區(qū)塊鏈概念在醫(yī)療上之應(yīng)用何謂區(qū)塊鏈?What

is

Blockchain

?3DistributedNetworkdecentralizedP2Parchitecture

withnodesconsisting

of

networkparticipantsSharedLedgerNomembers

hasthe

powertotamperoralterdataDigitalTransactionsInformationisencryptedanddigitallysignedtoguaranteeauthenticity

andaccuracy.Blocksareaddedina

linear,chronologicalorderFundamentalsofBlockchainTechnologyDatainteroperabilityInsuranceclaimsadjudicationWhat

Benefits

via

Blockchain

in

HealthcareSupplychainmanagement(Smartcontract)Single,longitudinal

patientrecordsSource:/2018/01/29/blockchain-technology-in-healthcare-benefits/?

ImprovesecurityanddataqualityNEJM

Catalyst2017;WEF20172016USD

2.5bn0504030201Insurance?

Transparencyandrelevantrecordskeeping

?

Reduceprocessinginsurance

claims2025USD19.9bnGovernance?

Reducecorruptionatstatelevel?

MoreopportunitiesforbusinessestomanagetheirassetsBanking?

ReducetransactioncostsandsettlementtimeRetail?

Proofofownership&resale?

Increased

trustdue&informationevidencesHealthcare?

Increaseefficiency

forinsurance

quotes

?

Completepatients’medical

historyGlobalBlockchainTechnology

ApplicationIndustryGlobal

Healthcare

Market

Outlook

2019-Value-based

care,technology-convergence

innovation702

SingaporePersonal

info

of1.5m

SingHealth

patients,including

PM

Lee,stolen

in

Singapore'sworst

cyber

attack(Jul.2018)06

USHealth

Data

Breach

on

Healthcare.govPortal

Impacts75K

People(Oct.2018)Cyber

attacks-latest

news

(International

&

domestic)NHS

trust

hit

by

cyber

attack

cancelsoperations

and

asks

patients

not

to

come

tohospital'unless

it

is

essential‘(May2017)04HackofDNAwebsite

92million

accounts(Jun.2018)Medical

sector

vulnerable

to

health

data

cyberattacks(Nov.2018)Websites

hit

with

over20millionattacks

a

month(Apr.

2018)AustraliaIsraelTaiwan050301exposesdatafromUKcyber隱私資料保護(hù)指令Directive

95/46/CE及各國(guó)法律?

初次統(tǒng)一

，但各國(guó)內(nèi)較為松散?

適用國(guó)家法律?

各國(guó)資料保護(hù)權(quán)責(zé)機(jī)關(guān)強(qiáng)制執(zhí)行

?

低罰則一般資料保護(hù)規(guī)則(GDPR)?

完整統(tǒng)一?

直接適用?

各國(guó)資料保護(hù)權(quán)責(zé)機(jī)關(guān)強(qiáng)制執(zhí)行及一

致性機(jī)制并設(shè)有歐盟資料保護(hù)委員會(huì)?

高罰則歐盟發(fā)布了關(guān)于隱私資料保護(hù)指令Directive95/46/CE歐盟“

一般資料保護(hù)規(guī)則”

（GDPR）已發(fā)布且生效，將取代1995年前的“隱私資料保護(hù)指

令經(jīng)過(guò)兩年的倡導(dǎo)期，GDPR將于

2018年5月在28個(gè)歐盟會(huì)員國(guó)

執(zhí)行Current199520162018歐盟GDPR進(jìn)程FutureFraudProtection?

Data

elements

arestored

in

a

block-likestructure?

Each

block

contains

a

hash

value*over

its

data?

Each

block

contains

the

hash

valuesof

the

preceding

block?

Data

manipulation

is

impossibleDecentralization?

Nocentralinstance,no

intermediaries?

A

network

of

equals?

All

decisions

areconsensuallySource:

https://www.europeandataportal.eu/en/highlights/open-data-and-

blockchain-match-made-heavenTransparency?

Every

member

owns

a

similarcopyof

all

data?

