No one can dispute the disruptive impact of blockchain technology, which has long been considered one of the major revolutions of contemporary times. Its integration into the healthcare ecosystem has helped overcome numerous difficulties and constraints faced by healthcare systems. This has been notably demonstrated in the meticulous management of electronic health records (EHR) and their access rights, as well as in its capabilities in terms of security, scalability, flexibility, and interoperability with other systems. This article undertakes the study and analysis of the most commonly adopted approaches in healthcare data management systems using blockchain technology. An evaluation is then conducted based on a set of observed common characteristics, distinguishing one approach from the others. The results of this analysis highlight the advantages and limitations of each approach, thus facilitating the choice of the method best suited to the readers' specific case study. Furthermore, for effective implementation in the context of e-health, we emphasize the existence of crucial challenges, such as the incomplete representation of major stakeholders in the blockchain network, the lack of regulatory flexibility to ensure legal interoperability by country, and the insufficient integration of an official regulatory authority ensuring compliance with ethical and legal standards. To address these challenges, it is necessary to establish close collaboration between regulators, technology developers, and healthcare stakeholders.

翻译：无人能否认区块链技术的颠覆性影响，该技术长期以来被视为当代重大革命之一。其与医疗生态系统的融合，帮助克服了医疗体系面临的诸多困难与约束。这一点在电子健康记录（EHR）及其访问权限的精细化管理，以及系统在安全性、可扩展性、灵活性和与其他系统的互操作性方面的能力上尤为凸显。本文对采用区块链技术的医疗数据管理系统中最常用的方法进行了研究与分析，随后基于一组可观测的共同特征（这些特征使不同方法得以区分）进行了评估。分析结果揭示了每种方法的优势与局限，从而便于读者根据自身具体案例选择最合适的方法。此外，为在电子医疗背景下实现有效部署，我们强调当前存在若干关键挑战，例如区块链网络中主要利益相关方的代表性不足、缺乏保障各国法律互操作性的监管灵活性，以及未能充分集成负责确保伦理与法律标准合规的官方监管机构。应对这些挑战，需要建立监管机构、技术开发者与医疗利益相关方之间的紧密协作。