Tamper-Resistant Mobile Health Using Blockchain Technology

A blockchain-based healthcare data marketplace: prototype and demonstration

Objectives

This study aimed to develop healthcare data marketplace using blockchain-based B2C model that ensures the transaction of healthcare data among individuals, companies, and marketplaces.

Materials and methods

We designed an architecture for the healthcare data marketplace using blockchain. A healthcare data marketplace was developed using Panacea, MySQL 8.0, JavaScript library, and Node.js. We evaluated the performance of the data marketplace system in 3 scenarios.

Results

We developed mobile and web applications for healthcare data marketplace. The transaction data queries were executed fully within about 1-2 s, and approximately 9.5 healthcare data queries were processed per minute in each demonstration scenario.

Discussion

Blockchain-based healthcare data marketplaces have shown compliance performance in the process of data collection and will provide a meaningful role in analyzing healthcare data.

Conclusion

The healthcare data marketplace developed in this project can iron out time and place limitations and create a framework for gathering and analyzing fragmented healthcare data.

The Hyperledger fabric as a Blockchain framework preserves the security of electronic health records

The Hyperledger Fabric (HF) framework is widely studied for securing electronic health records (EHRs) in the healthcare sector. Despite the various cross-domain blockchain technology (BCT) applications, little is known about the role of the HF framework in healthcare. The purpose of the systematic literature review (SLR) is to review the existing literature on the HF framework and its applications in healthcare. This SLR includes literature published between January 2015 and March 2023 in the ACM digital library, IEEE Xplore, SCOPUS, Springer, PubMed, and Google Scholar databases. Following the inclusion and exclusion criteria, a total of 57 articles emerged as eligible for this SLR. The HF framework was found to be useful in securing health records coming from the Internet of Medical Things (IoMT) and many other devices. The main causes behind using the HF framework were identified as privacy and security, integrity, traceability, and availability of health records. Additionally, storage issues with transactional data over the blockchain are reduced by the use of the HF framework. This SLR also highlights potential future research trends to ensure the high-level security of health records.

Exploring applications of blockchain in healthcare: road map and future directions

Blockchain technology includes numerous elements such as distributed ledgers, decentralization, authenticity, privacy, and immutability. It has progressed past the hype to find actual use cases in industries like healthcare. Blockchain is an emerging area that relies on a consensus algorithm and the idea of a digitally distributed ledger to eliminate any intermediary risks. By enabling them to trace data provenance and any changes made, blockchain technology can enable different healthcare stakeholders to share access to their networks without violating data security and integrity. The healthcare industry faces challenges like fragmented data, security and privacy concerns, and interoperability issues. Blockchain technology offers potential solutions by ensuring secure, tamper-proof storage across multiple network nodes, improving interoperability and patient privacy. Encrypting patient data further enhances security and reduces unauthorized access concerns. Blockchain technology, deployed over the Internet, can potentially use the current healthcare data by using a patient-centric approach and removing the intermediaries. This paper discusses the effective utilization of blockchain technology in the healthcare industry. In contrast to other applications, the exoteric evaluation in this paper shows that the innovative technology called blockchain technology has a major role to play in the existing and future applications of the healthcare industry and has significant benefits.

State-of-the-Art Research in Blockchain of Things for HealthCare

Existing blockchain approaches exhibit a diverse set of dimensions, and on the other hand, IoT-based health care applications manifest a wide variety of requirements. The state-of-the-art analysis of blockchain concerning existing IoT-based approaches for the healthcare domain has been investigated to a limited extend. The purpose of this survey paper is to analyze current state-of-the-art blockchain work in several IoT disciplines, with a focus on the health sector. This study also attempts to demonstrate the prospective use of blockchain in healthcare, as well as the obstacles and future paths of blockchain development. Furthermore, the fundamentals of blockchain have been thoroughly explained to appeal to a diverse audience. On the contrary, we analyzed state-of-the-art studies from several IoT disciplines for eHealth, and also the study deficit but also the obstacles when considering blockchain to IoT, which are highlighted and explored in the paper with suggested alternatives.

A Decentralized Marketplace for Patient-Generated Health Data: Design Science Approach

BACKGROUND

Wearable devices have limited ability to store and process such data. Currently, individual users or data aggregators are unable to monetize or contribute such data to wider analytics use cases. When combined with clinical health data, such data can improve the predictive power of data-driven analytics and can proffer many benefits to improve the quality of care. We propose and provide a marketplace mechanism to make these data available while benefiting data providers.

OBJECTIVE

We aimed to propose the concept of a decentralized marketplace for patient-generated health data that can improve provenance, data accuracy, security, and privacy. Using a proof-of-concept prototype with an interplanetary file system (IPFS) and Ethereum smart contracts, we aimed to demonstrate decentralized marketplace functionality with the blockchain. We also aimed to illustrate and demonstrate the benefits of such a marketplace.

METHODS

We used a design science research methodology to define and prototype our decentralized marketplace and used the Ethereum blockchain, solidity smart-contract programming language, the web3.js library, and node.js with the MetaMask application to prototype our system.

RESULTS

We designed and implemented a prototype of a decentralized health care marketplace catering to health data. We used an IPFS to store data, provide an encryption scheme for the data, and provide smart contracts to communicate with users on the Ethereum blockchain. We met the design goals we set out to accomplish in this study.

CONCLUSIONS

A decentralized marketplace for trading patient-generated health data can be created using smart-contract technology and IPFS-based data storage. Such a marketplace can improve quality, availability, and provenance and satisfy data privacy, access, auditability, and security needs for such data when compared with centralized systems.

Sharing Health Information Using a Blockchain

Data sharing in the health sector represents a big problem due to privacy and security issues. Health data have tremendous value for organisations and criminals. The European Commission has classified health data as a unique resource owing to their ability to enable both retrospective and prospective research at a low cost. Similarly, the Organisation for Economic Co-operation and Development (OECD) encourages member nations to create and implement health data governance systems that protect individual privacy while allowing data sharing. This paper proposes adopting a blockchain framework to enable the transparent sharing of medical information among health entities in a secure environment. We develop a laboratory-based prototype using a design science research methodology (DSRM). This approach has its roots in the sciences of engineering and artificial intelligence, and its primary goal is to create relevant artefacts that add value to the fields in which they are used. We adopt a patient-centric approach, according to which a patient is the owner of their data and may allow hospitals and health professionals access to their data.