Transparency

and

tracability

areguaranteed?

Network

and

data

integrity

aswellasreliabilityareguaranteedHow

Blockchain

Protect

of

Data

Privacy區(qū)(塊鏈技術(shù)如何保護(hù)資料隱私?)?*Hashvaluesarelikeuniquefingerprintsof

dataInconsistent

informationmisalignment

ofcustomersandcontracts

data

between

tradingpartners#01Enforce

businessrules

in

your

partner’s

system#02Rely

on

industrywide3rdpartydataUse

Case-Medical

SupplyChainManagementandDrugTraceabilityManualprocessing?1B

chargeback

claims

in

the

USeach

year?5%of

the

claims

requiresmanualintervention#01Rapid/Automatecustomer

and

contractresearchandevaluationDisputes

in

the

chargeback

process

betweenmanufactureranddistributorRx:pharmaceuticals,M:manufacturer,D:distributor,C:customerProblemSanFrancisco,

California

Source:Chronicled#02ImmediatechargebackAdjudicationSolutionEliminateunnecessaryspendingand

middlemen

in

the

geneticstudyingprocess?Eliminating

expensive

middlemen?Incentivizing

users

to

safely

selltheir

encrypted

genetic

dataUse

Case-Encrypted

GeneticInformation

Sharing

Problem

Boston,

MassachusettsFor

Pharmaceutical

and

biotech

companies#01Distributedledgertechnology#02GeneticdatabaseSpendbillionsofdollars/yearacquiringgenetic

data

from

thirdpartiesExpensivelongtimetomatchingcasesSource:NEBULAGENOMICS?

How

can

recipients

of

the

vaccine

rest

assured

that

their

vaccines

have

not

been

compromised

byfaultystoragehandling,puttingrecipientsandtheir

surrounding

social

environment

at

risk??

Is

it

possible

to

monitor

and

verify

proper

storageofthevaccine?Use

Case-UsingBlockchaintoMonitortheCOVID-19Vaccine

Supply

ChainThe

answer

could

lie

in

blockchainAsadvancesinsequencingtechnologykeephappening,sequencingcostswill

drop

drastically.Somuch

so,that

soon

Nebula

Genomics’token

economy

will

enable

people

to

fully

pay

for

their

personal

genomesequencing.They

could

even

make

a

profit

from

it.Ultimately,this

will

bring

genome

sequencing

closer

to

mass

adoption.Use

Case-NebulaGenomicsEnable

to

Share

Health

DataAcrosstheBlockchainNetworkto

AllPartiesafterPermissionPersonalHealthRecords

(PHRs)PHRs

have

the

potential–

to

give

patients

or

healthy

people?

fine-grained

(精釀)?

personalized(個(gè)人)?secure

(安全)–toaccess&control

their

own

medical

data–toenableself-managementof

careALedgerofMe:Personalizing

Healthcare

UsingBlockchain

Technology(GaryLeeming*,

JamesCunningham

andJohnAinsworth,

Frontiers

in

Medicine

|July2019|

Volume

6|Article

171)16?

Theadoptionofthe

ElectronicHealthRecord

(EHR)hasevolvedasaconsolidatedtechnologyforrecordingpatient

health

data?

Akeydifferencebetween

an

EHRandaPersonalHealthRecord

(PHR)isthat

a

PHR

enablespatientstoaccess

and

controltheirown

dataPersonalhealthrecord

(PHR)

and

electronichealthrecord

(EHR)relationships/2017/1/e13/ChallengesafterDigitizedHealthcare?

Challenges–

implementation

costs,privacy,security–

enable

data

sharing

(共享),or

interoperability(共通),between

data

sourcesandsystems–

assessment

of

the

effective

benefits

that

the

patient

may

have?

Governance(治理)–

Protect

the

personal

and

private

data(PHR)–

need

for

more

“Trust”?

transparency

of

consent

(同意書透明化)ALedgerofMe:PersonalizingHealthcareUsingBlockchain

Technology(Gary

Leeming*,JamesCunningham

and

John

Ainsworth,Frontiers

inMedicine|July2019|Volume6|Article171)?

anonymization

(匿名化)?

data

ownership

(資料所有權(quán))?

