TY - JOUR AU - Zhuang, Yan AU - Chen, Yin-Wu AU - Shae, zo - yin AU - Shyu, Chi-Ren PY - 2020 DA - 2020/7/27 TI -面向医疗保健应用的可推广分层区块链架构:开发、案例研究和评估JO - J Med Internet Res SP - e19029 VL - 22 IS - 7kw -区块链KW -智能合约KW -健康信息交换KW -电子健康记录KW -医疗保健应用AB -背景:对于许多新兴的医疗保健应用程序来说，跨多个医疗保健设施的数据协调变得越来越重要。不信任被认为是这类应用成功的一个关键障碍。利用区块链技术可以提供潜在的解决方案，通过利用区块链的安全性、不可变性、匿名性、去中心化和智能合约等属性，在数据提供者和接收者之间建立信任。许多卫生技术已经通过经验证明，区块链设计很好地符合卫生保健应用的需求，并取得了一定程度的成功。然而，缺乏健壮的体系结构来为开发人员提供一个实用的框架，以实现应用程序并使用标准区块链设计测试稳定性、效率和可伸缩性的性能。卫生保健界需要一个通用的区块链模型来采用区块链技术并及时开发应用程序。目的:本研究旨在构建一个通用的区块链体系结构，为广泛的医疗保健应用开发提供数据协调功能，包括数据请求、许可授予、数据交换和使用跟踪。方法:在私有区块链网络上建立一个增强的3层区块链架构。这三层从下到上分别是:(1)将区块链基础设置和智能合约设计整合到数据采集中; (2) interactions between the blockchain and health care application development environment using Node.js and web3.js; and (3) a flexible development platform that supports web technologies such as HTML, https, and various programing languages. Two example applications, health information exchange (HIE) and clinical trial recruitment, were developed in our design to demonstrate the feasibility of the layered architecture. Case studies were conducted to test the performance in terms of stability, efficiency, and scalability of the blockchain system. Results: A total of 331,142 simulated HIE requests from accounts of 40,000 patients were successfully validated through this layered blockchain architecture with an average exchange time of 11.271 (SD 2.208) seconds. We also simulated a clinical trial recruitment scenario with the same set of patients and various recruitment criteria to match potential subjects using the same architecture. Potential subjects successfully received the clinical trial recruitment information and granted permission to the trial sponsors to access their health records with an average time of 3.07 seconds. Conclusions: This study proposes a generalized layered blockchain architecture that offers health technology community blockchain features for application development without requiring developers to have extensive experience with blockchain technology. The case studies tested the performance of our design and empirically proved the feasibility of the architecture in 2 relevant health application domains. SN - 1438-8871 UR - //www.mybigtv.com/2020/7/e19029 UR - https://doi.org/10.2196/19029 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716300 DO - 10.2196/19029 ID - info:doi/10.2196/19029 ER -