Blockchain Papers

Wesley Moonsamy

Since announcing the implementation of a single electronic health record for all South Africans, the government has not yet informed healthcare facilities of how this would be accomplished. The siloed South African healthcare system would have to be redesigned to accommodate a single electronic health record. A systematic literature review conducted across three databases returned 9 790 results. By applying ten filters, 22 documents were eventually retrieved for analysis. The analysis showed that existing research focuses on healthcare architectures from a theoretical perspective. Therefore, the literature review revealed a practically based research deficiency and a lack of theoretical studies merged with practical cases. Seeking to enhance the understanding of designing a single electronic health record, the documents were analysed using a qualitative inductive content analysis technique, revealing that a single electronic health record cannot be formulated using a fully centralised architecture as this is not practical. A fully decentralised architecture, such as blockchain, is equally infeasible because this requires significant changes to the existing systems and infrastructure and would require re-skilling system builders. Since the South African healthcare architecture is already decentralised, hybrid architecture incorporating edge computing with clusters of systems and information that connect using middleware should be considered.

G. Indirapriyadarsini, Sireesha Guttapalam, Ramyasri Mogarala, Kalpeshkumar L. Guptha

Background Maintaining optimal youth nutritional health is an urgent socio-economic imperative that underpins long-term human productivity and rights-based development. However, modern youth cohorts face unique dietary threats caused by the widespread availability of ultra-processed foods, targeted digital marketing, and complex food labeling protocols. Although Artificial Intelligence (AI) presents innovative avenues for personalized dietary profiling, existing systems remain largely technocentric and detached from statutory frameworks or behavioral realities. Objective This study bridges this interdisciplinary divide by evaluating a rights-based, technology-driven framework to improve youth nutritional health. It aims to: (1) empirically evaluate the “Knowledge-Attitude-Practice” (KAP) gap linking statutory consumer rights to real-world eating habits; (2) present the engineering design of a non-commercial Progressive Web Application (PWA) built to translate legal safeguards into daily behavioral changes; and (3) triangulate these findings using data from youth surveys and expert legal and nutritional panels. Methods Using a cross-sectional approach based on non-parametric power constraints, a validated survey instrument was completed by a target sample of Indian youth ( n = 354, aged 15–25 years). Concurrently, data matrices were compiled from regional legal experts ( n = 12) and public nutrition professionals ( n = 12) to cross-verify structural bottlenecks. Group variances, demographic dependencies, and rank associations were analyzed using robust non-parametric tests, including One-Way ANOVA, Kruskal-Wallis (H), Welch’s t-test, and Kendall’s Tau ( τ ) correlation coefficients. Results Inferential analysis revealed unexpected demographic trends: undergraduate status predicted significantly higher FSSAI safety awareness than post-graduate status ( p = 0.0037), while subjective health ratings exhibited a non-linear relationship with household income ( p = 0.0004), peaking in the lower-middle financial tier. Crucially, rank correlation testing revealed that the relationship between statutory knowledge and actual dietary actions is functionally non-existent ( τ = −0.001). This near-zero correlation provides clear empirical proof of a pronounced Knowledge-Action Gap, confirming that passive legal literacy fails to influence food selection in modern environments. Conclusion By framing automated behavioral interventions within the constitutional protections of Article 21 of the Constitution of India and the Consumer Protection Act, 2019, this study shows how the open-access PWA (nutrition-zb.pages.dev) can bridge this behavioral gap. This shifts the focus of consumer health informatics from basic self-tracking to a rights-based, systemic public health intervention.

