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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.