@文章{info:doi/ 10.21960 /13563，作者=“Lo Yu-Sheng and Yang, chengyi and Chien, Hsiung-Fei and Chang, shhy - shin and Lu, Chung-Ying and Chen, Ray-Jade”，标题=“区块链支持的iWellChain框架与国家医疗转诊系统的集成:开发和可用性研究”，期刊=“J Med Internet Res”，年=“2019”，月=“12”，日=“4”，卷=“21”，数=“12”，页=“e13563”，关键词=“医疗转诊;电子转诊系统;区块链;分散的应用程序;电子病历;电子健康记录;背景:医疗转诊是根据病人的要求将病人的治疗从一个医生转移到另一个医生。这一过程涉及多个步骤，需要提供者与提供者之间以及提供者与患者之间的沟通。在台湾，国家健康保险局(NHIA)实施了全国医疗转诊(NMR)制度，鼓励医生将病人转诊到不同的医疗机构，以减少不必要的住院次数，减少国民健康保险的财政压力。然而，NHIA的NMR系统是一个基于政府的电子医疗转诊服务，其转诊数据的访问和交换仅限于通过NHIA虚拟专用网络使用国家健康智能卡的授权临床专业人员。 Therefore, this system lacks scalability and flexibility and cannot establish trusting relationships among patients, family doctors, and specialists. Objective: To eliminate the existing restrictions of the NHIA's NMR system, this study developed a scalable, flexible, and blockchain-enabled framework that leverages the NHIA's NMR referral data to build an alliance-based medical referral service connecting health care facilities. Methods: We developed a blockchain-enabled framework that can integrate patient referral data from the NHIA's NMR system with electronic medical record (EMR) and electronic health record (EHR) data of hospitals and community-based clinics to establish an alliance-based medical referral service serving patients, clinics, and hospitals and improve the trust in relationships and transaction security. We also developed a blockchain-enabled personal health record decentralized app (DApp) based on our blockchain-enabled framework for patients to acquire their EMR and EHR data; DApp access logs were collected to assess patients' behavior and investigate the acceptance of our personal authorization-controlled framework. Results: The constructed iWellChain Framework was installed in an affiliated teaching hospital and four collaborative clinics. The framework renders all medical referral processes automatic and paperless and facilitates efficient NHIA reimbursements. In addition, the blockchain-enabled iWellChain DApp was distributed for patients to access and control their EMR and EHR data. Analysis of 3 months (September to December 2018) of access logs revealed that patients were highly interested in acquiring health data, especially those of laboratory test reports. Conclusions: This study is a pioneer of blockchain applications for medical referral services, and the constructed framework and DApp have been applied practically in clinical settings. The iWellChain Framework has the scalability to deploy a blockchain environment effectively for health care facilities; the iWellChain DApp has potential for use with more patient-centered applications to collaborate with the industry and facilitate its adoption. ", issn="1438-8871", doi="10.2196/13563", url="//www.mybigtv.com/2019/12/e13563", url="https://doi.org/10.2196/13563", url="http://www.ncbi.nlm.nih.gov/pubmed/31799935" }