Blockchain Papers

Venice Lei De Luna Lucto

No abstract is available for this record.

Haytham A. Sheerah, Ahmed Arafa, Mansour A. Alfaya, Ashraf B AlDerbas · 10 authors

Problem: Traditional epidemiological surveillance methods are often limited by delays in reporting and fragmented data systems. Saudi Arabia faces additional public health challenges from mass gatherings during Hajj and Umrah, an increasing burden of noncommunicable diseases and rapid urbanization, highlighting the need for investing in digital epidemiology. Approach: Saudi Arabia has accelerated digital transformation in health care through Vision 2030 initiatives. The strategies include health information exchange platforms, analytics driven by artificial intelligence, telemedicine services and digital monitoring systems used during Hajj. We review current initiatives to invest in digital epidemiology in Saudi Arabia, implementation challenges and policy priorities. Local setting: Saudi Arabia's health system operates under a predominantly public model. The health ministry is the main provider, regulator and finance provider of most health-care services. Health-care coverage is nearly universal, with citizens receiving services free of charge through the public system. Ongoing reforms aim to gradually decentralize certain functions. Relevant changes: The initiatives under Vision 2030 have supported disease surveillance, data integration and public health response capacities. Existing digital health reforms have created a foundation for integrating digital epidemiology into routine public health practice. However, challenges remain, including fragmented interoperability between institutions, workforce shortages, unequal digital access, and concerns about data governance, privacy and algorithmic bias. Lessons learnt: Saudi Arabia's experience suggests that digital epidemiology is more effective when integrated within broader digital health reforms. Successful implementation requires not only digital infrastructure, but also workforce development, ethical governance, transparency and mechanisms for integrating digital data into public health decision-making.

Vedanta2.0 Agyat Agyani

Description:Bharat Secure Digital Identity (BSDI 2.0) is a citizen-centric, privacy-preserving identity overlay framework designed for India. It addresses the critical paradox of anonymous online harm versus mass surveillance. Unlike traditional systems that store raw identity documents, BSDI 2.0 uses Zero-Knowledge Proofs (ZKP), W3C Decentralized Identifiers (DIDs), and a Judicial Escrow Mechanism to enable attribute-based verification (e.g., age eligibility) without data disclosure. Platforms verify, but do not store, personal data. Lawful identity disclosure is only possible through multi-signature judicial authorization under strict proportionality and due process, anchored in Article 21. The framework is non-disruptive and interoperable with Aadhaar, DigiLocker, and DPDP Act 2023. It is a conceptual research framework for MeitY, NITI Aayog, and academic review. Keywords: Digital Identity, Privacy by Design, Zero-Knowledge Proof, DPDP Act, eIDAS, Judicial Oversight, Citizen Sovereignty

Virgil Kuassi Lokossou, Aishat Bukola Usman, Issiaka Sombie, Oluomachukwu Omeje · 34 authors

BACKGROUND: Lassa fever remains a major public health threat in West Africa, requiring coordinated scientific, policy, and financing responses. Regional scientific convenings are increasingly used to connect research evidence with policy action, yet their contribution to epidemic preparedness is not well documented. METHODS: We conducted a qualitative health systems and policy analysis of the 2nd ECOWAS Lassa Fever International Conference (ELFIC 2025) in Abidjan, Côte d'Ivoire. Data sources comprised 302 scientific abstracts, plenary and ministerial session records, and the official Ministerial Joint Communiqué. Using the conference's six thematic pillars as a deductive framework, we conducted a thematic content analysis and synthesized findings into four domains: scientific advances; surveillance and laboratory systems; policy and financing insights; and cross-cutting lessons for regional preparedness. RESULTS: Progress was noted in diagnostics, therapeutics, vaccine development, decentralized laboratory capacity, genomic surveillance, and digital reporting. Persistent gaps remain at sub-national and community levels, in surveillance coverage, workforce capacity, and operational readiness. A major outcome was the Ministerial Joint Communiqué endorsing regional co-financing for Lassa fever vaccine development. CONCLUSION: ELFIC 2025 demonstrates the role of regional scientific platforms in aligning evidence with policy commitments. Sustained impact will require institutionalized coordination, strengthened accountability, and targeted investments in frontline capacity.