Enabling Value Co-Creation in Healthcare through Blockchain Technology

The COVID-19 pandemic highlighted the need to manage complex relations within the healthcare ecosystem. The role of new technologies in achieving this goal is a topic of current interest. Among them, blockchain technology is experiencing widespread application in the healthcare context. The present work investigates how this technology fosters value co-creation paths in the new digital healthcare ecosystems. To this end, a multiple case study has been conducted examining the development and application of blockchain by 32 healthcare tech companies. The results show blockchain technology adoption's current and potential impacts on value co-creation regarding data and resource sharing, patient participation, and collaboration between professionals. Three main areas of activity emerge from the case studies where blockchain implementation brings significant benefits for value co-creation: improving service interaction, impacting actors' engagement, and fostering ecosystem transparency.

Tamper-proof multitenant data storage using blockchain

Technologies like Internet of Things (IoT), cloud, artificial intelligence, blockchain etc. have become a perceptible part of our lives resulting in the generation of enormous amounts of data. Consequently, the systems used for storage and processing of this data are required to be scalable for handling the huge volumes of data. A shared, multitenant system such as a cloud-based storage-as-a-service provides scalability of storage as well as economics of sharing. However, there is a risk of data tampering when multiple tenants work in a shared environment. The benefits of a multitenant solution can be leveraged only if tenants' data is isolated from each other. Further, prevention of data tampering from malicious tenant nodes is also required. Therefore, the paper proposes the use of a private blockchain for an implementation of a multi-tenant-based storage system. The objective is to develop a scalable system where tenants' data is not at a risk of tampering. The efficacy of the proposed system has been demonstrated with synthetic data of multiple tenants using a Software as a Service (SaaS) healthcare application.

Blockchain-Enabled Electronic Health Records for Healthcare 4.0

Healthcare delivery is on the verge of a fundamental shift into the new era of smart and connected health care, termed Health Care 4.0. Sharing healthcare data is an important step in improving the healthcare system's intelligence and service quality. Healthcare data, which is a personal asset of the patient, should be owned and managed by the patient rather than being dispersed among several healthcare systems, preventing data exchange and jeopardizing patient privacy. EHRs (electronic health records) assist individuals by allowing them to combine and manage their medical data. On the other hand, today's EHR systems fall short of providing patients with traceable, trustworthy, and secure ownership over their medical data, creating serious security risks. In this article, the authors propose PcBEHR (patient-controlled blockchain enabled electronic health records) as a way for patients to have safe control over their data that is decentralized, immutable, transparent, traceable, and trustworthy. Decentralized interplanetary file storage (IPFS) is used in the suggested technique.

Blockchain Technology and Artificial Intelligence Based Decentralized Access Control Model to Enable Secure Interoperability for Healthcare

Healthcare, one of the most important industries, is data-oriented, but most of the research in this industry focuses on incorporating the internet of things (IoT) or connecting medical equipment. Very few researchers are looking at the data generated in the healthcare industry. Data are very important tools in this competitive world, as they can be integrated with artificial intelligence (AI) to promote sustainability. Healthcare data include the health records of patients, drug-related data, clinical trials data, data from various medical equipment, etc. Most of the data management processes are manual, time-consuming, and error-prone. Even then, different healthcare industries do not trust each other to share and collaborate on data. Distributed ledger technology is being used for innovations in different sectors including healthcare. This technology can be incorporated to maintain and exchange data between different healthcare organizations, such as hospitals, insurance companies, laboratories, pharmacies, etc. Various attributes of this technology, such as its immutability, transparency, provenance etc., can bring trust and security to the domain of the healthcare sector. In this paper, a decentralized access control model is proposed to enable the secure interoperability of different healthcare organizations. This model uses the Ethereum blockchain for its implementation. This model interfaces patients, doctors, chemists, and insurance companies, empowering the consistent and secure exchange of data. The major concerns are maintaining a history of the transactions and avoiding unauthorized updates in health records. Any transaction that changes the state of the data is reflected in the distributed ledger and can be easily traced with this model. Only authorized entities can access their respective data. Even the administrator will not be able to modify any medical records.

Bibliometric Analysis of Health Technology Research: 1990~2020

This paper aims to summarize the publishing trends, current status, research topics, and frontier evolution trends of health technology between 1990 and 2020 through various bibliometric analysis methods. In total, 6663 articles retrieved from the Web of Science core database were analyzed by Vosviewer and CiteSpace software. This paper found that: (1) The number of publications in the field of health technology increased exponentially; (2) there is no stable core group of authors in this research field, and the influence of the publishing institutions and journals in China is insufficient compared with those in Europe and the United States; (3) there are 21 core research topics in the field of health technology research, and these research topics can be divided into four classes: hot spots, potential hot spots, margin topics, and mature topics. C21 (COVID-19 prevention) and C10 (digital health technology) are currently two emerging research topics. (4) The number of research frontiers has increased in the past five years (2016-2020), and the research directions have become more diverse; rehabilitation, pregnancy, e-health, m-health, machine learning, and patient engagement are the six latest research frontiers.

Exploring Data Integrity of Dual-Channel Supply Chain Using Blockchain Technology

The study intends to solve the problems of complex product circulation caused by information asymmetry and the untimely communication of production and sales information in the process of product sales to reduce the cost in the process of product circulation. Based on blockchain technology, the data integrity of the dual-channel supply chain is studied. First, the data of the supply chain conduct coordinated management to achieve the integrity of the supply chain data. Then, under the background that both retailers and suppliers are risk-neutral individuals, the benchmark model of the dual-channel supply chain is constructed, and the online and offline sales prices of products under different decision-making modes are analyzed. Finally, taking fresh agricultural products as an example, the sales strategies of the online and offline sales channels of fresh agricultural products are studied, and a dual-channel supply chain model is constructed. The profit of each member in the supply chain system under this model is obtained by the inverse method. The simulation results demonstrate that the retailer's revenue and the total revenue of the system increase obviously with the growth of the price discount coefficient after the price discount strategy is applied. When the compensation cost is between 1,000 and 3,000, the profit of retailers in the supply chain system is improved by using the price coordination mechanism, while the profit of suppliers decreases to some extent. When the value of compensation cost is 7,000–9,000, the application of the price coordination mechanism increases the profit of suppliers in the supply chain system, while the profit of retailers declines to a certain extent. The research content reported here effectively alleviates the profit conflict and the double marginal effect between the two channels and enriches the theoretical system knowledge of the coordination of the two channels' supply chain of agricultural products.

