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Blockchain Technology in Internet of Things Liehuang
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About the Authors
Aryan Chaudhary is the Research Head and lead member (the research project launched by Nijji Healthcare Pvt Ltd). He focuses on implementing technologies such as artificial intelligence, deep learning, IoT (Internet of Things), cognitive technology, and blockchain to better the healthcare sector. He has published academic papers in public health and digital health in international journals and has participated as a keynote speaker at many international and national conferences. His research includes the integration of IoT and sensor technology for gathering vital signs through one-time/ambulatory monitoring and then the functionality of artificial intelligence, machine learning leading to big data analytics for faster intervention, tracking of prognosis, and research on these vast data for effective clinical research for future development of treatment, drug, pathological tests, and supply systems. He is the editor of many books in biomedical science and the Chief Editor of a CRC book series. He also serves as the guest editor of many special issues in reputed journals. He has been awarded as Most Inspiring Young Leader in Healthtech Space 2022 by Business Connect and the Best Project Leader of Global Education and Corporate Leadership. He is a senior member of many international associations in science & brand ambassador of Bentham Science
Raman Chadha, Ph.D., (Computer Science & Engineering) has more than 23 years in the field of CSE and is working at Chandigarh University in the post of Professor (CSE). He is a member of the Computer Society of India, International Journal of Research Review in Engineering Science, International Association of Computer Science and Information Technology, International Journal of Technology and Computing, and chief editor of the Journal of Engineering Design and Analysis. He has filed approximately 20 patents in the field of computer science, electronics, and mechanical engineering. Dr. Chadha has published more than 50 research papers in Scopus, WoS, and UGC Care lists. He has also been honored at NITTTR, Chandigarh, and given an outstanding research award for his contribution to the field of sustainable development. He has also been selected two times as a judge at hackathons, which are usually day-long (can be 36 hours, 48 hours, etc.) coding competitions. He was also honored for his research work in IRSD as an international forum that provides the most coveted interdisciplinary research platform to address issues pertaining to all areas of sustainability. Dr. Chadha also earned the Professional Certificates on Coursera and LinkedIn Platform, which are highly demanding, acknowledging proficiency in Python, Blockchain, Full Stack Web Development, AI, and Data Science. Many programs also provide a pathway to industry-recognized certification.
About the Reviewers
v Anurag is a Certified Blockchain Solution Architect from Blockchain Training Alliance. He is an accomplished Solution Architect with 18 years of experience in the IT industry.
He has extensive experience in handling complex projects in domains such as Blockchain, Healthcare, Network Management, and Storage Virtualization working alongside teams spread across USA, UK, France, China & India.
He enjoys working as an educator and contributes to open-source projects in his free time. He currently works with Reliance Jio as a Senior Blockchain Solution Architect.
v Elayabharathi, Delivery Manager with 15 years of experience in the IT industry. Extensive knowledge and experience in the US healthcare industry. Well-versed in technical Project/Program/Delivery and People management.
Excelled in legacy technologies such as Mainframe and modern technologies like Cloud, Blockchain, etc. Transformed his career from Mainframe to modern technologies like Blockchain, Cloud, etc.
Successfully formed a big team from scratch and made them a high-performing one to deliver value-driven Digital transformation initiatives.
Highly interested in Blockchain and Metaverse, so he aspires to do some research on the same and work towards it.
“Presentation, inspiration, and motivation have always played an important role in the success of any venture.”
Firstly, I thank the Almighty for his inspiration and benevolence for giving me the opportunity to design this book.
I want to acknowledge the help of all the people involved in this project and, more specifically, the authors and reviewers that took part in the review process. Without their support, this book would not have become a reality.
I pay my sincere gratitude to my sister Tanya Chaudhary who always told me to aim high and says that do not ever aim low; otherwise, you will miss the mark. I am immensely obligated to my teacher RK Khangar, for their elevating inspiration, encouraging guidance, and kind supervision throughout the journey.
I wish to thank the officials at BPB Publications for their invaluable efforts, great support, and valuable advice for this project toward the successful publication of this book.
I am deeply grateful to my parents for their support, appreciation, encouragement, and keen interest in my academic achievements.
Preface
The Book - Analyzing Blockchain in Healthcare is written by Aryan Chaudhary (Research Head in Nijji HealthCare) and Raman Chadha (Professor and HoD in Chandigarh, University). The Book provides, extensive prospects of technology that intensify scientific advancement to recent information on the application & adoption of Blockchain Technology. Each chapter furnishes the deployment of BlockChain Technology in regulated settings & discusses how other evolving technologies like Artificial intelligence, machine learning, neural network, and deep learning along with BCT can set up a benchmark to improve healthcare services. This Book will be the first to include a description of real-world implementation to support evidence-based practice to educate researchers, hcp, ITPs, and health science organizations to make value propositions & recognize the economic value of blockchain
The book is an overview of 10 chapters, which provide a comprehensive structure to induce a high-class knowledge of applying blockchain in healthcare and come up with a mechanism to expedite patient-amiable automation to improve Healthcare
Chapter 1 examines how the Internet of Medical Things (IoMT) technical assessment of several current solutions that make use of blockchain technology. In addition to this, the unanswered questions about the implementation of blockchain technology via IoMT are detailed.
