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Obstetrics Nursing and Medical Health System Based on Blockchain Technology

Obstetrics Nursing and Medical Health System Based on Blockchain Technology Hindawi Journal of Healthcare Engineering Volume 2021, Article ID 6631457, 11 pages https://doi.org/10.1155/2021/6631457 Research Article Obstetrics Nursing and Medical Health System Based on Blockchain Technology Baolin Sun , Zhihui Lv, and Qin Li Department of Obstetrics, Affiliated Hospital of Qinghai University, Xining 810000, Qinghai, China Correspondence should be addressed to Baolin Sun; 2012990004@qhu.edu.cn Received 30 November 2020; Revised 29 December 2020; Accepted 29 January 2021; Published 5 March 2021 Academic Editor: Yang Gao Copyright © 2021 Baolin Sun et al. +is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Blockchain, as an emerging force transforming the Internet, has applications in finance, logistics, public services, and other fields. It will also have a huge impact on the medical and health industry. +e salient features of blockchain technology include guaranteeing in- formationsecurityanduserprivacy,decentralization,withouttheinvolvementofthird-partytrustinstitutions,andbeingabletoestablish a high-value input and output two-way system, which has a very important application space in obstetric care, medical, and health. +e traditionalmedicalandhealthsystemisfarfrombeingabletomeettheinformationexchangebetweendoctorsandindividuals.+erefore, building an interconnected obstetric care and health system based on blockchain technology is the direction of future obstetric care and medicaldevelopment.+ispaperhasconductedanin-depthstudyoftheobstetriccaremedicalhealthsystem,withthehelpoftheInternet of +ings, blockchain, and other technical means; the purpose is to realize the sharing and security of medical data and to break the limitations of traditional user information. +is paper builds a medical electronic health record system model and a hybrid consensus model based on blockchain technology to realize the safety and transparency of patients’ personal medical information data and achieve two-way communication and interconnection of information between doctors and patients. +is paper analyzes the current status of domestic and foreign medical and health systems and the blockchain-based medical electronic health record system. It is concluded that the domestic investment in medical and health in 2018 was as high as 113.2 billion yuan, and the entire investment scale is continuously expanding.Payattentiontothehealthsystem.Inthefuture,theobstetriccareandmedicalhealthsystembasedonblockchaintechnology will surely be realized and improved. data at will, with high transparency and openness. In summary, 1. Introduction it achieves data security and transparency and provides trust Withthedevelopmentofcitiesandtheimprovementofpeople’s guarantee for the use of blockchain. +e combined use of living standards, more and more people have begun to pay blockchain and obstetric care and medical care is well suited to attention to their personal health, especially paying more at- the characteristics of decentralization and promotes trust and tention to maternal health care. My country’s medical and cooperation between multiple subjects. health demand continues to grow. With the promotion of Huang H designed a health care system (HES) framework Internettechnology,“Internetof+ings+Medical”hasbecome that collects medical data from WBAN, transmits the medical an inevitable trend in the pharmaceutical industry. In addition, data through a wide range of wireless sensor network infra- the establishment of a medical and health system based on the structure, and finally publishes it to the wireless personal area blockchain is also a general trend. network through the gateway. In addition, HES involves a As a kind of information technology, blockchain can be groupoftransceivermodelsolutionstoachievekeydistribution used as a shared ledger distributed in scattered points, using a and secure data transmission, matrix-based homomorphic consensus mechanism to perform encryption algorithm cal- encryption to ensure privacy, and an expert system that can culation results and finally achieve point-to-point information analyzescrambledmedicaldataandautomaticallyfeedbackthe transmission. Its most prominent feature is as follows: in the results. +eoretical and experimental evaluations were con- data link, it can track the data source and cannot modify any ducted to prove the safety, privacy, and improved performance 2 Journal of Healthcare Engineering ofHEScomparedtocurrentsystemsorsolutions.However,the smart contracts. By using smart contracts, both parties do further prosperity of electronic/mobile healthcare still faces notneedtouseathirdpartyfortrustguarantee,whichsolves many challenges, including information security and privacy the problem of trust transactions. Generally speaking, the protection [1]. In order to promote learning in health system blockchain system consists of six layers: data layer, network science and add value to the health system, Gonzalo et al. tried layer, consensus layer, incentive layer, contract layer, and to determine the true roles of students in a series of clinical applicationlayer,whichcanbeprogrammedatvariouslevels settings and explored the value of the students who fulfilled [5]. theseroles.From2013to2015,theyconductedaseriesofon-site +ere are three types of blockchains, namely, public visits and leadership interviews at clinical sites (n �30). +e- blockchains, joint (industry) blockchains, and private matic analysis is used to determine the tasks and benefits of blockchains. +e scope and objects of application of the incorporating students into the interprofessional nursing team. three are different [6]. First of all, the public blockchain has Types of system roles include direct patient benefit activities, the widest scope of application, the least restrictive condi- including monitoring patient progress and facilitating access to tions, and the lowest requirements, and it can adapt to the resources through the care plan, and clinical benefit activities, most extensive blockchain needs. With the characteristics of including promoting coordination and improving clinical decentralization, its transaction speed is also the slowest. processes.+eperceivedbenefitsincludeenhancingthevalueof Secondly, the joint blockchain mainly refers to the block- the clinical mission and enhancing student education. +ese chain in a certain industry, which has the characteristics of results clarify a framework for student roles that can enhance multicentralization, and its data can realize multiparty in- learning and add value to the health system. However, the tercommunication. +e most typical one is the hyperledger. educational planthat seeks to include studentsin the role of the +e third is a private blockchain. +e typical representative systemhasnotbeenwelldescribed[2].Lemieuxaimstoexplore is Ant Financial. Its transaction speed is very fast, which can thevalueofblockchaintechnologyasasolutionforcreatingand fully guarantee the company’s internal information and maintaining trustworthy digital records and proposes the provide protection for the company’s privacy [7, 8]. +e limitations, risks, and opportunities of this approach. Meth- feature comparison between the three is shown in Table 1. +e main characteristics of the blockchain are as follows: odological approaches involve the use of requirements em- bedded in records management and digital preservation (1) Decentralization: the application of blockchain does not standards,inparticularISO15489,ARMA’srecognizedrecord- haveunified centralmanagement, anditsdistributed storage keeping principles, ISO 14721, and ISO 16363, as a common can resist hacker intrusion and protect the privacy of data. assessmentframeworkbasedonriskassessmentsfordeveloping And there is no need for unified software and hardware countries’ land registration systems of the specific proposed facilities, and the requirements for equipment are average. implementation of blockchain technology. +e analysis results (2) Cannot be tampered with: it is difficult to modify and show that assuming appropriate security architecture and in- delete data because of the constraints of the consensus frastructure management control measures, blockchain tech- mechanismintheblockchain[9,10].