Momodu Mustapha, Susan Konyeha, Akinola Samson Olayinka

This study examines user trust and perception of cryptographic technologies specifically SHA3-512 hashing, SERPENT encryption, and Zero-Knowledge Proofs (ZKP) in the context of centralized Electronic Health Record (EHR) systems. As healthcare institutions increasingly migrate patient data to digital platforms, the security and privacy properties of underlying cryptographic mechanisms have become critical determinants of user confidence and system adoption. Using a quantitative, survey-based design, data were collected from 92 healthcare practitioners, IT professionals, and system administrators actively engaged with EHR systems in Auchi, Nigeria. A Random Forest classifier was trained to predict perceived satisfaction levels (Low, Neutral, High) based on respondents' assessments of cryptographic effectiveness, usability, and trust. Results indicate that trust in ZKP is the strongest predictor of overall perception, followed by confidence in SERPENT encryption and SHA3-512 integrity guarantees. The model achieved a classification accuracy of 63.3% on a held-out test set derived from this exploratory sample, with a Kappa statistic of 0.52 reflecting moderate agreement beyond chance. Balanced accuracy across classes (approximately 0.49–0.50) and low per class sensitivity confirm that the findings should be interpreted as preliminary and directional rather than definitive. Key themes from open ended feedback analyzed using TF-IDF text mining reveal that while respondents broadly recognize the security value of these cryptographic mechanisms, concerns about system slowdown, usability complexity, and insufficient user education present barriers to wider adoption. This study contributes a pilot-level empirical baseline for understanding stakeholder perception of layered cryptographic security in resource-constrained healthcare environments, and highlights the need for larger-scale replication studies. Keywords: SHA3-512; SERPENT encryption; Zero-Knowledge Proofs; healthcare data security; user perception; Electronic Health Records; Random Forest

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.

Asghar Ehteshami, Mohammad Sattari

Background: Blockchain has many applications in healthcare and can improve mobile health applications, monitoring devices, electronic media record sharing and storage, clinical trial data, and insurance information storage. In this study, the aim was to investigate the application areas of blockchain and its impact in telemedicine. Methods: This study considers articles use blockchain for telemedicine. PubMed, Science direct, and Web of Science databases are considered as searchable databases. Information on authors' names, year of publication, country, application, privacy mechanism, blockchain platform, and encryption techniques are used. 249 studies were retrieved after the initial search. Finally, 16 cases had the necessary criteria to enter this study. The JBI checklist was applied to all 16 studies. Results: China with 5 studies and Italy with 3 studies are the most important countries about blockchain in telemedicine that electronic health records are more used than others. Blockchain platforms are Ethereum, Internet of thing, cloud-service provider, and GPS. Encryption techniques are Attribute-based encryption: Decentralized identity: Order-preserving encryption- hashcode- Double blockchain. Conclusions: Blockchain plays an important role in creating security for telemedicine technology. In the future, the use of technology will have a significant and important leap, which will attract the attention of many researchers.

