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. 2020 Jan 6;3:1. doi: 10.1038/s41746-019-0211-0

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© The Author(s) 2020

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 3 — Each box represents a Blockchain ledger. The Patient Directory lists all pseudonymised patients about whom data is stored across all providers’ Blockchain ledgers. Associated with each patient is a pointer to all centres (represented by number) where that individual has had a medical interaction. Individual Centres store their own ledgers, containing more detailed metadata (represented by code, e.g. Data A1, which does not imply storage of sensitive medical information) about interactions with patients, including associated cloud-based data storage locations and access permission information. When a Centre joins the system (e.g. Centre 3), basic pseudonymised information about its patients is relayed to the Patient Directory, allowing other Centres to access that information, subject to any associated smart contract-based permissions.