AU Lo TY - JOUR, AU Yang Yu-Sheng, AU Cheng-Yi - Chien, AU Hsiung-Fei - Chang, AU Shy-Shin - AU Lu, AU Chung-Ying - Chen, Ray-Jade PY - 2019 DA - 2019/12/4 TI -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JO - J Med Internet Res SP - e13563 VL - 21 IS - 12kw -医疗转诊KW -电子转诊系统KW -区块链KW -分散应用KW -电子病历KW -电子健康记录KW -互操作性AB -背景:医疗转诊是将病人的护理根据请求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。因此，该系统缺乏可扩展性和灵活性，无法建立患者、家庭医生和专家之间的信任关系。目的:为了消除NHIA核磁共振系统的现有限制，本研究开发了一个可扩展的、灵活的、区块链支持的框架，利用NHIA的核磁共振转诊数据构建一个连接医疗保健机构的基于联盟的医疗转诊服务。方法:我们开发了一个基于区块链的框架，将来自nih核磁共振系统的患者转诊数据与医院和社区诊所的电子病历(EMR)和电子健康记录(EHR)数据集成，建立基于联盟的医疗转诊服务，服务于患者、诊所和医院，提高关系信任和交易安全。我们还基于我们的区块链框架开发了一个区块链支持的个人健康记录去中心化应用程序(DApp)，用于患者获取他们的EMR和EHR数据;收集DApp访问日志以评估患者的行为，并调查对我们的个人授权控制框架的接受程度。 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. SN - 1438-8871 UR - //www.mybigtv.com/2019/12/e13563 UR - https://doi.org/10.2196/13563 UR - http://www.ncbi.nlm.nih.gov/pubmed/31799935 DO - 10.2196/13563 ID - info:doi/10.2196/13563 ER -