“NoTrust,NoData”18BLOCKCHAIN?Decentralized?DataSecurity&

Privacy?Transparent?Immutableand

Traceable?SmartContractsBlockchain

PlayaKey

Role

forValue-added

chain

of

the

Healthcare

SystemPatientsREINVENTING

HEALTHCARE

ONTHEBLOCKCHAIN:

TowardaNewErain

Precision

MedicineMYHEALTHDATA

ASSETS19iWellChain:WearecurrentlybetatestingintheseareasTheBlockchainApplicationat

TMUHInsurance

CompaniesLifeInsuranceClaimsPharmacyPatientComplianceHospital/

ClinicsEMR/

EHR/

PHRGovernment(NHIA)ApplicationsMedical/Healthdocuments

&imagesMedicalreferralservicesSmartinsurance

claimsClinicaltrialsExtension

ServicesOPD

ServicesPersonal

services

HealthecosystemIdentifyBCidentifyforpatient

BC

accountmanagementSmart

ContractSelf-verifiable

Self-executable

TamperproofTMUHBC

ApplicationsE-informedconsentMedicalDocuments

2-3day

<

1sec(2~3

MB/

perdocument)Images

CT,

MRI,

PathologyMedical

Documents

&

Images

(

Health

ExamReports

)HOW

LONG

DOES

IT

TAKE

BEFORE

A

REPORT

IS

READY?Before*(Paper-based

or

CD)IWELLCHAIN

:

IMPLEMENTATION2-

3

mins(5~10

MB/per

sec)

iWellChain(Network-based)(0.3-0.5GB)

1

day122to

besubmitted,

verified,andprocessedbeforethe

recipientcan

bereimbursed.This

involves

many

hospitals

&insurance

employees

duringthe

process.Usingoursolution,the

process

isexpeditedto:BEFORE

YOU

LEAVE

THEHOSPITAL.IWELLCHAIN

:

IMPLEMENTATION2

SMARTMEDICAL

INSURANCE

CLAIMSClaimcompensationPatientsA

typical

insurance

claim

takes1-3

monthsBlockchain

ITHospitalsInsurersiWellChainEMR/

EHRIWELLCHAIN

:

IMPLEMENTATIONPATIENT

REFERRALS

BETWEEN

T

MUH

AND

NON

-AFFILIATED

CLINICSClinicsClinicsClinicsHospital:Reply

a

referralletter

to

thepatient

&

clinic?

Referralsfromclinicsto

hospital?

Referralsfrom

hospitalto

clinicsWrite

a

referralletter

&

make

areferral

requesttoa

hospitalUse

3-stepauthenticationprocessto

identifythe

patient.The

patient

visitstothe

hospital

&uses

3-stepauthentication

….The

patient

visitstothe

hospital

&uses

3-stepauthentication

….3Referralsreceived(Referralcenter)Upload

tothe

patient’sledgerUpload

tothe

patient’sledgerBlockchain

ITHospitals….Hospital:NHIA/MOHWAccess

tothe

EMRdataAccess

tothe

EMRdataiWellChainReply-

referrals

received….Clinics:Patients!Clinics:TimeperiodTotal

usersHealth

check

departmentCommunity

medicinedepartmentIndividualapplicationNo.%Total

visits1No.(%oftotalvisits)%Total

visits2No.(%oftotalvisits)%No.%Entireperiod392100581175(30.12)44.6491299(10.86)25.2611830.10StatisticsofTMUH’s

BlockchainAccounts

byDifferentApplicationChannels561002158(3.72)14.2931425(7.96)44.642341.07*Period

I:

September

16,

2018

to

October

15,

2018;

Period

II:

October

16,

2018

to

November

15,

2018;

Period

III:

