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. 2019 Mar 25;26(5):462–478. doi: 10.1093/jamia/ocy185

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© The Author(s) 2019. Published by Oxford University Press on behalf of the American Medical Informatics Association.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contactjournals.permissions@oup.com

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Figure 1. — Healthcare and research examples of immutable recording of transactions. Note that in both examples the actual patient data are stored off-chain and only the access records (eg, requests for and receipts of records) are stored on-chain as transactions in blocks. (A) Health informatics exchange example: Patient P₁ requests use of data by Clinician C₁, institution I₁ provides access, and patient P₁ and/or primary care clinician C₂ are able to see the transaction. (B) Human subject research example: researcher R₁ requests use of trial data, institution I₂ provides access, and participant P₂ and/or principal investigator R₂ are able to see the transaction.