Background Personal health record (PHR) security, correctness, and protection are essential for health and medical services. Blockchain architecture can provide efficient data retrieval and security requirements. Exchangeable PHRs and the self-management of patient health can offer many benefits to traditional medical services by allowing people to manage their own health records for disease prevention, prediction, and control while reducing resource burdens on the health care infrastructure and improving population health and quality of life. Objective This study aimed to build a blockchain-based architecture for an international health record exchange platform to ensure health record confidentiality, integrity, and availability for health management and used Health Level 7 Fast Healthcare Interoperability Resource international standards as the data format that could allow international, cross-institutional, and patient/doctor exchanges of PHRs. Methods The PHR architecture in this study comprised 2 main components. The first component was the PHR management platform, on which users could upload PHRs, view their record content, authorize PHR exchanges with doctors or other medical health care providers, and check their block information. When a PHR was uploaded, the hash value of the PHR would be calculated by the SHA-256 algorithm and the PHR would be encrypted by the Rivest-Shamir-Adleman encryption mechanism before being transferred to a secure database. The second component was the blockchain exchange architecture, which was based on Ethereum to create a private chain. Proof of authority, which delivers transactions through a consensus mechanism based on identity, was used for consensus. The hash value was calculated based on the previous hash value, block content, and timestamp by a hash function. Results The PHR blockchain architecture constructed in this study is an effective method for the management and utilization of PHRs. The platform has been deployed in Southeast Asian countries via the Asia eHealth Information Network (AeHIN) and has become the first PHR management platform for cross-region medical data exchange. Conclusions Some systems have shown that blockchain technology has great potential for electronic health record applications. This study combined different types of data storage modes to effectively solve the problems of PHR data security, storage, and transmission and proposed a hybrid blockchain and data security approach to enable effective international PHR exchange. By partnering with the AeHIN and making use of the network’s regional reach and expert pool, the platform could be deployed and promoted successfully. In the future, the PHR platform could be utilized for the purpose of precision and individual medicine in a cross-country manner because of the platform’s provision of a secure and efficient PHR sharing and management architecture, making it a reasonable base for future data collection sources and the data analytics needed for precision medicine.

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Background COVID-19 is an ongoing global pandemic caused by SARS-CoV-2. As of June 2021, 5 emergency vaccines were available for COVID-19 prevention, and with the improvement of vaccination rates and the resumption of activities in each country, verification of vaccination has become an important issue. Currently, in most areas, vaccination and reverse transcription polymerase chain reaction (RT-PCR) test results are certified and validated on paper. This leads to the problem of counterfeit documents. Therefore, a global vaccination record is needed. Objective The main objective of this study is to design a vaccine passport (VP) validation system based on a general blockchain architecture for international use in a simulated environment. With decentralized characteristics, the system is expected to have the advantages of low cost, high interoperability, effectiveness, security, and verifiability through blockchain architecture. Methods The blockchain decentralized mechanism was used to build an open and anticounterfeiting information platform for VPs. The contents of a vaccination card are recorded according to international Fast Healthcare Interoperability Resource (FHIR) standards, and blockchain smart contracts (SCs) are used for authorization and authentication to achieve hierarchical management of various international hospitals and people receiving injections. The blockchain stores an encrypted vaccination path managed by the user who manages the private key. The blockchain uses the proof-of-authority (PoA) public chain and can access all information through the specified chain. This will achieve the goal of keeping development costs low and streamlining vaccine transit management so that countries in different economies can use them. Results The openness of the blockchain helps to create transparency and data accuracy. This blockchain architecture contains a total of 3 entities. All approvals are published on Open Ledger. Smart certificates enable authorization and authentication, and encryption and decryption mechanisms guarantee data protection. This proof of concept demonstrates the design of blockchain architecture, which can achieve accurate global VP verification at an affordable price. In this study, an actual VP case was established and demonstrated. An open blockchain, an individually approved certification mechanism, and an international standard vaccination record were introduced. Conclusions Blockchain architecture can be used to build a viable international VP authentication process with the advantages of low cost, high interoperability, effectiveness, security, and verifiability.

UNSTRUCTURED 2019 novel Coronavirus (COVID-19), which presumably originated in bats and transmitted to humans through unknown mechanisms in Wuhan, Hubei province, China in December 2019, has affected more than 180 countries and territories around the world. On March 11, 2020, World Health Organization (WHO) characterized the COVID-19 outbreak as a pandemic. This is the first pandemic known to be caused by a new coronavirus. While the complete clinical picture with regard to COVID-19 is not fully known, based on currently available information, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19. The emergence and rapid widespread of COVID-19 are not only becoming a new public health crisis, but also wreaking havoc on the global economy and industries. However, disease investigation, patient-tracking mechanisms and the transmission of case reports seem to both labor-intensive and slow. The ongoing pandemic is putting healthcare systems under strain worldwide and forcing hospitals and other medical facilities to scramble to make sure data can be shared effectively. The primary aim of this study is to design a Global Infectious Disease Surveillance and Case Tracking system capable of facilitating detection and control of COVID-19 transmission. A blockchain-based architecture is built to protect the security and guarantee the correctness of International Patient Summary (IPS). An International Patient Summary (IPS) document is an electronic health record extract containing essential healthcare information about a subject of care[1]. IPS is designed for supporting the use case scenario for ‘unplanned, cross border care’, but it is not limited to it. It is intended to be international, i.e., to provide generic solutions for global application beyond a particular region or country and the IPS dataset is minimal and non-exhaustive; specialty-agnostic and condition-independent; but still clinically relevant. The design, global scope, and utility of IPS towards unplanned cross border care, potential for re-use makes it suitable to be considered for a situation like COVID-19. A Fast Healthcare Interoperability Resources (FHIR) confirmed IPS, including symptoms, therapies, medications, laboratory data, can be transferred and exchanged on the platform for ease of access by the physicians efficiently. Patient data are de-identified to protect privacy. Members of the Centers for Disease Control and Prevention (CDC) around the countries will be able to carry out risk control and track high-risk groups using tracking module in the system. The results of this study help support the global infectious disease prevention and protection by exchanging and sharing case data which can speed up the clinical research of COVID-19 and expedite the efforts towards developing treatment protocols. Launching an integral system assembled with disease surveillance and case tracking modules on the Internet might help the international medical community to detect and respond to the situation of accelerated virus transmission thereby lifting constraints on COVID-19 research.

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