Mohamed Abdelhamid, Pamella Howell, Deepti Singh

Background: Health care has seen several new disruptive technologies. One such innovation is the introduction of blockchain smart contracts. These smart contracts are activated automatically once preprogrammed conditions are met. Smart contracts have improved patient outcomes, the efficiency of care delivery, and reduced costs. Despite their benefits, patients have had limited interactions with smart contracts in primary care; therefore, they may not trust blockchain-based smart contracts and may perceive them as risky or have concerns about their security. Objective: This study aimed to evaluate how patients' perceptions of smart contracts affect their adoption in primary care. Specifically, we investigated the impact of patients' perceptions of smart contract security, risk, and trust in their health care providers. Methods: This study used an experimental survey design to evaluate acceptance of smart contracts. Patients were randomly assigned to 1 of 2 research scenarios proposing either the positive use of blockchain smart contracts or the loss of benefits if a patient opted out. We collected data from a total of 387 participants. The Likert survey used 3 items to measure 5 constructs in the conceptual model. The 5 hypotheses were that gain-loss-framed messaging, perceived security, and trust would have a positive impact on the adoption of smart contracts, whereas perceived risk and the clinical setting would have a negative impact on patients' intention to adopt smart contracts. The conceptual model was tested using structural equation modeling, and the model fit indices suggested a good fit. Results: Most of the hypotheses were supported, except for the gain-loss-framing effect. As hypothesized, perceived security had the strongest positive influence on the intention to use smart contracts (β=.50; P<.001). Trust in health care providers also showed a significant positive relationship (β=.43; P<.001), while perceived risk had a smaller but still significant negative impact (β=-.071; P.048). Patients in clinic-based settings had a lower intention to use smart contracts than patients in telehealth settings, and male patients had a lower intention to use smart contracts than female patients. Conclusions: The results of this study have implications for health care providers who intend to adopt smart contracts early, that is, early majority or late adopters. To facilitate their implementation, providers should highlight the security benefits of smart contracts and leverage patient trust. Providers should customize smart contract implementation strategies based on patient demographics such as age, health status, and gender. By understanding these factors, health care organizations can more effectively promote the adoption of smart contracts and realize the potential benefits of this disruptive technology in primary care.

Shinsuke Miyano, Ikuma Nozaki, Masahiko Hachiya, Tetsuya Miyamoto · 5 authors

The COVID-19 pandemic exposed critical gaps in regional health security mechanisms, prompting ASEAN to establish the ASEAN Centre for Public Health Emergencies and Emerging Diseases (ACPHEED), with functions distributed across Indonesia, Thailand, and Vietnam. This policy analysis examines strategic development approaches for ACPHEED through comprehensive benchmarking of the European Centre for Disease Prevention and Control (ECDC), Africa Centres for Disease Control and Prevention (Africa CDC), and Gulf CDC, supported by consultations in Indonesia (2024) and Sweden (2025) involving ASEAN member states and international partners. A comparative analysis reveals distinct organizational models: the ECDC operates within European Union (EU) institutional frameworks emphasizing functional specialization; the Africa CDC employs decentralized Regional Coordination Centers; and the Gulf CDC implements hybrid governance via Permanent Communication Networks. Each model offers valuable lessons for ACPHEED's development, particularly concerning governance structures that balance regional coordination with national sovereignty. ACPHEED faces unique challenges due to ASEAN's consensus-based, nonlegislative institutional nature and its tri-country operational structure. Critical success factors include phased surveillance emphasizing a defined scope and capacity building; inclusive governance mechanisms ensuring equitable member-state ownership; and operational frameworks applying subsidiarity principles to complement existing ASEAN mechanisms. Sustainable financing remains paramount given ASEAN's limited budgetary authority. Japan's strategic partnership should capitalize on its technical expertise in laboratory systems, digital surveillance, and disaster preparedness through comprehensive institutional support. ACPHEED's success depends on sustained political commitment, realistic financial arrangements, and effective integration into global health security architectures. This analysis provides a strategic roadmap for ACPHEED's preparatory phase so that it can serve as a regional health security leader while addressing ASEAN-specific institutional constraints.

