Ye Seul Bae, Yujin Park, Seung Min Lee, Hee Hwa Seo · 9 authors
Health information exchange can improve health outcomes and reduce unnecessary medical expenses. An important task in health information exchange is to prove data integrity and strengthen the right to self-determination of individuals. This can be addressed using blockchain technology and dynamic consents. We aimed to develop a blockchain-based mobile platform called HealthPocket to exchange reliable health information with proven integrity through a dynamic consent system based on the HL7 FHIR standards. Through HealthPocket, subjects can selectively provide their consent to share specific medical and PHGD through proper authorization, and each response is converted into the JSON format with FHIR compatibility. We conducted a usability test to demonstrate health information exchange between primary and tertiary medical institutions. A total of 116 subjects used the HealthPocket mobile application to selectively share health information for at least one month, and conducted a questionnaire about their experience. In addition, medical staff of the institution could access the medical information shared by the participants and use it for treatment. The user surveys for patients examined the perceived usefulness, perceived ease of use, and overall service satisfaction. The mean overall satisfaction with the health information exchange service was the highest (4.67 out of 5 points). As security, personal information protection, and interoperability are main concerns related to health information exchange, blockchain technology can provide suitable solutions. For instance, when health information is exchanged using blockchain technology, it is impossible to alter data blocks. Therefore, by using a blockchain-based platform and dynamic consent system, we ensured the integrity of medical data.
BACKGROUND: Integrating pervasive computing with blockchain's ability to store privacy-protected mobile health (mHealth) data while providing Health Insurance Portability and Accountability Act (HIPAA) compliance is a challenge. Patients use a multitude of devices, apps, and services to collect and store mHealth data. We present the design of an internet of things (IoT)-based configurable blockchain with different mHealth apps on iOS and Android, which collect the same user's data. We discuss the advantages of using such a blockchain architecture and demonstrate 2 things: the ease with which users can retain full control of their pervasive mHealth data and the ease with which HIPAA compliance can be accomplished by providers who choose to access user data. OBJECTIVE: The purpose of this paper is to design, evaluate, and test IoT-based mHealth data using wearable devices and an efficient, configurable blockchain, which has been designed and implemented from the first principles to store such data. The purpose of this paper is also to demonstrate the privacy-preserving and HIPAA-compliant nature of pervasive computing-based personalized health care systems that provide users with total control of their own data. METHODS: This paper followed the methodical design science approach adapted in information systems, wherein we evaluated prior designs, proposed enhancements with a blockchain design pattern published by the same authors, and used the design to support IoT transactions. We prototyped both the blockchain and IoT-based mHealth apps in different devices and tested all use cases that formed the design goals for such a system. Specifically, we validated the design goals for our system using the HIPAA checklist for businesses and proved the compliance of our architecture for mHealth data on pervasive computing devices. RESULTS: Blockchain-based personalized health care systems provide several advantages over traditional systems. They provide and support extreme privacy protection, provide the ability to share personalized data and delete data upon request, and support the ability to analyze such data. CONCLUSIONS: We conclude that blockchains, specifically the consensus, hasher, storer, miner architecture presented in this paper, with configurable modules and software as a service model, provide many advantages for patients using pervasive devices that store mHealth data on the blockchain. Among them is the ability to store, retrieve, and modify ones generated health care data with a single private key across devices. These data are transparent, stored perennially, and provide patients with privacy and pseudoanonymity, in addition to very strong encryption for data access. Firms and device manufacturers would benefit from such an approach wherein they relinquish user data control while giving users the ability to select and offer their own mHealth data on data marketplaces. We show that such an architecture complies with the stringent requirements of HIPAA for patient data access.
