Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Mar 31, 2020
Date Accepted: May 8, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Generalizable Layered Blockchain Architecture for Healthcare Applications – Case Studies in Health Information Exchange and Clinical Trial Recruitment
ABSTRACT
Background:
Data coordination across multiple healthcare facilities has become increasingly important for many emerging healthcare applications. Distrust has been recognized as a key barrier to the success of such applications. Leveraging blockchain technology could provide potential solutions that bring trust between data providers and receivers by taking advantage of blockchain properties such as security, immutability, anonymous, decentralization, and smart contract. Many health technologies have empirically proven that blockchain designs fit well with the needs of healthcare applications with certain degrees of success. However, there is a lack of robust architecture to provide a practical framework for developers to implement applications and test the performance of stability, efficiency, and scalability using standard blockchain designs. A generalized blockchain model is needed for the healthcare community to adopt the blockchain technology and develop applications in a timely fashion.
Objective:
The goal of this work is to provide a generalized blockchain architecture that provides data coordination functions, including data request, permission granting, data exchange, usage tracing, etc., for a wide spectrum of healthcare application developments.
Methods:
An augmented, three-layered blockchain architecture was built on a private blockchain network. The three layers, from bottom to top, are (1) incorporation of fundamental blockchain settings and a smart contract design for data collection, (2) interactions between blockchain and healthcare application development environment using Node.js and web3.js, and (3) a flexible development platform which supports web technologies such as HTML, HTTPS, various programming languages, etc. Two example applications, health information exchange 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 stability, efficiency, and scalability of the blockchain system.
Results:
331,142 simulated health information exchange (HIE) requests from 40,000 patients’ accounts were successfully validated through this layered blockchain architecture with an average exchange time of 11.27 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 work proposes a generalized layered blockchain architecture that offers health technology community blockchain features for application development without requiring developers to have an extensive experience with blockchain technology. The case studies tested the performance of our design and empirically proved the feasibility of the architecture in two relevant health application domains.
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