Kehinde Oluwagbenga Falayi, Moses Uyi Osagie, Kehinde Olúwasayo Akinola, Prisca Chisom Igwemezie · 5 authors

The exponential growth of digital health data in hospitals has intensified concerns about data breaches, privacy violations, and interoperability failures within healthcare information systems. Traditional centralized data architectures remain highly vulnerable to cyberattacks, unauthorized access, and single points of failure, threatening the integrity of sensitive patient records. As healthcare systems transition toward smart and interconnected digital ecosystems, there is a pressing need for robust, transparent, and tamper-resistant data management frameworks. This study systematically reviews existing literature on the application of blockchain technology as a secure solution for health data management in smart hospitals. Adopting the PRISMA 2020 protocol, publications from 2016 to 2025 were retrieved from major databases, including Scopus, Web of Science, and PubMed. Out of 436 relevant studies, 42 peer-reviewed studies met the inclusion criteria. Data extraction captured study characteristics, blockchain types, implementation contexts, and findings. Evidence synthesis followed Braun and Clarke’s (2006) six-step thematic analysis framework. Findings reveal that blockchain enhances data security and integrity through cryptographic immutability and distributed consensus mechanisms, mitigates privacy risks via smart contracts and zero-knowledge proofs, and improves interoperability across healthcare stakeholders. However, challenges persist in scalability, regulatory alignment, and implementation costs, particularly in low-resource settings. This study concludes that hybrid and permissioned blockchain models offer the most viable pathway for achieving secure, compliant, and efficient healthcare data ecosystems. Therefore, this study recommends further integration with artificial intelligence and cloud technologies to optimize performance, while aligning deployment with ethical, legal, and institutional frameworks governing digital health.

Mohamed Chawki

In the contemporary global context, Information and Communication Technologies (ICTs) present multifaceted challenges, particularly in maintaining an appropriate balance between national security requirements and the protection of individual privacy. The rapid advancement of technology has led to an increase in cyber threats, necessitating closer collaboration between the public and private sectors. However, such collaboration often blurs the boundaries between security imperatives and individual privacy rights. This study examines the implications of this balance and assesses whether existing regulations adequately protect individuals’ privacy. The right to privacy is universally safeguarded by ethical norms and legal frameworks. Instruments such as the United States Constitution and the General Data Protection Regulation (GDPR) provide protection against unlawful searches, seizures and the misuse of personal data. Despite these safeguards, information sharing between public institutions and private entities may undermine privacy rights if appropriate accountability mechanisms are not in place. Navigating this complex terrain requires approaches that enable data collection and cybersecurity cooperation without violating individual privacy. Technological innovations, including artificial intelligence (AI) and zero-knowledge proof authentication systems, offer potential solutions by limiting unauthorized access to personal data. This paper argues that reconciling cybersecurity imperatives with the protection of individual rights requires continuous recalibration of legal and ethical boundaries. While data sharing within and across private industries can strengthen defenses against cyber threats, such practices must be carefully evaluated to prevent privacy violations. Achieving this balance ultimately depends on enhanced transparency and accountability.

M. A. Mansur

National identity systems require efficient, equitable decision-making that safeguards personal data. This article proposes a Self-Sovereign Identity (SSI) architecture, supported by a Verify-Without-Reveal (VWR) framework, designed for national-scale implementation. SSI places credentials in a citizen wallet and enables selective disclosure and zero-knowledge proofs, so services can verify attributes without seeing underlying records. VWR adds the policy and accountability spine: yes/no attribute APIs for holder-absent cases, purpose-bound and zero-trust enforcement on every call, and an immutable audit layer on a permissioned ledger. The study synthesises current standards and leading implementations in Europe and worldwide and formulates a deployable blueprint with clear roles, consent and lawful-override flows, per-agency pseudonyms, and regulator and citizen visibility. The study outlines reference APIs, user experiences for wallets and verifiers, and performance metrics suited for national workloads. Privacy-preserving AI strengthens biometric liveness, fraud detection, and anomaly response without centralising sensitive data. The framework aligns with GDPR data minimisation and purpose limitation, supports the European Digital Identity Wallet, and meets high-risk AI governance requirements. Results show how SSI proofs and VWR controls reduce unconsented disclosure and cross-agency browsing, while keeping latency low and interoperability high. The contribution is both conceptual and operational: a phased migration path that turns verify-without-reveal into the default mode for government and regulated services, improving security, inclusion, and public trust.

