## 4 Methodology  
As mentioned earlier the aim of this study was to develop a PHR solution to the existing patient and centralized system dilemma. To achieve this, a practical methodology was needed. The authors chose the design science (DS) method [42]. The DS method addresses human-related dilemmas [43] and contributes to the generation of knowledge for the scientific community. DS is a practical methodology for the information systems field due to the fact that it is in its nature to solve more problems in this area than in other areas such as the social sciences [44]. Moreover, it is appropriate as a base for developing a blockchain-based PHR architecture that researchers in information systems and computer science commonly use [45]. The first activity of the framework was to explicate the problem; this activity aimed to precisely formulate the initial problem, justify its significance, and identify its root causes. A literature review was conducted to determine the related works. A search for academic publications was conducted in information systems and healthcare databases, such as Sage, Emerald, IEEE Xplore, Springer, ProQuest, PubMed, ScienceDirect, Wiley, JMIR, Hindawi, MDPI, IEEE, Web of Science, and Google Scholar. The results include related works and their research problems. Additionally, to preserve the rigor and quality of this research, conference proceedings, working papers, and book chapters were not considered. Defining requirements was the second activity; this aimed to find and define an artifact that could overcome the identified problem and elicit requirements for that artifact. The data collection methods were essential for achieving the research objectives. Interviews with stakeholders were conducted through purposeful sampling to gather and accurately identify and recruit various information-rich interviewees [46; 47]. Only those with over four years of experience were selected because such participants would properly understand how health records were used in their working environment. The researcher briefly introduced the participants to the research objectives and to how they would benefit and contribute to enriching the research. For ethical considerations, the researcher asked the participant's permission before recording the interview, and the responses ranged between approval and rejection. Ethical principles, including respect for the person's privacy, integrity, and confidentiality, were guaranteed. According to [48], confidentiality is critical to having honest and free discussions during an interview. A total of 13 interviews were conducted with participants from the public and private sectors in the Kingdom of Saudi Arabia, and their experience was varied. Table 1 presents the participants' information. The interviews lasted approximately 40 min on average and included face-to-face and remote interviews. Thematic or qualitative content analysis was used to analyze the data [49]. Next, the interview transcripts were entered into Atlas.ti software version 9, which is used for qualitative data analysis [50], to help manage, organize, and discover richer insights. Three additional interviews were conducted to verify the results, and no new codes were created. The data and code saturation was reached in the tenth interview, where information and codes began to be repeated, and no new codes were generated. The third activity was to design and develop artifacts to fulfill the collected requirements, including the artifact's functionality and structure [42]. Unified modeling language (UML) has been used in designing different artifacts through the Lucidchart development tool. The high-level system architecture was illustrated and explained. The proposed Fabric architecture enables private permissioned blockchains where various healthcare stakeholders and users are registered and connected using channels to preserve privacy, confidentiality, access control, and scalability.