TY - JOUR AU - Hylock, Ray Hales AU - Zeng，晓明PY - 2019 DA - 2019/8/31 TI -以患者为中心的健康记录和交换的区块链框架(HealthChain):评估和概念验证研究JO - J医疗互联网Res SP - e13592 VL - 21 IS - 8 KW -区块链KW -变色龙哈希KW -健康信息交换KW -健康信息管理KW - HL7 FHIR KW -以患者为中心的健康KW -医疗记录KW -代理重新加密KW -可编区块链KW -智能合同KW -数字健康KW -电子健康记录AB -背景:区块链有可能颠覆现有的患者数据访问、积累、贡献、交换和控制模式。使用互操作性标准、智能合约和加密身份，患者可以安全地与提供者交换数据并规范访问。由此产生的全面的纵向医疗记录可以显著提高个人和人群的患者护理成本和质量。目的:本工作提出了一个新的以患者为中心的区块链框架HealthChain。其目的是在一个安全、可互操作的环境中加强患者参与、数据管理和累积信息的规范传播。提出了一个混合块区块链，以支持不可变的日志记录和可编辑的患者块。通过Health Level-7快速医疗互操作性资源生成和交换患者数据，允许与合规系统无缝传输。此外，患者还会收到公钥和私钥对形式的加密身份。 Public keys are stored in the blockchain and are suitable for securing and verifying transactions. Furthermore, the envisaged system uses proxy re-encryption (PRE) to share information through revocable, smart contracts, ensuring the preservation of privacy and confidentiality. Finally, several PRE improvements are offered to enhance performance and security. Methods: The framework was formulated to address key barriers to blockchain adoption in health care, namely, information security, interoperability, data integrity, identity validation, and scalability. It supports 16 configurations through the manipulation of 4 modes. An open-source, proof-of-concept tool was developed to evaluate the performance of the novel patient block components and system configurations. To demonstrate the utility of the proposed framework and evaluate resource consumption, extensive testing was performed on each of the 16 configurations over a variety of scenarios involving a variable number of existing and imported records. Results: The results indicate several clear high-performing, low-bandwidth configurations, although they are not the strongest cryptographically. Of the strongest models, one’s anticipated cumulative record size is shown to influence the selection. Although the most efficient algorithm is ultimately user specific, Advanced Encryption Standard–encrypted data with static keys, incremental server storage, and no additional server-side encryption are the fastest and least bandwidth intensive, whereas proxy re-encrypted data with dynamic keys, incremental server storage, and additional server-side encryption are the best performing of the strongest configurations. Conclusions: Blockchain is a potent and viable technology for patient-centered access to and exchange of health information. By integrating a structured, interoperable design with patient-accumulated and generated data shared through smart contracts into a universally accessible blockchain, HealthChain presents patients and providers with access to consistent and comprehensive medical records. Challenges addressed include data security, interoperability, block storage, and patient-administered data access, with several configurations emerging for further consideration regarding speed and security. SN - 1438-8871 UR - //www.mybigtv.com/2019/8/e13592/ UR - https://doi.org/10.2196/13592 UR - http://www.ncbi.nlm.nih.gov/pubmed/31471959 DO - 10.2196/13592 ID - info:doi/10.2196/13592 ER -