JMIR Publications

ABSTRACT

Background:

During the COVID-19 pandemic, personal health records (PHRs) have enabled patients to monitor and manage their medical data without visiting hospitals and, consequently, minimize their infection risk. Taiwan’s National Health Insurance Administration (NHIA) launched the My Health Bank (MHB) service, a national PHR system through which insured individuals to access their cross-hospital medical data. Furthermore, in 2019, the NHIA released the MHB software development kit (SDK), which enables development of mobile applications with which insured individuals can retrieve their MHB data. However, the NHIA MHB service has its limitations, and the participation rate among insured individuals is low.

Objective:

We aimed to integrate the MHB SDK with our developed blockchain-enabled PHR mobile app, which enables patients to access, store, and manage their cross-hospital PHR data. We also collected and analyzed the application’s log data to examine patients’ MHB use during the COVID-19 pandemic.

Methods:

We integrated our existing blockchain-enabled mobile application with the MHB SDK to enable NHIA MHB data retrieval. The application utilizes blockchain technology to encrypt the downloaded NHIA MHB data. Existing and new indexes can be synchronized between the application and blockchain nodes, and high security can be achieved for PHR management. Finally, we analyzed the application’s access logs to compare patients’ activities during high and low COVID-19 infection periods.

Results:

We successfully integrated the MHB SDK into our application, thereby enabling patients to retrieve their cross-hospital medical data, particularly those related to COVID-19 rapid and polymerase chain reaction testing and vaccination information and progress. We retrospectively collected the application’s log data for the period July 2019 to June 2021. From January 2020, the preliminary results revealed a steady increase in the number of people applying to create a blockchain account for access to their medical data and the number of application subscribers among patients visiting the outpatient department (OPD) and emergency department (ED). Notably, for patients visiting the OPD and ED, the peak proportions with respect to the use of the application for OPD and ED notes and laboratory test results also increased year by year. The highest proportions were 52.40% for ED notes in June 2021, 88.10% for ED laboratory test results in May 2021, 34.61% for OPD notes in June 2021, and 41.87% for OPD laboratory test results in June 2021. These peaks coincided with Taiwan’s local COVID-19 outbreak lasting from May to June 2021.

Conclusions:

This study developed a blockchain-enabled application, which can periodically retrieve and integrate PHRs from the NHIA MHB's cross-hospital data and the investigated hospital's self-pay medical data. Analysis of users’ access logs revealed that the COVID-19 pandemic substantially increased individuals’ use of PHRs and their health awareness with respect to COVID-19 prevention.