Known for its decentralized and tamper-aware properties, blockchain is attractive to enhance the infrastructure of systems that have been constrained by traditionally centralized and vendor-locked environments. Although blockchain has commonly been used as the operational model behind cryptocurrency, it has far more foreseeable utilities in domains like healthcare, where efficient data flow is highly demanded. Particularly, blockchain and related technologies have been touted as foundational technologies for addressing healthcare interoperability challenges, such as promoting effective communications and securing data exchanges across various healthcare systems. Despite the increasing interests in leveraging blockchain technology to improve healthcare infrastructures, a major gap in literature is the lack of available recommendations for concrete architectural styles and design considerations for creating blockchain-based apps and systems with a healthcare focus. This research provides two contributions to bridge the gap in existing research. First, we introduce a pattern sequence for designing blockchain-based healthcare systems focused on secure and at-scale data exchange. Our approach adapts traditional software patterns and proposes novel patterns that take into account both the technical requirements specific to healthcare systems and the implications of these requirements on naive blockchain-based solutions. Second, we provide a pattern-oriented reference architecture using an example application of the pattern sequence for guiding software developers to design interoperable (on the technical level) healthcare IT systems atop blockchain-based infrastructures. The reference architecture focuses on minimizing storage requirements on-chain, preserving the privacy of sensitive information, facilitating scalable communications, and maximizing evolvability of the system.
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