A Review of Blockchain Technology Applications in Ambient Assisted Living

The adoption of remote assisted care was accelerated by the COVID-19 pandemic. This type of system acquires data from various sensors, runs analytics to understand people’s activities, behavior, and living problems, and disseminates information with healthcare stakeholders to support timely follow-up and intervention. Blockchain technology may offer good technical solutions for tackling Internet of Things monitoring, data management, interventions, and privacy concerns in ambient assisted living applications. Even though the integration of blockchain technology with assisted care is still at the beginning, it has the potential to change the health and care processes through a secure transfer of patient data, better integration of care services, or by increasing coordination and awareness across the continuum of care. The motivation of this paper is to systematically review and organize these elements according to the main problems addressed. To the best of our knowledge, there are no studies conducted that address the solutions for integrating blockchain technology with ambient assisted living systems. To conduct the review, we have followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology with clear criteria for including and excluding papers, allowing the reader to effortlessly gain insights into the current state-of-the-art research in the field. The results highlight the advantages and open issues that would require increased attention from the research community in the coming years. As for directions for further research, we have identified data sharing and integration of care paths with blockchain, storage, and transactional costs, personalization of data disclosure paths, interoperability with legacy care systems, legal issues, and digital rights management.

GLASS: A Citizen-Centric Distributed Data-Sharing Model within an e-Governance Architecture

E-governance is a process that aims to enhance a government’s ability to simplify all the processes that may involve government, citizens, businesses, and so on. The rapid evolution of digital technologies has often created the necessity for the establishment of an e-Governance model. There is often a need for an inclusive e-governance model with integrated multiactor governance services and where a single market approach can be adopted. e-Governance often aims to minimise bureaucratic processes, while at the same time including a digital-by-default approach to public services. This aims at administrative efficiency and the reduction of bureaucratic processes. It can also improve government capabilities, and enhances trust and security, which brings confidence in governmental transactions. However, solid implementations of a distributed data sharing model within an e-governance architecture is far from a reality; hence, citizens of European countries often go through the tedious process of having their confidential information verified. This paper focuses on the sinGLe sign-on e-GovernAnce Paradigm based on a distributed file-exchange network for security, transparency, cost-effectiveness and trust (GLASS) model, which aims to ensure that a citizen can control their relationship with governmental agencies. The paper thus proposes an approach that integrates a permissioned blockchain with the InterPlanetary File System (IPFS). This method demonstrates how we may encrypt and store verifiable credentials of the GLASS ecosystem, such as academic awards, ID documents and so on, within IPFS in a secure manner and thus only allow trusted users to read a blockchain record, and obtain the encryption key. This allows for the decryption of a given verifiable credential that stored on IPFS. This paper outlines the creation of a demonstrator that proves the principles of the GLASS approach.

Mobile time banking on blockchain system development for community elderly care

This study aims to develop a mobile time-banking system on blockchain (MTBB), which can track service transaction records for community elderly care via mutual service exchange. The MTBB was developed to enable organizations, either corporate-social-responsibility organizations or nonprofit organizations to issue proprietary time tokens to members who participate in the organizations' volunteer activities. Database applications with smartphone apps integrated with MultiChain blockchain technology were developed. Metadata with the service transaction information are stored in the MultiChain blocks so that the transaction records are immutable and can be analyzed in the future. Cahn's time-banking guidelines were applied in developing this MTBB with MultiChain blockchain technology integrated for tracking service transaction records. The study also combines one-to-one mutual service exchange with organizations which offer volunteer activities and issue proprietary time tokens. With the blockchain transaction tracking mechanism, all elderly care service records via or within organizations can be tracked and analyzed to show their alignment with some of the Sustainable Development Goals of the United Nations.

The Use of Blockchain Technology in the Health Care Sector: Systematic Review

Background

Blockchain technology is a part of Industry 4.0’s new Internet of Things applications: decentralized systems, distributed ledgers, and immutable and cryptographically secure technology. This technology entails a series of transaction lists with identical copies shared and retained by different groups or parties. One field where blockchain technology has tremendous potential is health care, due to the more patient-centric approach to the health care system as well as blockchain’s ability to connect disparate systems and increase the accuracy of electronic health records.

Objective

The aim of this study was to systematically review studies on the use of blockchain technology in health care and to analyze the characteristics of the studies that have implemented blockchain technology.

Methods

This study used a systematic review methodology to find literature related to the implementation aspect of blockchain technology in health care. Relevant papers were searched for using PubMed, SpringerLink, IEEE Xplore, Embase, Scopus, and EBSCOhost. A quality assessment of literature was performed on the 22 selected papers by assessing their trustworthiness and relevance.

Results

After full screening, 22 papers were included. A table of evidence was constructed, and the results of the selected papers were interpreted. The results of scoring for measuring the quality of the publications were obtained and interpreted. Out of 22 papers, a total of 3 (14%) high-quality papers, 9 (41%) moderate-quality papers, and 10 (45%) low-quality papers were identified.

Conclusions

Blockchain technology was found to be useful in real health care environments, including for the management of electronic medical records, biomedical research and education, remote patient monitoring, pharmaceutical supply chains, health insurance claims, health data analytics, and other potential areas. The main reasons for the implementation of blockchain technology in the health care sector were identified as data integrity, access control, data logging, data versioning, and nonrepudiation. The findings could help the scientific community to understand the implementation aspect of blockchain technology. The results from this study help in recognizing the accessibility and use of blockchain technology in the health care sector.

User Control of Personal mHealth Data Using a Mobile Blockchain App: Design Science Perspective

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.

