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Abstract
Background: Health 3.0 allows decision making to be based on longitudinal data from multiple institutions, from across the patient’s healthcare journey. In such a distributed setting, blockchain smart contracts can act as neutral intermediaries to implement trustworthy decision making. Objective: In a distributed setting, transmitted data will be structured using standards (such as HL7 FHIR) for semantic interoperability. In turn, the smart contract will require interoperability with this standard, implement a complex communication setup (e.g., using oracles), and be developed using blockchain languages (e.g., Solidity). We propose the encoding of smart contract logic using a high-level semantic Knowledge Graph, using concepts from the domain standard. We then deploy this semantic KG on blockchain. Methods: Off-chain, a code generation pipeline compiles the KG into a concrete smart contract, which is then deployed on-chain. Our pipeline targets an intermediary bridge representation, which can be transpiled into a specific blockchain language. Our choice avoids on-chain rule engines, with unpredictable and likely higher computational cost; it is thus in line with the economic rules of blockchain. Results: We applied our code generation approach to generate smart contracts for 3 health insurance cases from Medicare. We discuss the suitability of our approach – the need for a neutral intermediary – for a number of healthcare use cases. Our evaluation finds that the generated contracts perform well in terms of correctness and execution cost (“gas”) on blockchain. Conclusions: We showed that it is feasible to automatically generate smart contract code based on a semantic KG, in a way that respects the economic rules of blockchain. Future work includes studying the use of Large Language Models (LLM) in our approach, and evaluations on other blockchains.