(3)Independence:each nology can be used to solve current and short-term issues smart contract is signedindependently by bothparties tothe related to information integrity. However, it cannot guarantee transaction, without the blessing and guarantee of a third the reliability of the information from the beginning, and it will party. It can calculate the contract according to mathe- besubjecttosomelimitationsasalong-termsolutiontoprovide maticalalgorithmssuchashashalgorithmandautomatically reliable information [3]. complete the transaction and transaction data. +e innovations of this paper are as follows: (1) +is In summary, it has the characteristics of decentralization, paper uses a combination of quantitative and qualitative nontampering, whole process mark, traceability, collective methods, which is well reflected in the third part of the maintenance, openness, and transparency. If these character- mixed consensus mechanism model. (2) +is paper uses a istics of the blockchain can be used well, the problem of combination of theoretical analysis and countermeasure decentralizedmanagementofmedicalequipmentcanbegreatly research. While establishing model analysis and giving solved. At the upstream end, enterprises and hospitals upload countermeasuresandsuggestions,thismethodrunsthrough relevant information through an encrypted system, including this paper. (3) +is paper uses the hash algorithm and medical equipment production information, production Merkle tree, data sharing, and lattice algorithm, which is for quantity, and logistics information; at the downstream end, medical electronics based on blockchain. +e health record hospitals, and manufacturers use blockchain technology to system EHRS has been fully analyzed. strengthen communication and strictly control the compliance of medical equipment, required standards, and so on and in- crease the recognizability of products, which will help hospitals 2. Method of Obstetric Care and Medical Health strengthen the daily management, calculation, and inventory of System Based on Blockchain Technology medical equipment. 2.1. Overview of Blockchain Technology. +e concept of blockchain was proposed by Nakamoto in 2008. It was 2.2. Hash Algorithm and Merkle Tree. +ehashalgorithmisa initially mainly used in economic fields such as finance and kind of mathematical algorithm, but in fact, it is more like a insurance and then developed into logistics, Internet of thought algorithm. It does not have a fixed formula for +ings, public services, and other fields [4]. Its core tech- calculation. It only needs to input information to compress nology is the consensus mechanism and the application of Journal of Healthcare Engineering 3 Table 1: Comparison of characteristics of public chain, alliance chain, and private chain. Blockchain Public chain Alliance chain Private chain characteristics Target the crowd Anyone Specific organization Individual person or entity Degree of Decentralization Polycentric Centralization centralization Incentives Need Optional Not needed Node write Free to join Authorization required Internal control Transaction speed 3–20 pens/sec 1000–10000 pens/sec 1000–10000 pens/sec +e Internet P2P network High-speed Internet High-speed Internet Node storage Personal computer Specific server Specific server Access threshold Low Higher Very high Application Bitcoin blockchain; Ethereum smart Hyperledger Ant Financial representative contract Companies, governments, Transaction within the organization, Digitalcurrency transactions, financialasset hospitals, Practical field bank or country clearing, and transactions, proof of existence, and so on and other entities, used as settlement internal information systems messages of any length into fixed-length information. For agreementisformulatedinaccordancewiththeresultsofthe any field, it can improve the utilization of storage space, so it lattice algorithm. is widely used [11]. In addition, another characteristic of the n n (1) Generate a random matrix A ∈ Z and select a safe hash algorithm is irreversibility; that is, it is difficult to find integer q, n. the reverse law, which is a very important application for the (2) Generate a public-private key pair: the public key medical and health field [12]. n 1 pk � P, P � R − A, and S ∈ Z , where R and S are +e Merkletrustedtreeisgeneratedtoverifythesecurity Gaussian parameters, and then the private key of information. It is only based on the security of the hash sk � S. algorithm and can be verified without too many other as- (3) Encryption algorithm: sumptions. It uses a traversal algorithm to reduce the cal- culation idea of redundant hash function values and finally c � c , c 􏼁 � 􏼒e A + e , e P + e + m · 􏼔 􏼕􏼓. (1) 1 2 1 2 1 3 obtains a root hash value through layer-by-layer processing of small data blocks. It has a wide range of applications, mainly in information security, so it is very useful to verify In formula (1), e , e , e are the error parameters. 1 2 3 the validity of data in the blockchain [13]. (4) Decryption algorithm: m � c S + c . (2) 1 2 2.3. Data Sharing and Lattice Algorithm. Obstetric nursing Determine whether it is 0 or 1 based on the distance users store all their personal medical information in a from 0. distributed database, use the reencryption key in cryptog- (5) Reencryption key generation algorithm: raphy to encrypt the information [14], and use it for data upload, browsing, and viewing. In a decentralized block- rk � P , Q 􏼁 , a⟶b B chain technology, there is no need for a third party to act as X −XS + E + S (3) B A anagentfordataaccessapplicationandcontrol.Tocomplete Q � 􏼢 􏼣. 0 I the reencryption operation, you only need to add and modify any node in AFS and MIFS [15]. Among them, X is a random matrix and E is noise. For example, when a doctor needs to view the patient’s past medical information, the patient will perform normal (6) Reencryption algorithm: encryption processing on the part that the doctor needs to ′ ′ c , c 􏼁 � h A, P 􏼁 + h , h 􏼁 + c , c 􏼁 · Q. (4) 1 2 1 B 2 3 1 2 view and at the same time generate a corresponding proxy reencryption key. +en, the patient selects one of the nodes Among them, h , h , h are selected from the error 1 2 3 in the list of competing agents and sends the reencryption distribution. key to this node, and then the agent reencryption node will complete the reencryption operation and store the cipher- text in the distributed database. Finally, the doctor uses the 3. Blockchain-Based Obstetric Care Medical private key to open the database and consult the relevant Health System Architecture Model information. +e method of using proxy reencryption can effectively +is section is based on the basic architectureand functional realize data sharing and protect users’ privacy rights. +is modules of the obstetric care medical and health system process is called the entrustment of rights [16]. +e based on the blockchain. It describes in detail how 4 Journal of Healthcare Engineering 3.1.3. Data Connection Layer. In the Bitcoin market, blockchain technology improves the privacy, security, and integrityofthemedicalandhealthsystem,soastorealizethe blockchain technology is used to test the authenticity, se- curity, and validity of the transaction process [23]. +en in blockchain and obstetrics’ effective integration of nursing care and health systems. the model of this paper, the application of blockchain can be used to verify the authenticity of the information of both parties in the transaction and the validity of data operations during the transaction. +e function of the data connection 3.1. Medical and Health Electronic File System Model Based on layeristointegratealltheuser’sdistributedinformationinto Blockchain a blockchain and select the appropriate node for storage, 3.1.1. Basic Logical Structure. +e architecture model of participate in the real-time update process of data, and obstetric care and medical health system based on block- ensure that users can effectively access the blockchain [24]. chain is designed into three levels: data storage layer, data +e blockchain nature of the data that cannot be tampered connection layer, and data application layer [17]. Take the with at will can ensure the integrity and authenticity of the personal electronic medical health file as a blockchain, and entire data chain and can also see the traceability of all data, all relevant data and information are stored in the distrib- giving users certain rights and operability to ensure the utedledgeroftheblockchain.+edataisinput,updated,and authenticity and validity of the data. output through the data connection layer to realize data Ingeneral,allinformationoperationsatthislevelaresafe viewing and review. Finally, the intelligent contract is used and reliable. Specifically, the starting block of the blockchain for data application, and the implementation of the trigger in the data connection layer mainly includes the following contract completes the operation of the data [18, 19]. Fig- aspects: first, determine candidate nodes. +e user needs to ure 1 shows the characteristics of the blockchain decen- select the applicable candidate node organization infor- tralized healthcare system. mation; generally speaking, he will choose the health in- formation data center [25]; second, determine the user role. Users who apply for the first time can choose among three user roles, namely, owner, operator, and manager [26]. 3.1.2. Data Storage Layer. +e construction of the obstetric care medical health system model based on blockchain Ordinary users generally choose to be the owner and have technology is based on the way of blockchain for data full operation authority for their own information and data storage. In a large database, each person’s medical and without any restrictions, but they still cannot modify or health records are organized into a separate chain. +is delete data information. +is is also true for the other two datalinkcan beupdatedand addedin real timebutcannot roles. +e operator role is generally selected as the health bemodified ordeleted.