Potential of Internet of Medical Things (IoMT) applications in building a smart healthcare system: A systematic review

Sudden spurting of Corona virus disease (COVID-19) has put the whole healthcare system on high alert. Internet of Medical Things (IoMT) has eased the situation to a great extent, also COVID-19 has motivated scientists to make new ‘Smart’ healthcare system focusing towards early diagnosis, prevention of spread, education and treatment and facilitate living in the new normal. This review aims to identify the role of IoMT applications in improving healthcare system and to analyze the status of research demonstrating effectiveness of IoMT benefits to the patient and healthcare system along with a brief insight into technologies supplementing IoMT and challenges faced in developing a smart healthcare system.

An internet-based search in PUBMED, Google Scholar and IEEE Library for english language publications using relevant terms resulted in 987 articles. After screening title, abstract, and content related to IoMT in healthcare and excluding duplicate articles, 135 articles published in journal with impact factor ≥1 were eligible for inclusion. Also relevant articles from the references of the selected articles were considered.

The habituation of IoMT and related technology has resolved several difficulties using remote monitoring, telemedicine, robotics, sensors etc. However mass adoption seems challenging due to factors like privacy and security of data, management of large amount of data, scalability and upgradation etc. Although ample knowledge has been compiled and exchanged, this structured systematic review will help the healthcare practitioners, policymakers/decision makers, scientists and researchers to gauge the applicability of IoMT in healthcare more efficiently.

Blockchain-based architecture design for personal health record (Preprint)

Background

The importance of blockchain-based architectures for personal health record (PHR) lies in the fact that they are thought and developed to allow patients to control and at least partly collect their health data. Ideally, these systems should provide the full control of such data to the respective owner. In spite of this importance, most of the works focus more on describing how blockchain models can be used in a PHR scenario rather than whether these models are in fact feasible and robust enough to support a large number of users.

Objective

To achieve a consistent, reproducible, and comparable PHR system, we build a novel ledger-oriented architecture out of a permissioned distributed network, providing patients with a manner to securely collect, store, share, and manage their health data. We also emphasize the importance of suitable ledgers and smart contracts to operate the blockchain network as well as discuss the necessity of standardizing evaluation metrics to compare related (net)works.

Methods

We adopted the Hyperledger Fabric platform to implement our blockchain-based architecture design and the Hyperledger Caliper framework to provide a detailed assessment of our system: first, under workload, ranging from 100 to 2500 simultaneous record submissions, and second, increasing the network size from 3 to 13 peers. In both experiments, we used throughput and average latency as the primary metrics. We also created a health database, a cryptographic unit, and a server to complement the blockchain network.

Results

With a 3-peer network, smart contracts that write on the ledger have throughputs, measured in transactions per second (tps) in an order of magnitude close to 10² tps, while those contracts that only read have rates close to 10³ tps. Smart contracts that write also have latencies, measured in seconds, in an order of magnitude close to 10¹ seconds, while that only read have delays close to 10⁰ seconds. In particular, smart contracts that retrieve, list, and view history have throughputs varying, respectively, from 1100 tps to 1300 tps, 650 tps to 750 tps, and 850 tps to 950 tps, impacting the overall system response if they are equally requested under the same workload. Varying the network size and applying an equal fixed load, in turn, writing throughputs go from 10² tps to 10¹ tps and latencies go from 10¹ seconds to 10² seconds, while reading ones maintain similar values.

Conclusions

To the best of our knowledge, we are the first to evaluate, using Hyperledger Caliper, the performance of a PHR blockchain architecture and the first to evaluate each smart contract separately. Nevertheless, blockchain systems achieve performances far below what the traditional distributed databases achieve, indicating that the assessment of blockchain solutions for PHR is a major concern to be addressed before putting them into a real production.

Applications of Blockchain in the Medical Field: Narrative Review

Background

As a distributed technology, blockchain has attracted increasing attention from stakeholders in the medical industry. Although previous studies have analyzed blockchain applications from the perspectives of technology, business, or patient care, few studies have focused on actual use-case scenarios of blockchain in health care. In particular, the outbreak of COVID-19 has led to some new ideas for the application of blockchain in medical practice.

Objective

This paper aims to provide a systematic review of the current and projected uses of blockchain technology in health care, as well as directions for future research. In addition to the framework structure of blockchain and application scenarios, its integration with other emerging technologies in health care is discussed.

Methods

We searched databases such as PubMed, EMBASE, Scopus, IEEE, and Springer using a combination of terms related to blockchain and health care. Potentially relevant papers were then compared to determine their relevance and reviewed independently for inclusion. Through a literature review, we summarize the key medical scenarios using blockchain technology.

Results

We found a total of 1647 relevant studies, 60 of which were unique studies that were included in this review. These studies report a variety of uses for blockchain and their emphasis differs. According to the different technical characteristics and application scenarios of blockchain, we summarize some medical scenarios closely related to blockchain from the perspective of technical classification. Moreover, potential challenges are mentioned, including the confidentiality of privacy, the efficiency of the system, security issues, and regulatory policy.

Conclusions

Blockchain technology can improve health care services in a decentralized, tamper-proof, transparent, and secure manner. With the development of this technology and its integration with other emerging technologies, blockchain has the potential to offer long-term benefits. Not only can it be a mechanism to secure electronic health records, but blockchain also provides a powerful tool that can empower users to control their own health data, enabling a foolproof health data history and establishing medical responsibility.

Comprehensive Survey of IoT, Machine Learning, and Blockchain for Health Care Applications: A Topical Assessment for Pandemic Preparedness, Challenges, and Solutions

Internet of Things (IoT) communication technologies have brought immense revolutions in various domains, especially in health monitoring systems. Machine learning techniques coupled with advanced artificial intelligence techniques detect patterns associated with diseases and health conditions. Presently, the scientific community is focused on enhancing IoT-enabled applications by integrating blockchain technology with machine learning models to benefit medical report management, drug traceability, tracking infectious diseases, etc. To date, contemporary state-of-the-art techniques have presented various efforts on the adaptability of blockchain and machine learning in IoT applications; however, there exist various essential aspects that must also be incorporated to achieve more robust performance. This study presents a comprehensive survey of emerging IoT technologies, machine learning, and blockchain for healthcare applications. The reviewed articles comprise a plethora of research articles published in the web of science. The analysis is focused on research articles related to keywords such as ‘machine learning’, blockchain, ‘Internet of Things or IoT’, and keywords conjoined with ‘healthcare’ and ‘health application’ in six famous publisher databases, namely IEEEXplore, Nature, ScienceDirect, MDPI, SpringerLink, and Google Scholar. We selected and reviewed 263 articles in total. The topical survey of the contemporary IoT-based models is presented in healthcare domains in three steps. Firstly, a detailed analysis of healthcare applications of IoT, blockchain, and machine learning demonstrates the importance of the discussed fields. Secondly, the adaptation mechanism of machine learning and blockchain in IoT for healthcare applications are discussed to delineate the scope of the mentioned techniques in IoT domains. Finally, the challenges and issues of healthcare applications based on machine learning, blockchain, and IoT are discussed. The presented future directions in this domain can significantly help the scholarly community determine research gaps to address.

