scholarly journals Mechanism Design of Health Care Blockchain System Token Economy: Development Study Based on Simulated Real-World Scenarios

10.2196/26802 ◽  
2021 ◽  
Vol 23 (9) ◽  
pp. e26802
Author(s):  
Se Young Jung ◽  
Taehyun Kim ◽  
Hyung Ju Hwang ◽  
Kyungpyo Hong
Keyword(s):  
Health Care ◽  
Mechanism Design ◽  
Real World ◽  
Health Care Organizations ◽  
Token Economy ◽  
Personal Health Records ◽  
Personal Health ◽  
Insurance Company ◽  
Health Records ◽  
Recruitment Time

Background Despite the fact that the adoption rate of electronic health records has increased dramatically among high-income nations, it is still difficult to properly disseminate personal health records. Token economy, through blockchain smart contracts, can better distribute personal health records by providing incentives to patients. However, there have been very few studies regarding the particular factors that should be considered when designing incentive mechanisms in blockchain. Objective The aim of this paper is to provide 2 new mathematical models of token economy in real-world scenarios on health care blockchain platforms. Methods First, roles were set for the health care blockchain platform and its token flow. Second, 2 scenarios were introduced: collecting life-log data for an incentive program at a life insurance company to motivate customers to exercise more and recruiting participants for clinical trials of anticancer drugs. In our 2 scenarios, we assumed that there were 3 stakeholders: participants, data recipients (companies), and data providers (health care organizations). We also assumed that the incentives are initially paid out to participants by data recipients, who are focused on minimizing economic and time costs by adapting mechanism design. This concept can be seen as a part of game theory, since the willingness-to-pay of data recipients is important in maintaining the blockchain token economy. In both scenarios, the recruiting company can change the expected recruitment time and number of participants. Suppose a company considers the recruitment time to be more important than the number of participants and rewards. In that case, the company can increase the time weight and adjust cost. When the reward parameter is fixed, the corresponding expected recruitment time can be obtained. Among the reward and time pairs, the pair that minimizes the company’s cost was chosen. Finally, the optimized results were compared with the simulations and analyzed accordingly. Results To minimize the company’s costs, reward–time pairs were first collected. It was observed that the expected recruitment time decreased as rewards grew, while the rewards decreased as time cost grew. Therefore, the cost was represented by a convex curve, which made it possible to obtain a minimum—an optimal point—for both scenarios. Through sensitivity analysis, we observed that, as the time weight increased, the optimized reward increased, while the optimized time decreased. Moreover, as the number of participants increased, the optimization reward and time also increased. Conclusions In this study, we were able to model the incentive mechanism of blockchain based on a mechanism design that recruits participants through a health care blockchain platform. This study presents a basic approach to incentive modeling in personal health records, demonstrating how health care organizations and funding companies can motivate one another to join the platform.

scholarly journals Mechanism Design of Health Care Blockchain System Token Economy: Development Study Based on Simulated Real-World Scenarios (Preprint)

2020 ◽  
Author(s):  
Se Young Jung ◽  
Taehyun Kim ◽  
Hyung Ju Hwang ◽  
Kyungpyo Hong
Keyword(s):  
Health Care ◽  
Mechanism Design ◽  
Real World ◽  
Health Care Organizations ◽  
Token Economy ◽  
Personal Health Records ◽  
Personal Health ◽  
Insurance Company ◽  
Health Records ◽  
Recruitment Time