Aijaz A. Shaikh, Galimkair Mutanov, Heikki Karjaluoto

The development of blockchain, metaverse, and digital payment technologies has pushed the boundaries of digital transformation even further—from financials to many other industries, most notably healthcare and education. Blockchain technology is widely recognized as a distributed ledger records transactions in a secured decentralized manner, thus eliminating the need for central control. Initially developed to support cryptocurrencies like Bitcoin, blockchain’s applications have expanded significantly in recent years. For example, it enables the execution of smart contracts and secure data management in finance, supply chain management, and healthcare. Its innovative features like decentralization, immutability, transparency, and security make it a breakthrough in ensuring tamper-proof and reliable record-keeping (Beck et al., 2017). Blockchain also addresses privacy and security challenges, making it suitable for diverse applications from personal data processing in compliance with General Data Protection Regulations (GDPR) (Nofer et al., 2020) to Internet of Things (IoT) integrations (Ghiro et al., 2021).

Ghanim Hamid Al-Khattabi

Blockchain, one of these new digital technologies, has special qualities like immutability, decentralization, and transparency that can be helpful in many different areas including managing electronic medical data and access rights, as well as mobile health. We reviewed all COVID-19-related and unrelated blockchain applications in the healthcare industry. MEDLINE, SpringerLink, Institute of Electrical and Electronics Engineers Xplore, ScienceDirect, arXiv, and Google Scholar were searched for pertinent reports up to July 29, 2021. There were articles with both technical and clinical designs, with or without prototype development. A total of 85 375 articles were assessed, and 415 full-length reports—37 of which were connected to COVID-19 and 378 of which were unrelated—were ultimately incorporated into the study. The three primary COVID-19-related applications that were reported were contact tracing, monitoring of immunity or vaccination passports, and pandemic control and surveillance. Management of electronic medical records, internet of things (such as remote monitoring or mobile health), and supply chain monitoring were the top three non-COVID-19-related applications. The majority of publications (277 [667%] of 415] focused on the technical performance of blockchain prototype systems, whereas nine (2%) research indicated actual clinical use and uptake. Only technical studies (129 [311%] of 415) made up the remaining investigations. The most popular platforms were Hyperledger and Ethereum. Numerous COVID-19-related and unrelated health care applications of blockchain technology are possible. The necessity to adapt fundamental blockchain technology for use in healthcare settings is highlighted by the fact that the majority of current research is still in the technical stage and only a small number offers practical clinical applications.

Muhammad Saad, Maaz Bin Ahmad, Muhammad Asif, Muhammad Khalid Khan · 7 authors

Pandemics have always been a nightmare for humanity, especially in developing countries. Forced lockdowns are considered one of the effective ways to deal with spreading such pandemics. Still, developing countries cannot afford such solutions because these may severely damage the country’s economy. Therefore, this study presents the proactive technological mechanisms for business organizations to run their standard business processes during pandemic-like situations smoothly. The novelty of this study is to provide a state-of-the-art solution to prevent pandemics using industrial internet of things (IIoT) and blockchain-enabled technologies. Compared to existing studies, the immutable and tamper-proof contact tracing and quarantine management solution is proposed. The use of advanced technologies and information security is a critical area for practitioners in the internet of things (IoT) and corresponding solutions. Therefore, this study also emphasizes information security, end-to-end solution, and experimental results. Firstly, a wearable wristband is proposed, incorporating 4G-enabled ultra-wideband (UWB) technology for smart contact tracing mechanisms in industries to comply with standard operating procedures outlined by the world health organization (WHO). Secondly, distributed ledger technology (DLT) omits the centralized dependency for transmitting contact tracing data. Thirdly, a privacy-preserving tracing mechanism is discussed using a public/private key cryptography-based authentication mechanism. Lastly, based on geofencing techniques, blockchain-enabled machine-to-machine (M2M) technology is proposed for quarantine management. The step-by-step methodology and test results are proposed to ensure contact tracing and quarantine management. Unlike existing research studies, the security aspect is also considered in the realm of blockchain. The practical implementation of the proposed solution also obtains the results. The results indicate the successful implementation of blockchain-enabled contact tracing and isolation management using IoT and geo-fencing techniques, which could help battle pandemic situations. Researchers can also consider the 5G-enabled narrowband internet of things (NB-IoT) technologies to implement contact tracing solutions.

