2023 International Conference on Intelligent Data Communication Technologies and Internet of Things (IDCIoT) | 978-1-6654-7451-1/23/$31.00 ©2023 IEEE | DOI: 10.1109/IDCIoT56793.2023.10053491
Proceedings of the International Conference on Intelligent Data Communication Technologies and Internet of Things (IDCIoT 2023)
IEEE Xplore Part Number: CFP23CV1-ART; ISBN: 978-1-6654-7451-1
A Secure Design of Healthcare System with
Blockchain and Internet of Things (IoT)
Shivam Pandey
Department of ITCA
Madan Mohan Malaviya
University of Technology
Gorakhpur, India
shivamvns111@gmail.com
Vanshika
Department of ITCA
Madan Mohan Malaviya
University of Technology
Gorakhpur, India
kvanshika0511@gmail.com
Abstract— Health is one of the most important aspects of
human life. For a healthy society, the healthcare sector must be
reliable and efficient as much as possible. Blockchain networks
can be used to provide innovative solutions to store and share
patient data among hospitals, pharmaceutical companies,
diagnostic labs, and physicians. Blockchain applications are
capable of building trust and detecting fatal errors in the
sharing of data. So blockchain can help in the security,
effectiveness, and transparency of sharing medical data in the
healthcare industry. Using this technology, medical institutions
can get quality and trustworthy knowledge which they can use
to improve the analysis of patient data and help in the good
diagnosis of health issues. A thorough study and analysis have
been done to explore the opportunities that blockchain
technology can provide to improve the healthcare industry. The
various characteristics, methods, and smooth workflow
processes of blockchain technology are discussed in diagrams as
a potential means of improving global healthcare. The article
concludes by listing and analyzing various significant
blockchain applications for the healthcare industry. It can help
in implementing the smart contract, nonce concepts, and P2P
distributed ledgers which ensure the immutability of the shared
data. The methods discussed in this paper improve the security
of Electronic Health Records (EHRs). The data of patients are
taken directly via IoT devices which are used as medical
instruments for patients which increases the reliability of data
as there is no human interference in between hence human error
is eliminated. The proposed technique implementation results
show that the security of data has increased and it is more
efficient.
Keywords—Blockchain, Electronic Health Records (EHRs),
Smart Contract, Peer to Peer(P2P) distributed ledger, Consensus,
Immutable, Throughput, Internet of Things (IoT), Proof of Work
(PoW), Proof of State (PoS), Proof of Authority (PoA), Hyper
(HER) Ledger.
I. INTRODUCTION
The three primary parts of the healthcare system are as
follows: I The primary providers of healthcare services, for
instance, medical staff such as administrators, nurses,
technicians, and doctors(ii) Emergency assistance (iii)
Patients who are concerned about their own health and the
health of others. To manage the data with high security and
trust in these systems an efficient model is required. The
existing models are not feasible as it is not being accepted in
the healthcare system. The cost of development and
maintenance is very high. It holds a negative image due to
security breaches in the famous bitcoin blockchain network.
It will take a lot of time and money to shift the existing data
into a blockchain network.
Anshul
Department of ITCA
Madan Mohan Malaviya
University of Technology
Gorakhpur, India
anshulkatiyar0011@gmail.com
Rajendra Kumar Dwivedi
Department of ITCA
Madan Mohan Malaviya
University of Technology
Gorakhpur, India
rajendra.gkp@gmail.com
A. Motivation
Security and privacy violations of the EHRs had increased
tremendously in past years. There were more than 300
confirmed breaches in 2017, and between 2010 and 2017, up
to 37 million records may have been impacted [1]. The
expanding digitization of healthcare has enhanced the
understanding of concerns around ownership, secure storage,
and access to patient medical records. The safe sharing of
medical records and compliance with data protection laws are
two important issues in healthcare that are urged to be
handled via blockchain [2].
A network of trusted individuals or nodes could manage
the blockchain, a particular type of database. It preserves
blocks of unchanging information that are firmly tradable and
unaffected by outside forces. Data is stored and registered
using consensus techniques and cryptographic signatures,
which play a crucial role in their implementation as enablers.
The utilization of smart contracts in the financial industries
and real estate was the focus of the second phase of
blockchain development, which followed the previous
phase's emphasis on cryptocurrencies. The third evolution
stage focused on using blockchain in fields other than
finance, like digital arts and healthcare [3].
