Electronic Health Records (EHRs) have improved many aspects of healthcare and allowed for easier patient management for medical providers. Blockchains have been proposed as a promising solution for supporting Electronic Health Records (EHRs), but have also been linked to scalability concerns about supporting real-world healthcare systems. This paper quantifies the scalability issues and bottlenecks related to current blockchains and puts into perspective the limitations blockchains have with supporting healthcare systems. Particularly we show that well known blockchains such as Bitcoin, Ethereum, and IOTA cannot support transactions of a large scale hospital system such as the University of Kentucky HealthCare system and leave over 7.5M unsealed transactions per day. We then discuss how bottlenecks of blockchains can be relieved with sidechains, enabling well-known blockchains to support even larger hospital systems of over 30M transactions per day. We then introduce the Patient-Healthchain architecture to provide future direction on how scaling blockchains for EHR systems with sidechains can be achieved.
André Henrique Mayer, Cristiano André da Costa, Rodrigo da Rosa Righi
Blockchain could reinvent the way patient's electronic health records are shared and stored by providing safer mechanisms for health information exchange of medical data in the healthcare industry, by securing it over a decentralized peer-to-peer network. Intending to support and ease the understanding of this distributed ledger technology, a solid Systematic Literature Review was conducted, aiming to explore the recent literature on Blockchain and healthcare domain and identify existing challenges and open questions, guided by the raise of research questions regarding EHR in a Blockchain. More than 300 scientific studies published in the last ten years were surveyed, resulting in an up-to-date taxonomy creation, challenges and open questions identified, and the most significant approaches, data types, standards and architectures regarding the use of Blockchain for EHR were assessed and discussed.
Matthew Johnson, Michael N. Jones, Mark Shervey, Joel T. Dudley · 5 authors
Decentralized apps (DApps) are computer programs that run on a distributed computing system, such as a blockchain network. Unlike the client-server architecture that powers most internet apps, DApps that are integrated with a blockchain network can execute app logic that is guaranteed to be transparent, verifiable, and immutable. This new paradigm has a number of unique properties that are attractive to the biomedical and health care communities. However, instructional resources are scarcely available for biomedical software developers to begin building DApps on a blockchain. Such apps require new ways of thinking about how to build, maintain, and deploy software. This tutorial serves as a complete working prototype of a DApp, motivated by a real use case in biomedical research requiring data privacy. We describe the architecture of a DApp, the implementation details of a smart contract, a sample iPhone operating system (iOS) DApp that interacts with the smart contract, and the development tools and libraries necessary to get started. The code necessary to recreate the app is publicly available.
Jamal N. Al‐Karaki, Amjad Gawanmeh, Meryeme Ayache, Ashraf Mashaleh
The healthcare industry is a complex system of interconnected entities. Each of these entities has disjoint information systems to manage patient data and records. The current IT solutions in healthcare systems have several challenges such as sharing and accessing medical records across several stakeholders while still maintaining security and privacy of these records. This global problem on how to create, maintain, and share sensitive medical records and clinical data among various stakeholders without sacrificing data privacy and integrity is still unresolved. In fact, existing healthcare records are decentralized, disjointed, non-uniform, and fragmented in nature. In this paper, we present a Blockchain-based framework, called DASS-CARE, that supports decentralized, accessible, scalable, and secure access to healthcare services including medical records. Such framework will greatly facilitate the process of real time access and updates without compromising security, integrity and confidentiality of patient data. Our objective is multifold. First, improve the quality of healthcare and lower the cost of delivery. Second, enhance medical records management including electronic health records unification. Finally, provide users with the ability to view their medical records regardless of their history, a task that is difficult to accomplish under the current fragmented systems.
Mohamad Kassab, Joanna F. DeFranco, Tarek Malas, Valdemar Vicente Graciano Neto · 5 authors
Healthcare systems have been supported by technology to help improve the user experience with the entire health system. However, many operational challenges still remain, in particular those related to a unified management of electronic health records (EHR) that could enable multiple doctors to have access to the complete health history of their patient. Blockchain could support unified records, data security and privacy improvement and insurance decisions/transactions making it an effective solution for the above mentioned healthcare technology challenges. The main contribution of this paper is providing preliminary results of a literature review on the adoption of blockchain to support the management of EHR in health systems - along with the benefits and challenges.
