Smart Decentralization of Personal Health Records with Physician Apps and Helper Agents on Blockchain: Platform Design and Implementation Studyopen access
- Authors
- Kim, Hyeong-Joon; Kim, Hye Hyeon; Ku, Hosuk; Yoo, Kyung Don; Lee, Suehyun; Park, Ji In; Kim, Hyo Jin; Kim, Kyeongmin; Chung, Moon Kyung; Lee, Kye Hwa; Kim, Ju Han
- Issue Date
- Jun-2021
- Publisher
- JMIR PUBLICATIONS, INC
- Keywords
- personal health records; blockchain; mobile health; semantic interoperatbility; decentralized system; patient-centered system
- Citation
- JMIR MEDICAL INFORMATICS, v.9, no.6
- Journal Title
- JMIR MEDICAL INFORMATICS
- Volume
- 9
- Number
- 6
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/88135
- DOI
- 10.2196/26230
- ISSN
- 2291-9694
- Abstract
- Background: The Health Avatar Platform provides a mobile health environment with interconnected patient Avatars, physician apps, and intelligent agents (termed IoA(3)) for data privacy and participatory medicine; however, its fully decentralized architecture has come at the expense of decentralized data management and data provenance. Objective: The introduction of blockchain and smart contract technologies to the legacy Health Avatar Platform with a clinical metadata registry remarkably strengthens decentralized health data integrity and immutable transaction traceability at the corresponding data-element level in a privacy-preserving fashion. A crypto-economy ecosystem was built to facilitate secure and traceable exchanges of sensitive health data. Methods: The Health Avatar Platform decentralizes patient data in appropriate locations (ie, on patients' smartphones and on physicians' smart devices). We implemented an Ethereum-based hash chain for all transactions and smart contract-based processes to guarantee decentralized data integrity and to generate block data containing transaction metadata on-chain Parameters of all types of data communications were enumerated and incorporated into 3 smart contracts, in this case, a health data transaction manager, a transaction status manager, and an application programming interface transaction manager. The actual decentralized health data are managed in an off-chain manner on appropriate smart devices and authenticated by hashed metadata on-chain. Results: Metadata of each data transaction are captured in a Health Avatar Platform blockchain node by the smart contracts. We provide workflow diagrams each of the 3 use cases of data push (from a physician app or an intelligent agents to a patient Avatar), data pull (request to a patient Avatar by other entities), and data backup transactions. Each transaction can be finely managed at the corresponding data-element level rather than at the resource or document levels. Hash-chained metadata support data element-level verification of data integrity in subsequent transactions. Smart contracts can incentivize transactions for data sharing and intelligent digital health care services. Conclusions: Health Avatar Platform and interconnected patient Avatars, physician apps, and intelligent agents provide a decentralized blockchain ecosystem for health data that enables trusted and finely tuned data sharing and facilitates health value-creating transactions with smart contracts.
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