Abstract
Secure and scalable data sharing is essential for collaborative clinical decision making. Conventional clinical data efforts are often siloed, however, which creates barriers to efficient information exchange and impedes effective treatment decision made for patients. This paper provides four contributions to the study of applying blockchain technology to clinical data sharing in the context of technical requirements defined in the “Shared Nationwide Interoperability Roadmap” from the Office of the National Coordinator for Health Information Technology (ONC). First, we analyze the ONC requirements and their implications for blockchain-based systems. Second, we present FHIRChain, which is a blockchain-based architecture designed to meet ONC requirements by encapsulating the HL7 Fast Healthcare Interoperability Resources (FHIR) standard for shared clinical data. Third, we demonstrate a FHIRChain-based decentralized app using digital health identities to authenticate participants in a case study of collaborative decision making for remote cancer care. Fourth, we highlight key lessons learned from our case study.
Highlights
The importance of data sharing in collaborative decision making
This paper described the FHIRChain prototype we designed to provide patients with more collaborative clinical decision support using blockchain technology and the Fast Healthcare Interoperability Resources (FHIR) data standards
Complemented by the adoption of public key cryptography, our FHIRChain design addressed five key requirements provided by the ONC interoperability roadmap, including user identifiability and authentication, secure data exchange, permissioned data access, consistent data formats, and system modularity
Summary
The importance of data sharing in collaborative decision making. Secure and scalable data sharing is essential to provide effective collaborative treatment and care decisions for patients. Many barriers exist in the technical infrastructure of health IT systems today that impede the secure and scalable data sharing across institutions, thereby limiting support for collaborative clinical decision making. Examples of such barriers include the following:. What is needed is a standards-based architecture that can integrate with existing health IT systems (and related mobile apps) to enable secure and scalable clinical data sharing for improving continuous, collaborative decision support. The remainder of this paper is organized as follows: Section 2 provides an overview of blockchain technologies and the Ethereum platform, which is an open-source blockchain implementation that supports the development of DApps via “smart contracts;” Section 3 surveys different blockchain-based research approaches in the healthcare domain and compares our research on FHIRChain with related work; Section 4 summarizes ONC’s key technical requirements for sharing clinical data and analyzes their implications for blockchain-based designs; Section 5 describes how the blockchain-based architecture of FHIRChain is designed to meet ONC requirements and motivates why we made certain architectural decisions; Section 6 analyzes the benefits and limitations of a case study that applied a FHIRChain-based DApp to provide collaborative clinical decision support; and Section 7 presents concluding remarks and outlines our key lessons learned and future work on extending the FHIRChain architecture described in this paper
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