Huma Saeed, Hassaan Malik, Umair Bashir, Aiesha Ahmad · 8 authors
Blockchain technology (BCT) has emerged in the last decade and added a lot of interest in the healthcare sector. The purpose of this systematic literature review (SLR) is to explore the potential paradigm shift in healthcare utilizing BCT. The study is compiled by reviewing research articles published in nine well-reputed venues such as IEEE Xplore, ACM Digital Library, Springs Link, Scopus, Taylor & Francis, Science Direct, PsycINFO, Ovid Medline, and MDPI between January 2016 to August 2021. A total of 1,192 research studies were identified out of which 51 articles were selected based on inclusion criteria for this SLR that presents the modern information on the recent implications and gaps in the use of BCT for enhancing the healthcare procedures. According to the outcomes, BCT is being applied to design the novel and advanced interventions to enrich the current protocol of managing, distributing, and processing clinical records and personal medical information. BCT is enduring the conceptual development in the healthcare domain, where it has summed up the substantial elements through better and enhanced efficiency, technological innovation, access control, data privacy, and security. A framework is developed to address the probable field where future researchers can add considerable value, such as data protection, system architecture, and regulatory compliance. Finally, this SLR concludes that the upcoming research can support the pervasive implementation of BCT to address the critical dilemmas related to health diagnostics, enhancing the patient healthcare process in remote monitoring or emergencies, data integrity, and avoiding fraud.
Irene Azogu, Alex Norta, Ingrid Papper, Justin Longo · 5 authors
The role of record keeping and information sharing in the health sector cannot be overemphasized. More recently, there has been renewed interest in finding a solution to the issues pertaining to privacy of health records and how these records can be easily accessed by different healthcare providers in healthcare-service delivery. Thus, such records comprise an individual's health history and other information that facilitates healthcare decisions. Furthermore, easy access to a patient's health information is an important aspect of health-service delivery that must be regulated and monitored because of the sensitivity of the information. Current approaches adopted in many hospitals face challenges of missing files, or records, lack of information sharing between healthcare providers, insecure records and also inaccessibility of patients' health information for healthcare providers that are needed to make informed health decisions. Building from a case study grounded in interviews and document review, we propose a scalable framework that supports the adoption of blockchain technology in addressing the issues of privacy, information sharing, and record keeping in the health sector.
This article describes the structure and functionality of OpTrak, a decentralized app implemented using the Ethereum blockchain that targets the opioid epidemic currently plaguing the United States. Over-prescription and distribution of opioids cost the national healthcare system over $78 billion every year. Problems persist in every stage of the process, from doctors prescribing the medication to the pharmacists fulfilling prescriptions. These problems arise from a combination of factors, including lack of accountability, transparency, and reliability in the current prescription drug monitoring programs. This work provides three key contributions to research on a technical approach to mitigate the opioid epidemic. First, the authors pinpoint key problems in the current opioid prescription system. Second, they propose an integrated approach for addressing the problems by leveraging distributed ledgers, focusing on blockchain technology. Third, the authors describe the structure and functionality of OpTrak that allows a consortium of care providers to exchange patient prescription data securely.
BACKGROUND Huge amounts of health-related data are generated every moment with the rapid development of Internet of Things (IoT) and wearable technologies. These big health data contain great value and can bring benefit to all stakeholders in the health care ecosystem. Currently, most of these data are siloed and fragmented in different health care systems or public and private databases. It prevents the fulfillment of intelligent health care inspired by these big data. Security and privacy concerns and the lack of ensured authenticity trails of data bring even more obstacles to health data sharing. With a decentralized and consensus-driven nature, distributed ledger technologies (DLTs) provide reliable solutions such as blockchain, Ethereum, and IOTA Tangle to facilitate the health care data sharing. OBJECTIVE This study aimed to develop a health-related data sharing system by integrating IoT and DLT to enable secure, fee-less, tamper-resistant, highly-scalable, and granularly-controllable health data exchange, as well as build a prototype and conduct experiments to verify the feasibility of the proposed solution. METHODS The health-related data are generated by 2 types of IoT devices: wearable devices and stationary air quality sensors. The data sharing mechanism is enabled by IOTA’s distributed ledger, the Tangle, which is a directed acyclic graph. Masked Authenticated Messaging (MAM) is adopted to facilitate data communications among different parties. Merkle Hash Tree is used for data encryption and verification. RESULTS A prototype system was built according to the proposed solution. It uses a smartwatch and multiple air sensors as the sensing layer; a smartphone and a single-board computer (Raspberry Pi) as the gateway; and a local server for data publishing. The prototype was applied to the remote diagnosis of tremor disease. The results proved that the solution could enable costless data integrity and flexible access management during data sharing. CONCLUSIONS DLT integrated with IoT technologies could greatly improve the health-related data sharing. The proposed solution based on IOTA Tangle and MAM could overcome many challenges faced by other traditional blockchain-based solutions in terms of cost, efficiency, scalability, and flexibility in data access management. This study also showed the possibility of fully decentralized health data sharing by replacing the local server with edge computing devices.
