@文章{信息:doi/10.2196/12426，作者=“O'Donoghue, Odhran和Vazirani, Anuraag A和Brindley, David和Meinert, Edward”，标题=“医疗保健区块链实施中的设计选择和权衡:系统评价”，期刊=“J医学互联网Res”，年=“2019”，月=“5”，日=“10”，卷=“21”，数=“5”，页=“e12426”，关键词=“区块链;互操作性;分布式账本技术;可伸缩性;健康信息交换"，abstract="背景:区块链是一个记录列表，使用加密技术使存储的数据不可变;最近有人提议将其应用于电子病历系统。本文详细介绍了与emr相关的区块链技术权衡的系统回顾。权衡被定义为“两个理想但不兼容的特性之间的妥协”。“目标:这篇综述的主要研究问题是:‘与基于区块链的电子病历系统的创建相关的不同区块链设计涉及哪些权衡?方法:使用系统评价和荟萃分析(PRISMA)首选报告项目系统检索7个数据库中的相关文章。选取2017年1月1日至2018年6月15日发表的论文。 Quality assessments of papers were performed using the Risk Of Bias In Non-randomized Studies---of Interventions (ROBINS-I) tool and the Critical Assessment Skills Programme (CASP) tool. Database searches identified 2885 articles, of which 15 were ultimately included for analysis. Results: A total of 17 trade-offs were identified impacting the design, development, and implementation of blockchain systems; these trade-offs are organized into themes, including business, application, data, and technology architecture. Conclusions: The key findings concluded the following: (1) multiple trade-offs can be managed adaptively to improve EMR utility; (2) multiple trade-offs involve improving the security of blockchain systems at the cost of other features, meaning EMR efficacy highly depends on data protection standards; and (3) multiple trade-offs result in improved blockchain scalability. Consideration of these trade-offs will be important to the specific environment in which electronic medical records are being developed. This review also uses its findings to suggest useful design choices for a hypothetical National Health Service blockchain. International Registered Report Identifier (IRRID): RR2-10.2196/10994 ", issn="1438-8871", doi="10.2196/12426", url="//www.mybigtv.com/2019/5/e12426/", url="https://doi.org/10.2196/12426", url="http://www.ncbi.nlm.nih.gov/pubmed/31094344" }