November

16,

2018

toDecember15,2018;1Total

number

of

high-end

health

check

visits;2Total

number

of

referral

patients

via

the

NHIA's

NMR

systemLoYS,YangCY,ChienHF,

ChangSS,LuCY,ChenRJBlockchain-enablediWellChain

FrameworkIntegration

WiththeNational

MedicalReferral

System:Implementation

andPreliminary

Results

JMIR

(2019)79(37.98)88(55.70)54(16.62)20(7.33)Period

III*Period

II*Period

I*38.0938.5319.0523.3875.245.71325273208231105100100158896TimeperiodTotalclicksLaboratorytestsreportsOPD

notesDischargenotesPathologyreportsHealthcheckreportsNo.(%)Totalreports1(%)No.(%

of

totalclicks)Totalnotes2(%)No.(%

of

totalclicks)Totalnotes3(%)No.(%

of

totalclicks)Totalreports4(%)No.(%

of

totalclicks)Totalreports5(%)No.(%

of

totalclicks)EntireperiodPeriod

I*Period

II*Period

III*5,612(100)406(100)4,540(80.90)1,358(100)721(12.85)2(100)7(0.12)134(100)4(0.07)175(100)340(6.06)2,878(100)116(28.57)2,302(79.99)281(20.69)362(12.58)1(50.00)2(0.07)19(14.18)1(0.03)88(50.29)211(7.33)906(100)82(20.20)789(87.09)530(39.03)88(9.71)0(0)2(0.22)31(23.13)0(0)8(4.57)27(2.98)1,828(100)208(51.23)1,449(79.27)547(40.28)271(14.82)1(50.00)3(0.16)84(62.69)3(0.16)79(45.14)102(5.58)*PeriodI:September

16,2018toOctober15,2018;PeriodII:October16,2018toNovember

15,2018;PeriodIII:

November

16,

2018toDecember

15,2018;1Totalnumber

oflaboratorytestsreports;2Totalnumber

ofOPDnotes;3Totalnumber

of

dischargenotes;4Totalnumber

of

pathology

reports;4Total

number

ofhealth

checkreportsLoYS,YangCY,

ChienHF,

Chang

SS,

Lu

CY,

Chen

RJBlockchain-enablediWellChainFramework

IntegrationWiththeNationalMedicalReferral

System:

Implementation

andPreliminary

ResultsJMIR

(2019)Statistics

of

User

Access

Logs

toiWellChainDAppAutomatedfreegoods

TrustedanalysisReduce

errors&admin.Real-time

notificationPSP

(Patient

SupportingPrograms)Analysis(i.e.DuringOfTreatment,Adherence)iWellChainDAppprovided

…

..Smart-contractTriggers

FreeGoodsFlowRegistration

&PatientAuthorizationTrust&Easy

sign-offProcess

automationDataFeed

&

EvaluationEventsfrom

EMRMonitoringSmart-ContractFulfilmentIn

Taiwan

：?

~901cases

(avg.103~107)?

60

(6.7%)cases

(TMUH)?

Medication

Treatment-3times

per

week(before)-2times

per

week(now)?

觀察因素-

出血部位(2020.Q1)Patient-reported

Outcome

System-血友病iTPass-病人報(bào)告系統(tǒng)(Patients)上傳健保署(Upload

to

MOHA)-不良反應(yīng)-疼痛指數(shù)?

搜集病人報(bào)告數(shù)據(jù)Administrative

DataResearchData血友病(區(qū)塊鏈)病友卡

(PatientVirtualCard)門診醫(yī)囑(CPOE)系統(tǒng)(Doctors)血友病個(gè)案管理平臺(tái)(StudyNurses)研究團(tuán)隊(duì)計(jì)劃(Research

Projects&Publication)68ProactiveCaseManagement

System(心衰竭個(gè)案照護(hù))快速追蹤個(gè)案就醫(yī)紀(jì)錄個(gè)人基本生理數(shù)據(jù)追蹤個(gè)人照護(hù)歷程持續(xù)性個(gè)案照護(hù)云端藥歷系統(tǒng)(西醫(yī)用藥)(3個(gè)月)特定藥品用藥紀(jì)錄(特定管制藥品&特定凝血因子用藥)(6個(gè)月)過(guò)敏藥物紀(jì)錄(永久)復(fù)健醫(yī)療紀(jì)錄(12個(gè)月)中醫(yī)用藥紀(jì)錄(3個(gè)月)出院病歷摘要