Design of an Architecture Contributing to the Protection and Privacy of the Data Associated with the Electronic Health Record

The Electronic Health Record (EHR) has brought numerous challenges since its inception that have prevented a unified implementation from being carried out in Colombia. Within these challenges, we find a lack of security, auditability, and interoperability. Moreover, there is no general vision of the patient’s history throughout its life since different systems store the information separately. This lack of unified history leads to multiple risks for patients’ lives and the leakage of private data because each system has different mechanisms to safeguard and protect the information, and in several cases, these mechanisms do not exist. Many researchers tried to build multiple information systems attempting to solve this problem. However, these systems do not have a formal and rigorous architectural design to analyze and obtain health needs through architectural drivers to construct robust systems to solve these problems. This article describes the process of designing a software architecture that provides security to the information that makes up the Electronic Health Record in Colombia (EHR). Once we obtained the architectural drivers, we proposed Blockchain mainly due to its immutable distributed ledger, consensus algorithms, and smart contracts that securely transport this sensitive information. With this design decision, we carried out the construction of structures and necessary architectural documentation. We also develop a Proof of Concept (POC) using Hyperledger Fabric according to the literature analysis review in order to build a primary health network, in addition to a Smart Contract (Chaincode) using the Go programming language to perform a performance evaluation and do a safety analysis that demonstrates that the proposed design is reliable. The proposed design allows us to conclude that it is possible to build a secure architecture that protects patient health data privacy, facilitating the EHR’s construction in Colombia.

eHealthChain-a blockchain-based personal health information management system

Medical IoT devices that use miniature sensors to collect patient's bio-signals and connected medical applications are playing a crucial role in providing pervasive and personalized healthcare. This technological improvement has also created opportunities for the better management of personal health information. The Personal Health Information Management System (PHIMS) supports activities such as acquisition, storage, organization, integration, and privacy-sensitive retrieval of consumer's health information. For usability and wide acceptance, the PHIMS should follow the design principles that guarantee privacy-aware health information sharing, individual information control, integration of information obtained from multiple medical IoT devices, health information security, and flexibility. Recently, blockchain technology has emerged as a lucrative option for the management of personal health information. In this paper, we propose eHealthChain-a blockchain-based PHIMS for managing health data originating from medical IoT devices and connected applications. The eHealthChain architecture consists of four layers, which are a blockchain layer for hosting a blockchain database, an IoT device layer for obtaining personal health data, an application layer for facilitating health data sharing, and an adapter layer, which interfaces the blockchain layer with an application layer. Compared to existing systems, eHealthChain provides complete control to the user in terms of personal health data acquisition, sharing, and self-management. We also present a detailed implementation of a Proof of Concept (PoC) prototype of eHealthChain system built using Hyperledger Fabric platform.

A new privacy framework for the management of chronic diseases via mHealth in a post-Covid-19 world

Aim

New challenges are being faced by global healthcare systems such as an increase in the elderly population, budget cuts as well as the ongoing Covid-19 pandemic. As pressures mount on healthcare systems to provide treatment to patients, mHealth is seen as one of the possible solutions to addressing these challenges. Given the sensitivity of health data, the rapid development of the mHealth sector raises privacy concerns. The aims of this research were to investigate privacy threats/concerns in the context of mHealth and the management of chronic diseases and to propose a novel privacy framework to address these concerns.

Subject and method

The study adopted a modified version of the engineering design process. After defining the problem, information was gathered through literature reviews, and analyses of existing regulatory (privacy) frameworks and past research on privacy threats/concerns. Requirements for a new framework were then specified leading to its development and comparison with existing frameworks.

Results

A novel future-proof privacy framework was developed and illustrated. Using existing regulatory frameworks for privacy and privacy threats/concerns from research studies, privacy principles and their resulting requirements were identified. Furthermore, mechanisms and associated technologies needed to implement the privacy principles/requirements into a functional prototype were also identified. A comparison of the proposed framework with existing frameworks, showed that it addressed privacy threats/concerns in a more comprehensive manner.

Conclusion

This research makes a valuable contribution to protecting privacy in mHealth. The novel framework developed is an improvement on existing frameworks. It is also future-proof since its foundations are built on regulatory frameworks and privacy threats/concerns existing at the time of its deployment/revision.

Data sharing: using blockchain and decentralized data technologies to unlock the potential of artificial intelligence: What can assisted reproduction learn from other areas of medicine?

The extension of blockchain use for nonfinancial domains has revealed opportunities to the health care sector that answer the need for efficient and effective data and information exchanges in a secure and transparent manner. Blockchain is relatively novel in health care and particularly for data analytics, although there are examples of improvements achieved. We provide a systematic review of blockchain uses within the health care industry, with a particular focus on the in vitro fertilization (IVF) field. Blockchain technology in the fertility sector, including data sharing collaborations compliant with ethical data handling within confines of international law, allows for large-scale prospective cohort studies to proceed at an international scale. Other opportunities include gamete donation and matching, consent sharing, and shared resources between different clinics.