Wa Ode Siti Nur Alam, Riri Fitri Sari

The accurate and timely classification of toddlers' nutritional status is critical for early intervention, particularly in remote or underserved communities with limited access to healthcare professionals. However, data security, especially for children's health data, is equally essential to ensure safe storage and access. To address these challenges, this study proposes a hybrid AI-powered chatbot that integrates ensemble learning, blockchain, and decentralized storage to support both nutritional status classification and educational interaction. The system combines a random forest model for classification with GPT-3.5 Turbo for bilingual (Indonesian–English) stunting education deployed via Telegram. Preprocessing includes standardizing, normalizing, and encoding Indonesian-language nutrition data to ensure machine learning readiness. Six ensemble algorithms are evaluated using stratified five-fold cross-validation, with classification results hashed using SHA-256 and immutably stored on the Interplanetary File System (IPFS) and a local Ethereum blockchain. The chatbot effectively manages both structured inputs and natural language queries, ensuring secure, transparent, and real-time nutritional assessments. Results demonstrate high classification performance, with the random forest model achieving the highest mean F1-score (0.9987) and the lowest deviation. Its robustness was validated by a 20% hold-out test set and stratified five-fold cross-validation, which obtained excellent balanced performance across nutritional status categories (F1-macro, precision, recall, accuracy ≈ 0.99; ROC AUC = 1.00). External validation also yielded robust and consistent results (F1-macro = 0.97, precision = 0.97, recall = 0.96, ROC AUC = 0.98, and accuracy = 0.97), demonstrating the model's generalization ability and mitigating concerns regarding overfitting. Blockchain evaluation confirmed stable and linear CID transaction throughput (blocks 29–46) with no observed latency, ensuring reliable and continuous data recording. Furthermore, gas prices decreased by ~87.5%, highlighting significant improvements in cost efficiency and scalability, which reinforces blockchain's feasibility for decentralized, AI-driven health data management. Received: 9 June 2025 | Revised: 29 September 2025 | Accepted: 31 October 2025 Conflicts of Interest The authors declare that they have no conflicts of interest to this work. Data Availability Statement The data that support the findings of this study are openly available in Kaggle at https://www.kaggle.com/datasets/rendiputra/stunting-balita-detection-121k-rows and https://www.kaggle.com/datasets/jabirmuktabir/stunting-wasting-dataset. Author Contribution Statement Wa Ode Siti Nur Alam: Conceptualization, Methodology, Software, Validation, Formal analysis, Investigation, Resources, Data curation, Writing – original draft, Writing – review &amp; editing, Visualization, Project administration. Riri Fitri Sari: Conceptualization, Writing – review &amp; editing, Supervision, Funding acquisition.

G. Gangadevi, Sudharsun Ravisankar, P Vikash

"With growing concerns about mental well-being, users want efficacious means to monitor emotions and get personalized assistance, with current solutions often sacrificing privacy or offering shallow revelations. ZenLoop overcomes the shortcomings by combining AI-based analysis of emotion with safe Web3 storage to provide both well-being support alongside privacy. This paper builds a conversational AI chatbot that offers coping mechanisms, a mood tracker to record emotion states, and an analysis dashboard to enable users to identify behavior patterns. Developed with React for frontend, Node.js for backend, and MongoDB for organized data, ZenLoop provides empathy-based responses leveraging NLP models trained on mental well-being dialogues. Journals are encrypted and stored in Web3-based storage, with immutable, decentralized protection. Trends in moods are depicted in interactive graphs, and AI-driven insights enable users to monitor emotion shifts. Tests show enhanced user engagement, improved self-perception, along with superior protection of data. The chatbot is effective in detecting levels of distress along with recommended interventions, promoting emotional resilience. By combining AI-driven tools for mental well-being with the security of blockchain, ZenLoop enables users to express emotion securely, monitor their mental well-being patterns, and get personalized advice at no cost of privacy. This work demonstrates the potential of privacy-based AI-based solutions to promote well-being at the emotional level, leading to the development of secure, user-centric applications for mental well-being.

Polina Bobrova, Paolo Perego

Integrating blockchain into healthcare devices offers the potential for improved data control but faces significant usability and acceptance challenges. This study addresses this gap by evaluating CipherPal, an improved blockchain-enabled Smart Fidget Toy prototype, using a multi-framework approach to understand the interplay between technology, design, and user experience. We synthesized insights from three complementary frameworks: an expert review assessing adherence to Web3 Design Guidelines, a User Acceptance Toolkit assessment with professionals based on UTAUT2, and an extended three-day user testing study. The findings revealed that users valued CipherPal’s satisfying tactile interaction and perceived benefits for well-being, such as stress relief. However, significant usability barriers emerged, primarily related to challenging device–application connectivity and data synchronization. The multi-framework approach proved valuable in revealing these core tensions. While the device was conceptually accepted, the blockchain integration added significant interaction friction that overshadowed its potential benefits during the study. This research underscores the critical need for user-centered design in health-related blockchain applications, emphasizing that seamless usability and abstracting technical complexity are paramount for adoption.

