Decision Model to Design Trust-Focused and Blockchain-Based Health Data Management Applications

Many Blockchain-based approaches have been published in the field of health data management applications (HDMAs). However, no comprehensive guideline exists to guide the multiple and interdependent design decisions to develop such systems. This paper aims to support the HDMA system design processes by introducing a novel decision model. The model considers all relevant requirements, from regulatory context to user needs and trust considerations. To generate the decision model, we define a taxonomy that organizes previously published approaches by their technical design features and combines it with the trust assumptions of the participating actors according to the STRIDE method. The model aims to support a cohesive overall system design by addressing Blockchain type, off-chain storage, identity and access management, security decisions, and the specific use case of data donation. A group of experts evaluated the decision tree and its utility is demonstrated in three representative use cases. Special attention is paid to the use case of data donation via a data trustee, which is examined in detail.