A Blockchain-Enabled Framework for mHealth Systems

Presently modern technology makes a significant contribution to the transition from traditional healthcare to smart healthcare systems. Mobile health (mHealth) uses advances in wearable sensors, telecommunications and the Internet of Things (IoT) to propose a new healthcare concept centered on the patient. Patients' real-time remote continuous health monitoring, remote diagnosis, treatment, and therapy is possible in an mHealth system. However, major limitations include the transparency, security, and privacy of health data. One possible solution to this is the use of blockchain technologies, which have found numerous applications in the healthcare domain mainly due to theirs features such as decentralization (no central authority is needed), immutability, traceability, and transparency. We propose an mHealth system that uses a private blockchain based on the Ethereum platform, where wearable sensors can communicate with a smart device (a smartphone or smart tablet) that uses a peer-to-peer hypermedia protocol, the InterPlanetary File System (IPFS), for the distributed storage of health-related data. Smart contracts are used to create data queries, to access patient data by healthcare providers, to record diagnostic, treatment, and therapy, and to send alerts to patients and medical professionals.

Security Aspects of Blockchain Technology Intended for Industrial Applications

Blockchain technology plays a significant role in the industrial development. Many industries can potentially benefit from the innovations blockchain decentralization technology and privacy protocols offer with regard to securing, data access, auditing and managing transactions within digital platforms. Blockchain is based on distributed and secure decentralized protocols in which there is no single authority, and no single point of control; the data blocks are generated, added, and validated by the nodes of the network themselves. This article provides insights into the current developments within blockchain technology and explores its ability to revolutionize the multiple industrial application areas such as supply chain industry, Internet of Things (IoT), healthcare, governance, finance and manufacturing. It investigates and provides insights into the security issues and threats related to the blockchain implementations by assessing the research through a systematic literature review. This article proposes possible solutions in detail for enhancing the security of the blockchain for industrial applications along with significant directions for future explorations. The study further suggests how in recent years the adoption of blockchain technology by multiple industrial sectors has gained momentum while in the finance sector it is touching new heights day by day.

Could Blockchain Technology Empower Patients, Improve Education, and Boost Research in Radiology Departments? An Open Question for Future Applications

Blockchain can be considered as a digital database of cryptographically validated transactions stored as blocks of data. Copies of the database are distributed on a peer-to-peer network adhering to a consensus protocol for authentication of new blocks into the chain. While confined to financial applications in the past, this technology is quickly becoming a hot topic in healthcare and scientific research. Potential applications in radiology range from upgraded monitoring of training milestones achievement for residents to improved control of clinical imaging data and easier creation of secure shared databases.

The case for establishing a blockchain research and development program at an academic medical center

Objective

To develop a research and development program to study factors that will support research, education and innovation using blockchain technology for health in an effective and sustainable manner. We proposed to conduct qualitative research to generate insights for developing a market strategy to build a research lab for the promotion of blockchain technologies in health in academic environments. The team aimed to identify the key barriers and opportunities for developing a sustainable research lab that generates research, education, and application of blockchain in healthcare at an academic medical institution and test those strategies in a real-world scenario.

Methods

The research team identified potential customers and stakeholders through interviews and snowball sampling. The team conducted semi-structured interviews with 4 faculty researchers, 10 industry leaders, and 6 students from a variety of disciplines and organizations. The findings of these research activities informed our understanding of the needs of stratified customers and helped identify key assets and activities the lab will have to offer to meet those needs.

Results

The research insights from data analysis were used to build the business model for establishing a blockchain in health impact lab. This systematic study of areas where blockchain technology can impact health will guide the future development of research agenda for the researchers on campus.

Conclusion

Based on our learnings, we hope to design a Blockchain in Health Impact Lab to serve as a platform for students and faculty to come together with industry partners and explore current challenges of blockchain in healthcare. The academic medical center's partnership with other healthcare providers will help create real-world opportunities to demonstrate and implement new technologies.

A Blockchain-Based Secret-Data Sharing Framework for Personal Health Records in Emergency Condition

Blockchain technology is the most trusted all-in-one cryptosystem that provides a framework for securing transactions over networks due to its irreversibility and immutability characteristics. Blockchain network, as a decentralized infrastructure, has drawn the attention of various startups, administrators, and developers. This system preserves transactions from tampering and provides a tracking tool for tracing past network operations. A personal health record (PHR) system permits patients to control and share data concerning their health conditions by particular peoples. In the case of an emergency, the patient is unable to approve the emergency staff access to the PHR. Furthermore, a history record management system of the patient's PHR is required, which exhibits hugely private personal data (e.g., modification date, name of user, last health condition, etc.). In this paper, we suggest a healthcare management framework that employs blockchain technology to provide a tamper protection application by considering safe policies. These policies involve identifying extensible access control, auditing, and tamper resistance in an emergency scenario. Our experiments demonstrated that the proposed framework affords superior performance compared to the state-of-the-art healthcare systems concerning accessibility, privacy, emergency access control, and data auditing.

The HealthChain Blockchain for Electronic Health Records: Development Study

Background

Health care professionals are required to maintain accurate health records of patients. Furthermore, these records should be shared across different health care organizations for professionals to have a complete review of medical history and avoid missing important information. Nowadays, health care providers use electronic health records (EHRs) as a key to the implementation of these goals and delivery of quality care. However, there are technical and legal hurdles that prevent the adoption of these systems, such as concerns about performance and privacy issues.

Objective

This study aimed to build and evaluate an experimental blockchain for EHRs, named HealthChain, which overcomes the disadvantages of traditional EHR systems.

Methods

HealthChain is built based on consortium blockchain technology. Specifically, three organizations, namely hospitals, insurance providers, and governmental agencies, form a consortium that operates under a governance model, which enforces the business logic agreed by all participants. Every peer node hosts an instance of the distributed ledger consisting of EHRs and an instance of chaincode regulating the permissions of participants. Designated orderers establish consensus on the order of EHRs and then disseminate blocks to peers.

Results

HealthChain achieves functional and nonfunctional requirements. It can store EHRs in a distributed ledger and share them among different participants. Moreover, it demonstrates superior features, such as privacy preservation, security, and high throughput. These are the main reasons why HealthChain is proposed.

Conclusions

Consortium blockchain technology can help to build new EHR systems and solve the problems that prevent the adoption of traditional systems.

Determining the Intellectual Structure and Academic Trends of Smart Home Health Care Research: Coword and Topic Analyses

Background

With the rapid development of information and communication technologies, smart homes are being investigated as effective solutions for home health care. The increasing academic attention on smart home health care has primarily been on the development and application of smart home technologies. However, comprehensive studies examining the general landscape of diverse research areas for smart home health care are still lacking.

