This paper discusses supporting collaborative care of elderly through a reward system based on distributed ledger technologies. The design and implementation of such a reward system that connect elderly and volunteers by mutual agreements involve technologies such as smart contracts and blockchains. The work is motivated by the demographic change, where an aging population consequently increases the need for care. This causes a great tension in our society, as care resources become increasingly constrained, both regarding costs and availability of care staff. Much of the daily care of the elderly is today done by family members (spouses, children) and friends, often on a voluntarily basis, which adds to the tension. The core idea of this work is to help broaden the involvement of people in caring for our elderly, enabled by a system for collaborative care. The proposed system benefits from recent advances in distributed ledger technologies, which similarly to digital currencies, are build on the ability for mutual agreements between people who do not know each other. The system also benefits from recent gamification techniques to motivate people to collaborate on a larger scale through performing simple daily tasks. The proposed system benefits from inherent distributed ledger technologies advantages, such as a high level of decentralization, thus a high availability, and strong data consistency. These advantages make it interesting to develop the possible links between blockchains and the outside world to allow for a higher level of automation and distribution of services such as collaborative care. New models for distributed ledger technologies, such as Iota tangles or the Swirld platform, may however scale and perform better than blockchains. These should thus be considered for a full implementation and test of the system. In summary, this paper presents a novel framework and prototype implementation of a reward system supporting collaborative care of elderly, that is based on distributed ledger technologies.
Peng Zhang, Jules White, Douglas C. Schmidt, Gunther Lenz · 5 authors
Secure and scalable data sharing is essential for collaborative clinical decision making. Conventional clinical data efforts are often siloed, however, which creates barriers to efficient information exchange and impedes effective treatment decision made for patients. This paper provides four contributions to the study of applying blockchain technology to clinical data sharing in the context of technical requirements defined in the “Shared Nationwide Interoperability Roadmap” from the Office of the National Coordinator for Health Information Technology (ONC). First, we analyze the ONC requirements and their implications for blockchain-based systems. Second, we present FHIRChain, which is a blockchain-based architecture designed to meet ONC requirements by encapsulating the HL7 Fast Healthcare Interoperability Resources (FHIR) standard for shared clinical data. Third, we demonstrate a FHIRChain-based decentralized app using digital health identities to authenticate participants in a case study of collaborative decision making for remote cancer care. Fourth, we highlight key lessons learned from our case study.
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.
Peng Zhang, Jules White, Douglas C. Schmidt, Gunther Lenz
Since the inception of the Bitcoin technology, its underlying data structure--the blockchain--has garnered much attention due to properties such as decentralization, transparency, and immutability. These properties make blockchains suitable for apps that require disintermediation through trustless exchange, consistent and incorruptible transaction records, and operational models beyond cryptocurrency. In particular, blockchain and its smart contract capabilities have the potential to address healthcare interoperability issues, such as enabling effective interactions between users and medical applications, delivering patient data securely to a variety of organizations and devices, and improving the overall efficiency of medical practice workflow. Despite the interest in using blockchain for healthcare interoperability, however, little information is available on the concrete architectural styles and patterns for applying blockchain to healthcare apps. This paper provides an initial step in filling this gap by showing: (1) the features and implementation challenges in healthcare interoperability, (2) an end-to-end case study of a blockchain-based healthcare app we are developing, and (3) how applying foundational software patterns can help address common interoperability challenges faced by blockchain-based healthcare apps.
Are there differences between the sale of an unopened Super Mario Bros. computer game and of the digital collage of 5,000 images? Viewed from the perspective of the doctrine of exhaustion, we can easily conclude that the two transfers have significant differences. The auction of the tangible data carrier of the Super Mario’s 1986 edition (for $660,000) 1 fits well into the doctrine. The auction of the NFT (non-fungible token) representing Beeple’s “Everdays: the First 5000 Days” (for an equivalent of an astounding $69.3 million) 2 seems to be hype with a snowball effect rather than a modern encapsulation of digital exhaustion. Some commentators, 3 including the present author in collaboration with Alexandra Giannapoulou, João Pedro Quintais, and Balázs Bodó, 4 have thoroughly introduced the incompatibility of the NFT mania with the existing copyright status quo, and so – in connection with the present book’s topic – the sale of tokenized information, which is capable of representing information related to digital artworks, is practically excluded from the scope of the exhaustion of the right of distribution. At the same time, NFTs de facto offer a “code-based digital ecosystem that has practical consequences for the copyright-relevant fields of creativeness.” 5 The sale and resale of NFTs is possible; an exchange of information and title to “own” and “trade” information related to copyrightable subject matter is technologically guaranteed. In line with that, a quasi-exhaustion regime has also emerged. As such, the NFT mania can practically evidence the need for and modern technology’s capability of offering digital marketplaces for artworks as well.