Michael Riedel, Lea Koisser, Thomas Czypionka

Abstract Background Demographic ageing, shortages in health workforce and increased use of digital tools in daily life kindle decision makers’ interest to utilize digital health applications (DHA). While there are several reviews that provide an overview across remuneration frameworks, no synthesis between additional regulatory aspects and frequency of remuneration approval has been conducted. Methods European countries with either strong status in digital health in general or regulation for health apps in particular were chosen for analysis (BE, DK, DE, EE, EN, FR, NL). Country specific information was collected from scientific and grey literature, legal and stakeholder webpages. Semi-structured interviews were conducted with country experts via video call or e-mail and analyzed using Mayring’s structured, qualitative content analysis. Preliminary results We find three approaches concerning DHT-definitions: For BE, DE, FR, specific regulations define national remuneration requirements. EN and NL define only minimum requirements while decentralized payors make financing decisions. DK and EE fit DHTs into existing financing schemes. Among countries with a national financing framework, DE achieved the largest number of approvals, followed by FR, while BE has not yet issued a (lasting) financing approval. Evaluation requirements focus on clinical and economic outcomes, largely ignoring non-clinical improvements for patients. Conclusions The German regulation stands out with a peculiar definition that might help clarify evaluation criteria, increase the number of financing approvals but also empower patients while reducing the role of health workforce in their application. BE and NL regulations necessitate involvement of health workers, thus addressing structurally different applications. Key messages • Drawing lessons for DHT regulations across countries needs to address differences in national definitions and evaluation criteria. • A standardization system for DHT may help to speed utilization of effective tools and clarify evaluation requirements.

Sathya Krishnasamy

WEB3 technologies on network architectures, distributed ledgers and decentralised artificial intelligence represent a transformative shift in how data are handled, stored and shared. These innovations promise to significantly enhance consumer data privacy rights by addressing fundamental vulnerabilities associated with traditional centralised systems and self-custody wallets. Data breaches in traditional systems operated mainly by third parties are more common, resulting in significant data leaks because of centralised storage and excessive data movement, sometimes unnecessarily. Healthcare data breaches have been a growing concern globally. Several hospitals faced operational halts on account of the impact of ransomware on patient care and privacy. WEB3 Wallets are a vital component emerging as a significant force for global financial inclusion, especially in developing economies. They promote inclusion, reduce costs and empower individuals through self-custody. Though major improvements are needed in these wallets, their use is rising steadily. The global cryptocurrency user base is expected to reach over 500 million by 2025, with substantial growth in emerging markets, according to a report by Statista in 2023. This paper introduces a concept beyond cryptocurrencies and finance into everyday real-world use cases that need combinatorial access to a person's holistic data, including financial and health records, genomic data, advanced directives, among others, that need to be privacy protected and shared with specific actors identified for their roles in the WEB3 ecosystem through decentralised identifiers and non-fungible token badges identifying particular recipients. The author introduced the concept at ETHBoston in April 2024, won accolades for a primitive implementation using underlying threshold cryptography technologies, and enhanced it into a conceptual holistic data share application for global healthcare as presented in this paper.

Sebastian Griewing, Johannes Knitza, Niklas Gremke, Markus Wallwiener · 7 authors