Objective

This study aims to determine the intellectual structure of smart home health care in a time series by conducting a coword analysis and topic analysis. Specifically, it investigates (1) the intellectual basis of smart home health care through overall academic status, (2) the intellectual foci through influential keywords and their evolutions, and (3) intellectual trends through primary topics and their evolutions.

Methods

Analyses were conducted in 5 steps: (1) data retrieval from article databases (Web of Science, Scopus, and PubMed) and the initial dataset preparation of 6080 abstracts from the year 2000 to the first half of 2019; (2) data preprocessing and refinement extraction of 25,563 words; (3) a descriptive analysis of the overall academic status and period division (ie, 4 stages of 3-year blocks); (4) coword analysis based on word co-occurrence networks for the intellectual foci; and (5) topic analysis for the intellectual trends based on latent Dirichlet allocation (LDA) topic modeling, word-topic networks, and researcher workshops.

Results

First, regarding the intellectual basis of smart home health care, recent academic interest and predominant journals and research domains were verified. Second, to determine the intellectual foci, primary keywords were identified and classified according to the degree of their centrality values. Third, 5 themes pertaining to the topic evolution emerged: (1) the diversification of smart home health care research topics; (2) the shift from technology-oriented research to technological convergence research; (3) the expansion of application areas and system functionality of smart home health care; (4) the increased focus on system usability, such as service design and experiences; and (5) the recent adaptation of the latest technologies in health care. Based on these findings, the pattern of technology diffusion in smart home health care research was determined as the adaptation of technologies, the proliferation of application areas, and an extension into system design and service experiences.

Conclusions

The research findings provide academic and practical value in 3 aspects. First, they promote a comprehensive understanding of the smart home health care domain by identifying its multifaceted intellectual structure in a time series. Second, they can help clinicians discern the development and dispersion level of their respective disciplines. Third, the pattern of technology diffusion in smart home health care could help scholars comprehend current and future research trends and identify research opportunities based on upcoming research waves of newly adapted technologies in smart home health care.

Research on the Application of Blockchain in Smart Healthcare: Constructing a Hierarchical Framework

This study aims to explore the application of blockchain technology in smart healthcare, establish a hierarchical theoretical framework of smart healthcare, reveal the impact of blockchain on smart healthcare, and finally, construct a development application system of smart healthcare under the blockchain based on stakeholder theory. However, such a hierarchical theoretical framework should consider not only the necessary attributes and the interrelationship among various aspects and attributes but also the role of multiple stakeholders. Therefore, the paper uses fuzzy set theory to filter unnecessary attributes, proposes a decision-making and experimental evaluation laboratory (DEMATEL) to manage the complex interrelationships between various aspects and attributes, and uses Interpretive Structure Modeling (ISM) to divide the hierarchy and construct a hierarchical theoretical framework. The results show that (1) the top-level design, the medical record management, and the doctor management are the root causes of system. (2) The specific application of blockchain in the field of smart healthcare is mainly carried out around the intelligent contract, which relies on the medical record management and is constrained by the system, and optimization of application is the key to system upgrading. (3) The internal and external regulation, the medical insurance, and the environmental governance play a guaranteed role for the development of the system and effectively safeguard the interests of stakeholders. (4) The application system of smart healthcare under the blockchain needs to be built based on three layers: the transaction layer, information layer, and stakeholder layer. The theoretical hierarchical framework is intended to guide smart healthcare towards blockchain applications, and stakeholders are suggested to participate in the development application systems.

Towards the Use of Blockchain in Mobile Health Services and Applications

With the advent of cryptocurrencies and blockchain, the growth and adaptation of cryptographic features and capabilities were quickly extended to new and underexplored areas, such as healthcare. Currently, blockchain is being implemented mainly as a mechanism to secure Electronic Health Records (EHRs). However, new studies have shown that this technology can be a powerful tool in empowering patients to control their own health data, as well for enabling a fool-proof health data history and establishing medical responsibility. Additionally, with the proliferation of mobile health (m-Health) sustained on service-oriented architectures, the adaptation of blockchain mechanisms into m-Health applications creates the possibility for a more decentralized and available healthcare service. Hence, this paper presents a review of the current security best practices for m-Health and the most used and widely known implementations of the blockchain protocol, including blockchain technologies in m-Health. The main goal of this comprehensive review is to further discuss and elaborate on identified open-issues and potential use cases regarding the uses of blockchain in this area. Finally, the paper presents the major findings, challenges and advantages on future blockchain implementations for m-Health services and applications.

A Privacy-Preserving Healthcare Framework Using Hyperledger Fabric

Electronic health record (EHR) management systems require the adoption of effective technologies when health information is being exchanged. Current management approaches often face risks that may expose medical record storage solutions to common security attack vectors. However, healthcare-oriented blockchain solutions can provide a decentralized, anonymous and secure EHR handling approach. This paper presents PREHEALTH, a privacy-preserving EHR management solution that uses distributed ledger technology and an Identity Mixer (Idemix). The paper describes a proof-of-concept implementation that uses the Hyperledger Fabric's permissioned blockchain framework. The proposed solution is able to store patient records effectively whilst providing anonymity and unlinkability. Experimental performance evaluation results demonstrate the scheme's efficiency and feasibility for real-world scale deployment.

Perspectives of Patients, Health Care Professionals, and Developers Toward Blockchain-Based Health Information Exchange: Qualitative Study

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.

Impact of Artificial Intelligence on Interventional Cardiology: From Decision-Making Aid to Advanced Interventional Procedure Assistance

Access to big data analyzed by supercomputers using advanced mathematical algorithms (i.e., deep machine learning) has allowed for enhancement of cognitive output (i.e., visual imaging interpretation) to previously unseen levels and promises to fundamentally change the practice of medicine. This field, known as "artificial intelligence" (AI), is making significant progress in areas such as automated clinical decision making, medical imaging analysis, and interventional procedures, and has the potential to dramatically influence the practice of interventional cardiology. The unique nature of interventional cardiology makes it an ideal target for the development of AI-based technologies designed to improve real-time clinical decision making, streamline workflow in the catheterization laboratory, and standardize catheter-based procedures through advanced robotics. This review provides an introduction to AI by highlighting its scope, potential applications, and limitations in interventional cardiology.