BACKGROUND Despite the fact that the adoption rate of electronic health records has increased dramatically among high-income nations, it is still difficult to properly disseminate personal health records. Token economy, through blockchain smart contracts, can better distribute personal health records by providing incentives to patients. However, there have been very few studies regarding the particular factors that should be considered when designing incentive mechanisms in blockchain. OBJECTIVE The aim of this paper is to provide 2 new mathematical models of token economy in real-world scenarios on health care blockchain platforms. METHODS First, roles were set for the health care blockchain platform and its token flow. Second, 2 scenarios were introduced: collecting life-log data for an incentive program at a life insurance company to motivate customers to exercise more and recruiting participants for clinical trials of anticancer drugs. In our 2 scenarios, we assumed that there were 3 stakeholders: participants, data recipients (companies), and data providers (health care organizations). We also assumed that the incentives are initially paid out to participants by data recipients, who are focused on minimizing economic and time costs by adapting mechanism design. This concept can be seen as a part of game theory, since the willingness-to-pay of data recipients is important in maintaining the blockchain token economy. In both scenarios, the recruiting company can change the expected recruitment time and number of participants. Suppose a company considers the recruitment time to be more important than the number of participants and rewards. In that case, the company can increase the time weight and adjust cost. When the reward parameter is fixed, the corresponding expected recruitment time can be obtained. Among the reward and time pairs, the pair that minimizes the company’s cost was chosen. Finally, the optimized results were compared with the simulations and analyzed accordingly. RESULTS To minimize the company’s costs, reward–time pairs were first collected. It was observed that the expected recruitment time decreased as rewards grew, while the rewards decreased as time cost grew. Therefore, the cost was represented by a convex curve, which made it possible to obtain a minimum—an optimal point—for both scenarios. Through sensitivity analysis, we observed that, as the time weight increased, the optimized reward increased, while the optimized time decreased. Moreover, as the number of participants increased, the optimization reward and time also increased. CONCLUSIONS In this study, we were able to model the incentive mechanism of blockchain based on a mechanism design that recruits participants through a health care blockchain platform. This study presents a basic approach to incentive modeling in personal health records, demonstrating how health care organizations and funding companies can motivate one another to join the platform.

scholarly journals Personal Health Records for Patients with Chronic Disease

2014 ◽  
Vol 05 (02) ◽  
pp. 416-429 ◽  
Author(s):  
R. Rozenblum ◽  
A. Park ◽  
M. Dunn ◽  
D.W. Bates ◽  
S. Wells
Keyword(s):  
Health Care ◽  
Chronic Disease ◽  
High Risk ◽  
Health Care Organizations ◽  
Personal Health Records ◽  
Personal Health ◽  
High Risk Population ◽  
Record System ◽  
Health Records ◽  
Management Interventions

SummaryBackground: Personal health records (PHRs) connected to a physician’s electronic health record system hold substantial promise for supporting and engaging patients with chronic disease. Objectives: To explore how U.S. health care organizations are currently utilizing PHRs for chronic disease populations.Methods: A mixed methods study including semi-structured interviews and a questionnaire was conducted. A purposive sample was developed of health care organizations which were recognized as exemplars for PHRs and were high performers in national patient satisfaction surveys (H-CAHPS or CAHPS). Within each organization, participants were health IT leaders or those managing high-risk or chronic disease populations.Results: Interviews were conducted with 30 informants and completed questionnaires were received from 16 organizations (84% response rate). Most PHRs allowed patients to access health records and educational material, message their provider, renew prescriptions and request appointments. Patient generated data was increasingly being sought and combined with messaging, resulted in greater understanding of patient health and functioning outside of the clinic visit. However for chronic disease populations, there was little targeted involvement in PHR design and few tools to help interpret and manage their conditions beyond those offered for all. The PHR was largely uncoupled from high risk population management interventions and no clear framework for future PHR development emerged.Conclusion: This technology is currently underutilized and represents a major opportunity given the potential benefits of patient engagement and shared decision making. A coherent patient-centric PHR design and evaluation strategy is required to realize its potential and maximize this natural hub for multidisciplinary care co-ordination.Citation: Wells S, Rozenblum R, Park A, Dunn M, Bates DW. Personal health records for patients with chronic disease: A major opportunity. Appl Clin Inf 2014; 5: 416–429 http://dx.doi.org/10.4338/ACI-2014-01-RA-0002

scholarly journals Continuity of care in Ghana: the promise of smart-med

2014 ◽  
Vol 3 (4) ◽  
pp. 473
Author(s):  
Henry Ogoe ◽  
Odame Agyapong ◽  
Fredrick Troas Lutterodt
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Continuity Of Care ◽  
Medical Information ◽  
Care Delivery ◽  
Personal Health Records ◽  
Personal Health ◽  
Care Providers ◽  
Health Records ◽  
Fragmentation Of Care

