Electronic Health Records (EHRs) have improved many aspects of healthcare and allowed for easier patient management for medical providers. Blockchains have been proposed as a promising solution for supporting Electronic Health Records (EHRs), but have also been linked to scalability concerns about supporting real-world healthcare systems. This paper quantifies the scalability issues and bottlenecks related to current blockchains and puts into perspective the limitations blockchains have with supporting healthcare systems. Particularly we show that well known blockchains such as Bitcoin, Ethereum, and IOTA cannot support transactions of a large scale hospital system such as the University of Kentucky HealthCare system and leave over 7.5M unsealed transactions per day. We then discuss how bottlenecks of blockchains can be relieved with sidechains, enabling well-known blockchains to support even larger hospital systems of over 30M transactions per day. We then introduce the Patient-Healthchain architecture to provide future direction on how scaling blockchains for EHR systems with sidechains can be achieved.

中文翻译：

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扩展区块链以支持医院系统的电子健康记录

电子健康记录 (EHR) 改善了医疗保健的许多方面，并允许医疗提供者更轻松地管理患者。区块链已被提议作为支持电子健康记录 (EHR) 的有前途的解决方案，但也与支持现实世界医疗保健系统的可扩展性问题有关。本文量化了与当前区块链相关的可扩展性问题和瓶颈，并透视了区块链在支持医疗保健系统方面的局限性。特别是我们表明，比特币、以太坊和 IOTA 等众所周知的区块链无法支持大型医院系统（如肯塔基大学医疗保健系统）的交易，并且每天会留下超过 750 万笔未密封的交易。然后我们讨论如何通过侧链来缓解区块链的瓶颈，使众所周知的区块链能够支持每天超过 3000 万笔交易的更大的医院系统。然后，我们介绍了 Patient-Healthchain 架构，以提供有关如何实现具有侧链的 EHR 系统扩展区块链的未来方向。