BACKGROUND: Patient-centered health care information systems (PHSs) enable patients to take control and become knowledgeable about their own health, preferably in a secure environment. Current and emerging PHSs use either a centralized database, peer-to-peer (P2P) technology, or distributed ledger technology for PHS deployment. The evolving COVID-19 decentralized Bluetooth-based tracing systems are examples of disease-centric P2P PHSs. Although using P2P technology for the provision of PHSs can be flexible, scalable, resilient to a single point of failure, and inexpensive for patients, the use of health information on P2P networks poses major security issues as users must manage information security largely by themselves. OBJECTIVE: This study aims to identify the inherent security issues for PHS deployment in P2P networks and how they can be overcome. In addition, this study reviews different P2P architectures and proposes a suitable architecture for P2P PHS deployment. METHODS: A systematic literature review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Thematic analysis was used for data analysis. We searched the following databases: IEEE Digital Library, PubMed, Science Direct, ACM Digital Library, Scopus, and Semantic Scholar. The search was conducted on articles published between 2008 and 2020. The Common Vulnerability Scoring System was used as a guide for rating security issues. RESULTS: Our findings are consolidated into 8 key security issues associated with PHS implementation and deployment on P2P networks and 7 factors promoting them. Moreover, we propose a suitable architecture for P2P PHSs and guidelines for the provision of PHSs while maintaining information security. CONCLUSIONS: Despite the clear advantages of P2P PHSs, the absence of centralized controls and inconsistent views of the network on some P2P systems have profound adverse impacts in terms of security. The security issues identified in this study need to be addressed to increase patients' intention to use PHSs on P2P networks by making them safe to use.
Eric Appiah Mantey, Conghua Zhou, Joseph Henry Anajemba, Izuchukwu Michael Okpalaoguchi · 5 authors
Recommender systems offer several advantages to hospital data management units and patients with special needs. These systems are more dependent on the extreme subtle hospital-patient data. Thus, disregarding the confidentiality of patients with special needs is not an option. In recent times, several proposed techniques failed to cryptographically guarantee the data privacy of the patients with special needs in the diet recommender systems (RSs) deployment. In order to tackle this pitfall, this paper incorporates a blockchain privacy system (BPS) into deep learning for a diet recommendation system for patients with special needs. Our proposed technique allows patients to get notifications about recommended treatments and medications based on their personalized data without revealing their confidential information. Additionally, the paper implemented machine and deep learning algorithms such as RNN, Logistic Regression, MLP, etc., on an Internet of Medical Things (IoMT) dataset acquired via the internet and hospitals that comprises the data of 50 patients with 13 features of various diseases and 1,000 products. The product section has a set of eight features. The IoMT data features were analyzed with BPS and further encoded prior to the application of deep and machine learning-based frameworks. The performance of the different machine and deep learning methods were carried out and the results verify that the long short-term memory (LSTM) technique is more effective than other schemes regarding prediction accuracy, precision, F1-measures, and recall in a secured blockchain privacy system. Results showed that 97.74% accuracy utilizing the LSTM deep learning model was attained. The precision of 98%, recall, and F1-measure of 99% each for the allowed class was also attained. For the disallowed class, the scores were 89, 73, and 80% for precision, recall, and F1-measure, respectively. The performance of our proposed BPS is subdivided into two categories: the secured communication channel of the recommendation system and an enhanced deep learning approach using health base medical dataset that spontaneously identifies what food a patient with special needs should have based on their disease and certain features including gender, weight, age, etc. The proposed system is outstanding as none of the earlier revised works of literature described a recommender system of this kind.
BACKGROUND: One of the most promising health care development areas is introducing telemedicine services and creating solutions based on blockchain technology. The study of systems combining both these domains indicates the ongoing expansion of digital technologies in this market segment. OBJECTIVE: This paper aims to review the feasibility of blockchain technology for telemedicine. METHODS: The authors identified relevant studies via systematic searches of databases including PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar. The suitability of each for inclusion in this review was assessed independently. Owing to the lack of publications, available blockchain-based tokens were discovered via conventional web search engines (Google, Yahoo, and Yandex). RESULTS: Of the 40 discovered projects, only 18 met the selection criteria. The 5 most prevalent features of the available solutions (N=18) were medical data access (14/18, 78%), medical service processing (14/18, 78%), diagnostic support (10/18, 56%), payment transactions (10/18, 56%), and fundraising for telemedical instrument development (5/18, 28%). CONCLUSIONS: These different features (eg, medical data access, medical service processing, epidemiology reporting, diagnostic support, and treatment support) allow us to discuss the possibilities for integration of blockchain technology into telemedicine and health care on different levels. In this area, a wide range of tasks can be identified that could be accomplished based on digital technologies using blockchains.