Individuals tend to receive medical care from different health care providers as they drift from one location to another. Oftentimes, multiple providers operate disparate systems of managing patients medical records. These disparate systems, which are unable to share and/or exchange information, have the propensity to create fragmentation of care, which poses a serious threat to the realization of continuity of care in the Ghanaian health care delivery. Continuity of care, which is the ability to seamlessly access, update, and manage patients medical information as they visit multiple providers, is a crucial component of quality of care in any health delivery system. The current system of managing patients records in Ghanapaper-basedmakes continuity of care difficult to actualize. To this end, we have developed a smartcard based personal health records system, SMART-MED, which can effectively promote continuity of care in Ghana. SMART-MED is platform-independent; it can run as standalone or configured to plug into any Java-based electronic medical record system. Results of a lab simulation test suggest that it can effectively promote continuity of care through improved data security, support interoperability for disparate systems, and seamless access and update of patients health records. Keywords: Continuity of Care, Fragmentation of Care, Interoperability, Personal Health Records, Smartcard.

Personal Health Records Status-Quo and Future Perspectives

2010 ◽  
pp. 43-63
Author(s):  
Simon Y. Liu,
Keyword(s):  
Health Care ◽  
Health Information ◽  
Personal Health Record ◽  
Full Range ◽  
Personal Health Records ◽  
Controlled Vocabulary ◽  
Care Process ◽  
Personal Health ◽  
Health Records ◽  
Access To Health

Consumers, industry, and government have recently focused attention on the potential of personal health records to empower patients in the health care process, improve patient-provider relationships, facilitate patient access to health information, and improve the quality of health care. A Personal Health Record (PHR) is a private and secure digital record that is created, managed, and owned by an individual, and contains the owner’s relevant health information. The benefits of PHRs have not yet been widely realized due to several significant challenges in their adoption, including the need for privacy, security, and interoperability, and the lack of accepted standards. Although many players in the healthcare arena are beginning to offer partial solutions, none have adequately addressed the full range of challenges. The adoption of PHRs can be significantly accelerated by the development of Open Source software that enables an individual to collect, create, organize, and manage his or her own private and secure PHR, using a standardized format and controlled vocabulary.

scholarly journals Caderneta de saúde da criança: vigilância do crescimento e desenvolvimento infantil

2018 ◽  
Vol 12 (12) ◽  
pp. 3445
Author(s):  
Talita Cristina Tomaz Silva ◽  
Emília Gallindo Cursino ◽  
Liliane Faria Da Silva
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Child Health ◽  
Growth And Development ◽  
Scientific Evidence ◽  
Child Growth ◽  
Personal Health Records ◽  
Personal Health ◽  
Health Records ◽  
Primary Health

RESUMOObjetivo: analisar as evidências científicas quanto à utilização da Caderneta de Saúde da Criança pelos profissionais de saúde para a vigilância do crescimento e desenvolvimento infantil. Método: trata-se um estudo bibliográfico, tipo revisão integrativa, com buscas nas bases de dados LILACS e BDENF e na biblioteca virtual SCIELO, utilizando os Descritores em Ciências da Saúde; crescimento e desenvolvimento, atenção primária à saúde e registros de saúde pessoal, que foram cruzados com o descritor criança empregando-se o operador booleano and. Selecionaram-se 15 artigos publicados entre 2014 a 2018 e os resultados apresentam-se em forma de figura. Resultados: evidenciou-se, nos estudos, a precária utilização da CSC, que está relacionada à ausência e à fragilidade de registros, à dificuldade de os profissionais perceberem a relevância do preenchimento, ao conhecimento deficiente dos profissionais, à insuficiência de orientações às famílias, além da participação da família nesse processo. Conclusão: compromete-se, pela precariedade da utilização da CSC, a vigilância da saúde infantil por ser este o instrumento essencial para o acompanhamento do crescimento e do desenvolvimento da criança. Descritores: Crescimento e Desenvolvimento; Atenção Primária à Saúde; Registros de Saúde Pessoal; Criança; Atenção Integral à Saúde; Saúde da Criança.ABSTRACT Objective: to analyze the scientific evidence regarding the use of the Child Health Booklet by health professionals for the monitoring of child growth and development. Method: a bibliographical study, type integrative, with searches in LILACS and BDENF databases and in the SCIELO virtual library, using Descriptors in Health Sciences; growth and development, primary health care and personal health records, which were cross-referenced with the child descriptor employing the Boolean operator and. 15 articles published between 2014 and 2018 were selected and the results are presented in figure form. Results: the poor use of CHB was evidenced in the studies, which is related to the absence and fragility of records, the difficulty of professionals to perceive the relevance of filling, poor knowledge of professionals, insufficient guidance to families, besides the participation of the family in this process. Conclusion: due to the precarious nature of the use of CHB, it is committed to monitoring child health as this is the essential instrument for monitoring child growth and development. Descriptors: Growth and Development; Primary Health Care; Personal Health Records; Kid; Comprehensive Health Care; Child Health. RESUMEN Objetivo: analizar las evidencias científicas en cuanto a la utilización de la libreta de Salud del Niño por los profesionales de salud para la vigilancia del crecimiento y desarrollo infantil. Método: se trata de un estudio bibliográfico, tipo revisión integrativa, con búsquedas en las bases de datos LILACS y BDENF y en la biblioteca virtual SCIELO, utilizando los Descriptores en Ciencias de la Salud; crecimiento y desarrollo, atención primaria a la salud y registros de salud personal, que fueron cruzados con el descriptor niño empleándose el operador booleano and. Se seleccionaron 15 artículos publicados entre 2014 y 2018 y los resultados se presentan en forma de figura. Resultados: se evidenció, en los estudios, la precaria utilización de la CSC, que está relacionada a la ausencia y fragilidad de registros, a la dificultad de los profesionales percibir la relevancia del llenado, el conocimiento deficiente de los profesionales, la insuficiencia de orientaciones a las familias, además de la participación de la familia en ese proceso. Conclusión: se compromete, por la precariedad de la utilización de la CSC, la vigilancia de la salud infantil por ser éste el instrumento esencial para el acompañamiento del crecimiento y del desarrollo del niño. Descriptores: Crecimiento y Desarrollo; Atención Primaria a la Salud; Registros de Salud Personal; Niño; Atención Integral de Salud; Salud del Niño. 