Nitish Pathak, Shams Tabrez Siddiqui, Anjani Kumar Singha, Heba G. Mohamed · 6 authors

The coronavirus, formerly known as COVID-19, has caused massive global disasters. As a precaution, most governments imposed quarantine periods ranging from months to years and postponed significant financial obligations. Furthermore, governments around the world have used cutting-edge technologies to track citizens’ activity. Thousands of sensors were connected to IoT (Internet of Things) devices to monitor the catastrophic eruption with billions of connected devices that use these novel tools and apps, privacy and security issues regarding data transmission and memory space abound. In this study, we suggest a blockchain-based methodology for safeguarding data in the billions of devices and sensors connected over the internet. Various trial secrecy and safety qualities are based on cutting-edge cryptography. To evaluate the proposed model, we recommend using an application of the system, a Raspberry Pi single-board computer in an IoT system, a laptop, a computer, cell phones and the Ethereum smart contract platform. The models ability to ensure safety, effectiveness and a suitable budget is proved by the Gowalla dataset results.

Md Mamunur Rashid, Piljoo Choi, Suk‐Hwan Lee, Ki‐Ryong Kwon

Due to its significant global impact, both domestic and international efforts are underway to cure the infection and stop the COVID-19 virus from spreading further. In resource-limited environments, overwhelmed healthcare institutions and surveillance systems are struggling to cope with this epidemic, necessitating a specific strategic response. In this study, we looked into the COVID-19 situation and to establish trust, accountability, and transparency, we employed blockchain's immutable and tamper-proof properties. We offered a smart contract (SC)-based solution (Block-HPCT) that has been successfully tested to preserve a digital health passport (DHP) for vaccine recipients; also, for contact tracing (CT) we employed proof of location concept, which aids in a swift and credible response directly from the appropriate healthcare authorities. To connect on-chain and off-chain data, trusted and registered oracles were integrated and to provide a double layer of security along with symmetric key encryption; both Interplanetary File System (IPFS) and Hyperledger Fabric were merged as storage center. We also provided a full description of the suggested solution's system design, implementation, experiment results, and evaluation (privacy and cost analysis). As per the findings, the suggested approach performed satisfactorily across all significant assessment criteria, implying that it can lead the way for practical implementations and also can be used for similar types of situations where contact tracing of infectious can be crucial.

Syed Ibtisam Tauhidi, Abdullahi Abubakar, Abdulhakeem Ishola, Alhaji Idi Babate · 10 authors

The Coronavirus disease 2019 has manifested into a global pandemic spreading into almost all the countries and territories in the world. Contact tracing, followed by testing and isolation, have been identified as important tools in containing the proliferation of the disease. Because of manual contact tracing limitations, smartphone apps for digital contact tracing have been deployed by authorities in multiple countries. However, many of these apps have faced criticism because of interoperability, privacy and security issues. This paper proposes an open architecture based on blockchain technology that addresses some of these criticisms. It enables interoperability through a publicly-readable consortium blockchain database, preserving privacy by distributing users’ partial identities among multiple decentralised authorities and providing security through digital signature and asymmetric key encryption. In addition, the architecture provides a fast proof-of-authority based consensus algorithm using reputation as a stake to add and validate blocks on the blockchain efficiently and a swift contact tracing algorithm using Spatio-temporal and key-valued databases.