Hessah A. Alsalamah, Shorog Nasser, Shada Alsalamah, Albatoul I. Almohana · 6 authors
Obesity is considered one of the leading causes of chronic and noncommunicable diseases; these include diabetes, cardiovascular disease, and cancer. The obesity prevalence is threefold higher in the Arab Gulf Cooperation Council (GCC) population than the rest of the world and leaves healthcare providers within the region with no alternative than to offer continuous and sustainable healthcare services. Obesity prevention would be more economical for governments than providing treatment. Preventing obesity is challenging because it requires motivating individuals to live a healthy lifestyle. Personal health (pHealth) has recently been actively involved in finding solutions to encourage healthy living. However, pHealth does not address the high percentage of people lacking the desire to maintain healthy living plans, which could have a negative effect on attempts aimed at reducing obesity prevalence. This study sheds light on the challenges faced by the GCC governments in reducing high obesity rates using pHealth; we propose a solution, Wholesome Coin, which incorporates advanced technologies to help governments reduce high obesity rates. Wholesome Coin has two components: one uses wearable IoT (WIoT) to help patients manage their behavior by tracking their physical activities and diet, and the other utilizes blockchain technology to help healthcare payers to incentify patients to maintain a healthy living plan by awarding digital coins that can be redeemed for real goods and services. GCC governments’ adoption of Wholesome Coin could improve the quality of life of obese patients in a seamless, secure, and self-motivated manner, resulting in a healthier tomorrow, especially amid challenging times featuring global social distance campaigns.
Michael Froehlich, Maurizio Raphael Wagenhaus, Albrecht Schmidt, Florian Alt
Cryptocurrencies have increasingly gained interest in practice and research alike. Current research in the HCI community predominantly focuses on understanding the behavior of existing cryptocurrency users. Little attention has been given to early users and the challenges they encounter. However, understanding how interfaces of cryptocurrency systems support, impede, or even prevent adoption through new users is essential to develop better, more inclusive solutions. To close this gap, we conducted a user study (n=34) exploring challenges first-time cryptocurrency users face. Our analysis reveals that even popular wallets are not designed for novice users’ needs, stopping them when they would be ready to engage with the technology. We identify multiple challenges ranging from general user interface issues to finance and cryptocurrency-specific ones. We argue that these challenges can and should be addressed by the HCI community and present implications for building better cryptocurrency systems for novice users.
Adopting and implementing the Clinical Decision Support System (CDSS) technology is a critical element in an effort to improve national quality initiatives and evidence-based practice at the point of care. CDSS is envisioned to be a potential solution to many current challenges in the healthcare sphere, which includes information overload, practice improvement, eliminating treatment errors, and reducing medical consultation costs. However, the CDSS did not manage to achieve these goals to the desired levels and provide context-appropriate alerts, although integrated with the electronic health records (EHRs) (1). Clinical decision support alerts can save lives, but frequent ones can cause increased cognitive burden to clinicians, worsen alert fatigue, and increase the duplication of tests. This ultimately increases health care costs without refining patient outcomes. Studies show that 49-96% of clinical alerts are ignored, raising questions about the effectiveness of CDSS (1). Blockchain, a decentralized, distributed digital ledger that contains a plethora of continuously updated, time-stamped, and highly encrypted virtual record, can be a key to addressing these challenges (2). The blockchain technology if integrated with the CDSS can serve as a potential solution to eliminating current drawbacks with CDSS (3). This article addresses the most significant and chronic problems facing the successful implementation of CDSS and how leveraging the Hyperledger Fabric can alleviate the clinical alert fatigue and reduce physician's burnout using patient-specific information. The proposed architecture framework for this study is designed to equip the CDSS with overall patient information at the point of care. This then empowers the physicians with the blockchain-integrated CDSS, which holds the potential to reduce clinician's cognitive burden, medical errors, and costs and ultimately enhance patient outcomes. The research study broadly discusses how the blockchain technology can be a potential solution, reasons for selecting the Hyperledger Fabric, and elaborates on how the Hyperledger Fabric can be leveraged to enhance the efficacy of CDSS.
