JMIR Publications

ABSTRACT

Background:

Medical referral is the transfer of a patient’s care from one physician to another upon request. This process involves multiple steps that require provider-to-provider and provider-to-patient communication. In Taiwan, the National Health Insurance Administration (NHIA) has implemented a national medical referral (NMR) system, which encourages physicians to refer their patients to different health care facilities to reduce unnecessary hospital visits and the financial stress on the national health insurance. However, the NHIA’s NMR system is a government-based electronic medical referral service, and its referral data access and exchange are limited only to authorized clinical professionals using their national health smart cards over the NHIA virtual private network. Therefore, this system lacks scalability and flexibility and cannot further establish trusting relationships among patients, family doctors, and specialists.

Objective:

To eliminate the existing restrictions of the NHIA’s NMR system, this study developed a scalable, flexible, and blockchain-enabled framework that leverages the NHIA's NMR referral data to build an alliance-based medical referral service connecting health care facilities.

Methods:

A blockchain-enabled framework was developed that can integrate patients’ referral data from the NHIA's NMR system with electronic medical records (EMRs) and electronic health records (EHRs) of hospitals and community-based clinics for the establishment of an alliance-based medical referral service among patients, clinics, and hospitals, as well as the enhancement of their trusting relationships and transaction security. We also developed a blockchain-enabled personal health record (PHR) decentralized application (DApp) based on our blockchain-enabled framework for patients to acquire their own EMRs and EHRs; DApp access logs were collected to explore patients’ behavior and obtain insight on the acceptance of our personal authorization–controlled framework.

Results:

The constructed iWellChain Framework was installed in a teaching affiliate hospital and 4 collaborative clinics. It can make all of the medical referral processes automatic and paperless as well as facilitate the NHIA’s reimbursements efficiently. In addition, the blockchain-enabled iWellChain DApp was distributed for patients to access and control their EMRs and EHRs. Analysis of 3 months (September 2018 to December 2018) of access logs revealed that patients were highly interested in acquiring their own health data, especially for laboratory test reports.

Conclusions:

To the best of our knowledge, our study was the first to use blockchain technology for medical referral services. The iWellChain Framework has the scalability to deploy a blockchain environment effectively for health care facilities; its iWellChain DApp also has potential for the development of more patient-centered applications to collaborate with the industry and facilitate its adoption.