+iseffectivelyguaranteesthetime manager of the hospital. After having this role permission, you can apply to view and share the relevant information of cohesion, authenticity, and integrity of its health files [20]. Electronic health records are a lifetime of data generated the patient and increase the relevant case information, provided that the owner is authorized to succeed. Each node by the physical health of different ages; it mainly records information related to physical examination items and in the initial module is a manager, in addition to operating functions, you can also change user roles [27]. To modify the health activities. +e time is not fixed. +erefore, the information is not stored at intervals but is updated in real user role, the following conditions should be met: the op- time [21]. erator’s role modification requires the identification of the For example, when a mother needs obstetric care, which operator, and the operator here must belong to a staff includes prenatal care and postpartum care, every physical member registered by a health service department with a examination data will be directly recorded in the mother’s relevant certificate of practice. personal exclusive blockchain. A complete blockchain is +e storage process of the blockchain and the transac- tion storage process of Bitcoin are essentially the same. Both composed of two parts, namely, the initial source module and the additional module. When creating a personal can record detailed operation records and update real-time status. +erefore, it is possible to increase the information electronichealthfile forthefirst time,you needtorecord the basic information of the individual. After that, each addi- storage in the blockchain at a fixed time interval. Smart contract is one of the important components of the tional physical examination will automatically generate a block and automatically record it in the blockchain. data connection layer. Intelligent contract is a scripting lan- +e blockchain deployment of the data storage layer guage based on blockchain, which can be triggered by the state adopts the private chain method and the public chain change of blockchain, thus realizing the data operation on methodineach case.If aprivatechainis used,theamountof blockchain.Itisanoperatingsystembasedontheblockchainto data is too large, but the number of nodes can be effectively verifytheidentityandtrustofbothpartiesinthetransaction.It controlled, it can be installed in major database centers, and connectsthedatastoragelayerandthedataapplicationlayerin theentiremodel,isthebridgeoftheentireprocess,andisatthe the feasibility of implementation is enhanced. If the latter method is used, huge computing resources are required. No core.Smartcontractsarealsodividedintotwocategories:oneis the smart contract that comes with the system and the other is matter which method is used, a common technical feature of the blockchain is the consensus mechanism, which can the smart contract form that can be customized to fully meet ensure the safety and effectiveness of the entire operation the transaction needs and personalized characteristics of the process and limit the control and sharing of its data [22]. transaction subject. Journal of Healthcare Engineering 5 Decentralization of blockchain Ensure the normal operation of the system Cannot be tampered with Safety Timestamp Data sharing certificate Transparency High redundancy Multiple private keys Information processing Figure 1: Blockchain decentralized healthcare system. 3.1.4. Data Application Layer. +e data application layer data manipulation. In order to realize the convenience of refers to the data operation of health files according to querying electronic medical health files, you can consider specific application requirements, such as user authority developing related applications, such as permission appli- management and doctor’s viewing information authority cation API or data manipulation API. [28]. In user authority management, the account owner needs to respond to the current authority application of the 3.2. Hybrid Consensus Mechanism Model Based on relevant person and set the content of the personal infor- mation file disclosure authority. +e specific process is as Blockchain. +e hybrid consensus mechanism model HL1 ∗ ∗ HL2 will be represented by a set N and a set N , re- follows. First, when the operator requests to access the 1 2 patient’s electronic file information, the smart contract will spectively. +ere are be triggered; the smart contract is mainly used to verify the N ≥3f + 1. (5) applicant’s identity information by verifying the applicant’s digitalsignature.Aftertheverificationispassed,theoperator Among them, f is the maximum number of error nodes can check whether the permission of the information he within the acceptable range of HL1. For the sake of simple needs is open. If it is open, the data operation is successful. If calculation, set as it is not open, it needs to send an application to the owner again and wait for its reply. If you agree, the next step will be N � 3f + 1. (6) taken. Abandon the operation. +e user owner can also set the disclosure of some project permissions, such that HL2 is the set of complements HL1. In the specific oper- nonprivate projects can be opened, but for information- ation, move HL1 the limited number of authorized repre- sensitive projects, multiple encryption operations are sentatives at the bottom to the HL2 bottom, and select HL2 required. the limited number of authorized representatives at the top +e two core functions of the data application layer are to be moved to the middle HL1. +e formula can be as follows: the first is permission management; the second is expressed as 6 Journal of Healthcare Engineering 􏼌 􏼌 􏼌 􏼌 Table 2: Scale and growth rate of domestic healthcare industry 􏼌1 􏼌 􏼌 􏼌 􏼌 􏼌 N � ⌊2f⌋, n � f . (7) 􏼌 􏼌 from 2011 to 2018. 􏼌 􏼌 Industrial scale (trillion yuan) Growth rate (%) First of all, it is necessary to reorganize the positional 2011 year 1.7 relationship between HL1 HL2 the information of, in- 2012 year 2 25 cluding the server information in the sum, so that they can 2013 year 2.8 35 match each other. +en, sort these servers by number 1− c. 2014 year 3.5 26 +en, according to the requirements of block height and 2015 year 3.9 15 server number, select the current node R, which needs to 2016 year 4.7 18 meet the following formula: 2017 year 5.2 11 2018 year 5.9 17 R � (H + c)modN , (8) where H is the height of the current block. Again, the remaining nodes HL1 in the setting are all 0, 7 40 and the number is expressed as 􏼈0,1, . . . , N − 1􏼉; as long as 5.9 35% 35 there is “upgrade and downgrade,” the random number can 6 5.2 be renumbered; the check node HL2 in the command is C. 30 4.7 26% +eformulaofthismodelneedstobedividedintotwosteps: 25% 25 3.9 initiating consensus and confirming consensus. As long as there 3.5 20 (%) 2.8 18% is a request from a user or hospital operator, HL1 will auto- 3 17% 15% matically initiate a consensus on the duty node. In the model in 2 2 1.7 11% this paper, we set Φ the time interval required for a consensus. +en, the value node will upload the received data information 5 together with the digital signature, then form a block after 0 0 2011 2012 2013 2014 2015 2016 2017 2018 encryption processing, and finally store it in the blockchain. In the blockchain, the trigger standard of the consensus Industrial scale (trillion yuan) mechanism is very high. For example, the original block must Growth rate maintain a high degree of consistency in order to initiate a Figure 2: Scale and growth rate of domestic healthcare industry consensus.Andintheprocessofconfirmingtheconsensus,the from 2011 to 2018. medical data, server information, H, and hash index of all nodes must be consistent, which is quite high for hospitals. Table 3: China’s healthcare financing. 4. Obstetric Care and Medical Health System Financing amount (100 million yuan) Based on Blockchain Technology 2010 65 2011 63 4.1. 0e Current Situation of Domestic and Foreign Medical 2012 75 and Health Systems 2013 120 2014 348 4.1.1. Scale of Domestic Medical and Health Industry. 2015 623 Compared with foreign countries, my country’s time to 2016 852 attach importance to the medical and health system is much 2017 967 later. However, following the national strategy and the 2018 1132 support of national policies, the development of the do- mestic obstetric care and medical health system is steadily improving. From the data in Table 2, it can be seen that the shown an upward trend from 2010 to 2018. In 2015, the scale of my country’s medical and health industry in 2011 investment amount was 623 trillion yuan, with an increase was only 1.7 trillion yuan, and the scale of development was of 48%; after 2015, my country’s investment in the medical notlargeenough;however,ascanbeseenfromthelinechart and health field has increased rapidly, and the total in- in Figure 2, the annual growth rate is very fast, and the vestment has expanded several times, which can well growth rate exceeds 10%, even as high as 35% growth rate in represent the domestic medical and health field in my 2013. As of the end of 2018, the market size of the domestic country. medical and health industry was 5.9 trillion yuan, and its scale has expanded several times. It can be seen that my 4.1.3. Global Healthcare Investment and Financing. As country’s medical and health industry has a bright future. shown in Table 4 and Figure 4, the financing scale of the global healthcare industry has made a huge leap in 2015 and 4.1.2. 