Keehyuck Lee, Kahyun Lim, Se Young Jung, Hyerim Ji · 7 authors
BACKGROUND: Although the electronic health record system adoption rate has reached 96% in the United States, implementation and usage of health information exchange (HIE) is still lagging behind. Blockchain has come into the spotlight as a technology to solve this problem. However, there have been no studies assessing the perspectives of different stakeholders regarding blockchain-based patient-centered HIE. OBJECTIVE: The objective of this study was to analyze the awareness among patients, health care professionals, and information technology developers toward blockchain-based HIE, and compare their different perspectives related to the platform using a qualitative research methodology. METHODS: In this qualitative study, we applied grounded theory and the Promoting Action on Research Implementation in the Health Service (PARiHS) framework. We interviewed 7 patients, 7 physicians, and 7 developers, for a total of 21 interviewees. RESULTS: Regarding the leakage of health information, the patient group did not have concerns in contrast to the physician and developer groups. Physicians were particularly concerned about the fact that errors in the data cannot be easily fixed due to the nature of blockchain technology. Patients were not against the idea of providing information for clinical trials or research institutions. They wished to be provided with the results of clinical research rather than being compensated for providing data. The developers emphasized that blockchain must be technically mature before it can be applied to the health care scene, and standards of medical information to be exchanged must first be established. CONCLUSIONS: The three groups' perceptions of blockchain were generally positive about the idea of patients having the control of sharing their own health information. However, they were skeptical about the cooperation among various institutions and implementation for data standardization in the establishment process, in addition to how the service will be employed in practice. Taking these factors into consideration during planning, development, and operation of a platform will contribute to establishing practical treatment plans and tracking in a more convenient manner for both patients and physicians. Furthermore, it will help expand the related research and health management industry based on blockchain.
Abstract The amount of exercise and fitness level of sports athletes can be quantitatively evaluated through the measurement of health and sports information, thereby ensuring effective fitness effects. The development of blockchain and Internet of Things technology provides a new perspective and technical means for fitness management technology. In view of the current problems in the field of sports fitness, this paper designs and implements a dynamic management technology for sports fitness based on the concept of Internet of Things and blockchain. First, based on an in-depth analysis of the current status of theoretical research and application of the Internet of health at home and abroad, the theories and methods of sports information and health information collection are studied. A temperature sensor and an acceleration sensor are used to collect human body temperature and exercise steps, respectively, and then estimate human health and exercise conditions. Second, solve the privacy problem in the collection and transmission of the Internet of Things by adding blockchain technology. Finally, the machine-learning method is used to clean and manage the information and data to realize the real-time detection and management of the athlete’s fitness status. The actual case test shows that the functions and technical performance indicators of the dynamic fitness management technology can meet the needs of users in indoor and outdoor fitness management, and promote the development of the sports industry and provide a scientific reference.
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.
BACKGROUND: Diabetes mellitus is one of the most prominent examples of chronic conditions that requires an active patient self-management and a network of specialists. OBJECTIVES: The aim of this study was to analyze the user and legal requirements and develop a rough technology concept for a secure and patient-centered exchange platform. METHODS: To this end, 14 experts representing different stakeholders were interviewed and took part in group discussions at three workshops, the pertinent literature and legal texts were analyzed. RESULTS: The user requirements embraced a comprehensive set of use cases and the demand for "one platform for all" which is underlined by the right for data portability according to new regulations. In order to meet these requirements a distributed ledger technology was proposed. CONCLUSION: We will therefore focus on a patient-centered application that showcases self-management and exchange with health specialists.