Compared with traditional paper-based medical records, electronic health records (EHRs) are widely used because of their efficiency, security, and reducing data redundancy. However, EHRs still manifest poor interoperability and privacy issues are unresolved. As a distributed ledger protocol composed of encrypted blocks of data organized in chains, blockchain represents a potential tool to solve the shortcomings of EHRs in terms of interoperability and privacy. In this paper, we define EHRs and blockchain technology and introduce several classic schemes based on blockchain technology to strengthen EHR interoperability and privacy protection. We then review ongoing challenges in the areas of data management efficiency, fairness of access, and trust in the systems. In this commentary, we suggest ongoing research needs for health informatics, data sciences, and ethics to establish EHRs based on blockchain technology. Blockchain-based EHR schemes must address the potential inequality of healthcare resources, the huge carbon footprint of computational needs, and potential distrust of health providers and patients that may ensue with wider use of blockchain technology.
Keywords: blockchain; electronic health records; interoperability; privacy.