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Objectives Currently, patients' consent is essential to use their medical records for various purposes; however, most people give their consent using paper forms and have no control over it. Healthcare organizations also have difficulties in dealing with patient consent. The objective of this research is to develop a system for patients to manage their consent flexibly and for healthcare organizations to obtain patient consent efficiently for a variety of purposes. Methods We introduce a new e-consent model, which uses a purpose-based access control scheme; it is implemented by a blockchain system using Hyperledger Fabric. All metadata of patient records, consents, and data access are written immutably on the blockchain and shared among participant organizations. We also created a blockchain chaincode that performs business logic managing patient consent. Results We developed a prototype and checked business logics with the chaincode by validating doctors' data access with purpose-based consent of patients stored in the blockchain. The results demonstrate that our system provides a fine-grained way of handling medical staff 's access requests with diverse intended purposes for accessing data. In addition, patients can create, update, and withdraw their consents in the blockchain. Conclusions Our consent model is a solution for consent management both for patients and healthcare organizations. Our system, as a blockchain-based solution that provides high reliability and availability with transparency and traceability, is expected to be used not only for patient data sharing in hospitals, but also for data donation for biobank research purposes.

Objectives Electronic Health Record (EHR) systems are increasingly used as an effective method to share patients' records among different hospitals. However, it is still a challenge to access scattered patient data through multiple EHRs. Our goal is to build a system to access patient records easily among EHRs without relying on a centralized supervisory system. Methods We apply consortium blockchain to compose a distributed system using Hyperledger Fabric incorporating existent EHRs. Peer nodes hold the same ledger on which the address of a patient record in an EHR is written. Individual patients are identified by unique certificates issued by a local certificate authorities that collaborate with each other in a channel of the network. To protect a patient's privacy, we use a proxy re-encryption scheme when the data are transferred. We designed and implemented various chaincodes to handle business logic agreed by member organizations of the network. Results We developed a prototype system to implement our concept and tested its performance including chaincode logic. The results demonstrated that our system can be used by doctors to find patient's records and verify patient's consent on access to the data. Patients also can seamlessly receive their past records from other hospitals. The access log is stored transparently and immutably in the ledger that is used for auditing purpose. Conclusions Our system is feasible and flexible with scalability and availability in adapting to existing EHRs for strengthening security and privacy in managing patient records. Our research is expected to provide an effective method to integrate dispersed patient records among medical institutions.

IT Strategic Headquarters of the Japanese government compiled the Priority Policy Program 2007, in which “Establishment of the structure for every citizen to be able to manage and utilize his health information by himself” and “Foundation of the e‐ Post‐Office box for the realization of the social security service in aspects of people” are declared. For this purpose, a health information system is considered that delivers healthcare data to the server, where the data is to be individually self‐administered by the owner. A patient can register his data, and download or reference it from any medical institution or home when necessary. We made a prototype system to realize such a personal health data referring system based on the e‐ post‐office box concept. The system is to be used in field trial experiment with the staffs and students of Tokyo Institute of Technology using their ID Card. This prototype system is expected to be available for the policy suggestion in the realization of the e‐P.O.Box stated in the Priority Policy Program of the government.

The need for an integrated program of case management and psychoeducation for people with mental disabilities and their families is discussed in this chapter. Such programs are needed in Japan in order to resolve the problems of long-stay patients and to change the hospital-centered mental health care system into a community-based system. First we present the results of our nationwide research and analysis of governmental statistics, and second we argue the feasibility and effectiveness of such programs.