockchain-based EHR data sharing and management for patient care, in particular radiation treatment for cancer. The prototype was built on Hyperledger Fabric, an open-source, permissioned blockchain framework. Data sharing transactions were implemented using chaincode and exposed as representational state transfer application programming interfaces used for the web portal for patients and users. The HL7 Fast Healthcare Interoperability Resources standard was adopted to represent shared EHR data, making it easy to interface with hospital EHR systems and integrate a patient's EHR data. We tested the system in a distributed environment at Stony Brook University using deidentified patient data.Conclusions: We studied and developed the critical technology components to enable patient-centric, blockchain-based EHR sharing to support cancer care. The prototype demonstrated the feasibility of our approach as well as some of the major challenges. The next step will be a pilot study with health care providers in both the United States and Switzerland. Our work provides an exemplar testbed to build next-generation EHR sharing infrastructures.