Blockchain in healthcare today最新文献

Hospitals provide diverse tasks essential for the delivery of patient care and are comprised of many functional units. This makes healthcare projects in construction highly complex among other types of building projects due to the specific regulations, multiple functions it must provide, complicated mechanical and electrical systems, and so on. This complexity embodies potential risk events during its construction, which not only influences the completion of the project but can impact the patients' safety and health conditions even after the project is finished. To prevent such outcomes, risk management is a crucial process that can identify, evaluate, and properly mitigate risks along the project lifecycle. A key aspect of risk management is that it requires the interaction and contribution from multiple stakeholders of the project. Various frameworks and tools that enable collaborative management of risks among multiple stakeholders have been developed in the past. However, the developed frameworks are not suitable in the sense that it does not protect the confidentiality of individual inputs from the stakeholders. Moreover, these frameworks are centralized systems, which can bring issues related to the security and transparency of the information that is being stored. Blockchain technology is an emergent distributed ledger technology (DLT) that can provide solutions to the listed problems found in centralized systems. It is a novel system that records information on a decentralized, distributed ledger, where transactions are constantly duplicated and updated. This study explores the applicability of blockchain technology for healthcare risk management. The key functional elements of blockchain that can resolve the challenges faced by prior risk management frameworks have been identified and discussed. Based on the discussions, a conceptual information management model for managing healthcare project risks on a blockchain has been conceived. The development of the initial prototype has been explained. The research study illustrates the process, benefits, and limitations of adopting the blockchain technology for collaborative risk management in healthcare projects.

Objective: While existing research by our team has demonstrated the feasibility of building a decentralized identity management application ("MediLinker") for health information, there are implementation issues related to testing such blockchain-based health applications in real-world clinical settings. In this study, we identified clinical, organizational and regulatory, and ethical and social (CORES) issues, including recommendations, associated with deploying MediLinker, and blockchain in general, for clinical testing.

Methods: CORES issues and recommendations were identified through a focus group with 11 academic, industry, and government experts on March 26, 2021. They were grouped according to their expertise: clinical care (n = 4), organizational and regulatory concerns (n = 4), and ethical and social issues (n = 3). The focus group was conducted via Zoom in which experts were briefed about the study aims, formed into breakout groups to identify key issues based on their group's expertise, and reconvened to share identified issues with other groups and to discuss potential recommendations to address such issues. The focus group was video recorded and transcribed. The resulting transcriptions and meeting notes were imported to MAXQDA 2018 for thematic analysis.

Results: Clinical experts identified issues that concern the clinical system, clinical administrators, clinicians, and patients. Organizational and regulatory experts emphasized issues on accountability, compliance, and legal safeguards. Ethics and social-context experts raised issues on trust, transparency, digital divide, and health-related digital autonomy. Accordingly, experts proposed six recommendations that could address most of the identified issues: (1) design interfaces based on patient preferences, (2) ensure testing with diverse populations, (3) ensure compliance with existing policies, (4) present potential positive outcomes to top management, (5) maintain clinical workflow, and (6) increase the public's awareness of blockchain.

Conclusions: This study identified a myriad of CORES issues associated with deploying MediLinker in clinical settings. Moreover, the study also uncovered several recommendations that could address such issues. The findings raise awareness on CORES issues that should be considered when designing, developing, and deploying blockchain for healthcare. Further, the findings provide additional insights into the development of MediLinker from a prototype to a minimum viable product for clinical testing. Future studies can use CORES as a socio-technical model to identify issues and recommendations associated with deploying health information technologies in clinical settings.

During the COVID-19 pandemic, we witnessed how sharing of biological and biomedical data facilitated researchers, medical practitioners, and policymakers to tackle the pandemic on a global scale. Despite the growing use of electronic health records (EHRs) by medical practitioners and wearable digital gadgets by individuals, 80% of health and medical data remain unused, adding little value to the work of researchers and medical practitioners. Legislative constraints related to health data sharing, centralized siloed design of traditional data management systems, and most importantly, lack of incentivization models are thought to be the underpinning bottlenecks for sharing health data. With the advent of the General Data Protection Regulation (GDPR) of the European Union (EU) and the development of technologies like blockchain and distributed ledger technologies (DLTs), it is now possible to create a new paradigm of data sharing by changing the incentivization model from current authoritative or altruistic form to a shared economic model where financial incentivization will be the main driver for data sharing. This can be achieved by setting up a digital health data marketplace (DHDM). Here, we review papers that proposed technical models or implemented frameworks that use blockchain-like technologies for health data. We seek to understand and compare different technical challenges associated with implementing and optimizing the DHDM operation outlined in these articles. We also examine legal limitations in the context of the EU and other countries such as the USA to accommodate any compliance requirement for such a marketplace. Last but not least, we review papers that investigated the short-, medium-, and long-term socioeconomic impact of such a marketplace on a wide range of stakeholders.