Tharuka Rupasinghe, Frada Burstein, Carsten Rudolph, Steven K. Strange
Falls are one of the major health concerns for the elderly people. These falls often result in severe injuries which lead into huge medical expenses. Over the recent years, many ICT based fall detection and fall prevention solutions emerged to address the risk factors associated with falls. However, despite of these research studies, predicting the likelihood of falls still remains as a huge challenge in both medical and IT research domains. Data related to these risk factors being scattered among different healthcare providers can be attributed as a main reason for this challenge. This is further amplified by healthcare providers being reluctant to disseminate the data beyond their entities due to the security and privacy concerns. However, in recent years, blockchain has been proven as a promising technology to address the security and privacy challenges in healthcare data exchange as it provides a shared, immutable, and transparent audit trail for accessing data. Therefore, in this paper, we are going to propose a conceptual blockchain based fall prediction model leveraging smart contracts and FHIR (Fast Healthcare Interoperability Resources) standard to identify the elderly people who are at a higher risk of falling.
This paper discusses the use of Blockchain and the Internet of Things (IoT) in the healthcare domain, identifying areas where current processes can be enhanced through the use of these new digital technologies while highlighting the issues these early developments present for an industry that is averse to risk, yet open to new technologies that improve patient safety and survival. The report discusses two uses of IoT with Blockchain as examples for the industry with many other possibilities being adoptable in a proposed single architecture that would integrate industry procedures to a common platform. While identifying technological improvements to the industry the paper also identifies the practical aspects of such a development, with varying interests across the sector, restricted funds and advancing computing power all being significant factors in whether and how to invest in such technologies. With reference to other industry attempts to make improved decisions from IoT technologies, the necessity for industry representation and leadership is seen as a significant factor in the success of any large-scale industry-wide development of a size where significant industry improvements would be achieved. While small scale isolated projects can assist individual institutions the savings industry-wide from these is likely to be much less significant than a single platform addressing total industry issues, however, the complexity in achieving this is not to be underestimated. A government body or the healthcare industry, is potentially required to coordinate the design and implementation, compiling the scope and design documentation with funding and development/implementation being provided for the industry as a whole. The paper concludes that the technologies can offer considerable technical advantages to healthcare but these are in the early stages of development. The opportunities and requirements for healthcare are significant and need early consideration and industry coordination, using existing network developments as a basis for healthcare platform designs and developed specifically to address the needs of the industry.
Smart health (s-health) is an emerging paradigm that brings together a whole new range of digital data, both personal and non-personal, in order to deliver a holistic approach to health that overcomes the boundaries of the traditional patient caring system. By including non-personal smart city data, mobile s-health applications can improve prediction, prevention, and prescriptive care, while generating feedback that make cities smarter when accounting for and adapting to individual needs. As a result, the constantly ongoing societal challenge of improving individual life will receive additional support. As an example of such life improvement, cities might reduce pollution by promoting mobile applications that incentivize people lacking of adequate physical activity to use alternative transport means. Despite of the envisioned benefits, the diverse nature and jurisdiction of infrastructures and data required to develop s-health applications open up a number of challenges that need to be addressed. In this position paper, we first present a sustainable model for fostering the creation of s-health applications, then identify and discuss the existing challenges, and finally explore the role of blockchain in overcoming some of them.
Health-related data analysis plays an important role in self-knowledge, disease prevention, diagnosis, and quality of life assessment. With the advent of data-driven solutions, a myriad of apps and Internet of Things (IoT) devices (wearables, home-medical sensors, etc) facilitates data collection and provide cloud storage with a central administration. More recently, blockchain and other distributed ledgers became available as alternative storage options based on decentralised organisation systems. We bring attention to the human data bleeding problem and argue that neither centralised nor decentralised system organisations are a magic bullet for data-driven innovation if individual, community and societal values are ignored. The motivation for this position paper is to elaborate on strategies to protect privacy as well as to encourage data sharing and support open data without requiring a complex access protocol for researchers. Our main contribution is to outline the design of a self-regulated Open Health Archive (OHA) system with focus on quality of life (QoL) data.