Xiao Li, Weili Wu, Tiantian Chen

Blockchain technology, recognized for its decentralized and privacy-preserving capabilities, holds potential for enhancing privacy in contact tracing applications. Existing blockchain-based contact tracing frameworks often overlook one or more critical design details, such as the blockchain data structure, a decentralized and lightweight consensus mechanism with integrated tracing data verification, and an incentive mechanism to encourage voluntary participation in bearing blockchain costs. Moreover, the absence of framework simulations raises questions about the efficacy of these existing models. To solve above issues, this article introduces a fully third-party independent blockchain-driven contact tracing (BDCT) framework, detailed in its design. The BDCT framework features an Rivest-Shamir-Adleman (RSA) encryption-based transaction verification method (RSA-TVM), achieving over 96% accuracy in contact case recording, even with a 60% probability of individuals failing to verify contact information. Furthermore, we propose a lightweight reputation corrected delegated proof of stake (RC-DPoS) consensus mechanism, coupled with an incentive model, to ensure timely reporting of contact cases while maintaining blockchain decentralization. Additionally, a novel simulation environment for contact tracing is developed, accounting for three distinct contact scenarios with varied population density. Our results and discussions validate the effectiveness, robustness of the RSA-TVM and RC-DPoS, and the low storage demand of the BDCT framework.

Cvetkovski, Oliver, Field, Carlo, Trinchi, Davide, Marti, Christof · 5 authors

Domain-specific Microservice Reference Architectures (MSRA) have become relevant study objects in software technology. They facilitate the technical evaluation of service designs, compositions patterns and deployment configurations in realistic operational practice. Current knowledge about MSRA is predominantly confined to business domains with modest numbers of users per application. Due to the ongoing massive digital transformation of society, people-related online services in e-government, e-health and similar domains must be designed to be highly scalable at entire nation level at affordable infrastructure cost. With ZVAX, we present such a service in the e-health domain. Specifically, the ZVAX implementation adheres to an MSRA for pandemic-related processes such as vaccination registration and passenger locator form submission, with emphasis on selectable levels of privacy. We argue that ZVAX is valuable as study object for the training of software engineers and for the debate on arbitrary government-to-people services at scale.

Alessio Ferone, Antonio Della Porta

No abstract is available for this record.

Karen Yeung

BACKGROUND: Academic literature highlights blockchain's potential to transform health care, particularly by seamlessly and securely integrating existing data silos while enabling patients to exercise automated, fine-grained control over access to their electronic health records. However, no serious scholarly attempt has been made to assess how these technologies have in fact been applied to real-world health care contexts. OBJECTIVE: The primary aim of this paper is to assess whether blockchain's theoretical potential to deliver transformative benefits to health care is likely to become a reality by undertaking a critical investigation of the health care sector's actual experience of blockchain technologies to date. METHODS: This mixed methods study entailed a series of iterative, in-depth, theoretically oriented, desk-based investigations and 2 focus group investigations. It builds on the findings of a companion research study documenting real-world engagement with blockchain technologies in health care. Data were sourced from academic and gray literature from multiple disciplinary perspectives concerned with the configuration, design, and functionality of blockchain technologies. The analysis proceeded in 3 stages. First, it undertook a qualitative investigation of observed patterns of blockchain for health care engagement to identify the application domains, data-sharing problems, and the challenges encountered to date. Second, it critically compared these experiences with claims about blockchain's potential benefits in health care. Third, it developed a theoretical account of challenges that arise in implementing blockchain in health care contexts, thus providing a firmer foundation for appraising its future prospects in health care. RESULTS: Health care organizations have actively experimented with blockchain technologies since 2016 and have demonstrated proof of concept for several applications (use cases) primarily concerned with administrative data and to facilitate medical research by enabling algorithmic models to be trained on multiple disparately located sets of patient data in a secure, privacy-preserving manner. However, blockchain technology is yet to be implemented at scale in health care, remaining largely in its infancy. These early experiences have demonstrated blockchain's potential to generate meaningful value to health care by facilitating data sharing between organizations in circumstances where computational trust can overcome a lack of social trust that might otherwise prevent valuable cooperation. Although there are genuine prospects of using blockchain to bring about positive transformations in health care, the successful development of blockchain for health care applications faces a number of very significant, multidimensional, and highly complex challenges. Early experience suggests that blockchain is unlikely to rapidly and radically revolutionize health care. CONCLUSIONS: The successful development of blockchain for health care applications faces numerous significant, multidimensional, and complex challenges that will not be easily overcome, suggesting that blockchain technologies are unlikely to revolutionize health care in the near future.