0e Scale of Domestic Medical and Health Investment. 2017, and at the same time, financing events have also in- It can be seen from Table 3 and Figure 3 that my country’s creased significantly. In 2018, the amount of financing was domestic healthcare investment and financing scale has 158 billion yuan, with a year-on-year increase of 37%. +e Journal of Healthcare Engineering 7 4.1.4. Global and Domestic Financing Changes in the Medical and Health Industry Segments. It can be clearly seen from Table 5 that, in 2018, the investment and financing fields of 1132 the global healthcare industry were mainly concentrated in biotechnology, medicine, medical informatization, and medical equipment, with financing amounts of 511 trillion yuan, 278 trillion yuan, and 299 trillion yuan, respectively. +e total investment is 295 trillion yuan, and the total number of investment events exceeds 1,000, accounting for 73% of the total. 65 63 75 120 It can be seen from Figure 5 that the amount of in- 2010 2011 2012 2013 2014 2015 2016 2017 2018 vestment in biotechnology far exceeds investment in other fields, and the latter are mainly innovative fields driven by Financing amount (100 million yuan) consumer demand. More exploration has not been carried Expon. (financing amount (100 million yuan)) out, such as rehabilitation nursing, bioengineering, and Figure 3: China’s healthcare financing. medical tools. +e financing situation in these areas is not optimistic. As can be seen from Table 6 and Figure 6, the domestic investment enthusiasm is still slightly different from the Table 4: Global healthcare financing. international investment field. +e top ones with the highest Financing amount (100 million yuan) Event (a) enthusiasm for domestic healthcare investment are bio- 2011 52 235 technology, medicine, medical informatization, and primary 2012 73 220 care. +e financing amount is much lower than the global 2013 122 336 financing amount, which is 119 trillion yuan, 69 trillion 2014 179 489 yuan, 73 trillion yuan, and 60.9 billion yuan, respectively. 2015 392 856 Secondly, there is a general investment preference in several 2016 587 1324 areas such as drug sales, medical equipment, medical 2017 985 1291 2018 1580 1030 technology, and consumer medicine. In general, in the direction of domestic and global medical and health investment and financing subdivisions, science and technology are the main orientation, and technological innovation has shown great advantages in the fields of biotechnology, medical informatization, medicine, and so on. +e amount of investment and financing is much higher than that in other fields; in addition, the enthusiasm for investment in consumption or service-oriented fields is not high. 4.2. Ehrs Analysis of Medical Electronic Health Record System Based on Blockchain. +e purpose of constructing a blockchain-based obstetric care medical health system is to use the advantages of blockchain to solve the short- comings of the traditional medical system, especially the reading of personal health information data and the se- curity of information data. Traditional medical and health Figure 4: Global healthcare financing. systems have disadvantages such as difficulty in storing information and cumbersome procedures for reviewing informationanddataverification,andtheentireprocessis financing event was 1030, and the increase in financing prone to data modification and data insecurity. +ese are events was not fluctuating. +is shows that the amount of not conducive to building a more complete and safe smart financing in the early years is directly proportional to the medical care. occurrence of financing events, while the performance in recent years has shown an irregular state. In the case of a It can be seen from Figure 7 that, since 2011, my smallincreaseinthenumberoffinancingevents,theamount country’s nursing hospitals have begun to use standardized of global medical and health financing is still increasing EHR on a large scale. By the end of 2017, almost 100% significantly, indicating that for most people the enthusiasm coverage has been completed. +is shows the development for financing has not diminished and may hold a wait-and- ofthemedicaldatainformationeraandtherelativelymature see attitude or increase investment in the same project. medical data informatization; these can partially solve the 8 Journal of Healthcare Engineering Table 5: Changes in financing of the global healthcare industry in 2018. Financing amount (100 million yuan), Number of events Event (a) Biotechnology 511 224 Medicine 278 82 Medical information 299 365 Medical equipment 295 372 Technology medical 119 301 Primary care 119 60 Drug sales 28 29 Great health 21 89 Medical finance 29 18 Consumer medical 26 19 Rehabilitation nursing 16 18 Seek medical advice 12 12 Medical tools 6 1 Motherhood 5 17 Medical support 5 12 Seek a doctor 5 8 Biological engineering 2 2 Circulation channel 0.8 1 0 100 200 300 400 500 600 Biotechnology Medicine Medical information Medical equipment Technology medical Primary care Drug sales Great health Medical finance Consumer medical Rehabilitation nursing Seek medical advice Medical tools Motherhood Medical support Seek a doctor Biological engineering 0.8 Circulation channel Financing amount (100 million yuan), number of events Financing amount (100 million yuan), number of events Figure 5: Changes in financing of the global health care industry in 2018. storage and access application problems of medical aware of the importance of medical and health data information. sharing, which brings great convenience to both doctors From Table 7 and Figure 8, we can see that different and patients. types of hospitals use the basic version of EHR to different In general, the current application and research of degrees, but there is a certain degree of growth every year. blockchain in the medical field have attracted much at- tention. +e development of blockchain technology has +e growth rates of small hospitals and rural hospitals are almost the same. Large hospitals and emergency hospitals changedthetraditionalwayofcentralizedstorageofmedical have increased significantly from 2014 to 2018. +e data of data, eliminating the auditing role of intermediaries and the two hospitals in 2018 were 83 and 80, respectively, blockchain technology. It can help doctors, patients, and comparedwith28and20in2014,anincreaseofmorethan researchers to authenticate permissions quickly and safely 60%. +is shows that more and more hospitals are also and realize free data access and sharing. Journal of Healthcare Engineering 9 Table 6: 2018 China’s medical and health industry sector financing situation. Financing amount (100 million yuan), number of events Event (a) Biotechnology 119 84 Medicine 69 38 Medical information 73 68 Medical equipment 25.8 76 Technology medical 21.3 37 Primary care 60.9 33 Drug sales 47.3 19 Great health 18.8 44 Medical finance 12.3 6 Consumer medical 24.3 25 Rehabilitation nursing 4.5 11 Seek medical advice 3.8 7 Medical tools 5.2 6 Motherhood 3.3 15 Medical support 2.3 8 Circulation channel 0.6 1 140 90 0 0 Financing amount (100 million yuan), number of events Event (a) Figure 6: 2018 China’s medical and health industry sector financing situation. 250.00 98% 97.80% 200.00 96% 95.69% 93.31% 85.22% 150.00 71.90% (%) 95.40% 89.52% 84.38% 100.00 74.54% 60.40% 45.40% 50.00 28.60% 16.50% 0.00 2010 2011 2012 2013 2014 2015 2016 2017 Certified EHR Basic EHR Figure 7: +e proportion of basic EHR and standard EHR adopted by nursing hospitals from 2010 to 2017. Biotechnology Medicine Medical information Medical equipment Technology medical Primary care Drug sales Great health Medical finance Consumer medical Rehabilitation nursing Seek medical advice Medical tools Motherhood Medical support Circulation channel 10 Journal of Healthcare Engineering Table 7: +e percentage of different types of hospitals using basic EHR. All hospitals Small hospital Rural hospital Critical access hospital 2014 28 21 21 20 2015 42 39 37 36 2016 59 51 51 52 2017 78 70 70 68 2018 83 81 80 80 90 exchange. In the process of in-depth research on the com- bination of blockchain and the medical field, we also realized thattherearestillsomedifficultiesintheresearchtopicofthis paper. +e first is the contradiction between decentralization and centralized management. Although decentralization has advantages, it also has disadvantages, such as the lack of a unified management core, and the system cannot be auto- matically adjusted or repaired. +e second is that the stan- dards of blockchain technology have yet to be improved. +e complexity of the blockchain itself, coupled with numerous problems in the medical and health field, has a serious impact on it and restrict the development of the blockchain medical and health system. 2014 2015 2016 2017 2018 All hospital Rural hospital Data Availability Small hospital Critical access hospital No data were used to support this study. Figure 8: +e percentage of different types of hospitals using basic EHR. Conflicts of Interest 5. Conclusions +e authors declare that they have no conflicts of interest. +e paper is mainly to study the construction of obstetric References nursing medical health system based on blockchain tech- nology. +rough in-depth research on blockchain, it can be [1] H. Huang, T. Gong, N. 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Obstetrics Nursing and Medical Health System Based on Blockchain Technology