B. Contribution
This paper is intended to enhance blockchain technology
used in the healthcare industry since it can address critical
problems like public health management and automated
claim authentication. The existing issues with data ownership
and sharing can be resolved by allowing patients to maintain
control of their private data and they can decide with whom
it can be shared. Simultaneously, it enables appropriate
authorities to use consensus protocols to integrate, modify,
distribute, and retrieve recorded material in a timely manner
. This is a crucial advantage of implementing this technology
in the healthcare system because current practices require
external companies to keep the data. Finally, blockchain has
the potential to increase responsibility for data management
procedures due to the possibility of human mistakes, which
would further reduce the risks of improper treatment or use
of recorded data.
According to the latest research, while organizations will
result in significant investments in blockchain-based
technology in the future because of a widely held belief that
the benefits may be overstated, they will probably choose a
circumspect, practical strategy. This technology hasn't quite
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Proceedings of the International Conference on Intelligent Data Communication Technologies and Internet of Things (IDCIoT 2023)
IEEE Xplore Part Number: CFP23CV1-ART; ISBN: 978-1-6654-7451-1
lived up to expectations, which may be a result of
blockchain's widespread adoption, particularly in terms of
regulatory restrictions and other difficulties. This could be
exacerbated by a widespread misunderstanding about
utilizing blockchain in government regulations and legal
action. This paper study emphasizes focusing on overcoming
these barriers to support blockchain operational growth and
accelerate its adoption.Figure 1 provides a brief overview of
the overall model which is proposed in this paper.
Fig. 1. Blockchain System in Healthcare
C. Organization
This paper gives readers a useful summary of current
research projects, knowledge gaps, and potential future
research areas. This research makes two contributions. It first
contributes to the expanding body of literature on blockchain
in healthcare. It does two things: first, it offers a
sophisticated, thematically organized classification of earlier
literature in terms of their implementation areas, constraints,
and recommendations. Second, relying on the SLR results,
this paper proposed a model which increased the efficiency
in comparison to previous models. Finally, a brief discussion
has been done on potential areas that need scholarly research
in order to further upgrade the body of literature.
II. TYPES OF BLOCKCHAIN
There are different types of blockchain models are
available: Public Blockchain, Hybrid Blockchain, Private
Blockchain,
Consortium
Blockchain,
Permissioned
Blockchain, and Decentralized application some of these are
discussed in detail [6].
A. Public Blockchain
In this network of blockchain anyone who is authorized
can participate. It also holds the property of immutability and
distributed ledger. Anyone who has access to this network
can write, read and participate in the blockchain. The
individuals who are part of this blockchain can see all the
transactions [4]. Every node has the capability to prove a
transaction by performing some mathematical calculation on
it. Whenever a transaction is proved by a node then it is
immediately added to the blockchain and becomes part of the
network. The data which is posted on the network cannot be
tempered.
B. Private Blockchain
In private blockchain a network administrator manages
the network and participants require consent to join the
network. It is developed on cryptographic principles and it is
closed in nature. It can only be accessed when permission is
granted by the administrator. Some of the characteristics of
private blockchain are complete privacy, fast transactions,
highly efficient, and scalable. In this blockchain read and
write is done upon invitation and network users are known to
each other.
C. Hybrid Blockchain
A hybrid blockchain is formed when a private blockchain
and a public blockchain are combined. This permits the
creation of networks that rely on both private and public
consensus by fusing the advantages of the two different types
of blockchains. Users may check who has the authority to
access the data in such a decentralized network [7],[8]. Some
data in blockchain can be made public while keeping the rest
of the data secret on private network. Since blockchain hybrid
network is versatile, users can access various public as well
as private blockchains. This has the potential to provide profit
to governments and companies which have strict regulations
and with this company can not only interact with its
stakeholders but it is also the best possible way by combining
the best features of both public and private blockchain. The
complete access to the network is given to the people that join
the hybrid blockchain [16]. The identity of an individual is
kept private unless they engage in business with other users.
After that only, the identity is informed to the opposite party.
