Background: Personal health record (PHR) security, correctness, and protection are essential for health and medical services. Blockchain architecture can provide efficient data retrieval and security requirements. Exchangeable PHRs and the self-management of patient health can offer many benefits to traditional medical services by allowing people to manage their own health records for disease prevention, prediction, and control while reducing resource burdens on the health care infrastructure and improving population health and quality of life. Objective: This study aimed to build a blockchain-based architecture for an international health record exchange platform to ensure health record confidentiality, integrity, and availability for health management and used Health Level 7 Fast Healthcare Interoperability Resource international standards as the data format that could allow international, cross-institutional, and patient/doctor exchanges of PHRs. Methods: The PHR architecture in this study comprised 2 main components. The first component was the PHR management platform, on which users could upload PHRs, view their record content, authorize PHR exchanges with doctors or other medical health care providers, and check their block information. When a PHR was uploaded, the hash value of the PHR would be calculated by the SHA-256 algorithm and the PHR would be encrypted by the Rivest-Shamir-Adleman encryption mechanism before being transferred to a secure database. The second component was the blockchain exchange architecture, which was based on Ethereum to create a private chain. Proof of authority, which delivers transactions through a consensus mechanism based on identity, was used for consensus. The hash value was calculated based on the previous hash value, block content, and timestamp by a hash function. Results: The PHR blockchain architecture constructed in this study is an effective method for the management and utilization of PHRs. The platform has been deployed in Southeast Asian countries via the Asia eHealth Information Network (AeHIN) and has become the first PHR management platform for cross-region medical data exchange. Conclusions: Some systems have shown that blockchain technology has great potential for electronic health record applications. This study combined different types of data storage modes to effectively solve the problems of PHR data security, storage, and transmission and proposed a hybrid blockchain and data security approach to enable effective international PHR exchange. By partnering with the AeHIN and making use of the network’s regional reach and expert pool, the platform could be deployed and promoted successfully. In the future, the PHR platform could be utilized for the purpose of precision and individual medicine in a cross-country manner because of the platform’s provision of a secure and efficient PHR sharing and management architecture, making it a reasonable base for future data collection sources and the data analytics needed for precision medicine.

Inadequate dietary intake, poor nutritional status, heavy smoking, and alcohol consumption are associated with the risk of anemia. The objective of this study was to investigate the associations between dietary patterns, lifestyle, nutritional status, and anemia-related biomarkers among adults using a multivariable regression model. Taiwanese adults aged 20–45 years (n = 118,924, 43,055 men and 75,869 women) were obtained from the Mei Jau Health Management Institution database, between 2001 and 2015, for data analysis. The anemia–inflammation-related dietary pattern was derived by reduced rank regression analysis. Dietary patterns with high intakes of eggs, meat, organ meats, rice or flour products, fried foods, sugary beverages, and processed foods significantly increased the risk of anemia, and was associated with decreased hemoglobin, hematocrit, and red blood cells, but increased white blood cells and C-reactive protein levels. Moreover, current alcohol drinkers, as well as people who were underweight, overweight, obese, and central obese, were more likely to increase their risk of anemia by 46%, 20%, 23%, 34%, and 28%, respectively. Interestingly, participants who are current or past smokers were inversely associated with risk of anemia. In conclusion, adherence to the anemia–inflammation dietary pattern was associated with an increased risk of anemia in Taiwanese adults. Furthermore, abnormal weight status and alcohol drinking were correlated with an increased risk of anemia.

Background: COVID-19 has affected more than 180 countries and is the first known pandemic to be caused by a new virus. COVID-19’s emergence and rapid spread is a global public health and economic crisis. However, investigations into the disease, patient-tracking mechanisms, and case report transmissions are both labor-intensive and slow. Objective: The pandemic has overwhelmed health care systems, forcing hospitals and medical facilities to find effective ways to share data. This study aims to design a global infectious disease surveillance and case tracking system that can facilitate the detection and control of COVID-19. Methods: The International Patient Summary (IPS; an electronic health record that contains essential health care information about a patient) was used. The IPS was designed to support the used case scenario for unplanned cross-border care. The design, scope, utility, and potential for reuse of the IPS for unplanned cross-border care make it suitable for situations like COVID-19. The Fast Healthcare Interoperability Resources confirmed that IPS data, which includes symptoms, therapies, medications, and laboratory data, can be efficiently transferred and exchanged on the system for easy access by physicians. To protect privacy, patient data are deidentified. All systems are protected by blockchain architecture, including data encryption, validation, and exchange of records. Results: To achieve worldwide COVID-19 surveillance, a global infectious disease information exchange must be enacted. The COVID-19 surveillance system was designed based on blockchain architecture. The IPS was used to exchange case study information among physicians. After being verified, physicians can upload IPS files and receive IPS data from other global cases. The system includes a daily IPS uploading and enhancement plan, which covers real-time uploading through the interoperation of the clinic system, with the module based on the Open Application Programming Interface architecture. Through the treatment of different cases, drug treatments, and the exchange of treatment results, the disease spread can be controlled, and treatment methods can be funded. In the Infectious Disease Case Tracking module, we can track the moving paths of infectious disease cases. The location information recorded in the blockchain is used to check the locations of different cases. The Case Tracking module was established for the Centers for Disease Control and Prevention to track cases and prevent disease spread. Conclusions: We created the IPS of infectious diseases for physicians treating patients with COVID-19. Our system can help health authorities respond quickly to the transmission and spread of unknown diseases, and provides a system for information retrieval on disease transmission. In addition, this system can help researchers form trials and analyze data from different countries. A common forum to facilitate the mutual sharing of experiences, best practices, therapies, useful medications, and clinical intervention outcomes from research in various countries could help control an unknown virus. This system could be an effective tool for global collaboration in evidence-based efforts to fight COVID-19.