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Copyright © 2021 Baolin Sun et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Hindawi Journal of Healthcare Engineering Volume 2021, Article ID 6631457, 11 pages https://doi.org/10.1155/2021/6631457 Research Article Obstetrics Nursing and Medical Health System Based on Blockchain Technology Baolin Sun , Zhihui Lv, and Qin Li Department of Obstetrics, Affiliated Hospital of Qinghai University, Xining 810000, Qinghai, China Correspondence should be addressed to Baolin Sun; 2012990004@qhu.edu.cn Received 30 November 2020; Revised 29 December 2020; Accepted 29 January 2021; Published 5 March 2021 Academic Editor: Yang Gao Copyright © 2021 Baolin Sun et al. +is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Blockchain, as an emerging force transforming the Internet, has applications in finance, logistics, public services, and other fields. It will also have a huge impact on the medical and health industry. +e salient features of blockchain technology include guaranteeing in- formationsecurityanduserprivacy,decentralization,withouttheinvolvementofthird-partytrustinstitutions,andbeingabletoestablish a high-value input and output two-way system, which has a very important application space in obstetric care, medical, and health. +e traditionalmedicalandhealthsystemisfarfrombeingabletomeettheinformationexchangebetweendoctorsandindividuals.+erefore, building an interconnected obstetric care and health system based on blockchain technology is the direction of future obstetric care and medicaldevelopment.+ispaperhasconductedanin-depthstudyoftheobstetriccaremedicalhealthsystem,withthehelpoftheInternet of +ings, blockchain, and other technical means; the purpose is to realize the sharing and security of medical data and to break the limitations of traditional user information. +is paper builds a medical electronic health record system model and a hybrid consensus model based on blockchain technology to realize the safety and transparency of patients’ personal medical information data and achieve two-way communication and interconnection of information between doctors and patients. +is paper analyzes the current status of domestic and foreign medical and health systems and the blockchain-based medical electronic health record system. It is concluded that the domestic investment in medical and health in 2018 was as high as 113.2 billion yuan, and the entire investment scale is continuously expanding.Payattentiontothehealthsystem.Inthefuture,theobstetriccareandmedicalhealthsystembasedonblockchaintechnology will surely be realized and improved. data at will, with high transparency and openness. In summary, 1. Introduction it achieves data security and transparency and provides trust Withthedevelopmentofcitiesandtheimprovementofpeople’s guarantee for the use of blockchain. +e combined use of living standards, more and more people have begun to pay blockchain and obstetric care and medical care is well suited to attention to their personal health, especially paying more at- the characteristics of decentralization and promotes trust and tention to maternal health care. My country’s medical and cooperation between multiple subjects. health demand continues to grow. With the promotion of Huang H designed a health care system (HES) framework Internettechnology,“Internetof+ings+Medical”hasbecome that collects medical data from WBAN, transmits the medical an inevitable trend in the pharmaceutical industry. In addition, data through a wide range of wireless sensor network infra- the establishment of a medical and health system based on the structure, and finally publishes it to the wireless personal area blockchain is also a general trend. network through the gateway. In addition, HES involves a As a kind of information technology, blockchain can be groupoftransceivermodelsolutionstoachievekeydistribution used as a shared ledger distributed in scattered points, using a and secure data transmission, matrix-based homomorphic consensus mechanism to perform encryption algorithm cal- encryption to ensure privacy, and an expert system that can culation results and finally achieve point-to-point information analyzescrambledmedicaldataandautomaticallyfeedbackthe transmission. Its most prominent feature is as follows: in the results. +eoretical and experimental evaluations were con- data link, it can track the data source and cannot modify any ducted to prove the safety, privacy, and improved performance 2 Journal of Healthcare Engineering ofHEScomparedtocurrentsystemsorsolutions.However,the smart contracts. By using smart contracts, both parties do further prosperity of electronic/mobile healthcare still faces notneedtouseathirdpartyfortrustguarantee,whichsolves many challenges, including information security and privacy the problem of trust transactions. Generally speaking, the protection [1]. In order to promote learning in health system blockchain system consists of six layers: data layer, network science and add value to the health system, Gonzalo et al. tried layer, consensus layer, incentive layer, contract layer, and to determine the true roles of students in a series of clinical applicationlayer,whichcanbeprogrammedatvariouslevels settings and explored the value of the students who fulfilled [5]. theseroles.From2013to2015,theyconductedaseriesofon-site +ere are three types of blockchains, namely, public visits and leadership interviews at clinical sites (n �30). +e- blockchains, joint (industry) blockchains, and private matic analysis is used to determine the tasks and benefits of blockchains. +e scope and objects of application of the incorporating students into the interprofessional nursing team. three are different [6]. First of all, the public blockchain has Types of system roles include direct patient benefit activities, the widest scope of application, the least restrictive condi- including monitoring patient progress and facilitating access to tions, and the lowest requirements, and it can adapt to the resources through the care plan, and clinical benefit activities, most extensive blockchain needs. With the characteristics of including promoting coordination and improving clinical decentralization, its transaction speed is also the slowest. processes.+eperceivedbenefitsincludeenhancingthevalueof Secondly, the joint blockchain mainly refers to the block- the clinical mission and enhancing student education. +ese chain in a certain industry, which has the characteristics of results clarify a framework for student roles that can enhance multicentralization, and its data can realize multiparty in- learning and add value to the health system. However, the tercommunication. +e most typical one is the hyperledger. educational planthat seeks to include studentsin the role of the +e third is a private blockchain. +e typical representative systemhasnotbeenwelldescribed[2].Lemieuxaimstoexplore is Ant Financial. Its transaction speed is very fast, which can thevalueofblockchaintechnologyasasolutionforcreatingand fully guarantee the company’s internal information and maintaining trustworthy digital records and proposes the provide protection for the company’s privacy [7, 8]. +e limitations, risks, and opportunities of this approach. Meth- feature comparison between the three is shown in Table 1. +e main characteristics of the blockchain are as follows: odological approaches involve the use of requirements em- bedded in records management and digital preservation (1) Decentralization: the application of blockchain does not standards,inparticularISO15489,ARMA’srecognizedrecord- haveunified centralmanagement, anditsdistributed storage keeping principles, ISO 14721, and ISO 16363, as a common can resist hacker intrusion and protect the privacy of data. assessmentframeworkbasedonriskassessmentsfordeveloping And there is no need for unified software and hardware countries’ land registration systems of the specific proposed facilities, and the requirements for equipment are average. implementation of blockchain technology. +e analysis results (2) Cannot be tampered with: it is difficult to modify and show that assuming appropriate security architecture and in- delete data because of the constraints of the consensus frastructure management control measures, blockchain tech- mechanismintheblockchain[9,10].