Emerging digital technologies promise to improve breast cancer care, however lack of awareness among clinicians often prevents timely adoption. This study aims to investigate current awareness and intention-to-use of three technologies among breast cancer healthcare professionals (HCP): (1) digital health applications (DHA), (2) artificial intelligence (AI), and (3) blockchain technology (BC). A 22-item questionnaire was designed and administered before and after a 30 min educational presentation highlighting technology implementation examples. Technology awareness and intention-to-use were measured using 7-point Likert scales. Correlations between demographics, technology awareness, intention-to-use, and eHealth literacy (GR-eHEALS scale) were analyzed. 45 HCP completed the questionnaire, of whom 26 (57.8%) were female. Age ranged from 24 to 67 {mean age (SD): 44.93 ± 12.62}. Awareness was highest for DHA (68.9%) followed by AI (66.7%) and BC (24.4%). The presentation led to a non-significant increase of intention-to-use AI {5.37 (±1.81) to 5.83 (±1.64)}. HCPs´ intention-to-use BC after the presentation increased significantly {4.30 (±2.04) to 5.90 (±1.67), p < 0.01}. Mean accumulated score for GR-eHEALS averaged 33.04 (± 6.61). HCPs´ intended use of AI significantly correlated with eHealth literacy (ρ = 0.383; p < 0.01), intention-to-use BC (ρ = 0.591; p < 0.01) and participants´ age (ρ = −0.438; p < 0.01). This study demonstrates the effect that even a short practical presentation can have on HCPs´ intention-to-use emerging digital technologies. Training potential professional users should be addressed alongside the development of new information technologies and is crucial to increase HCPs´ corresponding awareness and intended use.

David Mauricio, Paulo César Llanos-Colchado, Leandro Sebastián Cutipa-Salazar, Pedro Castañeda · 7 authors

In Peru, there is currently no integrated electronic health record (EHR) system that can be automatically shared between healthcare facilities. This leads to increased service costs due to duplicated examinations and records, as well as additional time required to manage patients’ clinical information. One alternative for ensuring the secure interoperability of EHRs while preserving data privacy is the use of blockchain technology. However, existing works consider a pre-established format for exchanging EHRs, which is not applicable when systems have different formats, as is the case in Peru. This work proposes an architecture and a web application for exchanging EHRs in heterogeneous systems. The proposed system includes the homologation of an EHR with rapid interoperability resources for medical attention using FHIR HL7, and vice versa, to achieve interoperability. Additionally, it utilizes blockchain technology to ensure data security and privacy. The web application was tested using a case simulation to demonstrate EHR interoperability between clinics in a clear, secure, and efficient manner. In addition, a survey was conducted with 30 patients regarding adoption, and another survey was conducted with 10 doctors from a public hospital in Peru regarding usability. The results demonstrate a very high level of adoption and usability for them all. Unlike other studies, the proposal does not necessitate alterations to existing EHR systems for interoperability. In other words, the proposal presents a feasible and cost-effective alternative to addressing the EHR interoperability issue in clinics and hospitals in Peru.

Authors unavailable

Health Insurance Portability and Accountability Act Regulations place a high priority on healthcare data security. In 2021, there were over 750 data breaches, and the top seven of those exposed over 193 million personal records to fraud and identity theft. Data security is the process of preventing data from being accessed by unauthorised parties and being corrupted at any point in its lifespan. Data across all apps and platforms is protected via data encryption, hashing, tokenization, and key management procedures. The security solution now in use data encryption software to successfully improve data security by converting plain text into encrypted cypher text using an algorithm (referred to as a cypher) and an encryption key. The encrypted data will be unintelligible to unauthorised individuals. With a permitted key, only that user can then decrypt the data. Yet, when data security becomes more lax, confidential data is lost because the key is so easily hackable due to the use of a single algorithm. This project offers a solution for this issue: an effective data security system that heavily relies on WEB 3.0 and smart contracts to protect data. Additionally, it offers total data protection, ensuring that a hacker is unable to alter the data in any way. The development of a framework known as WEB 3.0 includes a block chain framework to safeguard the data at the backend. Data access does not require an encryption or decryption key, thus there is no need to worry about data breaches or tampering by hackers. Thus, this system offers complete data protection for a hospital's medical records.

