MinDong Sung, Sung-Jun Park, Sung-Jae Jung, Eunsol Lee · 6 authors
BACKGROUND: Although we are living in an era of transparency, medical documents are often still difficult to access. Blockchain technology allows records to be both immutable and transparent. OBJECTIVE: Using blockchain technology, the aim of this study was to develop a medical document monitoring system that informs patients of changes to their medical documents. We then examined whether patients can effectively verify the monitoring of their primary care clinical medical records in a system based on blockchain technology. METHODS: We enrolled participants who visited two primary care clinics in Korea. Three substudies were performed: (1) a survey of the recognition of blockchain medical records changes and the digital literacy of participants; (2) an observational study on participants using the blockchain-based mobile alert app; and (3) a usability survey study. The participants' medical documents were profiled with HL7 Fast Healthcare Interoperability Resources, hashed, and transacted to the blockchain. The app checked the changes in the documents by querying the blockchain. RESULTS: A total of 70 participants were enrolled in this study. Considering their recognition of changes to their medical records, participants tended to not allow these changes. Participants also generally expressed a desire for a medical record monitoring system. Concerning digital literacy, most questions were answered with "good," indicating fair digital literacy. In the second survey, only 44 participants-those who logged into the app more than once and used the app for more than 28 days-were included in the analysis to determine whether they exhibited usage patterns. The app was accessed a mean of 5.1 (SD 2.6) times for 33.6 (SD 10.0) days. The mean System Usability Scale score was 63.21 (SD 25.06), which indicated satisfactory usability. CONCLUSIONS: Patients showed great interest in a blockchain-based system to monitor changes in their medical records. The blockchain system is useful for informing patients of changes in their records via the app without uploading the medical record itself to the network. This ensures the transparency of medical records as well as patient empowerment.
Hao Xu, Lei Zhang, Oluwakayode Onireti, Yang Fang · 6 authors
The outbreak of the coronavirus disease 2019 (COVID-19) pandemic has exposed an urgent need for effective contact tracing solutions through mobile phone applications to prevent the infection from spreading further. However, due to the nature of contact tracing, public concern on privacy issues has been a bottleneck to the existing solutions, which is significantly affecting the uptake of contact tracing applications across the globe. In this article, we present a blockchain-enabled privacy-preserving contact tracing scheme: BeepTrace, where we propose to adopt blockchain bridging the user/patient and the authorized solvers to desensitize the user ID and location information. Compared with recently proposed contact tracing solutions, our approach shows higher security and privacy with the additional advantages of being battery friendly and globally accessible. Results show viability in terms of the required resource at both server and mobile phone perspectives. Through breaking the privacy concerns of the public, the proposed BeepTrace solution can provide a timely framework for authorities, companies, software developers, and researchers to fast develop and deploy effective digital contact tracing applications, to conquer the COVID-19 pandemic soon. Meanwhile, the open initiative of BeepTrace allows worldwide collaborations, integrate existing tracing and positioning solutions with the help of blockchain technology.
Background : The healthcare domain is undergoing a major shift towards electronic health records (EHR) and data management as illustrated by the global trend in with a shift over recent times from passive technology adopters towards more investigators and explorers. There is a vital need for a universal patient record in a distributed ledger and new approaches to ensure collaborative health when we can manage our own wellness outside of the system to improve outcomes and contain healthcare costs. There are a few immediate needs to address which are patient-centric management regarding high incidence chronic diseases and identification and optimization of at-risk parameters. Methods: This is an ideation for exploring “Blockchain” implementation to match the correct individual to their health data which is critical to their medical care. It is recognized that a significant proportion of EHR are not accurately matched within the same healthcare system and this hinders critical success factors such as effective patient management, patient satisfaction, and continuity of quality care (Figure 2). Results: The following outcomes and advantages are expected to be delivered for patient care records management offering transparent and verifiable records which are encrypted to provide streamlined clinical data flow benefitting patients. Core benefits also include enhancing transparency to patients, reducing threats of hacking, increasing patient records safety, eliminating workarounds, and minimizing IT expenditures and downtimes. Conclusion: As a promising breakthrough, this idea should result in patients no longer needing to perform the tedious task of gathering records from various providers. Instead patients would only need to provide access to their health blockchain, hence retaining control of their data and not spending time and energy keeping their data up to date .