Chapter 2 unveils the benefits and barriers of Blockchain (BC) technology in the health sector.
Chapter 3 covers the impact of Blockchain (BC) technology on patient engagement in the healthcare industry. The Technology, Environment, and Organization model were examined in this chapter.
Chapter 4 works on Distributed Ledger Technology, the study which is being included in the chapter provide a methodology that may be used by central banks and other authorities to examine and evaluate the usability of this technology for payment, clearing, and settlement purposes. The findings of this study may be helpful to players in the market as well as other parties. The primary goal of the framework is to assist in understanding the applications of distributed ledger technology (DLT).
Chapter 5 investigates the ways in which the Internet of Medical Devices (IoMD) and blockchain technology are contributing to the development of and having an effect on the healthcare business.
Chapter 6 provides an overview of how blockchain application helps in mitigating and fighting the challenges of the Covid-19 Pandemic.
Chapter 7 study seeks to understand how health facilities adopt blockchain networks to satisfy their patients without any quagmire.
Chapter 8 induce a study's specific goals to identify the use cases for Blockchain technology in healthcare, sample applications that have been created for those use cases, challenges and restrictions facing Blockchain-based healthcare applications, current development methods used for those applications, and potential future research areas.
Chapter 9 seeks to give a thorough evaluation of the existing and anticipated usage of blockchain technology in health care, as well as future research possibilities, and
Chapter 10 concludes with security end-user analysis using Blockchain Technology
— Aryan Chaudhary Research Head, Nijji Health Care Pvt Ltd
— Raman Chadha Professor, Computer Science & Engineering Research Head, Chandigarh University
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Chapter 1
Internet of Medical Things-Blockchain Integration
Abstract
The Internet of Medical Things (IoMT) is a network of implanted or worn medical devices that gather patient health data. Large files containing sensitive information need tight security. Researchers are exploring blockchain-based solutions to boost the safety of healthcare apps. However, owing to the distinct needs of these two systems, such integration is very complex and demanding. In this chapter, we give a technical assessment of several current solutions that make use of Blockchain (BC) technology. These studies are analyzed, and a discussion is held on the suggested designs about how the authors solved the integration problems. In addition to this, the unanswered questions about the implementation of blockchain technology via IoMT are detailed in this chapter.
Introduction
Researchers are digitizing and decentralizing healthcare institutions to meet human needs. This overlaps with wearable, implantable, and wireless sensors. Medical records must be protected against manipulation although, Blockchain is a secure, decentralized platform. Tamper-proof, immutability, traceability, data integrity, confidentiality, and privacy are third-party services. Several studies have pointed to blockchain’s potential in healthcare. This chapter reviewed research on blockchain’s
usage in healthcare to improve patient safety. None of these efforts have focused on blockchain for IoMT. In this context, we provide our book, which analyzes the technical features of each current study related to integrating blockchain technology with the IoMT and assesses related past studies.
Structure
The structure of this chapter includes the following topics:
● Obstacles presented by the Internet of Medical Things (IoMT) and Blockchain
● Internet of Things (IoT) Solutions founded on three distinct blockchains
● Debates and unsolved problems
● IoT market drivers
● Protocols integrated into the system
● Data overload
● The management system of information at hospitals
● Mobile healthcare
Objectives
This chapter examines the Internet of Medical Things (IoMT) technical assessment of several current solutions that make use of blockchain technology. In addition to this, the unanswered questions about the implementation of blockchain technology via IoMT are detailed.
Obstacles presented by the Internet of Medical Things and blockchain
Blockchain technology is certainly beneficial for medical internet safety. Merging the two technologies is not easy due to their opposing demands.
Processing
Blockchain mining and cryptography need intense computing and energy. IoMT devices with limited resources and energy cannot perform this since it demands many resources.
Storage
IoT and mobile devices create a flood of data, to preserve and authenticate this data, the blockchain must be employed and that is complex. Blockchain technology relies on nodes to give distributed storage, which IoMT devices can’t afford because of their limited storage capabilities.
Blockchain was originally designed for fixed network architecture. Implanted and wearable medical devices constantly move, altering topology.
IoMT applications are generally mission-critical, requiring a real-time, immediate response. Block manufacture is time-consuming, and Bitcoin blocks get 1 MB every 10 minutes, the real-time is hard to achieve when chunking data streams.
