Advancing Healthcare Security: A Cutting-Edge Zero-Trust Blockchain Solution for Protecting Electronic Health Records

The effective management of electronic health records (EHRs) is vital in healthcare. However, traditional systems often need help handling data inconsistently, providing limited access, and coordinating poorly across facilities. This study aims to tackle these issues using blockchain technology to improve EHR systems' data security, privacy, and interoperability. By thoroughly analyzing blockchain's applications in healthcare, we propose an innovative solution that leverages blockchain's decentralized and immutable nature, combined with advanced encryption techniques such as the Advanced Encryption Standard and Zero Knowledge Proof Protocol, to fortify EHR systems. Our research demonstrates that blockchain can effectively overcome significant EHR challenges, including fragmented data and interoperability problems, by facilitating secure and transparent data exchange, leading to enhanced coordination, care quality, and cost-efficiency across healthcare facilities. This study offers practical guidelines for implementing blockchain technology in healthcare, emphasizing a balanced approach to interoperability, privacy, and security. It represents a significant advancement over traditional EHR systems, boosting security and affording patients greater control over their health records. Doi: 10.28991/HIJ-2023-04-03-012 Full Text: PD

Implementing Blockchain in Public Sectors in MENA Countries: Opportunities and Challenges

Governments all around the world are expanding their study and use of Blockchain technology Blockchains have the potential to improve many aspects of the public sector.  This research discusses opportunities and challenges in using blockchain in the public sectors of MENA countries.  Their public sectors may use it to safeguard sensitive documents and streamline interactions with residents and solve record-keeping challenges and improve the capabilities of the present public systems.  Instability and corruption have weakened public and market trust in MENA countries. Moreover, public data in the region is housed in a disjointed bureau and division. The process of acquiring and transferring assets, whether physical goods or financial instruments, often entails multiple transactions and a long paper trail. We argued that as blockchain needs a minimal digital trace, integrity, and immutability, it is particularly fit for the public sectors in the MENA region. A blockchain would keep detailed records of the exchanged assets as well as every step of the transaction.  All important information about each person or corporation would be maintained in a separate ledger inside an encrypted blockchain. However, the lack of expertise and experience among the government employees, and the lack of real use cases around the world are the main barriers to implementing blockchain technology in the public sector of MENA countries

Trade-offs between Distributed Ledger Technology Characteristics

When developing peer-to-peer applications on distributed ledger technology (DLT), a crucial decision is the selection of a suitable DLT design (e.g., Ethereum), because it is hard to change the underlying DLT design post hoc. To facilitate the selection of suitable DLT designs, we review DLT characteristics and identify trade-offs between them. Furthermore, we assess how DLT designs account for these trade-offs and we develop archetypes for DLT designs that cater to specific requirements of applications on DLT. The main purpose of our article is to introduce scientific and practical audiences to the intricacies of DLT designs and to support development of viable applications on DLT

Mind the Gap: Trade-Offs between Distributed Ledger Technology Characteristics

When developing peer-to-peer applications on Distributed Ledger Technology (DLT), a crucial decision is the selection of a suitable DLT design (e.g., Ethereum) because it is hard to change the underlying DLT design post hoc. To facilitate the selection of suitable DLT designs, we review DLT characteristics and identify trade-offs between them. Furthermore, we assess how DLT designs account for these trade-offs and we develop archetypes for DLT designs that cater to specific quality requirements. The main purpose of our article is to introduce scientific and practical audiences to the intricacies of DLT designs and to support development of viable applications on DLT

DBKnot: A Transparent and Seamless, Pluggable Tamper Evident Database

Database integrity is crucial to organizations that rely on databases of important data. They suffer from the vulnerability to internal fraud. Database tampering by internal malicious employees with high technical authorization to their infrastructure or even compromised by externals is one of the important attack vectors. This thesis addresses such challenge in a class of problems where data is appended only and is immutable. Examples of operations where data does not change is a) financial institutions (banks, accounting systems, stock market, etc., b) registries and notary systems where important data is kept but is never subject to change, and c) system logs that must be kept intact for performance and forensic inspection if needed. The target of the approach is implementation seamlessness with little-or-no changes required in existing systems. Transaction tracking for tamper detection is done by utilizing a common hashtable that serially and cumulatively hashes transactions together while using an external time-stamper and signer to sign such linkages together. This allows transactions to be tracked without any of the organizations’ data leaving their premises and going to any third-party which also reduces the performance impact of tracking. This is done so by adding a tracking layer and embedding it inside the data workflow while keeping it as un-invasive as possible. DBKnot implements such features a) natively into databases, or b) embedded inside Object Relational Mapping (ORM) frameworks, and finally c) outlines a direction of implementing it as a stand-alone microservice reverse-proxy. A prototype ORM and database layer has been developed and tested for seamlessness of integration and ease of use. Additionally, different models of optimization by implementing pipelining parallelism in the hashing/signing process have been tested in order to check their impact on performance. Stock-market information was used for experimentation with DBKnot and the initial results gave a slightly less than 100% increase in transaction time by using the most basic, sequential, and synchronous version of DBKnot. Signing and hashing overhead does not show significant increase per record with the increased amount of data. A number of different alternate optimizations were done to the design that via testing have resulted in significant increase in performance