Steffen Baumann, Richard Stone, Esraa Abdelall, Varun A. Srikrishnan · 7 authors
The adoption of blockchain shows a variety of benefits owing to an incorruptible digital ledger and a decentralized database. This has eliminated the need for a gatekeeper to oversee all associated transactions. Blockchain, the underlying technology behind Bitcoin and other crypto-currencies, has found use in many industries besides finance, such as healthcare, where it is used for verifying medical licensing and credentialing, for tracking medical equipment (or consumables) from production to usage, and in cases associated with high levels of privacy and security. Patient data is collected using a plethora of patient-generated data devices, such as Internet of Things (IoT)-enabled wearables, health trackers, and home use medical devices. As a result, the data is siloed amongst several applications and/or vendors’ proprietary solutions. Of all this data, only some of it is transmitted to Electronic Medical Records. This produces the risk that not all data collected will be reviewed at the point of care due to the abundance of data collected. This article explains the areas within healthcare where blockchain could address data usability challenges and analyzes new ways in which patient health data can be collected to address the increasing number of challenges associated with the amount of data being generated over time. It also describes the drivers behind this data collection trend, the associated challenges and the subsequent ramifications. It concludes with a review of previous studies on data usability challenges and the means by which blockchain can be used to overcome these challenges.
Tsung-Ting Kuo, Hugo Zavaleta Rojas, Lucila Ohno‐Machado
OBJECTIVES: To introduce healthcare or biomedical blockchain applications and their underlying blockchain platforms, compare popular blockchain platforms using a systematic review method, and provide a reference for selection of a suitable blockchain platform given requirements and technical features that are common in healthcare and biomedical research applications. TARGET AUDIENCE: Healthcare or clinical informatics researchers and software engineers who would like to learn about the important technical features of different blockchain platforms to design and implement blockchain-based health informatics applications. SCOPE: Covered topics include (1) a brief introduction to healthcare or biomedical blockchain applications and the benefits to adopt blockchain; (2) a description of key features of underlying blockchain platforms in healthcare applications; (3) development of a method for systematic review of technology, based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, to investigate blockchain platforms for healthcare and medicine applications; (4) a review of 21 healthcare-related technical features of 10 popular blockchain platforms; and (5) a discussion of findings and limitations of the review.
OBJECTIVES: This pilot study aimed to provide an overview of the potential for blockchain technology in the healthcare system. The review covers technological topics from storing medical records in blockchains through patient personal data ownership and mobile apps for patient outreach. METHODS: We performed a preliminary survey to fill the gap that exists between purely technically focused manuscripts about blockchains, on the one hand, and the literature that is mostly concerned with marketing discussions about their expected economic impact on the other hand. RESULTS: The findings show that new digital platforms based on blockchains are emerging to enabling fast, simple, and seamless interaction between data providers, including patients themselves. CONCLUSIONS: We provide a conceptual understanding of the technical foundations of the potential for blockchain technology in healthcare, which is necessary to understand specific blockchain applications, evaluate business cases such as blockchain startups, or follow the discussion about its expected economic impacts.
Anuraag A Vazirani, Odhran O’Donoghue, David Brindley, Edward Meinert
BACKGROUND: The decentralized nature of sensitive health information can bring about situations where timely information is unavailable, worsening health outcomes. Furthermore, as patient involvement in health care increases, there is a growing need for patients to access and control their data. Blockchain is a secure, decentralized online ledger that could be used to manage electronic health records (EHRs) efficiently, therefore with the potential to improve health outcomes by creating a conduit for interoperability. OBJECTIVE: This study aimed to perform a systematic review to assess the feasibility of blockchain as a method of managing health care records efficiently. METHODS: Reviewers identified studies via systematic searches of databases including PubMed, MEDLINE, Scopus, EMBASE, ProQuest, and Cochrane Library. Suitability for inclusion of each was assessed independently. RESULTS: Of the 71 included studies, the majority discuss potential benefits and limitations without evaluation of their effectiveness, although some systems were tested on live data. CONCLUSIONS: Blockchain could create a mechanism to manage access to EHRs stored on the cloud. Using a blockchain can increase interoperability while maintaining privacy and security of data. It contains inherent integrity and conforms to strict legal regulations. Increased interoperability would be beneficial for health outcomes. Although this technology is currently unfamiliar to most, investments into creating a sufficiently user-friendly interface and educating users on how best to take advantage of it would lead to improved health outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/10994.