Substantial overhead traffic
In order to synchronize, the nodes in a blockchain are constantly communicating with one another, this results in a significant amount of overhead traffic. IoT devices, which have restricted bandwidth, are not capable of bearing this.
Internet of Things solutions founded on three distinct blockchains
In this section, we explain the most recent study on the application of Blockchain technology in IoMT. We classify this research, based on the most cutting-edge way of using blockchain technology in IoMT.
Ethereum-based financial contributions
A study suggests, a private Ethereum-based smart contract architecture for handling user and device requests and regulating access based on credentials, role, and domain To manage requests from users and devices, data is saved through IPFS. The Inter Planetary File System (IPFS) is where medical data and equipment information are stored. Smart contracts manage behind-the-scenes consensus. Product Ownership Management System (PoMS) is an alternative to Proof of Stake (PoS), which the authors devised to safeguard smart contracts against malicious activity. PoMS enables stakeholders with access to medical data tokens to validate and construct blocks.
Another study proposes a private blockchain-based system for managing medical data. It maintains data access authorization between patients, hospitals, physicians, research groups, and other stakeholders using Ethereum smart contracts. A digitized patient medical history with permissions, record ownership, and data integrity is included in the smart contract. Only a cryptographic hash of the medical record data
is preserved on the blockchain to guarantee its validity. To keep things simple, the proposed technique excludes mining.
The research we induced developed a cloud-based system to monitor neurological illness using IoMT sensors. The research principle describes the framework as, to store and analyze IoMT data. Cloud computing was deployed, and an Ethereumbased Blockchain network was created so that healthcare users could safely exchange data. Smart contracts govern how users access cloud data and there is no explanation for how blockchain technology works.
A study describes, a blockchain-based permissioned-blockchain architecture for remote patient monitoring. To analyze data and notify patients and doctors, they used Ethereum smart contracts. They suggested Practical Byzantine Fault Tolerance (PBFT) as an alternative to PoW. PBFT suggested approach does not address the challenges of IoMT and blockchain integration. Smart contracts are used by Secured Mobile Enabled Assisting Device for Diabetics monitoring (SMEAD) to remotely monitor diabetic patients, while the data access is governed by contracts.
Protocol for modified consensus
Several studies, advocate for modifying the consensus approach to incorporate the IoMT. It describes a consortium blockchain-based architecture for reliably capturing IoMT data while protecting patient privacy. The Proposed Architecture (PA) employs patient agent software, which defines blockchain functionality. It is installed on the Edge computing network to conduct lightweight jobs and on a cloud server to securely store health data.
Both deployments increase the efficiency of the system. The authors also created a modified PoS consensus in which a leader is chosen for a group of nodes to verify and generate blocks. This PoS consensus version was included in their submission. Smart contracts are used to, filter clinically insignificant health data, provide alerts, transport data to the cloud, classify data, and perform other functions. According to the authors, the new PoS consumes less energy and creates blocks quicker than the PoS.
Improved cryptography method
Engineers employ numerous blockchain technologies to safeguard user privacy and data integrity while exchanging IoMT data. To protect patient’s personal information and sensitive data, they use hashing and proprietary encryption technology. This approach has the potential to cover a vast number of medical commodities with distinct identities. IoMT’s real-time requirements are met by low temporal complexity.
A blockchain records all healthcare provider transactions. In our past research, we presented a blockchain-based architecture for IoMT devices. The planned blockchain is confidential therefore to join the network and submit transactions, nodes must be certificated. POW consensus is no longer used by authors, to manage the massive volumes of data generated by IoMT devices, they store encrypted data in linked blocks on the cloud.
To protect data integrity, blockchain stores cryptographic hashes of each block. Using “A lightweight privacy-preserving ring signature approach,” a group of nodes may participate in the data signature. This ensures privacy and authenticity. The authors utilized double encryption in addition to the digital signature to protect the data during transmission and storage. The key is encrypted using the public key of the receiver and lightweight ARX techniques.
To ensure public key safety, the authors suggested the Diffie-Hellman key exchange method. Network node clustering enhances scalability and speed. A cluster head is in charge of hash block verification, storage, digital signature validation, and node interactions. In addition to their improved consensus approach, the authors proposed employing ring signatures instead of public-key digital signatures and the patient’s privacy was respected.
Contributions of Hyperledger
The authors proposed an IoT blockchain-based architecture for healthcare remote monitoring. The structure contains two blockchains:
● Medtech uses blockchain technology to store medical equipment treatment data.
● Consultation medical facilities use blockchain to store patients’ medical records. Endorsing peers employ Byzantine Fault Tolerance (BFT) to verify smart contract transactions (Chaincodes in Fabric), these contracts validate transactions and therefore the authors created a visual interface for patient health data.