Dietary patterns have been proposed to be related to dyslipidemia and hyperglycemia. This study investigated the correlation of dietary patterns with components of dyslipidemia and fasting plasma glucose (FPG) among young and middle-aged adults (aged between 20 and 50 years) with dyslipidemia and abnormal FPG in Taiwan. This cross-sectional study used the database compiled in Taiwan between 2001 to 2010. A total of 13,609 subjects aged between 20 and 50 years were selected. Dyslipidemia was defined primarily according to the National Cholesterol Education Program Adult Treatment Panel III guidelines with minor modification. Elevated FPG level was defined according to the American Diabetes Association. The factor analysis was conducted to identify three dietary patterns. Higher scores of the meat–convenience dietary pattern (high intake of deep-fried and processed food, sauces, sugar-added beverages, meat and organ meats, instant noodles, rice or flour cooked in oil, and eggs) had no association with components of dyslipidemia and abnormal FPG. Higher scores of the vegetables–fruits–seafood dietary pattern (high intake of vegetables, vegetables with oil or dressing, fruits, seafood, legumes, soy products, and rice or flour products) was inversely associated with hypercholesterolemia and positively associated with hyperglycemia. Higher scores of the dairy–complex carbohydrate dietary pattern (high intake of dairy products, milk, root crops, jam or honey, and whole grains) was inversely correlated with hypertriglycemia and low high-density lipoprotein cholesterol level. Our results support that the dietary pattern may have a role in the prevention and management of dyslipidemia and abnormal fasting plasma glucose.

Personal health records (PHRs) have lots of benefits for things such as health surveillance, epidemiological surveillance, self-control, links to various services, public health and health management, and international surveillance. The implementation of an international standard for interoperability is essential to accessing personal health records. In Taiwan, the nationwide exchange platform for electronic medical records (EMRs) has been in use for many years. The Health Level Seven International (HL7) Clinical Document Architecture (CDA) was used as the standard of the EMRs. However, the complication of implementing CDA became a barrier for many hospitals to realize the standard EMRs. In this study, we implemented a Fast Healthcare Interoperability Resources (FHIR)-based PHR transformation process including a user interface module to review the contents of PHRs. We used “My Health Bank, MHB”, a PHR data book developed and issued to all people by the Taiwan National Health Insurance, as the PHRs contents in this study. Network Time Protocol (NTP)/Simple Network Time Protocol (SNTP) was used in the security and user authentication mechanism when processing and applying personal health information. Transport Layer Security (TLS) 1.2 (such as HyperText Transfer Protocol Secure (HTTPS) was used for protection in data communication. User authentication is important in the platform. OAuth (OAuth 2.0) was used as a user authentication mechanism to confirm legitimate user access to ensure data security. The contents of MHB were analyzed and mapped to the FHIR, and then converted to FHIR format according to the mapping logic template. The function of format conversion was carried out by using ASP.NET. XPath and JSPath technologies filtered out specific information tags. The converted data structure was verified through an HL7 Application Programming Interface (HAPI) server, and a new JSON file was finally created. This platform can not only capture any PHR based on the FHIR format but also publish FHIR-based MHB records to any other platform to bridge the interoperability gap between different PHR systems. Therefore, our implementation/application with the automatic transformation from MHB to FHIR format provides an innovative method for people to access their own PHRs (MHB). No one has published a similar application like us using a nationwide PHR standard, MHB, in Taiwan. The application we developed will be very useful for a single person to use or for other system developers to implement their own standard PHR software.