BACKGROUND: A blockchain is a digitized, decentralized, distributed public ledger that acts as a shared and synchronized database that records cryptocurrency transactions. Despite the shift toward digital platforms enabled by electronic medical records, demonstrating a will to reform the health care sector, health systems face issues including security, interoperability, data fragmentation, timely access to patient data, and silos. The application of health care blockchains could enable data interoperability, enhancement of precision medicine, and reduction in prescription frauds through implementing novel methods in access and patient consent. OBJECTIVE: To summarize the evidence on the strategies and frameworks utilized to implement blockchains for patient data in health care to ensure privacy and improve interoperability and scalability. It is anticipated this review will assist in the development of recommendations that will assist key stakeholders in health care blockchain implementation, and we predict that the evidence generated will challenge the health care status quo, moving away from more traditional approaches and facilitating decision making of patients, health care providers, and researchers. METHODS: A systematic search of MEDLINE/PubMed, Embase, Scopus, ProQuest Technology Collection and Engineering Index will be conducted. Two experienced independent reviewers will conduct titles and abstract screening followed by full-text reading to determine study eligibility. Data will then be extracted onto data extraction forms before using the Cochrane Collaboration Risk of Bias Tool to appraise the quality of included randomized studies and the Risk of Bias in nonrandomized studies of Interventions to assess the quality of nonrandomized studies. Data will then be analyzed and synthesized. RESULTS: Database searches will be initiated in September 2018. We expect to complete the review in January 2019. CONCLUSIONS: This review will summarize the strategies and frameworks used to implement blockchains in health care to increase data privacy, interoperability, and scalability. This review will also help clarify if the strategies and frameworks required for the operationalization of blockchains in health care ensure the privacy of patient data while enabling efficiency, interoperability, and scalability. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/10994.
Open access
Blockchain Technology Applications and Security
Artificial Intelligence in Healthcare and Education
Thomas K. Dasaklis, Fran Casino, Constantinos Patsakis
Blockchain technology is rapidly gaining traction in healthcare industry as one of the most exciting technological developments. In particular, blockchain technology presents numerous opportunities for healthcare industry such as reduced transaction costs, increased transparency for regulatory reporting, efficient healthcare data management and healthcare records universality. In the context of smart health, blockchain may provide distinct benefits, particularly from a context-aware perspective where efficient and personalised solutions may be provided to citizens and the society in general. In this article, we portray the symbiotic relationship between blockchain and smart health. Among others, we identify and analyse three individual streams of possible synergies. In addition, we discuss several challenges for actually implementing blockchain-based applications in the healthcare industry along with several opportunities for future research directions.
Work is already underway to bring blockchain technology to the healthcare industry, and hospital administrators are trying to figure out what it can do for them, their clinicians, and their patients. That includes administrators at Beth Israel Deaconess Medical Center, a leading academic medical center located in Boston.
This paper discusses supporting collaborative care of elderly through a reward system based on distributed ledger technologies. The design and implementation of such a reward system that connect elderly and volunteers by mutual agreements involve technologies such as smart contracts and blockchains. The work is motivated by the demographic change, where an aging population consequently increases the need for care. This causes a great tension in our society, as care resources become increasingly constrained, both regarding costs and availability of care staff. Much of the daily care of the elderly is today done by family members (spouses, children) and friends, often on a voluntarily basis, which adds to the tension. The core idea of this work is to help broaden the involvement of people in caring for our elderly, enabled by a system for collaborative care. The proposed system benefits from recent advances in distributed ledger technologies, which similarly to digital currencies, are build on the ability for mutual agreements between people who do not know each other. The system also benefits from recent gamification techniques to motivate people to collaborate on a larger scale through performing simple daily tasks. The proposed system benefits from inherent distributed ledger technologies advantages, such as a high level of decentralization, thus a high availability, and strong data consistency. These advantages make it interesting to develop the possible links between blockchains and the outside world to allow for a higher level of automation and distribution of services such as collaborative care. New models for distributed ledger technologies, such as Iota tangles or the Swirld platform, may however scale and perform better than blockchains. These should thus be considered for a full implementation and test of the system. In summary, this paper presents a novel framework and prototype implementation of a reward system supporting collaborative care of elderly, that is based on distributed ledger technologies.
