Smart Contracts in E-Health records using Blockchain

Smart Contracts in E-Health records using Blockchain

Abstract - The fact that organizations are now storing various and fragmented patient health data is one of the majorissuesinthefieldofhealthcare.Allcompaniesthat chargeforhealthinsurancekeeprecordsoftheircustomers' healthdata.Insomecases,informationmayevenneedtobe shared across medical facilities. This might result in a number of problems, including data sharing between organizations,whichcouldresultindataabuseandalossof privacy.Duetotheparticipationofallinterestedparties,the ElectronicHealthRecord(EHR)structureonblockchainuses smart contracts to address such difficulties. By placing medicalrecordtransactionsontheblockchain,EHRcreatesa smarthealthcaree-caresystemandaddressestheissue.To providetime-limitedaccesstothepatient'selectronichealth recordswheneverthedataisneeded,anEHRsmartcontract isestablished.Smartcontractsallowfortherecodingofall transactionsintoasinglesystem,preservingdataprivacy.

Key Words: Ethereum, EHR, Hyperledger Fabric, Merkle Tree,Blockchain.

1. INTRODUCTION

Doctorscanentercomments,scans,andlabresultsintothis system,allofwhichareloggedastransactions.Inadditionto dispensing medication, the pharmacy also logs the transactionsontheblockchain.Toguaranteetheverification oftherapyand paymentsettlement,the patientisgranted access for a certain period of time. Patients' doctors can remotelyexaminemedicalissuesusingsmartcontracts.In orderforinsurerstoimmediatelyaccessapatient'shealth characteristics and provide the appropriate insurance, patients can provide their health information to insurers. Patientsgetrewardsforgrantingtime-limitedaccesstotheir healthrecordstoresearchorganizationsforuseinclinical trials.Thesuggestedsystemcanevenbeadvancedbybeing able to differentiate between the individuals involved in varioustransactions.

2. Literature Survey

In[1],AlaaHaddad,MohamedHadiHabaebiandMd.Rafiqul Islam propose a system in which EHRs are preserved digitally,containdataaboutaperson'shealth.CombiningAI withblockchaintechnologycaneffectivelyovercomesomeof thedrawbacksofthesetwotechnicalecosystems.Toenhance theefficiencyofAIalgorithms,datafromadatarepositoryor otherreliable,credibleplatformisemployed.Sinceallhealthrelated data will be securely saved and reviewed, doctors,

healthcareworkers,andpayerswillbeabletogetupdates immediately. Cons of this approach include a capacity problemwithblockchainthatneedssignificantconsideration. Theirtacticsshouldfocusoninteractionsbetweenjustthose networkparticipantswhohaveaneedtoknow,oronaneedto-knowbasis.

In[2],AbdullahAlMamun,SamiAzamandClementineGritti, Accordingtothissystem,HyperledgerFabricandEthereum (private)arethetwomostoftenusedblockchainsystemsfor managingEHRssincetheymostlymeetalltherequirements. Theyalsodiscoveredthatusingblockchaintomanagelargescale big EHR data has drawbacks, including constrained storage capacity, high computing costs, and high communication costs. However, technologies like edge computing,IoMT,andartificialintelligenceprovidepossible remedies to these constraints. Potential researchers can createanewarchitectureormodelbycompilingallrelevant publications, their contributions, and their limits. Furthermore,newroutesinblockchainresearchmaysuggest moreintriguinganswerstotheissuesathand.Consofthe systemincludetheinabilitytoaddressthesituationwhena patienthastohaveaccesstohisEHRswhileheisinacoma, unconscious,orilliterate.

In [3], Vardhini B, Shreyas N Dass, Sahana R and R. Chinnaiyanproposeasystemtosolvethecurrentproblems thehealthcareindustryiscurrentlyexperiencing,thispaper suggests putting medical record transactions on the Blockchaininordertocreateasmartecosystem.Theywant tomakepatientdataaccessiblesecurelysothatunauthorized thirdpartiescannotaccessit.Blockchaintechnologyisused byEHRFrameworktostorerecordssecurelyandupholda single source of truth. To commit the transaction to the distributed ledger and gain access to a patient's medical history, the stakeholders will need to ask for approval. A blockchain-based solution can promote widespread accessibility,dataprivacy,financialefficiency,andconfidence intheinformationsystem.Cons:Thismethodmightbemade betterbyenablingrapidaccesstomedicalrecordsincaseof crises.Itsstructuremightbeadjustedtomatchaparticular conditionorbebasedonpre-existingguidelines.