Dounia Marbouh, Mecit Can Emre Simsekler, Khaled Salah, Raja Jayaraman · 5 authors

Mobile health (mHealth) is playing a key role in facilitating health services for patients. Such services may include remote diagnostics and monitoring, chronic conditions management, preventive medicine, and health promotion. While mHealth has gained significant traction during the COVID-19 pandemic, they may pose safety risks to patients. This entails regulations and monitoring of shared data and management of potential safety risks of all mHealth applications continuously and systematically. In this study, we propose a blockchain-based framework for regulating mHealth apps and governing their safe use. We systematically identify the needs, stakeholders, and requirements of the current mHealth practices and regulations that may benefit from blockchain features. Further, we exemplify our framework on a diabetes mHealth app that supports safety risk assessment and incident reporting functions. Blockchain technology can offer a solution to achieve this goal by providing improved security, transparency, accountability, and traceability of data among stakeholders. Blockchain has the potential to alleviate existing mHealth problems related to data centralization, poor data quality, lack of trust, and the absence of robust governance. In the paper, we present a discussion on the security aspects of our proposed blockchain-based framework, including limitations and challenges.

Ye Seul Bae, Yujin Park, Seung Min Lee, Hee Hwa Seo · 9 authors

Health information exchange can improve health outcomes and reduce unnecessary medical expenses. An important task in health information exchange is to prove data integrity and strengthen the right to self-determination of individuals. This can be addressed using blockchain technology and dynamic consents. We aimed to develop a blockchain-based mobile platform called HealthPocket to exchange reliable health information with proven integrity through a dynamic consent system based on the HL7 FHIR standards. Through HealthPocket, subjects can selectively provide their consent to share specific medical and PHGD through proper authorization, and each response is converted into the JSON format with FHIR compatibility. We conducted a usability test to demonstrate health information exchange between primary and tertiary medical institutions. A total of 116 subjects used the HealthPocket mobile application to selectively share health information for at least one month, and conducted a questionnaire about their experience. In addition, medical staff of the institution could access the medical information shared by the participants and use it for treatment. The user surveys for patients examined the perceived usefulness, perceived ease of use, and overall service satisfaction. The mean overall satisfaction with the health information exchange service was the highest (4.67 out of 5 points). As security, personal information protection, and interoperability are main concerns related to health information exchange, blockchain technology can provide suitable solutions. For instance, when health information is exchanged using blockchain technology, it is impossible to alter data blocks. Therefore, by using a blockchain-based platform and dynamic consent system, we ensured the integrity of medical data.

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.

Yi Xie, Lin Lu, Fei Gao, Shuangjiang He · 10 authors

No abstract is available for this record.

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.

Eric Appiah Mantey, Conghua Zhou, Joseph Henry Anajemba, Izuchukwu Michael Okpalaoguchi · 5 authors

Recommender systems offer several advantages to hospital data management units and patients with special needs. These systems are more dependent on the extreme subtle hospital-patient data. Thus, disregarding the confidentiality of patients with special needs is not an option. In recent times, several proposed techniques failed to cryptographically guarantee the data privacy of the patients with special needs in the diet recommender systems (RSs) deployment. In order to tackle this pitfall, this paper incorporates a blockchain privacy system (BPS) into deep learning for a diet recommendation system for patients with special needs. Our proposed technique allows patients to get notifications about recommended treatments and medications based on their personalized data without revealing their confidential information. Additionally, the paper implemented machine and deep learning algorithms such as RNN, Logistic Regression, MLP, etc., on an Internet of Medical Things (IoMT) dataset acquired via the internet and hospitals that comprises the data of 50 patients with 13 features of various diseases and 1,000 products. The product section has a set of eight features. The IoMT data features were analyzed with BPS and further encoded prior to the application of deep and machine learning-based frameworks. The performance of the different machine and deep learning methods were carried out and the results verify that the long short-term memory (LSTM) technique is more effective than other schemes regarding prediction accuracy, precision, F1-measures, and recall in a secured blockchain privacy system. Results showed that 97.74% accuracy utilizing the LSTM deep learning model was attained. The precision of 98%, recall, and F1-measure of 99% each for the allowed class was also attained. For the disallowed class, the scores were 89, 73, and 80% for precision, recall, and F1-measure, respectively. The performance of our proposed BPS is subdivided into two categories: the secured communication channel of the recommendation system and an enhanced deep learning approach using health base medical dataset that spontaneously identifies what food a patient with special needs should have based on their disease and certain features including gender, weight, age, etc. The proposed system is outstanding as none of the earlier revised works of literature described a recommender system of this kind.

