Abdulatif Alabdulatif, Ibrahim Khalil, Mohammad Saidur Rahman
A smart device carries a great amount of sensitive patient data as it offers innovative and enhanced functionalities in the smart healthcare system. Moreover, the components of healthcare systems are interconnected via the Internet, bringing significant changes to the delivery of healthcare services to individuals. However, easy access to healthcare services and applications has given rise to severe risks and vulnerabilities that hamper the performance of a smart healthcare system. Moreover, a large number of heterogeneous devices accumulate data that vary in terms of size and formats, making it challenging to manage the data in the healthcare repository and secure it from attackers who seek to profit from the data. Thus, smart healthcare systems are susceptible to numerous security threats and risks, such as hardware and software-based attacks, system-level attacks, and network attacks that have the potential to place patients’ lives at risk. An analysis of the literature revealed a research gap in that most security surveys on the healthcare ecosystem examined only the security challenges and did not explore the possibility of integrating modern technologies to alleviate security issues in the smart healthcare system. Therefore, in this article, we conduct a comprehensive review of the various most recent security challenges and their countermeasures in the smart healthcare environment. In addition, an artificial intelligence (AI) and blockchain-based secure architecture is proposed as a case study to analyse malware and network attacks on wearable devices. The proposed architecture is evaluated using various performance metrics such as blockchain scalability, accuracy, and dynamic malware analysis. Lastly, we highlight different open issues and research challenges facing smart healthcare systems.
The metaverse and non-fungible tokens (NFTs) were some of the hottest tech terms in 2021, according to a Google Trends search. Our review aims to describe the metaverse and NFTs in the context of their potential application in the treatment of mental health disorders. Advancements in technology have been changing human lives at an ever-increasing pace. Metaverse, also known as the three-dimensional (3D) internet, is the convergence of virtual reality (VR) and physical reality in a digital space. It could potentially change the internet as we know it, with NFTs as the key building blocks in the new expansive virtual ecosystem. This immersive 3D virtual world boasts the features of the real world with the added ability to change the surrounding environment according to individual needs and requirements. VR, augmented reality (AR) and mixed reality (MR) have been employed as tools in the treatment of various mental health disorders for the past decade. Studies have reported positive results on their effectiveness in the diagnosis and treatment of mental health disorders. VR/AR/MR have been hailed as a solution to the acute shortage of mental health professionals and the lack of access to mental healthcare. But, on the flip side, young adults tend to spend a significant amount of time playing 3D immersive games and using social media, which can lead to insecurity, anxiety, depression, and behavioural addiction. Additionally, endless scrolling through social media platforms negatively affects individuals9 attention span as well as aggravating the symptoms of adolescents with attention deficit hyperactivity disorder. We aimed to explore the ramifications of expanding applications of the metaverse on mental health. So far, no other review has explored the future of mental health in the context of the metaverse.
Jaizah Othman, Fandy Lim Md Daniel Lim, Raudhah Mohd Tarmizi, Shahrullizuannizam Salehuddin
This study's main objective and purpose is to investigate the social factors that influence cryptocurrency awareness among Generation Z in Malaysia. The practical implications of this study can be helpful for future policymakers to understand better the drive behind cryptocurrency awareness among the general population, i.e., young working adults in Malaysia. In addition, this study will assist future researchers in better identifying the importance of social acceptance, trust, and confidence factors. The research design is a quantitative study of the factors driving cryptocurrency awareness among Generation Z here in Malaysia based on social factors, specifically social acceptance, trust, and confidence. The methodology is based on primary data collection techniques such as using questionnaires and surveys implemented through a cross-sectional research design. Questionnaire data were collected from a sample of 211 participants in Malaysia, with the majority of participants between 18 and 25 years old. The results confirm that trust, confidence level, and social acceptance have a moderately positive and significant relationship with cryptocurrency awareness. This means that social factors such as trust, trust level, and social acceptance have an impact on the awareness of cryptocurrencies among Generation Z in Malaysia. However, since there are some limitations, suggestions and recommendations were discussed in this study.