In[4],Mrs.UsharaniChelladurai,Dr.SeethalakshmiPandian and Dr. Krishna moorthy Ramasamy proposed a system whichofferssafe,openaccesstohealthdataandthefulllife cycleofindividualhealthinformationforpatients,doctors, caregivers,andserviceproviders,.Inadditiontoprivacy,itis intendedtoachievetransparencyandsecurity.Thesuggested

method introduces a Merkle Tree as a significant advancement for hashing input data to guarantee content integrity. The outcomes of testing this strategy on a live hospital built on the blockchain Hyperledger Fabric are promising.Byusingfewerresources,itincreasesthesystem's throughput and performance while reducing network latency.Consinsystemistheydidn’tconsidermoreabout privacyandscalability.

In[5],AsmaKhatoon,Blockchainisbecomingintoasafeand reliable platform for secure data exchange in application industries including the financial sector, supply chain management,foodindustry,energysector,internetofthings, and healthcare. A number of medical processes, including challengingsurgicalandclinicaltrialprocedures,havebeen developedandimplementedusingtheEthereumblockchain platform. The associated cost for this system has been assessed in terms of a feasibility study, which has been thoroughly covered in this article. Many members of the healthcaresystemwillfinditsimplerthankstothiseffortto providebetterhealthcarewhilespendingless.Inadditionto giving patients and service providers access to a contemporary and digitalized healthcare environment, blockchainandinformationandcommunicationtechnologies (ICTs) are significant enabling technologies for the decentralisation and digitalization of healthcare organisations.

In[6],AndreHenriqueMayer,CristianoAndredaCostaand RodrigoDaRosaRighi,Inthisstudy,athoroughassessment oftheliteratureonEHRsinsideaBlockchainwasconducted inordertopinpointandassessthemainissues,challenges, andpossiblebenefitsofblockchainadoptioninthehealthcare sector. After conducting their analysis, they came to the conclusionthatBlockchaintechnologymight,inthefuture,be a good solution for problems in healthcare, such as EHR interoperability, fostering trust between healthcare providers, auditability, privacy, and allowing patients to manageaccesstotheirhealthdata.Theywouldthenbeable tochoosewhotheywanttotrustandwithwhomtheywant tosharetheirmedicalrecords.However,theyalsomadeit clear that additional study, testing, and experiments are necessarybeforedeployingBlockchaintechnologyonabroad scaleinhealthcarebecauseapatient'shealthdataareprivate, very sensitive, and important information. Cons in this systemarerestrictedtoEHRandblockchain-relatedissues and do not cover other healthcare related blockchain applications, such supply chain and medication access management. This is to say that the review was solely concernedwithpapersthataddressedthefundamentalEHR andBlockchainprinciples.

In [7], Santosh T. Jagtap, Chetan M. Thakar and Ouail El imrani,Thissystem-madeintelligentcontractualhealthcare management framework demonstrated the extension of decentralisationconceptsforlarge-scaledataadministration to medical ecosystems as well as the simplification of intricatemedicalprocedures.Inordertoprovideauditability,

interoperability,andusability,theyprovideanovelapproach to maintaining medical records that takes use of smart contracts.Thissystem,whichismadetoshowflexibilityand granularity, streamlines the medical testing process and permits the sharing of patient data. Storage is another drawbackofthistechnology.

In[8],UsharaniChelladurai,SeethalakshmiPandian:Inthis systemBlockchainsmartcontractsweredevelopedinorder tosatisfytherequirementsofpatients,physicians,andother healthcare specialists. Tree data structure for updating medical records, transferring health information between many providers, seeing contracts on the peer-to-peer blockchain network, and securely storing and easily retrieving health records. A practical way for exchanging healthcaredata[EHR]ontheblockchainisprovidedbythe MedRecplatform.Patientsaregrantedaccesstotheirmedical informationinordertotrackhealthimprovementandlower healthcarecharges.Intheproposedsystem,thepatientisin controlofsendingthesystemtheirownpersonalhealthdata andisthedatasender.Instantaneouslysavedinadatabase server are blocks with hashes generated by the system. A transaction identification is given to each blockchain user. Thismakesiteasierforconsumerstoobtainthedata.The system'sdrawbackisthatitrequiresexpandingthebodyof research based on the Merkle Tree data format. For the extendedworktoensurecontentintegrity,anewModified MerkleTreedatastructureshouldbeadopted.

In [9], Harshini V M, Shreevani Danai, Usha H R and Manjunath, In this system, forecasts of a person's health through time are included in their health records. Data breachesoccurasaresultofthecentralizedmanagementof health records. 27,314,647 patient data were impacted in 2016.Theuseofsmartcontractsinthehealthcareindustry might further simplify things. Around the world, patientdriveninteroperability inwhichpatientsconsentto ondemand access to their medical records is starting to catch on. They used a strategy smart contracts, which are piecesofcodethatrunontheirownwhenbothpartiesaccept a set of protocols. Here, the patient and hospital administrationareseenastwodifferentparties.Thesmart contract can be executed inthree steps: invoking,creating records, and validation. According to their analysis, blockchaintechnologyisoneofthepotentialsolutionsforthe efficient maintenance of medical records. Additional study mayaidintheadoptionofblockchaintechnologyacrossall industries,makinglifeeasier.