scholarly journals Personal health records in the Netherlands: potential user preferences quantified by a discrete choice experiment

2016 ◽  
Vol 24 (3) ◽  
pp. 529-536 ◽  
Author(s):  
Domino Determann ◽  
Mattijs S Lambooij ◽  
Dorte Gyrd-Hansen ◽  
Esther W de Bekker-Grob ◽  
Ewout W Steyerberg ◽  
...  
Keyword(s):  
Health Care ◽  
Data Storage ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Health Care Providers ◽  
Choice Experiment ◽  
Personal Health Records ◽  
Personal Health ◽  
Care Providers ◽  
Health Records

Objective: To identify groups of potential users based on their preferences for characteristics of personal health records (PHRs) and to estimate potential PHR uptake. Methods: We performed a discrete choice experiment, which consisted of 12 choice scenarios, each comprising 2 hypothetical PHR alternatives and an opt-out. The alternatives differed based on 5 characteristics. The survey was administered to Internet panel members of the Dutch Federation of Patients and Consumer Organizations. We used latent class models to analyze the data. Results: A total of 1,443 potential PHR users completed the discrete choice experiment. We identified 3 latent classes: “refusers” (class probability 43%), “eager adopters” (37%), and “reluctant adopters” (20%). The predicted uptake for the reluctant adopters ranged from 4% in the case of a PHR with the worst attribute levels to 68% in the best case. Those with 1 or more chronic diseases were significantly more likely to belong to the eager adopter class. The data storage provider was the most decisive aspect for the eager and reluctant adopters, while cost was most decisive for the refusers. Across all classes, health care providers and independent organizations were the most preferred data storage providers. Conclusion: We identified 3 groups, of which 1 group (more than one-third of potential PHR users) indicated great interest in a PHR irrespective of PHR characteristics. Policymakers who aim to expand the use of PHRs will be most successful when health care providers and health facilities or independent organizations store PHR data while refraining from including market parties.

scholarly journals Preferred Functions of Personal Health Records in Rural Primary Health Clinics in Canada: Health Care Team Perspectives

2021 ◽  
Vol 12 (01) ◽  
pp. 041-048
Author(s):  
Matthias Görges ◽  
Kathy L. Rush ◽  
Lindsay Burton ◽  
Mona Mattei ◽  
Selena Davis ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Focus Groups ◽  
Health Care Team ◽  
Personal Health Records ◽  
Personal Health ◽  
Health Records ◽  
Rural Primary Care ◽  
Virtual Care ◽  
Primary Health