Secure Information Sharing with Distributed Ledgers

In 2009, blockchain technology was first introduced as the supporting database technology for digital currencies. Since then, more advanced derivations of the technology have been developed under the broader term Distributed Ledgers, with improved scalability and support for general-purpose application logic. As a distributed database, they are able to support interorganizational information sharing while assuring desirable information security attributes like non-repudiation, auditability and transparency. Based on these characteristics, researchers and practitioners alike have begun to identify a plethora of disruptive use cases for Distributed Ledgers in existing application domains. While these use cases are promising significant efficiency improvements and cost reductions, practical adoption has been slow in the past years. This dissertation focuses on improving three aspects contributing to slow adoption. First, it attempts to identify application areas and substantiated use cases where Distributed Ledgers can considerably advance the security of information sharing. Second, it considers the security aspects of the technology itself, identifying threats to practical applications and detection approaches for these threats. And third, it investigates success factors for successful interorganizational collaborations using Distributed Ledgers

Experiência Profissionalizante na vertente de Farmácia Comunitária e Investigação

O presente relatório para a obtenção do grau de mestre em Ciências Farmacêuticas é constituído por dois capítulos e encontra-se inserido na Unidade Curricular Estágio. O primeiro capítulo, refere-se à componente de Investigação, consiste numa revisão bibliográfica sobre a aplicação da tecnologia blockchain como meio de atingir a interoperabilidade de registos clínicos em saúde. O segundo capítulo corresponde ao relatório do estágio curricular em farmácia comunitária realizado na Farmácia Sena Padez no Fundão, sob orientação da Dra. Teresa Padez. A digitalização dos registos clínicos traduziu-se numa grande evolução para os cuidados de saúde, as instituições e a sociedade em geral. No entanto, a parca capacidade das instituições de saúde de comunicarem entre si e partilharem os registos clínicos eletrónicos (EHR), é um entrave à formulação de sistemas de informação robustos que assistam os profissionais de saúde na prática clínica diária. Neste trabalho introduzimos o problema da interoperabilidade e o estado da arte nesta matéria, desde o surgimento dos EHR e dos standards para facilitarem a sua partilha, até ao ecossistema de saúde digital que vigora em Portugal. Numa segunda fase deste estudo procurámos perceber de que forma a tecnologia blockhain poderá facilitar a transição para ambientes interoperáveis em saúde, de forma segura, robusta e confiável. Abordamos ainda aplicações adicionais da tecnologia, como a integração com a Internet of Things e a Inteligência Artificial e a gestão de cadeias de abastecimento farmacêuticas. Concluímos que no seu estado atual de desenvolvimento ainda há desafios que devem ser resolvidos, como a escalabilidade, o mecanismo de consenso que gere a rede e qual deve ser o tipo de dados a armazenar na blockchain. Assim, não é possível afirmar de forma categórica que a blockchain é uma solução absoluta para o problema da interoperabilidade. O segundo capítulo descreve o estágio curricular realizado entre 21 de janeiro de 2019 e 31 de maio de 2019, com um total de 800 horas. Este capítulo pretende expor a realidade quotidiana do farmacêutico de comunidade, as suas funções enquanto especialista do medicamento e as vicissitudes da farmácia comunitária. No decorrer do estágio em farmácia comunitária foi fácil constatar que os farmacêuticos, dispõem de poucas informações clínicas dos utentes, o que muitas vezes limita a sua intervenção na prestação de cuidados de saúde de qualidade.This report for obtaining the master’s degree in Pharmaceutical Sciences consists of two chapters and is included in the “Estágio” (Internship) Curricular Unit. The first chapter, which refers to the Research component, consists of a literature review on the application of blockchain technology as a mean to achieve interoperability in clinical health records. The second chapter refers to the report of the curricular internship in community pharmacy held at Farmácia Sena Padez in Fundão, under the supervision of Dr. Teresa Padez. The digitization of clinical records turned out to be a major evolution for healthcare, institutions and society at large. However, the poor capacity of health institutions to communicate with each other and share electronic clinical records (EHR) is a barrier to the formulation of robust information systems that assist health professionals in daily clinical practice. In this report we introduce the interoperability problem and the state of the art in this field, from the emergence of EHR and standards to facilitate their sharing, to the digital health ecosystem that exists in Portugal. In the second phase of this study we sought to understand how the blockhain technology can facilitate the transition to interoperable, safe, robust and reliable healthcare environments. We also address additional applications of this technology, such as the integration with the Internet of Things and Artificial Intelligence, and pharmaceutical supply chain management. We conclude that in its current state of development, there are still challenges that need to be addressed, such as scalability, the consensus engine that manages the network, and what type of data to store in the blockchain. Thus, it cannot be categorically stated that blockchain is an absolute solution to the interoperability problem. The second chapter describes the community pharmacy curricular internship, developed between January 21st, 2019 and May 31st, 2019, with a total of 800 hours. This chapter aims to expose the daily reality of the community pharmacist, his duties as a healthcare professional and the vicissitudes of the community pharmacy. During the internship in community pharmacy it was easy to see that pharmacists have little clinical information from users, which often limits their intervention in providing quality health care