A high-level overview of blockchain without specifics
The secured IoT-driven remote healthcare data through blockchain can be employed as blockchain’s tamper-proof functionality to store and exchange IoMT data with patients and clinicians. Patients’ information is kept as strings in blockchain blocks, while IoMT data is maintained in an off-chain database like IPFS. Smart contracts increase the privacy and security of blockchain transactions.
A partnership resulted in MedChain, a blockchain-based system for successfully exchanging medical sensor data streams. This comprises both evolving and unchanging medical data, as well as time-series data streams. This includes the efficient storage and distribution of sensitive data. The MedChain network is divided into two decentralized sub-networks:
● A Blockchain network for storing immutable data such as user IDs, data digests, session and operation information and,
● A P2P network for storing changeable data that simplifies data querying and contains session and data descriptions. MedChain relies on Byzantine FaultTolerant State Machine Replication project (BFT-SMaRt) consensus.
The BIoMT framework is a lightweight blockchain-based solution for IoMT security and privacy. The proposed architecture is divided into four levels:
● The device layer comprises IoMT devices that implement the Elliptic Curve Cryptography (ECC)
● Key establishment protocol and Identity-Based Credential (IBC) mechanism to provide decentralized anonymity.
● The cloud layer employs anonymization methods to enable identity-free data analysis and storage.
● The cluster layer organizes medical facilities, service providers, and cloud servers into clusters. Each cluster has a “cluster head” who is in charge of lowering network overhead and delay. The work needs technical specifics. It has not been deployed or assessed. Some studies even proposed a blockchainbased architecture to securely transmit and store IoMT’s massive amounts of sensitive data.
Debates and unsolved problems
Research depicts a taxonomy of blockchain-based IoMT contributions. These are not mentioned here because of its flexibility in implementing smart contracts for management-related purposes. The majority of suggested solutions are built on private blockchains and they leverage Ethereum infrastructure. Many challenges arise while integrating blockchain with IoMT. The majority of studies recommend storing IoMT data off-chain. Because of its decentralized and distributed data structure, IPFS has been advocated for research. In other studies, cloud computing was utilized to store, encrypted data, and the blockchain was employed to store its hash. These methods do not ensure immutability, a critical blockchain attribute. Because their hash is stored on the blockchain and any changes to the data will be discovered. However, since the data is only saved on the cloud,
it cannot be recovered (centralized storage). Other studies have explored on-chain storage, however, they lack technical information on handling the massive data streams generated by IoMT devices. Healthcare applications need real-time replies, necessitating a rapid consensus mechanism. IoT devices are limited and generate a lot of data. To fulfill IoMT standards, the majority of research examined omitted the consensus procedure.
Some writers use smart contracts, which validate and execute transactions independently. Smart contracts are protected by a lightweight consensus method. Others propose a simple consensus procedure: Researchers improved the PoS approach for IoMT. Other experiments split nodes into clusters and assigned a header to each cluster to process transactions, verify blocks, and produce blocks. Some earlier publications proposed approaches for monitoring and managing access credentials for healthcare security. Most of them utilize smart contracts to restrict access to authorized users based on the IoMT ecosystem and user/stakeholder engagement. This safeguards user privacy and offers lightweight privacy-preserving approaches such as the ring signature scheme to safeguard patient information.
Current blockchain solutions are not scalable, which inhibits wider usage in IoMT. Transactional throughput is a metric used to analyze the scalability of blockchain systems. Bitcoin which is one of the most renowned public blockchains, has 7 transactions per second (tps), compared to 2,000 and 170 tps for VISA and PayPal, respectively. IoMT requires quicker public blockchains to manage its huge transactions and real-time requests, using private or consortium blockchains, which are more scalable than public blockchains. These are the primary methods for increasing the scalability of blockchain. Recent research has used localized consensus mechanisms (such as sharding) to achieve speedier consensus. Private and consortium blockchains process transactions quicker than public blockchains. Permissioned systems may achieve a consensus quicker than public blockchains and IoMT may perform better on private or consortium blockchains.
Despite advances in deep learning and AI, security and privacy issues in AI models continue to pose trust challenges. AI models may be stolen, faked, and poisoned (or polluted). Meanwhile, IoMT data processing and analysis are often outsourced to cloud servers, which have more computing capabilities. Cloud servers are frequently held by untrustworthy third parties who may accidentally or intentionally leak critical information, while combining blockchain and AI may be able to fix the problem.
Blockchain technology might be effective for checking and allowing IoMT data access on cloud servers. During this period, authentication and permission procedures may be applied to cloud server management, which needs decentralized blockchain authentication. Recent advances in federated learning algorithms provide fresh approaches to this problem. Instead of transmitting IoMT data to cloud servers, federated learning systems may train AI models locally at edge nodes like base
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