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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.

The CORBA Event Service provides a j%xible model for asynchronous communication among objects. However, the standard CORBA Event Service specification lacks important features required by real-time applications. For instance, operational flight programs for fighter aircraft have complex real-time processing requirements. This paper describes the design and performance of an object-oriented, real-time implementation of the CORBA Event Service that is designed to meet these requirements.This paper makes three contributions to the design and performance measurement of object-oriented real-time systems. First, it illustrates how to extend the CORBA Event Service so that it is suitable for real-time systems. These extensions support periodic rate-based event processing and efficient event filtering and correlation. Second, it describes how to develop object-oriented event dispatching and scheduling mechanisms that can provide real-time guarantees. Finally, the paper presents benchmarks that demonstrate the performance tradeoffs of alternative concurrent dispatching mechanisms for real-time Event Services.

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