Yu Rang Park, Eunsol Lee, Wonjun Na, Sung-Jun Park · 6 authors
BACKGROUND: There are many perspectives on the advantages of introducing blockchain in the medical field, but there are no published feasibility studies regarding the storage, propagation, and management of personal health records (PHRs) using blockchain technology. OBJECTIVE: The purpose of this study was to investigate the usefulness of blockchains in the medical field in relation to transactions with and propagation of PHRs in a private blockchain. METHODS: We constructed a private blockchain network using Ethereum version 1.8.4 and conducted verification using the de-identified PHRs of 300 patients. The private blockchain network consisted of one hospital node and 300 patient nodes. In order to verify the effectiveness of blockchain-based PHR management, PHRs at a time were loaded in a transaction between the hospital and patient nodes and propagated to the whole network. We obtained and analyzed the time and gas required for data transaction and propagation on the blockchain network. For reproducibility, these processes were repeated 100 times. RESULTS: Of 300 patient records, 74 (24.7%) were not loaded in the private blockchain due to the data block size of the transaction block. The remaining 226 individual health records were classified into groups A (80 patients with outpatient visit data less than 1 year old), B (84 patients with outpatient data from between 1 and 3 years before data collection), and C (62 patients with outpatient data 3 to 5 years old). With respect to mean transaction time in the blockchain, C (128.7 seconds) had the shortest time, followed by A (132.2 seconds) and then B (159.0 seconds). The mean propagation times for groups A, B, and C were 1494.2 seconds, 2138.9 seconds, and 4111.4 seconds, respectively; mean file sizes were 5.6 KB, 18.6 KB, and 45.38 KB, respectively. The mean gas consumption values were 1,900,767; 4,224,341; and 4,112,784 for groups A, B, and C, respectively. CONCLUSIONS: This study confirms that it is possible to exchange PHR data in a private blockchain network. However, to develop a blockchain-based PHR platform that can be used in practice, many improvements are required, including reductions in data size, improved personal information protection, and reduced operating costs.
Diabetes Mellitus, usually called only Diabetes, is a worldwide chronic metabolic disorder that is characterized by abnormal oscillations in blood sugar levels. Such levels should be monitored by diabetes patients, which traditionally have had to take blood samples by finger-pricking, at least between twice and four times a day. Finger-pricking has a number of drawbacks that can be tackled by Continuous Glucose Monitors (CGMs), which are able to determine blood sugar levels throughout the day and not only at specific time instants. In this paper, the design of an IoT CGM-based system is proposed, whose collected blood sugar sample values can be accessed remotely; thus being able to monitor patients, specifically dependent ones (e.g., children, elders, and pregnant women) and warn them in the case where a dangerous situation is detected. In order to create such a system, a fog computing system, based on distributed mobile smart phones, has been devised to collect data from the CGMs. Moreover, the use of a blockchain is proposed, to receive, validate, and store the collected data with the objective of avoiding untrusted sources and, thus, to provide a transparent and trustworthy data source of a population, which can vary in age, ethnicity, psychology, education, self-care, and/or geographic location, in a rapid, flexible, scalable, and low-cost way. These crowdsourced data can enable novel mHealth applications for diagnosis, patient monitoring, or even public health actions, which can help to advance in the control of the disease and raise global awareness on the increasing prevalence of diabetes.
Blockchain technology is often considered as the fourth industrial revolution that will change the world. The enthusiasm of the transformative nature of blockchain technology has infiltrated healthcare. Blockchain is often seen as the much needed and perfect technology for healthcare, addressing the difficult and complex issues of security and inter-operability. More importantly, the "value" and trust-based system can deliver automated action and response via its smart contract mechanism. Healthcare, however, is a complex system. Health information technology (HIT) so far, has not delivered its promise of transforming healthcare due to its complex socio-technical and context sensitive interaction. The introduction of blockchain technology will need to consider a whole range of socio-technical issues in order to improve the quality and safety of patient care. This paper presents a discussion on these socio-technical issues. More importantly, this paper argues that in order to achieve the best outcome from blockchain technology, there is a need to consider a clinical transformation from "information" to "value " and trust. This paper argues that urgent research is needed to address these socio-technical issues in order to facilitate best outcomes for blockchain in healthcare. These socio-technical issues must then be further evaluated by means of working prototypes in the medical domain in coming years.
Open access
Electronic Health Records Systems
Mobile Health and mHealth Applications
Artificial Intelligence in Healthcare and Education
BACKGROUND: Digital health technologies, including telemedicine, mobile health (mHealth), and remote monitoring, are playing a greater role in medical practice. Safe and accurate management of medical information leads to the advancement of digital health, which in turn results in a number of beneficial effects. Furthermore, mHealth can help lower costs by facilitating the delivery of care and connecting people to their health care providers. Mobile apps help empower patients and health care providers to proactively address medical conditions through near real-time monitoring and treatment, regardless of the location of the patient or the health care provider. Additionally, mHealth data are stored in servers, and consequently, data management that prevents all forms of manipulation is crucial for both medical practice and clinical trials. OBJECTIVE: The aim of this study was to develop and evaluate a tamper-resistant mHealth system using blockchain technology, which enables trusted and auditable computing using a decentralized network. METHODS: We developed an mHealth system for cognitive behavioral therapy for insomnia using a smartphone app. The volunteer data collected with the app were stored in JavaScript Object Notation format and sent to the blockchain network. Thereafter, we evaluated the tamper resistance of the data against the inconsistencies caused by artificial faults. RESULTS: Electronic medical records collected using smartphones were successfully sent to a private Hyperledger Fabric blockchain network. We verified the data update process under conditions where all the validating peers were running normally. The mHealth data were successfully updated under network faults. We further ensured that any electronic health record registered to the blockchain network was resistant to tampering and revision. The mHealth data update was compatible with tamper resistance in the blockchain network. CONCLUSIONS: Blockchain serves as a tamperproof system for mHealth. Combining mHealth with blockchain technology may provide a novel solution that enables both accessibility and data transparency without a third party such as a contract research organization.