Peng Zhang, Jules White, Douglas C. Schmidt, Gunther Lenz · 5 authors
Secure and scalable data sharing is essential for collaborative clinical decision making. Conventional clinical data efforts are often siloed, however, which creates barriers to efficient information exchange and impedes effective treatment decision made for patients. This paper provides four contributions to the study of applying blockchain technology to clinical data sharing in the context of technical requirements defined in the “Shared Nationwide Interoperability Roadmap” from the Office of the National Coordinator for Health Information Technology (ONC). First, we analyze the ONC requirements and their implications for blockchain-based systems. Second, we present FHIRChain, which is a blockchain-based architecture designed to meet ONC requirements by encapsulating the HL7 Fast Healthcare Interoperability Resources (FHIR) standard for shared clinical data. Third, we demonstrate a FHIRChain-based decentralized app using digital health identities to authenticate participants in a case study of collaborative decision making for remote cancer care. Fourth, we highlight key lessons learned from our case study.
BACKGROUND: Digital health technologies, including telemedicine, mobile health (mHealth), and remote monitoring, are playing a greater role in medical practice. Safe and accurate management of medical information leads to the advancement of digital health, which in turn results in a number of beneficial effects. Furthermore, mHealth can help lower costs by facilitating the delivery of care and connecting people to their health care providers. Mobile apps help empower patients and health care providers to proactively address medical conditions through near real-time monitoring and treatment, regardless of the location of the patient or the health care provider. Additionally, mHealth data are stored in servers, and consequently, data management that prevents all forms of manipulation is crucial for both medical practice and clinical trials. OBJECTIVE: The aim of this study was to develop and evaluate a tamper-resistant mHealth system using blockchain technology, which enables trusted and auditable computing using a decentralized network. METHODS: We developed an mHealth system for cognitive behavioral therapy for insomnia using a smartphone app. The volunteer data collected with the app were stored in JavaScript Object Notation format and sent to the blockchain network. Thereafter, we evaluated the tamper resistance of the data against the inconsistencies caused by artificial faults. RESULTS: Electronic medical records collected using smartphones were successfully sent to a private Hyperledger Fabric blockchain network. We verified the data update process under conditions where all the validating peers were running normally. The mHealth data were successfully updated under network faults. We further ensured that any electronic health record registered to the blockchain network was resistant to tampering and revision. The mHealth data update was compatible with tamper resistance in the blockchain network. CONCLUSIONS: Blockchain serves as a tamperproof system for mHealth. Combining mHealth with blockchain technology may provide a novel solution that enables both accessibility and data transparency without a third party such as a contract research organization.
Peng Zhang, Jules White, Douglas C. Schmidt, Gunther Lenz
Since the inception of the Bitcoin technology, its underlying data structure--the blockchain--has garnered much attention due to properties such as decentralization, transparency, and immutability. These properties make blockchains suitable for apps that require disintermediation through trustless exchange, consistent and incorruptible transaction records, and operational models beyond cryptocurrency. In particular, blockchain and its smart contract capabilities have the potential to address healthcare interoperability issues, such as enabling effective interactions between users and medical applications, delivering patient data securely to a variety of organizations and devices, and improving the overall efficiency of medical practice workflow. Despite the interest in using blockchain for healthcare interoperability, however, little information is available on the concrete architectural styles and patterns for applying blockchain to healthcare apps. This paper provides an initial step in filling this gap by showing: (1) the features and implementation challenges in healthcare interoperability, (2) an end-to-end case study of a blockchain-based healthcare app we are developing, and (3) how applying foundational software patterns can help address common interoperability challenges faced by blockchain-based healthcare apps.
Are there differences between the sale of an unopened Super Mario Bros. computer game and of the digital collage of 5,000 images? Viewed from the perspective of the doctrine of exhaustion, we can easily conclude that the two transfers have significant differences. The auction of the tangible data carrier of the Super Mario’s 1986 edition (for $660,000) 1 fits well into the doctrine. The auction of the NFT (non-fungible token) representing Beeple’s “Everdays: the First 5000 Days” (for an equivalent of an astounding $69.3 million) 2 seems to be hype with a snowball effect rather than a modern encapsulation of digital exhaustion. Some commentators, 3 including the present author in collaboration with Alexandra Giannapoulou, João Pedro Quintais, and Balázs Bodó, 4 have thoroughly introduced the incompatibility of the NFT mania with the existing copyright status quo, and so – in connection with the present book’s topic – the sale of tokenized information, which is capable of representing information related to digital artworks, is practically excluded from the scope of the exhaustion of the right of distribution. At the same time, NFTs de facto offer a “code-based digital ecosystem that has practical consequences for the copyright-relevant fields of creativeness.” 5 The sale and resale of NFTs is possible; an exchange of information and title to “own” and “trade” information related to copyrightable subject matter is technologically guaranteed. In line with that, a quasi-exhaustion regime has also emerged. As such, the NFT mania can practically evidence the need for and modern technology’s capability of offering digital marketplaces for artworks as well.