D. Consortium Blockchain
It is a semi-decentralized model in which multiple private
blockchains belonging to different enterprises operate
together, each of which forms a node on the chain as a
stakeholder. Anyone can only leave or join the network with
the permission of another stakeholder. It is formed to
facilitate partnerships in complementary blockchains.
E. Permissioned Blockchain
In order to participate in the verification of transactions or
to access network data, a centralized regulator’s approval is
required. This is advantageous for companies helping
finances and government organizations that are confidently
adhering to most laws and are well aware of the need to
maintain tight record monitoring [17]. Since they maintain an
authentication layer that limits the ability of certain acts to be
performed only by certain identifiable parties involved,
permission blockchains may be seen as an improved
blockchain protection mechanism. Both the private and
public blockchains operate very differently from
permissioned blockchains.
It is designed to take advantage of blockchain technology
without eroding the authority of a centralized system. Ripple
is a prime illustration of a permissioned blockchain.
F. Decentralized Blockchain
In the blockchain, decentralization is the process in which
the network is used by many nodes which are unknown to
each other instead of some particular person or institute. A
decision cannot be taken by any individual. For any important
decision, there must be a majority of people agree to it i.e.,
51%. [5] A decentralized network is a process that is mainly
created to reduce the problem of trust among individuals.
This process is mainly system driven instead of emotiondriven. This will enhance democracy in the network and
discourage the monopoly of any individual.
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Proceedings of the International Conference on Intelligent Data Communication Technologies and Internet of Things (IDCIoT 2023)
IEEE Xplore Part Number: CFP23CV1-ART; ISBN: 978-1-6654-7451-1
There are mainly three ways for a network to work as a
system distributed, centralized, and decentralized.
Blockchain is mainly focused on a decentralized network and
increases the power of the system which will result in
reducing the interference of any particular person’s idea or
hidden motive. Decentralized networks are implemented at
different levels of the network which enhances its
authenticity and security more than any other technology
present in history. The frequent use of decentralization may
have certain limitations which result in a reduction in the
number of transactions in exchange for good service and
security.
III. LITERATURE REVIEW
This section provides readers with detailed knowledge of
this field's research through a comprehensive and wellorganized summary that follows accepted procedures. SLR
assists in identifying available information shortages and help
in identifying potential research directions.
The study of Dhir et al. aims to present a systematic
literature review (SLR) of research on blockchain
applications in the healthcare domain [9]. The SLR findings
show that blockchain is being utilized to provide unique
solutions to increase the bar for how medical data and
individual health records are handled, shared, and processed
currently. For Research the SLR was performed on four wellregarded digital databases which follow specific protocols to
identify appropriate tract or columns and the findings were
used to encapsulate learning on blockchain applications in
individual sectors of healthcare [10], [11].
as well as experimenting with novel constructs and elements
in algorithmic architectures. For more efficient frameworks,
previously used attribute-based cryptosystems, approaches,
sibling intractable functions, the Stackelberg game, and
homomorphic computations are examples.
Intelligent healthcare ecosystems are springing up. Some
researchers focus their efforts on combining blockchain
platforms to introduce healthcare ecosystems. The
continuous development of better models results in making
more and more intelligent healthcare systems day by day. For
example, Vara and Corchado argue that blockchain adoption
can help to create an optimized e-health ecosystem.
Figure 2 proposed a flowchart for keeping records of
patients using blockchain as an intermediary for the secure
and verified keeping of data. Hyper ledger used for the
process provides the functionality of private, permissioned,
smart contract, consensus mechanism. The introduction of
the blockchain network provides trust in the user of the data.
The chances of error or wrong data are reduced drastically
and the user can be confident about the authenticity of it
because of the transmission of data directly from medical
equipment to the blockchain network. This data can be
fearlessly used by pharma companies for developing better
drugs, doctors can recommend better treatment and the
overall healthcare system efficiency increased. This will
result in better health for general people.
The study of Pratap Singh et al. finds benefits in
healthcare from blockchain technology, various Capabilities,
Enablers, and Unified Work-Flow Processes of Blockchain
Technology to support healthcare globally are discussed
diagrammatically and results in finding fourteen important
applications [12]. Those applications help to gain people's
trust in blockchain and encourage the monetization of health
data, boost interoperability across healthcare organizations,
increase the safety of patients' electronic medical records, and
aid in the development of anti-counterfeit drug technologies.