The metaverse and non-fungible tokens (NFTs) were some of the hottest tech terms in 2021, according to a Google Trends search. Our review aims to describe the metaverse and NFTs in the context of their potential application in the treatment of mental health disorders. Advancements in technology have been changing human lives at an ever-increasing pace. Metaverse, also known as the three-dimensional (3D) internet, is the convergence of virtual reality (VR) and physical reality in a digital space. It could potentially change the internet as we know it, with NFTs as the key building blocks in the new expansive virtual ecosystem. This immersive 3D virtual world boasts the features of the real world with the added ability to change the surrounding environment according to individual needs and requirements. VR, augmented reality (AR) and mixed reality (MR) have been employed as tools in the treatment of various mental health disorders for the past decade. Studies have reported positive results on their effectiveness in the diagnosis and treatment of mental health disorders. VR/AR/MR have been hailed as a solution to the acute shortage of mental health professionals and the lack of access to mental healthcare. But, on the flip side, young adults tend to spend a significant amount of time playing 3D immersive games and using social media, which can lead to insecurity, anxiety, depression, and behavioural addiction. Additionally, endless scrolling through social media platforms negatively affects individuals' attention span as well as aggravating the symptoms of adolescents with attention deficit hyperactivity disorder. We aimed to explore the ramifications of expanding applications of the metaverse on mental health. So far, no other review has explored the future of mental health in the context of the metaverse.
Maryam Yousefi Nejad, Gabriel Lee Yung, Jaizah Othman, Aza Azlina Md Kssim · 7 authors
The main objective of this study is to investigate the social factors that influence the awareness of cryptocurrencies among young working adults in Malaysia. The study is a cross-sectional, quantitative, and conceptual research. This study focuses on three possible factors that influence cryptocurrency awareness: social acceptance, trust, and confidence. The study suggests that the most appropriate data collection technique for this conceptual work is primary data collection through questionnaires. The results of this study can also provide important input for policy makers to better understand the drive behind cryptocurrency awareness among the population. In addition, this study expands the knowledge of the possible relationship between social factors and cryptocurrency awareness by considering social acceptance, trust, and confidence.
Mustafa Abdul‐Moheeth, Muhammad Usman, Daniel Toshio Harrell, Anjum Khurshid
Background: The current healthcare ecosystem in the United States is plagued by inefficiencies in transitions of patient care between healthcare providers due in large part to a lack of interoperability among the many electronic medical record (EMR) systems that exist today. Both providers and patients experience significant frustration due to the negative effects of increased costs, unnecessary administrative burden, and duplication of services that occur because of data fragmentation in the system. Blockchain technology provides a potential solution to mitigate or eliminate these gaps by allowing for exchange of healthcare information that is distributed, auditable, immutable, and respectful of patient autonomy. Our multidisciplinary team identified key tasks required for a transition of care to design and develop a blockchain application, MediLinker, which served as a patient-centric identity management system to address issues of data fragmentation ultimately aiding in the delivery of high-value care services. Methods: The MediLinker application was evaluated for its ability to accomplish various key tasks needed for a successful transition of patient care in an outpatient setting. Our team created 20 unique patient use cases covering a diversity of medical needs and social circumstances that were played out by participants who were asked to perform various tasks as they received case across a simulated healthcare ecosystem composed of four clinics, a research institution, and other ancillary public services. Tasks included, but were not limited to, clinic enrollment, verification of identity, medication reconciliation, sharing insurance and billing information, and updating demographic information. With this iteration of MediLinker, we specifically focused on the functionality of digital guardianship and patient revocation of healthcare information. In addition, throughout the simulation, we surveyed participant perceptions regarding the use of MediLinker and blockchain technology to better ascertain comfortability and usability of the application. Results: Quantitative evaluation of simulation results revealed that MediLinker was able to successfully accomplish all seven clinical scenarios tested across the 20 patient use cases. MediLinker successfully achieved its goal of patient-centered interoperability as participants transitioned their simulated healthcare data, including COVID-19 vaccination status and current medications, across the four clinic sites and research institution. In addition to completing all key tasks designated, all eligible participants were able to enroll with and subsequently revoke data access with our simulated research site. MediLinker had a low data-entry error rate, with most errors occurring due to work-flow vulnerabilities. Our qualitative analysis of user perceptions indicated that comfortability and trust with blockchain technology, such as MediLinker, grew with increased education and exposure to such technology. Conclusions: The ubiquitous problem of data fragmentation in our current healthcare ecosystem has placed considerable strain on providers and patients alike. Blockchain applications for health identity management, such as MediLinker, provide a viable solution to stem the inefficiencies that exist today. The interoperability that MediLinker provided across our simulated healthcare system has the potential to improve transitions of care by sharing key aspects of healthcare information in a timely, secure, and patent-centric fashion allowing for the delivery of consistent and personalized high value care. Blockchain technologies appear to face similar challenges to widespread adoption as other novel interventions, namely recognition, trust, and usability. Further development and scaling are required for such technology to realize its full potential in the real world and transform the practice of modern health care.
