# FHIRChain: Applying Blockchain to Securely and Scalably Share Clinical Data

arXiv: https://arxiv.org/abs/1807.03227 · HTML: https://mlsanity.com/paper/1807.03227/

## Key facts

- Cited by 7 papers in the map (data through 14 Oct 2026).
- First posted on arXiv 9 Jul 2018.

## Built on by (most cited first, 7 of 7)

- [Proof of Quality: A Costless Paradigm for Trustless Generative AI Model Inference on Blockchains](https://mlsanity.com/paper/2405.17934/) (2024)
- [Design and Evaluation of Cost-Aware PoQ for Decentralized LLM Inference](https://mlsanity.com/paper/2512.16317/) (2025)
- [Decentralized Intelligence Network (DIN)](https://mlsanity.com/paper/2407.02461/) (2024)
- [Byzantine Fault-Tolerant Multi-Agent System for Healthcare: A Gossip Protocol Approach to Secure Medical Message Propagation](https://mlsanity.com/paper/2512.17913/) (2025)
- [Decentralized Health Intelligence Network (DHIN)](https://mlsanity.com/paper/2408.06240/) (2024)
- [Decentralized AI-driven IoT Architecture for Privacy-Preserving and Latency-Optimized Healthcare in Pandemic and Critical Care Scenarios](https://mlsanity.com/paper/2507.15859/) (2025)
- [A Proposed Biomedical Data Policy Framework to Reduce Fragmentation, Improve Quality, and Incentivize Sharing in Indian Healthcare in the era of Artificial Intelligence and Digital Health](https://mlsanity.com/paper/2604.11125/) (2026)

## Abstract (arXiv)

Secure and scalable data sharing is essential for collaborative clinical decision making. Conventional clinical data efforts are often siloed, however, which creates barriers to efficient information exchange and impedes effective treatment decision made for patients. This paper provides four contributions to the study of applying blockchain technology to clinical data sharing in the context of technical requirements defined in the "Shared Nationwide Interoperability Roadmap" from the Office of the National Coordinator for Health Information Technology (ONC). First, we analyze the ONC requirements and their implications for blockchain-based systems. Second, we present FHIRChain, which is a blockchain-based architecture designed to meet ONC requirements by encapsulating the HL7 Fast Healthcare Interoperability Resources (FHIR) standard for shared clinical data. Third, we demonstrate a FHIRChain-based decentralized app using digital health identities to authenticate participants in a case study of collaborative decision making for remote cancer care. Fourth, we highlight key lessons learned from our case study.