(3)Independence:each nology can be used to solve current and short-term issues smart contract is signedindependently by bothparties tothe related to information integrity. However, it cannot guarantee transaction, without the blessing and guarantee of a third the reliability of the information from the beginning, and it will party. It can calculate the contract according to mathe- besubjecttosomelimitationsasalong-termsolutiontoprovide maticalalgorithmssuchashashalgorithmandautomatically reliable information [3]. complete the transaction and transaction data. +e innovations of this paper are as follows: (1) +is In summary, it has the characteristics of decentralization, paper uses a combination of quantitative and qualitative nontampering, whole process mark, traceability, collective methods, which is well reflected in the third part of the maintenance, openness, and transparency. If these character- mixed consensus mechanism model. (2) +is paper uses a istics of the blockchain can be used well, the problem of combination of theoretical analysis and countermeasure decentralizedmanagementofmedicalequipmentcanbegreatly research. While establishing model analysis and giving solved. At the upstream end, enterprises and hospitals upload countermeasuresandsuggestions,thismethodrunsthrough relevant information through an encrypted system, including this paper. (3) +is paper uses the hash algorithm and medical equipment production information, production Merkle tree, data sharing, and lattice algorithm, which is for quantity, and logistics information; at the downstream end, medical electronics based on blockchain. +e health record hospitals, and manufacturers use blockchain technology to system EHRS has been fully analyzed. strengthen communication and strictly control the compliance of medical equipment, required standards, and so on and in- crease the recognizability of products, which will help hospitals 2. Method of Obstetric Care and Medical Health strengthen the daily management, calculation, and inventory of System Based on Blockchain Technology medical equipment. 2.1. Overview of Blockchain Technology. +e concept of blockchain was proposed by Nakamoto in 2008. It was 2.2. Hash Algorithm and Merkle Tree. +ehashalgorithmisa initially mainly used in economic fields such as finance and kind of mathematical algorithm, but in fact, it is more like a insurance and then developed into logistics, Internet of thought algorithm. It does not have a fixed formula for +ings, public services, and other fields [4]. Its core tech- calculation. It only needs to input information to compress nology is the consensus mechanism and the application of Journal of Healthcare Engineering 3 Table 1: Comparison of characteristics of public chain, alliance chain, and private chain. Blockchain Public chain Alliance chain Private chain characteristics Target the crowd Anyone Specific organization Individual person or entity Degree of Decentralization Polycentric Centralization centralization Incentives Need Optional Not needed Node write Free to join Authorization required Internal control Transaction speed 3–20 pens/sec 1000–10000 pens/sec 1000–10000 pens/sec +e Internet P2P network High-speed Internet High-speed Internet Node storage Personal computer Specific server Specific server Access threshold Low Higher Very high Application Bitcoin blockchain; Ethereum smart Hyperledger Ant Financial representative contract Companies, governments, Transaction within the organization, Digitalcurrency transactions, financialasset hospitals, Practical field bank or country clearing, and transactions, proof of existence, and so on and other entities, used as settlement internal information systems messages of any length into fixed-length information. For agreementisformulatedinaccordancewiththeresultsofthe any field, it can improve the utilization of storage space, so it lattice algorithm. is widely used [11]. In addition, another characteristic of the n n (1) Generate a random matrix A ∈ Z and select a safe hash algorithm is irreversibility; that is, it is difficult to find integer q, n. the reverse law, which is a very important application for the (2) Generate a public-private key pair: the public key medical and health field [12]. n 1 pk � P, P � R − A, and S ∈ Z , where R and S are +e Merkletrustedtreeisgeneratedtoverifythesecurity Gaussian parameters, and then the private key of information. It is only based on the security of the hash sk � S. algorithm and can be verified without too many other as- (3) Encryption algorithm: sumptions. It uses a traversal algorithm to reduce the cal- culation idea of redundant hash function values and finally c � c , c 􏼁 � 􏼒e A + e , e P + e + m · 􏼔 􏼕􏼓. (1) 1 2 1 2 1 3 obtains a root hash value through layer-by-layer processing of small data blocks. It has a wide range of applications, mainly in information security, so it is very useful to verify In formula (1), e , e , e are the error parameters. 1 2 3 the validity of data in the blockchain [13]. (4) Decryption algorithm: m � c S + c . (2) 1 2 2.3. Data Sharing and Lattice Algorithm. Obstetric nursing Determine whether it is 0 or 1 based on the distance users store all their personal medical information in a from 0. distributed database, use the reencryption key in cryptog- (5) Reencryption key generation algorithm: raphy to encrypt the information [14], and use it for data upload, browsing, and viewing. In a decentralized block- rk � P , Q 􏼁 , a⟶b B chain technology, there is no need for a third party to act as X −XS + E + S (3) B A anagentfordataaccessapplicationandcontrol.Tocomplete Q � 􏼢 􏼣. 0 I the reencryption operation, you only need to add and modify any node in AFS and MIFS [15]. Among them, X is a random matrix and E is noise. For example, when a doctor needs to view the patient’s past medical information, the patient will perform normal (6) Reencryption algorithm: encryption processing on the part that the doctor needs to ′ ′ c , c 􏼁 � h A, P 􏼁 + h , h 􏼁 + c , c 􏼁 · Q. (4) 1 2 1 B 2 3 1 2 view and at the same time generate a corresponding proxy reencryption key. +en, the patient selects one of the nodes Among them, h , h , h are selected from the error 1 2 3 in the list of competing agents and sends the reencryption distribution. key to this node, and then the agent reencryption node will complete the reencryption operation and store the cipher- text in the distributed database. Finally, the doctor uses the 3. Blockchain-Based Obstetric Care Medical private key to open the database and consult the relevant Health System Architecture Model information. +e method of using proxy reencryption can effectively +is section is based on the basic architectureand functional realize data sharing and protect users’ privacy rights. +is modules of the obstetric care medical and health system process is called the entrustment of rights [16]. +e based on the blockchain. It describes in detail how 4 Journal of Healthcare Engineering 3.1.3. Data Connection Layer. In the Bitcoin market, blockchain technology improves the privacy, security, and integrityofthemedicalandhealthsystem,soastorealizethe blockchain technology is used to test the authenticity, se- curity, and validity of the transaction process [23]. +en in blockchain and obstetrics’ effective integration of nursing care and health systems. the model of this paper, the application of blockchain can be used to verify the authenticity of the information of both parties in the transaction and the validity of data operations during the transaction. +e function of the data connection 3.1. Medical and Health Electronic File System Model Based on layeristointegratealltheuser’sdistributedinformationinto Blockchain a blockchain and select the appropriate node for storage, 3.1.1. Basic Logical Structure. +e architecture model of participate in the real-time update process of data, and obstetric care and medical health system based on block- ensure that users can effectively access the blockchain [24]. chain is designed into three levels: data storage layer, data +e blockchain nature of the data that cannot be tampered connection layer, and data application layer [17]. Take the with at will can ensure the integrity and authenticity of the personal electronic medical health file as a blockchain, and entire data chain and can also see the traceability of all data, all relevant data and information are stored in the distrib- giving users certain rights and operability to ensure the utedledgeroftheblockchain.+edataisinput,updated,and authenticity and validity of the data. output through the data connection layer to realize data Ingeneral,allinformationoperationsatthislevelaresafe viewing and review. Finally, the intelligent contract is used and reliable. Specifically, the starting block of the blockchain for data application, and the implementation of the trigger in the data connection layer mainly includes the following contract completes the operation of the data [18, 19]. Fig- aspects: first, determine candidate nodes. +e user needs to ure 1 shows the characteristics of the blockchain decen- select the applicable candidate node organization infor- tralized healthcare system. mation; generally speaking, he will choose the health in- formation data center [25]; second, determine the user role. Users who apply for the first time can choose among three user roles, namely, owner, operator, and manager [26]. 