Tyler B. Wray, Philip A. Chan, Erik M. Simpanen, Don Operario
BACKGROUND: Men who have sex with men (MSM) are the group at highest risk for contracting human immunodeficiency virus (HIV) in the United States, but many do not test as frequently as recommended. Home-based self-testing (HBST) for HIV holds promise for promoting regular testing among these individuals, but currently available HBSTs have limited follow-up options, providing only a 1-800 number that participants can call. Failure to actively conduct follow-up counseling and referrals after HBST use could result in delays in seeking confirmatory testing and care among users receiving reactive (preliminary positive) test results. HBST also fails to connect users who test negative with other prevention services that can reduce their future risk for HIV. OBJECTIVE: The aim of our study was to use qualitative research methods with high-risk MSM to inform development of a "smart" HBST kit. The kit utilizes existing Internet-of-Things (IoT) technologies to monitor HBST use in real-time and enable delivery of timely, active follow-up counseling and referrals over the phone. METHODS: In phase 1, individual interviews (n=10) explored how participants might use HBST and their views and preferences for conducting counseling and referral after HBST. Based on these perspectives, we developed a smartphone app (iOS, Android) that uses data from light sensors on Bluetooth low energy (BLE) beacons to monitor when HBST kits are opened, facilitating timely follow-up phone contact with users. In phase 2, a usability study conducted among high-risk MSM (n=10) examined the acceptability and feasibility of this system and provided user perspectives after using the system along with HBST. RESULTS: Phase 1 themes suggested that MSM preferred HBST, that most thought active follow-up after HBST would be valuable, and that doing so over the phone within 24 h after testing was preferable. Phase 2 results showed that the eTEST system successfully detected HBST use in nearly all cases. Participant perspectives also suggested that the timing, method (ie, phone call), and duration of follow-up were appropriate and helpful. CONCLUSIONS: Using BLE beacons and a smartphone app to enable follow-up counseling and referral over the phone after HBST use is feasible and acceptable to high-risk MSM. Future research is needed to compare the effects of follow-up counseling on rates of repeat testing and receipt of referral services (eg, testing for sexually transmitted infections and initiation of preexposure prophylaxis) and to explore the acceptability of the eTEST system over longer periods of time.
BACKGROUND: Software to help control diabetes is currently an embryonic market with the main activity to date focused mainly on the development of noncomputerized solutions, such as cardboard calculators or computerized solutions that use "flat" computer models, which are applied to each person without taking into account their individual lifestyles. The development of true, mobile device-driven health applications has been hindered by the lack of tools available in the past and the sheer lack of mobile devices on the market. This has now changed, however, with the availability of pocket personal computer handsets. METHOD: This article describes a solution in the form of an intelligent neural network running on mobile devices, allowing people with diabetes access to it regardless of their location. Utilizing an easy to learn and use multipanel user interface, people with diabetes can run the software in real time via an easy to use graphical user interface. The neural network consists of four neurons. The first is glucose. If the user's current glucose level is within the target range, the glucose weight is then multiplied by zero. If the glucose level is high, then there will be a positive value multiplied to the weight, resulting in a positive amount of insulin to be injected. If the user's glucose level is low, then the weights will be multiplied by a negative value, resulting in a decrease in the overall insulin dose. RESULTS: A minifeasibility trial was carried out at a local hospital under a consultant endocrinologist in Belfast. The short study ran for 2 weeks with six patients. The main objectives were to investigate the user interface, test the remote sending of data over a 3G network to a centralized server at the university, and record patient data for further proofing of the neural network. We also received useful feedback regarding the user interface and the feasibility of handing real-world patients a new mobile phone. Results of this short trial confirmed to a large degree that our approach (which also can be known as intensive insulinotherapy) has value and perhaps that our neural network approach has implications for future intelligent insulin pumps. CONCLUSIONS: Currently, there is no software available to tell people with diabetes how much insulin to inject in accordance with their lifestyle and individual inputs, which leads to adjustments in software predictions on the amount of insulin to inject. We have taken initial steps to supplement the knowledge and skills of health care professionals in controlling insulin levels on a daily basis using a mobile device for people who are less able to manage their disease, especially children and young adults.