Konstantin Koshechkin, Georgy Lebedev, G.P. Radzievsky, Ralf Seepold · 5 authors

BACKGROUND: One of the most promising health care development areas is introducing telemedicine services and creating solutions based on blockchain technology. The study of systems combining both these domains indicates the ongoing expansion of digital technologies in this market segment. OBJECTIVE: This paper aims to review the feasibility of blockchain technology for telemedicine. METHODS: The authors identified relevant studies via systematic searches of databases including PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar. The suitability of each for inclusion in this review was assessed independently. Owing to the lack of publications, available blockchain-based tokens were discovered via conventional web search engines (Google, Yahoo, and Yandex). RESULTS: Of the 40 discovered projects, only 18 met the selection criteria. The 5 most prevalent features of the available solutions (N=18) were medical data access (14/18, 78%), medical service processing (14/18, 78%), diagnostic support (10/18, 56%), payment transactions (10/18, 56%), and fundraising for telemedical instrument development (5/18, 28%). CONCLUSIONS: These different features (eg, medical data access, medical service processing, epidemiology reporting, diagnostic support, and treatment support) allow us to discuss the possibilities for integration of blockchain technology into telemedicine and health care on different levels. In this area, a wide range of tasks can be identified that could be accomplished based on digital technologies using blockchains.

Hessah A. Alsalamah, Shorog Nasser, Shada Alsalamah, Albatoul I. Almohana · 6 authors

Obesity is considered one of the leading causes of chronic and noncommunicable diseases; these include diabetes, cardiovascular disease, and cancer. The obesity prevalence is threefold higher in the Arab Gulf Cooperation Council (GCC) population than the rest of the world and leaves healthcare providers within the region with no alternative than to offer continuous and sustainable healthcare services. Obesity prevention would be more economical for governments than providing treatment. Preventing obesity is challenging because it requires motivating individuals to live a healthy lifestyle. Personal health (pHealth) has recently been actively involved in finding solutions to encourage healthy living. However, pHealth does not address the high percentage of people lacking the desire to maintain healthy living plans, which could have a negative effect on attempts aimed at reducing obesity prevalence. This study sheds light on the challenges faced by the GCC governments in reducing high obesity rates using pHealth; we propose a solution, Wholesome Coin, which incorporates advanced technologies to help governments reduce high obesity rates. Wholesome Coin has two components: one uses wearable IoT (WIoT) to help patients manage their behavior by tracking their physical activities and diet, and the other utilizes blockchain technology to help healthcare payers to incentify patients to maintain a healthy living plan by awarding digital coins that can be redeemed for real goods and services. GCC governments’ adoption of Wholesome Coin could improve the quality of life of obese patients in a seamless, secure, and self-motivated manner, resulting in a healthier tomorrow, especially amid challenging times featuring global social distance campaigns.