The Current State of Research, Challenges, and Future Research Directions of Blockchain Technology in Patient Care: Systematic Review

Background

Blockchain offers a promising new distributed technology to address the challenges of data standardization, system interoperability, security, privacy, and accessibility of medical records.

Objective

The purpose of this review is to assess the research on the use of blockchain technology for patient care and the associated challenges and to provide a research agenda for future research.

Methods

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We queried the Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, Excerpta Medica dataBASE (EMBASE), and Web of Science databases for peer-reviewed research articles published up to December 2019 that examined the implementation of blockchain technology in health care settings. We identified 800 articles from which we selected 70 empirical research articles for a detailed review.

Results

Blockchain-based patient care applications include medical information systems, personal health records, mobile health and telemedicine, data preservation systems and social networks, health information exchanges and remote monitoring systems, and medical research systems. These blockchain-based health care applications may improve patient engagement and empowerment, improve health care provider access to information, and enhance the use of health care information for medical research.

Conclusions

Blockchain health information technology (HIT) provides benefits such as ensuring data privacy and security of health data, facilitating interoperability of heterogeneous HIT systems, and improving the quality of health care outcomes. However, barriers to using blockchain technology to build HIT include security and privacy vulnerabilities, user resistance, high computing power requirements and implementation costs, inefficient consensus algorithms, and challenges of integrating blockchain with existing HIT. With 51% of the research focused on medical information systems such as electronic health record and electronic medical record, and 53% of the research focused on data security and privacy issues, this review shows that HIT research is primarily focused on the use of blockchain technologies to address the current challenges HIT faces. Although Blockchain presents significant potential for disrupting health care, most ideas are in their infancy.

Data Validation and Verification Using Blockchain in a Clinical Trial for Breast Cancer: Regulatory Sandbox

Background

The integrity of data in a clinical trial is essential, but the current data management process is too complex and highly labor-intensive. As a result, clinical trials are prone to consuming a lot of budget and time, and there is a risk for human-induced error and data falsification. Blockchain technology has the potential to address some of these challenges.

Objective

The aim of the study was to validate a system that enables the security of medical data in a clinical trial using blockchain technology.

Methods

We have developed a blockchain-based data management system for clinical trials and tested the system through a clinical trial for breast cancer. The project was conducted to demonstrate clinical data management using blockchain technology under the regulatory sandbox enabled by the Japanese Cabinet Office.

Results

We verified and validated the data in the clinical trial using the validation protocol and tested its resilience to data tampering. The robustness of the system was also proven by survival with zero downtime for clinical data registration during a Amazon Web Services disruption event in the Tokyo region on August 23, 2019.

Conclusions

We show that our system can improve clinical trial data management, enhance trust in the clinical research process, and ease regulator burden. The system will contribute to the sustainability of health care services through the optimization of cost for clinical trials.

Application of Blockchain Technology in Healthcare: A Comprehensive Study

Blockchain technology has been emerged in the last decade and has gained a lot of interests from several sectors such as finance, government, energy, health, etc. This paper gives a broad ranging survey of the application of blockchain in healthcare domain. In fact, the ongoing research in this area is evolving rapidly. Therefore, we have identified several use cases in the state of art applying the blockchain technology, for instance for sharing electronic medical records, for remote patient monitoring, for drug supply chain, etc. We have focused also on identifying limitations of studied approaches and finally we have discussed some open research issues and the areas of future research.

Dwarna: a blockchain solution for dynamic consent in biobanking

Dynamic consent aims to empower research partners and facilitate active participation in the research process. Used within the context of biobanking, it gives individuals access to information and control to determine how and where their biospecimens and data should be used. We present Dwarna-a web portal for 'dynamic consent' that acts as a hub connecting the different stakeholders of the Malta Biobank: biobank managers, researchers, research partners, and the general public. The portal stores research partners' consent in a blockchain to create an immutable audit trail of research partners' consent changes. Dwarna's structure also presents a solution to the European Union's General Data Protection Regulation's right to erasure-a right that is seemingly incompatible with the blockchain model. Dwarna's transparent structure increases trustworthiness in the biobanking process by giving research partners more control over which research studies they participate in, by facilitating the withdrawal of consent and by making it possible to request that the biospecimen and associated data are destroyed.

Examining the Potential of Blockchain Technology to Meet the Needs of 21st-Century Japanese Health Care: Viewpoint on Use Cases and Policy

Japan is undergoing a major population health transition as its society ages, and it continues to experience low birth rates. An aging Japan will bring new challenges to its public health system, highlighted as a model for universal health coverage (UHC) around the world. Specific challenges Japan’s health care system will face include an increase in national public health expenditures, higher demand for health care services, acute need for elder and long-term care, shortage of health care workers, and disparities between health care access in rural versus urban areas. Blockchain technology has the potential to address some of these challenges, but only if a health blockchain is conceptualized, designed, localized, and deployed in a way that is compatible with Japan’s centralized UHC-centric public health system. Blockchain solutions must also be adaptive to opportunities and barriers unique to Japan’s national health and innovation policy, including its regulatory sandbox system, while also seeking to learn from blockchain adoption in the private sector and in other countries. This viewpoint outlines the major opportunities and potential challenges to blockchain adoption for the future of Japan’s health care.

A Blockchain-Based Smart Contract System for Healthcare Management

Blockchain is evolving to be a secure and reliable platform for secure data sharing in application areas such as the financial sector, supply chain management, food industry, energy sector, internet of things and healthcare. In this paper, we review existing literature and applications available for the healthcare system using blockchain technology. Besides, this work also proposes multiple workflows involved in the healthcare ecosystem using blockchain technology for better data management. Different medical workflows have been designed and implemented using the ethereum blockchain platform which involves complex medical procedures like surgery and clinical trials. This also includes accessing and managing a large amount of medical data. Within the implementation of the workflows of the medical smart contract system for healthcare management, the associated cost has been estimated for this system in terms of a feasibility study which has been comprehensively presented in this paper. This work would facilitate multiple stakeholders who are involved within the medical system to deliver better healthcare services and optimize cost.