In[10],SergeyP,NovikovandOlegD.Kazakov:Thearticle givesanexampleofthedecentraliseddesignofthehealthcare system. In this situation, an electronic environment that enables seamless communication between all healthcare providersandpatientsisrequired.Theconstructionofsuch an environment enables the use of integrated electronic medical records to create medical information storages (IEMC).TheIEMC'smaindutyistogatherasmuchpractical electronic medical data on a particular patient. One of

blockchain's fundamental benefits over alternative distributed database models is the integration of data processing,preservingconsistencyandsecurityina single protocol,donealgorithmicallyandwiththeleastamountof humaninvolvement.Asaresultofitsextensivedeployment andirreversibility,itenablesyoutoretainthehighestlevelof security.Themaindifficultyinusingblockchaintechnologyto healthcare is finding a balance between defending the interestsofsystemmembersandcateringtosociety'smore generalneedsanddesires.

In [11], Ayesha Shanaz, Dr Usman Qamar and Dr Ayesha Khalid,TheEthereumplatformanditsdependencieswere usedtoconstructthissystem.Thefollowingcontractsarea part of this framework: Roles and patient records. Their suggestedapproachcombines granularaccesscontrols for records withsecure recordstorage. They didn'tlistall the parties the patient will deal with. Certain laws and regulations that adhere to the standards of the healthcare industryweren'tdefined.

In[12],HeguiZhu,YujiaGuoandLiboZhang:Toaddressthe drawbacksoftheconventionalrecordingsystem,theusageof electronicmedicalrecords(EMR)hasdramaticallyexpanded. The revelation of personal information, however, poses a possibleriskduringthetransmissionofEMR.Theprimary goal of this study is to improve the Merkle tree-based blockchainEMRstoragestrategybyusingittoincreasethe system'ssecurityandefficiency.Inthesuggestedconvolution Merkle tree, the original binary tree structure is replaced withaconvolutionallayerstructure,whichcansignificantly increase efficiency. Using the same amount of input data, experimentsdemonstratethatthenumberofstorednodes hasfallengreatly,andthenumberoflayersinthemodified convolution Merkle tree and the hash calculation amount havebothbeendrasticallyreduced.Theuseofanupgraded Merkle tree structure ensured data storage simplicity and security, which improved the EMR record and query application's speed. Merkle trees have higher CPU and memoryfootprintsthanotherformsoftrees,whichistheir biggest drawback. When compared to the Merkle tree, the rootgenerationofabinarysearchtreeisextremelysimple.

In[13],YonggangXiao,BinXu,WenhaoJiangandYunjunWu : In this study, the enterprise-grade approved distributed ledger technology Hyperledger Fabric v1.4.1 is used to implement the HealthChain prototype. It is installed on a computerrunningUbuntu16.04.1LTSandpoweredbyan Intel Xeon E5-26xx v4 2.4 GHz CPU with 2 GB of RAM. All servers are constructed using Docker 18.06.1-ce, which virtualizes peers and orderers into containers that share hardware and the kernel of the operating system. Docker Compose,aprogrammeforconfiguringandmanagingmulticontainer Docker applications, creates the HealthChain network.First,thereisasinglepointoffailureduetothelone order.Theentiresystemwillcrashiftheordererfailssince EHRtransactionscannotbeorderedintoablock.Second,as theledgergrows,thereadlatencygetslonger.

In[14],SuzannaSchmeelk,MeghaKanabar,KevinPeterson and Jyotishman Pathak: Their analysis explores the possibilities,difficulties,andunansweredissuesassociated withtheadoptionandintegrationofblockchaintechnology inside EHR systems. For solutions to open practitioner questions in the healthcare sector, they aggregated and evaluateddata.Futureresearchshouldfocusonissueswith patient matching and adequate semantic analysis of blockchaindatatransfer,amongotherissueswithhistorical healthinformaticsobstacles.OtherBlockchainapplicationsin thehealthcaresector,suchaspharmaceuticalapps,arenot covered in this research because it is restricted to studies involvingEHRsandBlockchain.

3. CONCLUSION

Everyoptionnowinusehascertainlimitations,accordingto researchacrossnumerousstudies.Physiciansshouldbeable tosafelyaccessthepatient'srecordsiftheyneedtoreadthe electronic health information when the patient is unconscious, in a coma, or illiterate. It is necessary to distinguish between transactions conducted by different people.Thesystemmustbeeffective,scalable,andprovide theaforementionedfeatures.

REFERENCES

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