Applying blockchain technology to aspects of electronic health records in South Africa: lessons learnt

The purpose of this study was to explore the applicability of blockchain technology as a viable alternative for the secure storage and distribution of electronic health records in a South African context. The adoption of electronic health records (EHRs) has grown over recent years. Electronic health records (EHRs) can be seen as electronic versions of patients’ medical history. EHRs promise benefits such as improving the quality of care, reducing medical errors, reducing costs, saving time, and enhancing the availability and sharing of medical records. Blockchain, in simple terms, could be seen as a distributed database controlled by a group of individuals. Blockchain technology differs from other distributed ledger technology by bundling unrelated data into blocks that are chained together in a linked-list manner, hence the name blockchain. Blockchain technology strives to provide desirable features, such as decentralization, immutability, audibility, and transparency. EHRs are traditionally constructed with a cloud-based infrastructure to promote the storing and distribution of medical records. These medical records are commonly stored in a centralized architecture, such as a relational database. The centralized architecture employed by EHRs may present a single point of failure. These kinds of failures may lead to data-breaches. The cloud-based infrastructure is effective and efficient from an availability standpoint. The increased availability of electronic health records has brought forth challenges related to the security and privacy of the patient’s medical records. The sensitive nature of EHRs attracts the attention of cyber-criminals. There has been a rise in the number of data breaches related to electronic health records. The traditional infrastructure used by electronic health records can no longer ensure the privacy and security of patient’s medical records. To determine whether blockchain is a viable alternative to these approaches, the main objective of this study was to compile a technical report on the applicability of aspects of blockchain technology to the secure storage and distribution of electronic health records. The study first conducted a literature review to gather background on the current state of electronic health records and blockchain technology. The results of the literature review were used to compile an initial report. Experiments were conducted with various aspects of blockchain technology to build a technical baseline and to ultimately validate the initial report. The insights gained from the experiments served to refine the initial report into a final technical report. The final deliverable of this study was to devise a technical report. The technical report serves as a generalized overview of the applicability of blockchain technology as a secure storage and distribution mechanism for electronic health records. The main topics covered by the technical report to outline the applicability of blockchain technology to EHRs are as follows: authentication, authorization, audit log, storage and transactions. The insights gained from the study illustrate that permissioned blockchain technology can enhance the traditional AAA security scheme employed by traditional EHRs. The AAA security scheme entails the use of certificate-based authentication and attributebased access control for authorization. Audit logs can be stored in a semi-decentralized architecture that can enhance the security and privacy of audit logs. Using blockchain technology for storing electronic health records might not be a viable alternative to traditional EHRs architecture. Blockchain technology violates certain privacy regulations as information is stored in a permanent manner. Furthermore, blockchain technology is not optimized for dealing with large volumes of data. However, blockchain technology could be used to store a cryptographic hash of electronic health records to ensure the integrity of records. Permissioned blockchain technology can enhance the EHRs transaction process by transacting health records in a peer-to-peer infrastructure. In doing so, the above-mentioned AAA security scheme can enhance the security, confidentiality, and integrity of electronic health records shared across organizational bounds

A privacy preserving online learning framework for medical diagnosis applications

Electronic Health records are an important part of a digital healthcare system. Due to their significance, electronic health records have become a major target for hackers, and hospitals/clinics prefer to keep the records at local sites protected by adequate security measures. This introduces challenges in sharing health records. Sharing health records however, is critical in building an accurate online diagnosis framework. Most local sites have small data sets, and machine learning models developed locally based on small data sets, do not have knowledge about other data sets and learning models used at other sites. The work in this thesis utilizes the framework of coordinating the blockchain technology and online training mechanism in order to address the concerns of privacy and security in a methodical manner. Specifically, it integrates online learning with a permissioned blockchain network, using transaction metadata to broadcast a part of models while keeping patient health information private. This framework can treat different types of machine learning models using the same distributed dataset. The study also outlines the advantages and drawbacks of using blockchain technology to tackle the privacy-preserving predictive modeling problem and to improve interoperability amongst institutions. This study implements the proposed solutions for skin cancer diagnosis as a representative case and shows promising results in preserving security and providing high detection accuracy. The experimentation was done on ISIC dataset, and the results were 98.57, 99.13, 99.17 and 97,18 in terms of precision, accuracy, F1-score and recall, respectively

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

The Cost- Saving Role of Blockchain Technology As a Data Integrity Tool: E-health Scenario

The digital economy of health and its global proliferation have led to the use of health information systems in the daily health services delivery to patients. Consequently, there is a development of web-based electronic healthcare aimed at providing electronic health services in real-time. In this way,  through the implementation of  the concept of electronic health, there is an exchange of health information among all stakeholders of the health organization, all with the aim of monitoring the health status of patients, timely intervention and adequate allocation of medical resources. Processing and sharing a large amount of health data in real time, with the constant need to maintain a high level of interoperability and scalability of network infrastructure, requires the highest possible level of security in accessing data, in order to reduce the misuse of health data. By using blockchain technology, the risk of misusing health information, asymmetry of information and the risk of increasing transaction costs are reduced in a very short time. Blockchain is a robust mathematical algorithm that can provide maximum security of the transaction using cryptographic methods. This type of technology is based on a distributed database that contains encrypted data that can not be changed or disturbed. For this reason, the application of this technology as a data integration tool is increasingly reflected in the electronic business of health organizations - electronic healthcare. Blockchain technology is especially used in information-intensive electronic healthcare records and medical applications, which ultimately results in reduced costs of providing health services, especially when it comes to system maintenance and security costs, interoperability and data redundancy. According to above-mentioned cost-saving role of blockchain technology in processing, sharing and analyzing healthcare data, in this paper, there will be more to say about the positive economic impact of blockchain technology on electronic healthcare, especially in the case of Estonia. This European country is a pioneer in creating, implementing and using the e-Health concept as an integral part of health information system through its healthcare system, in order to increase efficiency of healthcare services. Keywords: Blockchain technology, data integrity, e-Health, health economic

Secure Decentralized Blockchain Based Web Application for Medical Records

The online storage and sharing of electronic health records has undergone a paradigm shift in recent years. The introduction of a centralized cloud computing concept to streamline records transfer between patients and healthcare providers has been an easy task. As a result, the availability of electronically stored health records with minimal operational costs is made possible, but the primary concern is related to the privacy and security of records. How can we securely exchange medical documents online while maintaining strong security standards? This research suggests a framework that fuses online federated learning with blockchain technology. In particular, we develop a reliable access control system using smart contracts to provide secure Health records sharing between various patients and healthcare professionals. Over a web 3.0-based website, we demonstrate a blockchain implementation prototype in a real-world data-sharing scenario. Our suggestion offers a practical defense against potential dangers for trustworthy data exchanges of sensitive health information. Moreover, compared to existing models, this approach provides the highest level of protection for sharing medical records