3.1.2. Data Storage Layer. +e construction of the obstetric care medical health system model based on blockchain Ordinary users generally choose to be the owner and have technology is based on the way of blockchain for data full operation authority for their own information and data storage. In a large database, each person’s medical and without any restrictions, but they still cannot modify or health records are organized into a separate chain. +is delete data information. +is is also true for the other two datalinkcan beupdatedand addedin real timebutcannot roles. +e operator role is generally selected as the health bemodified ordeleted.+iseffectivelyguaranteesthetime manager of the hospital. After having this role permission, you can apply to view and share the relevant information of cohesion, authenticity, and integrity of its health files [20]. Electronic health records are a lifetime of data generated the patient and increase the relevant case information, provided that the owner is authorized to succeed. Each node by the physical health of different ages; it mainly records information related to physical examination items and in the initial module is a manager, in addition to operating functions, you can also change user roles [27]. To modify the health activities. +e time is not fixed. +erefore, the information is not stored at intervals but is updated in real user role, the following conditions should be met: the op- time [21]. erator’s role modification requires the identification of the For example, when a mother needs obstetric care, which operator, and the operator here must belong to a staff includes prenatal care and postpartum care, every physical member registered by a health service department with a examination data will be directly recorded in the mother’s relevant certificate of practice. personal exclusive blockchain. A complete blockchain is +e storage process of the blockchain and the transac- tion storage process of Bitcoin are essentially the same. Both composed of two parts, namely, the initial source module and the additional module. When creating a personal can record detailed operation records and update real-time status. +erefore, it is possible to increase the information electronichealthfile forthefirst time,you needtorecord the basic information of the individual. After that, each addi- storage in the blockchain at a fixed time interval. Smart contract is one of the important components of the tional physical examination will automatically generate a block and automatically record it in the blockchain. data connection layer. Intelligent contract is a scripting lan- +e blockchain deployment of the data storage layer guage based on blockchain, which can be triggered by the state adopts the private chain method and the public chain change of blockchain, thus realizing the data operation on methodineach case.If aprivatechainis used,theamountof blockchain.Itisanoperatingsystembasedontheblockchainto data is too large, but the number of nodes can be effectively verifytheidentityandtrustofbothpartiesinthetransaction.It controlled, it can be installed in major database centers, and connectsthedatastoragelayerandthedataapplicationlayerin theentiremodel,isthebridgeoftheentireprocess,andisatthe the feasibility of implementation is enhanced. If the latter method is used, huge computing resources are required. No core.Smartcontractsarealsodividedintotwocategories:oneis the smart contract that comes with the system and the other is matter which method is used, a common technical feature of the blockchain is the consensus mechanism, which can the smart contract form that can be customized to fully meet ensure the safety and effectiveness of the entire operation the transaction needs and personalized characteristics of the process and limit the control and sharing of its data [22]. transaction subject. Journal of Healthcare Engineering 5 Decentralization of blockchain Ensure the normal operation of the system Cannot be tampered with Safety Timestamp Data sharing certificate Transparency High redundancy Multiple private keys Information processing Figure 1: Blockchain decentralized healthcare system. 3.1.4. Data Application Layer. +e data application layer data manipulation. In order to realize the convenience of refers to the data operation of health files according to querying electronic medical health files, you can consider specific application requirements, such as user authority developing related applications, such as permission appli- management and doctor’s viewing information authority cation API or data manipulation API. [28]. In user authority management, the account owner needs to respond to the current authority application of the 3.2. Hybrid Consensus Mechanism Model Based on relevant person and set the content of the personal infor- mation file disclosure authority. +e specific process is as Blockchain. +e hybrid consensus mechanism model HL1 ∗ ∗ HL2 will be represented by a set N and a set N , re- follows. First, when the operator requests to access the 1 2 patient’s electronic file information, the smart contract will spectively. +ere are be triggered; the smart contract is mainly used to verify the N ≥3f + 1. (5) applicant’s identity information by verifying the applicant’s digitalsignature.Aftertheverificationispassed,theoperator Among them, f is the maximum number of error nodes can check whether the permission of the information he within the acceptable range of HL1. For the sake of simple needs is open. If it is open, the data operation is successful. If calculation, set as it is not open, it needs to send an application to the owner again and wait for its reply. If you agree, the next step will be N � 3f + 1. (6) taken. Abandon the operation. +e user owner can also set the disclosure of some project permissions, such that HL2 is the set of complements HL1. In the specific oper- nonprivate projects can be opened, but for information- ation, move HL1 the limited number of authorized repre- sensitive projects, multiple encryption operations are sentatives at the bottom to the HL2 bottom, and select HL2 required. the limited number of authorized representatives at the top +e two core functions of the data application layer are to be moved to the middle HL1. +e formula can be as follows: the first is permission management; the second is expressed as 6 Journal of Healthcare Engineering 􏼌 􏼌 􏼌 􏼌 Table 2: Scale and growth rate of domestic healthcare industry 􏼌1 􏼌 􏼌 􏼌 􏼌 􏼌 N � ⌊2f⌋, n � f . (7) 􏼌 􏼌 from 2011 to 2018. 􏼌 􏼌 Industrial scale (trillion yuan) Growth rate (%) First of all, it is necessary to reorganize the positional 2011 year 1.7 relationship between HL1 HL2 the information of, in- 2012 year 2 25 cluding the server information in the sum, so that they can 2013 year 2.8 35 match each other. +en, sort these servers by number 1− c. 2014 year 3.5 26 +en, according to the requirements of block height and 2015 year 3.9 15 server number, select the current node R, which needs to 2016 year 4.7 18 meet the following formula: 2017 year 5.2 11 2018 year 5.9 17 R � (H + c)modN , (8) where H is the height of the current block. Again, the remaining nodes HL1 in the setting are all 0, 7 40 and the number is expressed as 􏼈0,1, . . . , N − 1􏼉; as long as 5.9 35% 35 there is “upgrade and downgrade,” the random number can 6 5.2 be renumbered; the check node HL2 in the command is C. 30 4.7 26% +eformulaofthismodelneedstobedividedintotwosteps: 25% 25 3.9 initiating consensus and confirming consensus. As long as there 3.5 20 (%) 2.8 18% is a request from a user or hospital operator, HL1 will auto- 3 17% 15% matically initiate a consensus on the duty node. In the model in 2 2 1.7 11% this paper, we set Φ the time interval required for a consensus. +en, the value node will upload the received data information 5 together with the digital signature, then form a block after 0 0 2011 2012 2013 2014 2015 2016 2017 2018 encryption processing, and finally store it in the blockchain. In the blockchain, the trigger standard of the consensus Industrial scale (trillion yuan) mechanism is very high. For example, the original block must Growth rate maintain a high degree of consistency in order to initiate a Figure 2: Scale and growth rate of domestic healthcare industry consensus.Andintheprocessofconfirmingtheconsensus,the from 2011 to 2018. medical data, server information, H, and hash index of all nodes must be consistent, which is quite high for hospitals. Table 3: China’s healthcare financing. 4. Obstetric Care and Medical Health System Financing amount (100 million yuan) Based on Blockchain Technology 2010 65 2011 63 4.1. 0e Current Situation of Domestic and Foreign Medical 2012 75 and Health Systems 2013 120 2014 348 4.1.1. Scale of Domestic Medical and Health Industry. 