Tandon et al focus on obtaining descriptive records for the
number of articles produced annually, the place of publishing,
and the typical number of citations for research papers that
are made annually. For the purpose of conducting this SLR,
the paper is written by looking at surveys, systematic reviews
(SR), systematic literature reviews (SLR), and research
articles on blockchain in healthcare and published in the field
of blockchain from 2010 to 2019 [13], [14]. Peer-reviewed
literature was viewed to determine the current scenario of
research on blockchain applications in healthcare. A large
rise in the number of annual publications and the average
number of citations for the chosen studies implies that there
has been a recent rise in academic interest in this area. It was
found that the writers of the articles under evaluation were
connected to institutions in 17 different nations [15].
IV. PROPOSED MODEL
Concept development: According to the findings of the
review, the notable focus has been devoted to developing new
methods and proofs, such as proof of familiarity, proof of
primitiveness of data, and simplified evaluation for proof of
work. Furthermore, research has concentrated on improving
the framework that allows blockchain execution on inclusion,
Fig.2. Keeping records of patients
Technical advancements in blockchain technology in
healthcare: The researchers have been continuously
improving the performance of developed systems through
technical advances such as reducing transaction propagation
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Proceedings of the International Conference on Intelligent Data Communication Technologies and Internet of Things (IDCIoT 2023)
IEEE Xplore Part Number: CFP23CV1-ART; ISBN: 978-1-6654-7451-1
delay by using smaller data block sizes. The proposed model
in this paper also addresses the issues that have been
previously identified as potential barriers to the effective
evolution of blockchain technology in healthcare. Some of
the issues addressed include storage loads, memory and CPU
requirements, temperature, and reliable node identification.
Data management: On thorough research of past
literature, we believe that the handling of data and medical
records received the most scholarly attention in this field.
Prior research has suggested that blockchain can be used to
manage medical data effectively. The model shown in (figure
2) has improved the data management even more and
efficiency of overall system can be improved by
implementing the hybrid blockchain and consensus protocol.
Previous research has focused on the need to ensure ethical
processing and legal ethical. To some extent, healthcare data
is processed, shared, and handled. According to our review,
few studies have recognized the need for regulatory
compliance or even the compliance requirements' standards
and goals. However, much emphasis has been placed on the
significance of maintaining data integrity.
Prior studies have addressed issues such as authentic data
leakage prevention, data mobilization, and double storage
costs (Rahmadika & Rhee, 2019). Scholars have focused on
the issue of preserving and storing sensitive data from various
sources, such as medical devices, as inter-institutional
adoption of blockchain has increased, and medical insurance.
Furthermore, review of past research papers has identified the
need for more efficient data processing. Some methods for
inducing these improvements were proposed model in
(Figure 4) such as effective integration of various data from
many sources and incorporation of smart contracts.
Data security: The proposed model improves the security
of data because the data management aspects of blockchain
has been ensuring authorized access to medical records by
placing a strong significance on various protocols on
maintaining data privacy.
Enhancement of efficiency: Previous studies in the
existing research papers have been concentrated on
understanding how blockchain adoption can effectively and
efficiently improve the performance of healthcare processes.
Scholars' attention has been drawn to two aspects of
efficiency improvement, according to this review: processes
and systems.
A.
Fig.3 Patient Enrolments
B. Patient Monitoring and updating records
Methodology for Patient Enrolments
The registration has been now done using consensus
protocols and smart contracts whenever a new patient arrives
in hospital. All the data which are created during the
treatment whether it is prescription of medicines or tests
reports has been saved and encrypted on blockchain network.
This will allow that if a patient is referred to some other
hospital, then that hospital does not need to perform same
tests again and a lot of time is saved. Figure 3 represents the
step-by-step process for registration. This method keeps the
data of the patient linked to its registration card which can be
only accessed by authorized personnel. All the data stored are
authentic because of the initial check in the methodology and
can be fully trusted by the doctors and medical staff.
After enrolment it is necessary to continuous monitoring
and updating of EHRs of patients it is done to ensure that all
the details are kept intact and in line with the current situation
of health. The doctors can continuously monitor from
anywhere the situation of patient and due to blockchain
network technology it is entrusted to be true all the time.