Open access
Electronic Health Records Systems
Artificial Intelligence in Healthcare and Education
Ki Young Huh, Seol Ju Esther Moon, Sang-Un Jeong, Minji Kim · 10 authors
Blockchain is a novel data architecture characterized by a chronological sequence of blocks in a decentralized manner. We aimed to evaluate the real-world feasibility of a blockchain-based dynamic consent platform (METORY) in a decentralized and multicenter trial. The study consisted of three visits (i.e., screening and 2 follow-up visits) with a 2-week interval. Each subject was required to report the self-measured body temperatures and take a virtual investigational drug by entering the unique drug code on the application. To simulate real-world study settings, two major (i.e., changes in the schedule of body temperature measurement) and three minor protocol amendments (i.e., nonsignificant changes without any changes in the procedures) were set. Overall study completion rates, proportion of consent, and response time to each protocol amendment and adherence were evaluated. A total of 60 subjects (30 in each center) were enrolled in two study centers. All subjects completed the study, and the overall proportion of consent to each protocol amendment was 95.7 ± 13.7% (mean ± SD), with a median response time of 0.2 h. Overall, subjects took 90.8% ± 19.2% of the total drug, whereas compliance with the schedule was 69.1% ± 27.0%. Subjects reported 96.7% ± 4.2% of the total body temperature measurements whereas the adherence to the schedule was 59.0% ± 25.0%, which remarkably decreased after major protocol amendments. In conclusion, we evaluated a blockchain-based dynamic consent platform in real clinical trial settings. The results suggested that major changes should be avoided unless subjects' proper understanding is warranted.
Open access
Blockchain Technology Applications and Security
Neuroethics, Human Enhancement, Biomedical Innovations
Ji Woong Kim, Su Jin Kim, Won Chul Cha, Taerim Kim
This study aims to introduce a novel blockchain-applied personal health records (PHR) application and validate its user experience. The system transmits the part corresponding to the patient’s personal information off-chain and prevents data forgery and falsification by storing encrypted data on-chain. Patients may easily trace the opt-in and opt-out history of their consent data and dynamically store the consent system for data exchange on the blockchain. A mixed-method study using a questionnaire, in-depth interviews, and usability evaluation were conducted for 30 participants. The system usability score was 74.0, indicating the high usability of the application. Those who were familiar with blockchain showed confidence in the application, but those unfamiliar wanted their data to be safe using another way. Most of the participants were interested in exchanging and using their medical data and considered security important but those unfamiliar wanted their data to be safe using another way. We found that participants were concerned about data security and considered a blockchain-based PHR as a novel way to store and exchange their medical information securely. Blockchain is not a visible technology. However, a blockchain-applied PHR must be able to win user trust through visualizations, certificates, and system descriptions.
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.