Arijit Sengupta, Hemang Subramanian

BACKGROUND: Integrating pervasive computing with blockchain's ability to store privacy-protected mobile health (mHealth) data while providing Health Insurance Portability and Accountability Act (HIPAA) compliance is a challenge. Patients use a multitude of devices, apps, and services to collect and store mHealth data. We present the design of an internet of things (IoT)-based configurable blockchain with different mHealth apps on iOS and Android, which collect the same user's data. We discuss the advantages of using such a blockchain architecture and demonstrate 2 things: the ease with which users can retain full control of their pervasive mHealth data and the ease with which HIPAA compliance can be accomplished by providers who choose to access user data. OBJECTIVE: The purpose of this paper is to design, evaluate, and test IoT-based mHealth data using wearable devices and an efficient, configurable blockchain, which has been designed and implemented from the first principles to store such data. The purpose of this paper is also to demonstrate the privacy-preserving and HIPAA-compliant nature of pervasive computing-based personalized health care systems that provide users with total control of their own data. METHODS: This paper followed the methodical design science approach adapted in information systems, wherein we evaluated prior designs, proposed enhancements with a blockchain design pattern published by the same authors, and used the design to support IoT transactions. We prototyped both the blockchain and IoT-based mHealth apps in different devices and tested all use cases that formed the design goals for such a system. Specifically, we validated the design goals for our system using the HIPAA checklist for businesses and proved the compliance of our architecture for mHealth data on pervasive computing devices. RESULTS: Blockchain-based personalized health care systems provide several advantages over traditional systems. They provide and support extreme privacy protection, provide the ability to share personalized data and delete data upon request, and support the ability to analyze such data. CONCLUSIONS: We conclude that blockchains, specifically the consensus, hasher, storer, miner architecture presented in this paper, with configurable modules and software as a service model, provide many advantages for patients using pervasive devices that store mHealth data on the blockchain. Among them is the ability to store, retrieve, and modify ones generated health care data with a single private key across devices. These data are transparent, stored perennially, and provide patients with privacy and pseudoanonymity, in addition to very strong encryption for data access. Firms and device manufacturers would benefit from such an approach wherein they relinquish user data control while giving users the ability to select and offer their own mHealth data on data marketplaces. We show that such an architecture complies with the stringent requirements of HIPAA for patient data access.

Imrana Abdullahi Yari, Tobias Dehling, Felix Kluge, Juergen Geck · 6 authors

BACKGROUND: Patient-centered health care information systems (PHSs) enable patients to take control and become knowledgeable about their own health, preferably in a secure environment. Current and emerging PHSs use either a centralized database, peer-to-peer (P2P) technology, or distributed ledger technology for PHS deployment. The evolving COVID-19 decentralized Bluetooth-based tracing systems are examples of disease-centric P2P PHSs. Although using P2P technology for the provision of PHSs can be flexible, scalable, resilient to a single point of failure, and inexpensive for patients, the use of health information on P2P networks poses major security issues as users must manage information security largely by themselves. OBJECTIVE: This study aims to identify the inherent security issues for PHS deployment in P2P networks and how they can be overcome. In addition, this study reviews different P2P architectures and proposes a suitable architecture for P2P PHS deployment. METHODS: A systematic literature review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Thematic analysis was used for data analysis. We searched the following databases: IEEE Digital Library, PubMed, Science Direct, ACM Digital Library, Scopus, and Semantic Scholar. The search was conducted on articles published between 2008 and 2020. The Common Vulnerability Scoring System was used as a guide for rating security issues. RESULTS: Our findings are consolidated into 8 key security issues associated with PHS implementation and deployment on P2P networks and 7 factors promoting them. Moreover, we propose a suitable architecture for P2P PHSs and guidelines for the provision of PHSs while maintaining information security. CONCLUSIONS: Despite the clear advantages of P2P PHSs, the absence of centralized controls and inconsistent views of the network on some P2P systems have profound adverse impacts in terms of security. The security issues identified in this study need to be addressed to increase patients' intention to use PHSs on P2P networks by making them safe to use.