Figure 4 gives a step-by-step method for continuous updating
of records while patient is within the premises of hospital. IoT
integrated with smart contracts and blockchain networks can
be used for the continuous monitoring of patient health
outside the hospital. If any serious issue arises while patient
is discharged an alert message is sent to concern doctor and
medical staffs associated to the health of patient. This
integration of IoT and blockchain enhanced the capabilities
of each other and the whole system more efficient.
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Proceedings of the International Conference on Intelligent Data Communication Technologies and Internet of Things (IDCIoT 2023)
IEEE Xplore Part Number: CFP23CV1-ART; ISBN: 978-1-6654-7451-1
healthcare-related industries have embraced blockchain
technology most effectively. This sought to comprehend the
context of blockchain application, and the response outlined
particular sub-themes and themes that reflected the main
applications of blockchain in the medical field.
Fig. 5 Computational Time (in ms) vs EHRs Size onDifferent
Consensus Protocols (in million)
In figure 5, after analyzing and plotting a graph on
computational time with respect to EHR’s size on different
consensus protocols, it outperforms as compared to previous
models which were given on a consensus protocol. The
performance is measured on multiple records of patients by
putting their records on consensus protocols.
Fig.4 Patient Monitoring and updating records
Due to the involvement of blockchain data is now
decentralized and cannot be attacked by hackers and this will
fix the issue of sensitive data leakage problem.
V. PERFORMANCE EVALUATION
To better comprehend blockchain's present situation and
future possibilities, the current study carried out a thorough
analysis of the literature on its uses in healthcare. The
responsibility of summarizing the leading authors,
publishers, publishing companies, and styles of publication
trends in this field were handed to current research findings
regarding healthcare applications of blockchain.
A. Tools and Techniques
Recent tools and technologies have been used for
performance evaluation of designed methodology. The
evaluation is carried out on i9 processor of 11 th generation
and solidity is used for programming.
B. Results and Discussion
Fig. 6 Throughput vs No. of Users on Different ConsensusProtocols
After plotting a graph of throughput with respect to
number of different consensus protocols, it yields much better
results as compared to other models that have been previously
discussed. The proposed model implemented the blockchain
in healthcare, which stores data about a single patient
throughout the clinical study phases, and creates a substantial
quantity of health data about the patient. A variety of quality
estimates, assessments, blood tests and wellness polls are
available.
The result contains the outcomes of the current research
agenda for blockchain use in the healthcare industry. The
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TABLE 1 COMPUTATIONAL TIME OF PoS, PoW AND PoA
VI. CONCLUSION AND FUTURE WORK
In-depth understanding of blockchain's use in the
healthcare industry is the goal of this research paper and
provides an efficient solution in healthcare. To choose
pertinent articles for evaluation, SLRs were carried out on
nine reputable databases according to predetermined
protocols. The results were utilized to summarize both the
past and present trends in academic research themes in the
area of medical care applications for blockchain technology.
Digital agreements made possible by intelligent contracts are
one of blockchain technology's most important uses in the
healthcare sector, which has the potential to completely
change a number of healthcare fields.
Overall, the usage of clinical records by patients, doctors,
and other healthcare professionals would be improved and
ultimately revolutionized by this technology, which would
also enhance healthcare services.
Blockchain technology offers superior security and
transparency, allowing doctors to save time and offer more
care to the patient. Additionally, it allows for the financing of
therapeutic trials for any uncommon disorder. Blockchain
technology could be ideal for medical record keeping. Its
applications include the sharing of healthcare data, the
keeping of electronic healthcare records, administrative
tasks, and insurance management. Patients are linked with a
blockchain network which allows them to send their data on
a decentralized network by using an app. The merging of data
from various sources like sensors and intelligent devices is
provided by using smart contracts.
Blockchain enables the analysis of business platforms to
investigate continuously changing market scenarios in order
to make the healthcare sector aware of opportunities.
Blockchain technology can protect sensitive data more
effectively than ever before if used properly. Several
industries like real estate, finance and retail have started using
blockchain networks to display information which will result
in several benefits.
C. Characteristics of the Proposed Approach
Blockchain technology is the information and storage of
data in a chain of blocks linked together by hash algorithms,
which manages the security of the data efficiently in each
block. There are various characteristics of blockchain that are
present which is shown in figure 7.
Fig. 7 Characteristics of the Proposed Model
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