Humberto Jorge De Moura Costa, Cristiano André da Costa, Rodrigo da Rosa Righi, Rodolfo Stoffel Antunes · 6 authors
Nowadays, there are many fragmented records of patient’s health data in different locations like hospitals, clinics, and organizations all around the world. With the arrival of the COVID-19 pandemic, several governments and institutions struggled to have satisfactory, fast, and accurate decision-making in a wide, dispersed, and global environment. In the current literature, we found that the most common related challenges include delay (network latency), software scalability, health data privacy, and global patient identification. We propose to design, implement and evaluate a healthcare software architecture focused on a global vaccination strategy, considering healthcare privacy issues, latency mitigation, support of scalability, and the use of a global identification. We have designed and implemented a prototype of a healthcare software called Fog-Care, evaluating performance metrics like latency, throughput and send rate of a hypothetical scenario where a global integrated vaccination campaign is adopted in wide dispensed locations (Brazil, USA, and United Kingdom), with an approach based on blockchain, unique identity, and fog computing technologies. The evaluation results demonstrate that the minimum latency spends less than 1 second to run, and the average of this metric grows in a linear progression, showing that a decentralized infrastructure integrating blockchain, global unique identification, and fog computing are feasible to make a scalable solution for a global vaccination campaign within other hospitals, clinics, and research institutions around the world and its data-sharing issues of privacy, and identification.
Traditional medical systems are vulnerable to attacks, leaks, and loss of data. The centralized structure of medical systems makes them more susceptible to attacks. Blockchain can be used as a solution to this issue. In particular, using blockchain to track patient medical history and vaccination records can guarantee privacy and security, which are critical requirements for healthcare systems. In this paper, we propose a blockchain-based application to maintain and share medical data and vaccination records using Hyperledger Fabric and Ethereum platforms to ensure data integrity and immutability. Our vaccination tracking system based on the Ethereum platform allows easy verification for people who want to travel abroad. For this system, we employ Ganache to test these vaccination records in a safe and deterministic environment. We have evaluated the performance of our implementation using Hyperledger Caliper and Explorer. The results show that our blockchain-based systems can increase the efficiency and transparency of tracking medical and vaccination records. We believe our proposal is especially valuable in the context of the ongoing COVID-19 pandemic because it providesa secure way to update, share and verify vaccination records.
Medical data exchange between diverse e-health entities can lead to a better healthcare quality, improving the response time in emergency conditions, and a more accurate control of critical medical events (e.g., national health threats or epidemics). However, exchanging large amount of information between different e-health entities is challenging in terms of security, privacy, and network loads, especially for large-scale healthcare systems. Indeed, recent solutions suffer from poor scalability, computational cost, and slow response. Thus, this article proposes medical-edge-blockchain (MEdge-Chain), a holistic framework that exploits the integration of edge computing and blockchain-based technologies to process large amounts of medical data. Specifically, the proposed framework describes a healthcare system that aims to aggregate diverse health entities in a unique national healthcare system by enabling swift, secure exchange, and storage of medical data. Moreover, we design an automated patients monitoring scheme, at the edge, which enables the remote monitoring and efficient discovery of critical medical events. Then, we integrate this scheme with a blockchain architecture to optimize medical data exchanging between diverse entities. Furthermore, we develop a blockchain-based optimization model that aims to optimize the latency and computational cost of medical data exchange between different health entities, hence providing effective and secure healthcare services. Finally, we show the effectiveness of our system in adapting to different critical events, while highlighting the benefits of the proposed intelligent health system.
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.