Mohamed Torky, Essam Goda, Václav Snåšel, Aboul Ella Hassanien

The fight against the COVID-19 pandemic still involves many struggles and challenges. The greatest challenge that most governments are currently facing is the lack of a precise, accurate, and automated mechanism for detecting and tracking new COVID-19 cases. In response to this challenge, this study proposes the first blockchain-based system, called the COVID-19 contact tracing system (CCTS), to verify, track, and detect new cases of COVID-19. The proposed system consists of four integrated components: an infection verifier subsystem, a mass surveillance subsystem, a P2P mobile application, and a blockchain platform for managing all transactions between the three subsystem models. To investigate the performance of the proposed system, CCTS has been simulated and tested against a created dataset consisting of 300 confirmed cases and 2539 contacts. Based on the metrics of the confusion matrix (i.e., recall, precision, accuracy, and F1 Score), the detection evaluation results proved that the proposed blockchain-based system achieved an average of accuracy of 75.79% and a false discovery rate (FDR) of 0.004 in recognizing persons in contact with COVID-19 patients within two different areas of infection covered by GPS. Moreover, the simulation results also demonstrated the success of the proposed system in performing self-estimation of infection probabilities and sending and receiving infection alerts in P2P communications in crowds of people by users. The infection probability results have been calculated using the binomial distribution function technique. This result can be considered unique compared with other similar systems in the literature. The new system could support governments, health authorities, and citizens in making critical decisions regarding infection detection, prediction, tracking, and avoiding the COVID-19 outbreak. Moreover, the functionality of the proposed CCTS can be adapted to work against any other similar pandemics in the future.

Bhaskara S. Egala, Ashok Kumar Pradhan, Venkataramana Badarla, Saraju P. Mohanty

The recent COVID-19 outbreak highlighted the requirement for a more sophisticated healthcare system and real-time data analytics in the pandemic mitigation process. Moreover, real-time data plays a crucial role in the detection and alerting process. Combining smart healthcare systems with accurate real-time information about medical service availability, vaccination, and how the pandemic is spreading can directly affect the quality of life and economy. The existing architecture models are become inadequate in handling the pandemic mitigation process using real-time data. The present models are server-centric and controlled by a single party, where the management of confidentiality, integrity, and availability (CIA) of data is doubtful. Therefore, a decentralised user-centric model is necessary, where the CIA of user data is assured. In this paper, we have suggested a decentralized blockchain-based pandemic detection and assistance system (iBlock). The iBlock uses robust technologies like hybrid computing and IPFS to support system functionality. A pseudo-anonymous personal identity is introduced using H-PCS and cryptography for anonymous data sharing. The distributed data management module guarantees data CIA, security, and privacy using cryptography mechanisms. Furthermore, it delivers useful intelligent information in the form of suggestions and alerts to assist the users. Finally, the iBlock reduces stress on healthcare infrastructure and workers by providing accurate predictions and early warnings using AI/ML.

Wei Yan Ng, Tien-En Tan, Prasanth V H Movva, Andrew Hao Sen Fang · 12 authors

The COVID-19 pandemic has had a substantial and global impact on health care, and has greatly accelerated the adoption of digital technology. One of these emerging digital technologies, blockchain, has unique characteristics (eg, immutability, decentralisation, and transparency) that can be useful in multiple domains (eg, management of electronic medical records and access rights, and mobile health). We conducted a systematic review of COVID-19-related and non-COVID-19-related applications of blockchain in health care. We identified relevant reports published in MEDLINE, SpringerLink, Institute of Electrical and Electronics Engineers Xplore, ScienceDirect, arXiv, and Google Scholar up to July 29, 2021. Articles that included both clinical and technical designs, with or without prototype development, were included. A total of 85 375 articles were evaluated, with 415 full length reports (37 related to COVID-19 and 378 not related to COVID-19) eventually included in the final analysis. The main COVID-19-related applications reported were pandemic control and surveillance, immunity or vaccine passport monitoring, and contact tracing. The top three non-COVID-19-related applications were management of electronic medical records, internet of things (eg, remote monitoring or mobile health), and supply chain monitoring. Most reports detailed technical performance of the blockchain prototype platforms (277 [66·7%] of 415), whereas nine (2·2%) studies showed real-world clinical application and adoption. The remaining studies (129 [31·1%] of 415) were themselves of a technical design only. The most common platforms used were Ethereum and Hyperledger. Blockchain technology has numerous potential COVID-19-related and non-COVID-19-related applications in health care. However, much of the current research remains at the technical stage, with few providing actual clinical applications, highlighting the need to translate foundational blockchain technology into clinical use.