2015 623 Compared with foreign countries, my country’s time to 2016 852 attach importance to the medical and health system is much 2017 967 later. However, following the national strategy and the 2018 1132 support of national policies, the development of the do- mestic obstetric care and medical health system is steadily improving. From the data in Table 2, it can be seen that the shown an upward trend from 2010 to 2018. In 2015, the scale of my country’s medical and health industry in 2011 investment amount was 623 trillion yuan, with an increase was only 1.7 trillion yuan, and the scale of development was of 48%; after 2015, my country’s investment in the medical notlargeenough;however,ascanbeseenfromthelinechart and health field has increased rapidly, and the total in- in Figure 2, the annual growth rate is very fast, and the vestment has expanded several times, which can well growth rate exceeds 10%, even as high as 35% growth rate in represent the domestic medical and health field in my 2013. As of the end of 2018, the market size of the domestic country. medical and health industry was 5.9 trillion yuan, and its scale has expanded several times. It can be seen that my 4.1.3. Global Healthcare Investment and Financing. As country’s medical and health industry has a bright future. shown in Table 4 and Figure 4, the financing scale of the global healthcare industry has made a huge leap in 2015 and 4.1.2. 0e Scale of Domestic Medical and Health Investment. 2017, and at the same time, financing events have also in- It can be seen from Table 3 and Figure 3 that my country’s creased significantly. In 2018, the amount of financing was domestic healthcare investment and financing scale has 158 billion yuan, with a year-on-year increase of 37%. +e Journal of Healthcare Engineering 7 4.1.4. Global and Domestic Financing Changes in the Medical and Health Industry Segments. It can be clearly seen from Table 5 that, in 2018, the investment and financing fields of 1132 the global healthcare industry were mainly concentrated in biotechnology, medicine, medical informatization, and medical equipment, with financing amounts of 511 trillion yuan, 278 trillion yuan, and 299 trillion yuan, respectively. +e total investment is 295 trillion yuan, and the total number of investment events exceeds 1,000, accounting for 73% of the total. 65 63 75 120 It can be seen from Figure 5 that the amount of in- 2010 2011 2012 2013 2014 2015 2016 2017 2018 vestment in biotechnology far exceeds investment in other fields, and the latter are mainly innovative fields driven by Financing amount (100 million yuan) consumer demand. More exploration has not been carried Expon. (financing amount (100 million yuan)) out, such as rehabilitation nursing, bioengineering, and Figure 3: China’s healthcare financing. medical tools. +e financing situation in these areas is not optimistic. As can be seen from Table 6 and Figure 6, the domestic investment enthusiasm is still slightly different from the Table 4: Global healthcare financing. international investment field. +e top ones with the highest Financing amount (100 million yuan) Event (a) enthusiasm for domestic healthcare investment are bio- 2011 52 235 technology, medicine, medical informatization, and primary 2012 73 220 care. +e financing amount is much lower than the global 2013 122 336 financing amount, which is 119 trillion yuan, 69 trillion 2014 179 489 yuan, 73 trillion yuan, and 60.9 billion yuan, respectively. 2015 392 856 Secondly, there is a general investment preference in several 2016 587 1324 areas such as drug sales, medical equipment, medical 2017 985 1291 2018 1580 1030 technology, and consumer medicine. In general, in the direction of domestic and global medical and health investment and financing subdivisions, science and technology are the main orientation, and technological innovation has shown great advantages in the fields of biotechnology, medical informatization, medicine, and so on. +e amount of investment and financing is much higher than that in other fields; in addition, the enthusiasm for investment in consumption or service-oriented fields is not high. 4.2. Ehrs Analysis of Medical Electronic Health Record System Based on Blockchain. +e purpose of constructing a blockchain-based obstetric care medical health system is to use the advantages of blockchain to solve the short- comings of the traditional medical system, especially the reading of personal health information data and the se- curity of information data. Traditional medical and health Figure 4: Global healthcare financing. systems have disadvantages such as difficulty in storing information and cumbersome procedures for reviewing informationanddataverification,andtheentireprocessis financing event was 1030, and the increase in financing prone to data modification and data insecurity. +ese are events was not fluctuating. +is shows that the amount of not conducive to building a more complete and safe smart financing in the early years is directly proportional to the medical care. occurrence of financing events, while the performance in recent years has shown an irregular state. In the case of a It can be seen from Figure 7 that, since 2011, my smallincreaseinthenumberoffinancingevents,theamount country’s nursing hospitals have begun to use standardized of global medical and health financing is still increasing EHR on a large scale. By the end of 2017, almost 100% significantly, indicating that for most people the enthusiasm coverage has been completed. +is shows the development for financing has not diminished and may hold a wait-and- ofthemedicaldatainformationeraandtherelativelymature see attitude or increase investment in the same project. medical data informatization; these can partially solve the 8 Journal of Healthcare Engineering Table 5: Changes in financing of the global healthcare industry in 2018. Financing amount (100 million yuan), Number of events Event (a) Biotechnology 511 224 Medicine 278 82 Medical information 299 365 Medical equipment 295 372 Technology medical 119 301 Primary care 119 60 Drug sales 28 29 Great health 21 89 Medical finance 29 18 Consumer medical 26 19 Rehabilitation nursing 16 18 Seek medical advice 12 12 Medical tools 6 1 Motherhood 5 17 Medical support 5 12 Seek a doctor 5 8 Biological engineering 2 2 Circulation channel 0.8 1 0 100 200 300 400 500 600 Biotechnology Medicine Medical information Medical equipment Technology medical Primary care Drug sales Great health Medical finance Consumer medical Rehabilitation nursing Seek medical advice Medical tools Motherhood Medical support Seek a doctor Biological engineering 0.8 Circulation channel Financing amount (100 million yuan), number of events Financing amount (100 million yuan), number of events Figure 5: Changes in financing of the global health care industry in 2018. storage and access application problems of medical aware of the importance of medical and health data information. sharing, which brings great convenience to both doctors From Table 7 and Figure 8, we can see that different and patients. types of hospitals use the basic version of EHR to different In general, the current application and research of degrees, but there is a certain degree of growth every year. blockchain in the medical field have attracted much at- tention. +e development of blockchain technology has +e growth rates of small hospitals and rural hospitals are almost the same. Large hospitals and emergency hospitals changedthetraditionalwayofcentralizedstorageofmedical have increased significantly from 2014 to 2018. +e data of data, eliminating the auditing role of intermediaries and the two hospitals in 2018 were 83 and 80, respectively, blockchain technology. It can help doctors, patients, and comparedwith28and20in2014,anincreaseofmorethan researchers to authenticate permissions quickly and safely 60%. +is shows that more and more hospitals are also and realize free data access and sharing. Journal of Healthcare Engineering 9 Table 6: 2018 China’s medical and health industry sector financing situation. Financing amount (100 million yuan), number of events Event (a) Biotechnology 119 84 Medicine 69 38 Medical information 73 68 Medical equipment 25.8 76 Technology medical 21.3 37 Primary care 60.9 33 Drug sales 47.3 19 Great health 18.8 44 Medical finance 12.3 6 Consumer medical 24.3 25 Rehabilitation nursing 4.5 11 Seek medical advice 3.8 7 Medical tools 5.2 6 Motherhood 3.3 15 Medical support 2.3 8 Circulation channel 0.6 1 140 90 0 0 Financing amount (100 million yuan), number of events Event (a) Figure 6: 2018 China’s medical and health industry sector financing situation. 250.00 98% 97.80% 200.00 96% 95.69% 93.31% 85.22% 150.00 71.90% (%) 95.40% 89.52% 84.38% 100.00 74.54% 60.40% 45.40% 50.00 28.60% 16.50% 0.00 2010 2011 2012 2013 2014 2015 2016 2017 Certified EHR Basic EHR Figure 7: +e proportion of basic EHR and standard EHR adopted by nursing hospitals from 2010 to 2017. Biotechnology Medicine Medical information Medical equipment Technology medical Primary care Drug sales Great health Medical finance Consumer medical Rehabilitation nursing Seek medical advice Medical tools Motherhood Medical support Circulation channel 10 Journal of Healthcare Engineering Table 7: +e percentage of different types of hospitals using basic EHR. All hospitals Small hospital Rural hospital Critical access hospital 2014 28 21 21 20 2015 42 39 37 36 2016 59 51 51 52 2017 78 70 70 68 2018 83 81 80 80 90 exchange. In the process of in-depth research on the com- bination of blockchain and the medical field, we also realized thattherearestillsomedifficultiesintheresearchtopicofthis paper. +e first is the contradiction between decentralization and centralized management. 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Journal of Healthcare Engineering – Hindawi Publishing Corporation

Published: Mar 5, 2021

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