Ye Seul Bae, Yujin Park, Taekhoon Kim, Taehoon Ko · 8 authors
The concept of MyData emerged as a paradigm shift in personal data management and the process of seeking to transform the current organization-centered system. MyData enables the utilization of one’s own personal information that is scattered among various institutions as a system for data subjects to exercise rights of self-determination. We aimed to develop and demonstrate a MyData platform (MyHealthData) that allows data subjects to download and manage health-related personal data stored in various medical institutions. The platform consists of a mobile app for users, API (application–program interface) for data conversion and exchange installed in the hospital information system (HIS), and a relay server connected to the blockchain to ensure data integrity. User surveys were conducted to explore perceived usefulness, perceived ease of use, and satisfaction. We provided four services to users through the platform developed in this study: inquiring about medical and health checkup records, health coaching, checking conditions of participation in clinical research, and claims, all by using an app. A total of 1228 participants signed up for the service and the overall user satisfaction was high, especially with ‘inquire about medical and health checkup records’. MyData brings a user-centered paradigm in which data subjects can directly participate in the use of their own data. MyData will improve healthcare data interoperability, allowing it to be used not only in research areas but also in other areas by sharing and integrating various healthcare data.
The study presents a blockchain-based incentive mechanism intended to encourage those in underserved communities to engage with healthcare services. The smart healthcare system, which is the result of the amalgamation of advanced technologies, has emerged recently and is increasingly seen as essential to meet the needs of modern society. An important part of the healthcare system is the prescription management system, but studies show that prescription affordability and accessibility play a part in creating unequal access for underserved communities. This is a form of unequal access that results in those living in underserved communities to become disengaged from accessing healthcare services. In New Zealand, the prescription management system plays a crucial role and this study seeks to address the issue by presenting the BlockPres framework, which uses a novel incentive mechanism to encourage patients to participate and engage with services in order to be rewarded. The blockchain attribute of immutability in BlockPres enhances equality and participation by providing sophisticated authorisation and authentication capabilities for healthcare providers and patients. BlockPres empowers the patient by assigning ownership or control of some patient information to the patient. A simulation is carried out using the Ethereum blockchain and the evaluation of successful transaction completion and superficial performance assessment demonstrates that the blockchain would be sufficient to cope with the needs of a prescription management system. Furthermore, for the simulation, a BlockPres Smart Contract is developed using solidity and implemented in Remix. The Ropsten network is used as the simulation environment and the initial results show that the proposed incentive mechanism mitigates unequal access.
Because of the availability of more than an actor and a wireless component among e-health applications, providing more security and safety is expected. Moreover, ensuring data confidentiality within different services becomes a key requirement. In this paper, we propose to collect data from health and fitness smart devices deployed in connection with the proposed IoT blockchain platform. The use of these devices helps us in extracting an amount of highly valuable heath data that are filtered, analyzed, and stored in electronic health records (EHRs). Different actors of the platform, coaches, patients, and doctors, collaborate to provide an on-time diagnosis and treatment for various diseases in an easy and cost-effective way. Our main purpose is to provide a distributed, secure, and authorized access to these sensitive data using the Ethereum blockchain technology. We have designed an integrated low-powered IoT blockchain platform for a healthcare application to store and review EHRs. This architecture, based on the blockchain Ethereum, includes a web and mobile application allowing the patient as well as the medical and paramedical staff to have a secure access to health information. The Ethereum node is implemented on an embedded platform, which should provide an efficient, flexible, and secure system despite the limited resources and low power consumption of the multiprocessor platform.
Basetty Mallikarjuna, D. Kiranmayee, V. Saritha, P. Venkata Krishna
In the COVID-19 pandemic situation, the transmission of health records sharing and maintaining the integrity of data to receive the end-user is not consistent. Already, some countries decide to conduct lockdown using data models. In this scenario, the end user loss of integrity, loss of confidentiality and security on health records impacts the patients. The security of electronic health records (EHR) is a challenging task especially in COVID-19 like situations. It is a necessity to share secure EHR to physicians and patients which plays a vital role in COVID-19, and also data availability, scalability, and performance of data to receive the end-user is the loss of integrity. In this paper, we proposed an integrated approach of blockchain 4.0 technology used in IoT-based cloud environment that reduce the latency while transmission of health care records and introduce the blockchain-based electronic health records named as BEHR transmission between the physicians and patients. The performance of the proposed approach tested with the NodeJs software and ApacheJmeter open source JMeter Cloud Test environment and proved that the simulation-results of BEHR are an efficient approach in response time and file storage and transmission of EHR than the present conventional system.