Each year, Blockchain and Healthcare Today reaches out to journal board members, annual ConV2X Symposium speakers, and ecosystem subject matter experts to share their near-term views and perspectives for blockchain technology advances in healthcare. This article presents insights into where authors anticipate market opportunities and where gaps exist that should be addressed for regional and global collaboration, governance, and efficiency for the year 2022.

Background: The increasing use of various online services requires an efficient digital identity management (DIM) approach. Unfortunately, the original Internet protocols were not designed with built-in identity management, which creates challenges related to privacy, security, and usability. There is an increasing societal concern regarding the management of these sensitive data, access to it, and where it is stored. Blockchain technology can potentially offer a secure solution to address these issues in a decentralized manner without centralized authority. This is important for e-health services where the patient and the healthcare provider often are required to prove their identity. Blockchain technology can be utilized for creating digital identities and making its management easier, thus giving a higher degree of control to the user than what current solutions offer. It can be used to create a digital identity on the blockchain, making it easier for individuals and entities to manage, giving them greater control over who has their personal information and how they handle it. In addition, it might be utilized to create a higher degree of trust and security for e-health applications.

Objective: The aim of this research work was to review the state-of-the-art regarding blockchain-based decentralized identity management for healthcare applications. Based on this summary, we provide a viewpoint on how blockchain-based decentralized identity frameworks might be utilized for virtualized healthcare applications.

Methods: This research study applied a scoping, semi-systematic review approach to summarize the state-of-the-art. Included identity management systems were evaluated based on seven criteria: autonomy, authority, availability, approval, confidentiality, tenacity, and Interoperability.

Results: Seven blockchain-based identity management systems were included and evaluated in this work: these include solutions built with Ethereum, Hyperledger Indy, Hyperledger Fabric, Hedera, and Sovrin blockchains.

Conclusions: DIM is crucial for virtual health care. Decentralized identity management for healthcare purposes is currently being explored in both academia and the private sector. More work is needed with the aim of improving the efficiency of current DIM solutions and to fully understand what technical frameworks are best suited for e-health applications.

Substandard and falsified (SF) pharmaceuticals account for an estimated 10% of the pharmaceutical supply chain in low- and middle-income countries (LMICs), where a lack of regulatory and laboratory resources limits the ability to conduct effective post-market surveillance and allows SF products to penetrate the supply chain. The Distributed Pharmaceutical Analysis Laboratory (DPAL) was established in 2014 to expand testing of pharmaceutical dosage forms sourced from LMICs; DPAL is an alliance of academic institutions throughout the United States and abroad that provides high-quality, validated chemical analysis of pharmaceutical dosage forms sourced from partners in LMICs. Results from analysis are reported to relevant regulatory agencies and are used to inform purchasing decisions made by in-country stakeholders. As the DPAL program has expanded to testing more than 1,000 pharmaceutical dosage forms annually, challenges have surfaced regarding data management and sample tracking. Here, we describe a pilot project between DPAL and ARTiFACTs that applies the blockchain to organize and manage key data generated during the DPAL workflow, including a sample's progress through the workflow, its physical location, provenance of metadata, and lab reputability. Recording time and date stamps with these data will create a permanent and verifiable chain of custody for samples. This secure, distributed ledger will be linked to an easy-to-use dashboard, allowing stakeholders to view results and experimental details for each sample in real time and verify the integrity of DPAL analysis data. Introducing this blockchain-based system as a pilot will allow us to test the technology with real users analyzing real samples. Feedback from users will be recorded and necessary adjustments will be made to the system before the implementation of blockchain across all DPAL sites. Anticipated benefits of implementing the blockchain technology for managing DPAL data include efficient management for routing work, increasing throughput, creating a chain of custody for samples and their data in alignment with the distributed nature of DPAL, and using the analysis results to detect patterns of quality within and across brands of products and develop enhanced sampling techniques and best practices.

