杂志文章%@ 1438-8871 %I JMIR出版物%V 21 %N卡塔尔世界杯8强波胆分析 5 %P 12426 %T卫生保健实施中的设计选择和权衡:%A O'Donoghue,Odhran %A Vazirani,Anuraag A %A Brindley,David %A Meinert,Edward %+医疗保健翻译研究小组，牛津大学儿科，二级，约翰拉德克利夫医院儿童医院，牛津，OX3 9DU，英国，44 7824446808，edward.meinert@paediatrics.ox.ac.uk %K区块链%K互操作性%K分布式账本技术%K可扩展性%K健康信息交换%D 2019 %7 10.05.2019 %9 Review %J J Med Internet Res %G English %X背景:区块链是使用密码学使存储的数据不可变的记录列表;最近有人提议将其用于电子病历(EMR)系统。本文详细介绍了与EMRs相关的区块链技术的权衡。权衡被定义为“两个理想但不兼容的特性之间的妥协”。目的:本综述的主要研究问题是:“与基于区块链的电子医疗记录系统的创建相关的不同区块链设计中涉及的权衡是什么?”方法:采用系统评价和荟萃分析首选报告项目(PRISMA)系统检索7个数据库中的相关文章。2017年1月1日至2018年6月15日发表的论文入选。使用非随机干预研究的偏倚风险(ROBINS-I)工具和关键评估技能计划(CASP)工具对论文进行质量评估。 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 %M 31094344 %R 10.2196/12426 %U //www.mybigtv.com/2019/5/e12426/ %U https://doi.org/10.2196/12426 %U http://www.ncbi.nlm.nih.gov/pubmed/31094344