(6個(gè)月)手術(shù)紀(jì)錄(6個(gè)月)檢查檢驗(yàn)紀(jì)錄(6個(gè)月)牙科處置及手術(shù)(24個(gè)月)檢查檢驗(yàn)結(jié)果(Report

&

Lab

Data)(6個(gè)月)健保醫(yī)療信息云端查詢系統(tǒng)-信息共享與節(jié)制浪費(fèi)(2019.07.26BioAsia)64分類資料類型資料說(shuō)明SDK釋出醫(yī)院上傳時(shí)

效開(kāi)放查詢區(qū)間個(gè)人資料

輸入維護(hù)生理量測(cè)自費(fèi)健檢資料登錄※自行輸入資料

※自行輸入資料健保申報(bào)

資料就醫(yī)資料西醫(yī)門診資料V<24小時(shí)近3年~前2日中醫(yī)門診資料V牙醫(yī)門診資料V住院資料V用藥資料同門牙住資料手術(shù)資料過(guò)敏資料出院病歷同門牙住資料

VX104年1月1日起104年1月1日起檢驗(yàn)檢查結(jié)果血糖、血脂檢驗(yàn)資料V近3年~前2日其他檢驗(yàn)資料V影像或病理檢查資料V預(yù)防與保健成人預(yù)防保健結(jié)果V于國(guó)民健康署登錄/上傳時(shí)間癌癥篩檢結(jié)果V預(yù)防接種資料器捐或安寧緩和醫(yī)療意愿VV依檢送疾管署預(yù)防接種資料依檢送衛(wèi)福部醫(yī)事司資料保險(xiǎn)計(jì)費(fèi)健?？顩r及領(lǐng)卡紀(jì)錄保費(fèi)計(jì)費(fèi)明細(xì)※個(gè)人負(fù)擔(dān)部份保險(xiǎn)繳納保險(xiǎn)費(fèi)繳納明細(xì)※雇主+個(gè)人明細(xì)Patients65健?？ㄌ?hào)及網(wǎng)絡(luò)

密碼登入勾選項(xiàng)目或全部產(chǎn)制下載前出現(xiàn)提示字樣與聲明書進(jìn)行用戶確認(rèn)(*健康存折驗(yàn)證程序)TMUH

EMR/EHR

與健保署健康存折

(My

Health

Bank)數(shù)據(jù)互通與整合范例5下載健康存折數(shù)據(jù)

后，數(shù)據(jù)將儲(chǔ)存于個(gè)人手機(jī)以區(qū)塊鏈技術(shù)連結(jié)醫(yī)院數(shù)據(jù)與健康存摺數(shù)據(jù)點(diǎn)選各式e卡服務(wù)

(NHIA健康存折卡)瀏覽個(gè)人過(guò)

去就醫(yī)數(shù)據(jù)

(e.g.診所與

牙科紀(jì)錄)民眾同意書授權(quán)內(nèi)容

(*開(kāi)啟健康存折功能)民眾登入?yún)^(qū)塊鏈賬戶

(個(gè)人密碼+私鑰密碼)67314266TMUH

EMR/EHR

與健保署健康存折

(My

Health

Bank)數(shù)據(jù)互通與整合范例TheTMUH’s

iTPass

Appcantrigger

the

NHIAMHB’s

SDK:?acquire

the

individual's

Claim

data,?integrate

his

or

her

hospital’s

EMR

data?share

the

data

with

ones

who

he

or

shehas

permissioned

through

Blockchain67COVID-19:BeyondTomorrow

Choicesforthe“New

Normal”JAMA.Published

online

May4,2020doi:10.1001/jama.2020.69496

PropertiesofCarefor

DurableChangeForwardThinkingPro