Ramya Gangula, Sri Varun Thalla, Ijeoma Ikedum, Chineze Okpala · 5 authors

Adopting and implementing the Clinical Decision Support System (CDSS) technology is a critical element in an effort to improve national quality initiatives and evidence-based practice at the point of care. CDSS is envisioned to be a potential solution to many current challenges in the healthcare sphere, which includes information overload, practice improvement, eliminating treatment errors, and reducing medical consultation costs. However, the CDSS did not manage to achieve these goals to the desired levels and provide context-appropriate alerts, although integrated with the electronic health records (EHRs) (1). Clinical decision support alerts can save lives, but frequent ones can cause increased cognitive burden to clinicians, worsen alert fatigue, and increase the duplication of tests. This ultimately increases health care costs without refining patient outcomes. Studies show that 49-96% of clinical alerts are ignored, raising questions about the effectiveness of CDSS (1). Blockchain, a decentralized, distributed digital ledger that contains a plethora of continuously updated, time-stamped, and highly encrypted virtual record, can be a key to addressing these challenges (2). The blockchain technology if integrated with the CDSS can serve as a potential solution to eliminating current drawbacks with CDSS (3). This article addresses the most significant and chronic problems facing the successful implementation of CDSS and how leveraging the Hyperledger Fabric can alleviate the clinical alert fatigue and reduce physician's burnout using patient-specific information. The proposed architecture framework for this study is designed to equip the CDSS with overall patient information at the point of care. This then empowers the physicians with the blockchain-integrated CDSS, which holds the potential to reduce clinician's cognitive burden, medical errors, and costs and ultimately enhance patient outcomes. The research study broadly discusses how the blockchain technology can be a potential solution, reasons for selecting the Hyperledger Fabric, and elaborates on how the Hyperledger Fabric can be leveraged to enhance the efficacy of CDSS.

Keehyuck Lee, Kahyun Lim, Se Young Jung, Hyerim Ji · 7 authors

BACKGROUND: Although the electronic health record system adoption rate has reached 96% in the United States, implementation and usage of health information exchange (HIE) is still lagging behind. Blockchain has come into the spotlight as a technology to solve this problem. However, there have been no studies assessing the perspectives of different stakeholders regarding blockchain-based patient-centered HIE. OBJECTIVE: The objective of this study was to analyze the awareness among patients, health care professionals, and information technology developers toward blockchain-based HIE, and compare their different perspectives related to the platform using a qualitative research methodology. METHODS: In this qualitative study, we applied grounded theory and the Promoting Action on Research Implementation in the Health Service (PARiHS) framework. We interviewed 7 patients, 7 physicians, and 7 developers, for a total of 21 interviewees. RESULTS: Regarding the leakage of health information, the patient group did not have concerns in contrast to the physician and developer groups. Physicians were particularly concerned about the fact that errors in the data cannot be easily fixed due to the nature of blockchain technology. Patients were not against the idea of providing information for clinical trials or research institutions. They wished to be provided with the results of clinical research rather than being compensated for providing data. The developers emphasized that blockchain must be technically mature before it can be applied to the health care scene, and standards of medical information to be exchanged must first be established. CONCLUSIONS: The three groups' perceptions of blockchain were generally positive about the idea of patients having the control of sharing their own health information. However, they were skeptical about the cooperation among various institutions and implementation for data standardization in the establishment process, in addition to how the service will be employed in practice. Taking these factors into consideration during planning, development, and operation of a platform will contribute to establishing practical treatment plans and tracking in a more convenient manner for both patients and physicians. Furthermore, it will help expand the related research and health management industry based on blockchain.

Yu Shan, Yuehui Mai

Abstract The amount of exercise and fitness level of sports athletes can be quantitatively evaluated through the measurement of health and sports information, thereby ensuring effective fitness effects. The development of blockchain and Internet of Things technology provides a new perspective and technical means for fitness management technology. In view of the current problems in the field of sports fitness, this paper designs and implements a dynamic management technology for sports fitness based on the concept of Internet of Things and blockchain. First, based on an in-depth analysis of the current status of theoretical research and application of the Internet of health at home and abroad, the theories and methods of sports information and health information collection are studied. A temperature sensor and an acceleration sensor are used to collect human body temperature and exercise steps, respectively, and then estimate human health and exercise conditions. Second, solve the privacy problem in the collection and transmission of the Internet of Things by adding blockchain technology. Finally, the machine-learning method is used to clean and manage the information and data to realize the real-time detection and management of the athlete’s fitness status. The actual case test shows that the functions and technical performance indicators of the dynamic fitness management technology can meet the needs of users in indoor and outdoor fitness management, and promote the development of the sports industry and provide a scientific reference.