Abstract Background Personal health records (PHR) provide opportunities for improved patient engagement, collection of patient-generated data, and overcome health-system inefficiencies. While PHR use is increasing, uptake in rural populations is lower than in urban areas. Objectives The study aimed to identify priorities for PHR functionality and gain insights into meaning, value, and use of patient-generated data for rural primary care providers. Methods We performed PHR preimplementation focus groups with rural providers and their health care teams from five primary care clinics in a sparsely populated mountainous region of British Columbia, Canada to obtain their understanding of PHR functionality, needs, and perceived challenges. Results Eight general practitioners (GP), five medical office assistants, two nurse practitioners (NP), and two registered nurses (14 females and 3 males) participated in focus groups held at their respective clinics. Providers (GPs, NPs, and RNs) had been practicing for a median of 9.5 (range = 1–38) years and had used an electronic medical record for 7.0 (1–20) years. Participants expressed interest in incorporating functionality around two-way communication and appointment scheduling, previsit data gathering, patient and provider data sharing, virtual care including visits using videoconferencing tools, and postvisit sharing of educational materials. Three further themes emerged from the focus groups: (1) the context in which the providers' practice matters, (2) the need for providing patients and providers with choice (e.g., which data to share, who gets to initiate/respond in communications, and processes around virtual care visits), and (3) perceived risks of system use (e.g., increased complexity for older patients and workload barriers for the health care team). Conclusion Rural primary care teams perceived PHR opportunities for increased patient engagement and access to patient-generated data, while worries about changes in workflow were the biggest perceived risk. Recommendations for PHR adoption in a rural primary health network include setting provider-patient expectations about response times, ability to share notes selectively, and automatically augmented note-taking from virtual-care visits.

scholarly journals A pilot study to evaluate the magnitude of association of patient activation in HIV-infected veterans who use electronic personal health records

2014 ◽  
Author(s):  
Pierre-Cedric Crouch ◽  
Carol PhD, RN, FAAN Dawson Rose ◽  
Mallory I. Johnson ◽  
Susan Janson
Keyword(s):  
Health Care ◽  
Viral Load ◽  
Personal Health Record ◽  
Patient Activation ◽  
Personal Health Records ◽  
Personal Health ◽  
Health Record ◽  
Health Records ◽  
Electronic Personal Health Record ◽  
Electronic Personal Health Records

Background: The HITECH Act signed into law in 2009 requires hospitals to provide patients with electronic access to their health information through an electronic personal health record (ePHR) in order to receive Medicare/Medicaid incentive payments. Little is known about who uses these systems or the impact these systems will have on patient outcomes in HIV care. The health care empowerment model provides rationale for the hypothesis that knowledge from an electronic personal health record can lead to greater patient empowerment resulting in improved outcomes. Objective: To determine the patient characteristics and patient activation, empowerment, satisfaction, knowledge of their CD4, Viral Loads, and antiretroviral medication, and medication adherence outcomes associated with electronic personal health record use in Veterans living with HIV at the San Francisco VA Medical Center. Participants: HIV-Infected Veterans receiving care in a low volume HIV-clinic at the San Francisco VA Medical Center, divided into two groups of users and non-users of electronic personal health records. Methods: In-person surveys were completed either online or on paper and data abstraction was completed from medical records for current anti-retroviral therapy (ART), CD4 count, and plasma HIV-1 viral load. Measures: The measures included the Patient Activation Measure, Health Care Empowerment Inventory, ART adherence, provider satisfaction, current CD4 count, current plasma viral load, knowledge of current ART, knowledge of CD4 counts, and knowledge of viral load. Results: In all, 40 participants were recruited. The use of electronic personal health records was associated with significantly higher levels of patient activation and levels of patient satisfaction for getting timely appointments, care, and information. ePHR was also associated with greater proportions of undetectable plasma HIV-1 viral loads, of knowledge of current CD4 count, and of knowledge of current viral load. The two groups differed by race and computer access. There was no difference in the current CD4, provider satisfaction, Health Care Empowerment Inventory score, satisfaction with provider-patient communication, satisfaction with courteous and helpful staff, knowledge of ART, or ART adherence. Conclusions: The use of electronic personal health records is associated with positive clinical and behavioral characteristics. The use of these systems may play a role in improving the health of people with HIV. Larger studies are needed to further evaluate these associations.

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