There is increasing recognition about health-oriented datasets that could be regarded as intangible assets: distinct assets with future economic benefits but without physical properties. While health-oriented datasets - particularly health records - are ascribed monetary value on the black market, there are few established methods for assessing the value for legitimate research and business purposes. The emergence of blockchain has created new commercial opportunities for transferring assets without intermediaries. Therefore, blockchain is proposed as a medium by which research datasets could be transacted to provide future value. For authorized individuals to verify their transactions, blockchain methodologies offer security, auditability, and transparency. The authors share data valuation methodologies consistent with accounting principles and include discussions of black market valuation of health data. Furthermore, this article describes blockchain-based methods of managing real-time payment/micropayment strategies.

Pharmaceutical supply chains are complex structures that include various participants. Furthermore, blockchains are viewed as a promising solution to increase effectiveness and overcome some of the main challenges in these supply chains-especially lack of trust. The European Union (EU) set strict rules in the domain of pharmaceutical supply chains in order to protect patient safety and public health. In addition, blockchains bring legal requirements. Among these requirements, personal data protection is of utmost importance. This is because, as has been argued for years, blockchains and the EU data protection regime are in conflict by their natures. However, it is also claimed that when rightly designed and combined with other technological solutions, blockchains potentially offer great opportunities to enhance data protection. Nevertheless, potential for blockchains in the pharmaceutical supply chain is not yet been realized as most use cases are in the proof of concept or pilot stage. This article examines the debates surrounding blockchains and data protection. The goal is to draw constructive conclusions on whether blockchain solutions can be designed in data protection-enhancing ways and whether this might help realize the potential for blockchain in pharmaceutical supply chains-particularly by creating trust. For this purpose, the example of an ongoing EU-funded innovative research project called PharmaLedger as a case study to concretize its theoretical examinations is examined. This project is chosen because it gathers a wide variety of stakeholders representing different interests and aims to create a digital trust ecosystem in health care by providing a widely trusted platform that supports the design and adoption of blockchain-enabled healthcare solutions while accelerating the delivery of innovation that benefits the entire ecosystem from manufacturers to patients.

Objective: Clinical data in the United States are highly fragmented, stored in numerous different databases, and are defined by service providers or clinical specialties rather than by individuals or their families. As a result, linking or aggregating a complete record for a patient is a major technological, legal, and operational challenge. One of the factors that has made clinical data integration so difficult to achieve is the lack of a universal ID for everyone. This leads to other related problems of having to prove identity at each interaction with the health system and repeatedly providing basic information on demographics, insurance, payment, and medical conditions. Traditional solutions that require complex governance, expensive technology, and risks to privacy and security of the data have failed adequately to solve this interoperability problem. We describe the technical design decisions of a patient-centric decentralized health identity management system using the blockchain technology, called MediLinker, to address some of these challenges.

Design: Our multidisciplinary research group developed and implemented an identity wallet, which uses the blockchain technology to manage verifiable credentials issued by healthcare clinics, banks, and insurance companies. To manage patient's self-sovereign identity, we leveraged the Hyperledger Indy blockchain framework to store patient's decentralized identifiers (DIDs) and the schemas or format for each credential type. In contrast, the credentials containing patient data are stored 'off-ledger' in each person's wallet and accessible via a computer or smartphone. We used Hyperledger Aries as a middleware layer (API: Application Programming Interface) to connect Hyperledger Indy with the front-end, which was developed using a JavaScript framework, ReactJS (Web Application) and React Native (iOS Application).

Results: MediLinker allows users to store their personal data on digital wallets, which they control. It uses a decentralized trusted identity using Hyperledger Indy and Hyperledger Aries. Patients use MediLinker to register and share their information securely and in a trusted system with healthcare and other service providers. Each MediLinker wallet can have six credential types: health ID with patient demographics, insurance, medication list including COVID-19 vaccination status, credit card, medical power of attorney (MPOA) for guardians of pediatric or geriatric patients, and research consent. The system allows for in-person and remote granting and revoking of such permissions for care, research, or other purposes without repeatedly requiring physical identity documents or enrollment information.

Conclusion: We successfully developed and tested a blockchain-based technical architecture, described in this article, as an identity management system that may be operationalized and scaled for future impl