| Network Permission |
Permission-less network: A public blockchain network configuration designed to allow public participation (eg, some applications that rely on patient-managed data).92
Permissioned network: A private blockchain network configuration that includes only authorized participants (eg, networks that exchange information among hospitals).31,43
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| Consensus Protocol |
Proof of Work: A compute-intensive protocol with proof of security; suitable for permission-less blockchain networks but can also be used in permissioned blockchain networks to increase security. The Bitcoin blockchain uses this protocol: unfortunately, many people mistakenly believe that all blockchain networks need to use this typically high-energy consumption protocol, which is not true.1,66
Proof of Stake: A low-energy consumption protocol that is suitable for healthcare applications operating on permission-less or permissioned blockchain networks.93–95
Mining Diversity: A round-robin, low-energy consumption protocol specifically designed for permissioned healthcare applications.31 Variations can be designed to suit various needs.
Kafka: A voting-based, low-energy consumption protocol that can finalize the consensus decision faster (at least initially), but that requires more time as the number of nodes in the network grows.43
Proof of Elapsed Time: A lottery-based, low-energy consumption protocol that can scale well for a network with many nodes while needing more time to reach consensus.43
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| Special Hardware Requirement |
Yes: If special hardware (eg, Intel SGX43) is required, the specifications of the computing environment need to be confirmed before the healthcare applications can be deployed properly.
No: If no special hardware is required, the healthcare application can be deployed without further hardware checking.
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| Smart Contracts Support |
Yes: If the healthcare applications focus on autonomous operations (eg, automatic payment for insurance claims), the immutable smart contract support can be essential.25,43
No: If the healthcare applications aim at primarily serving as a ledger (eg, recording access rights or data transaction records), the blockchain platform without smart contract support would be sufficient.91
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| Scripting Language |
Bitcoin Script: If smart contracts are not required for the healthcare applications, this basic scripting language would be sufficient.82,96
Solidity: The main smart contract language for Ethereum; it is one of the most popular languages for writing smart contracts.97
Chaincode: The main smart contract language for Hyperledger Fabric; it is also one of the most popular languages for writing smart contracts.98
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| Software License |
MIT: A “permissive” license that allows healthcare applications to reuse the source code of the platform.99,100
GPL: A “copyleft” license that also allows using the source code; the derivative works in some situations must be open-source too.99,100
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