## 7 Conclusions  
As the current centralized systems are not designed to facilitate the effective management of patients' data across various institutions, this results in the loss of easy access to  
\begin{table}
\begin{tabular}{c c c c c c c} \hline \hline \multirow{2}{*}{**Author**} & \multirow{2}{*}{**Fabric Version**} & \multicolumn{2}{c}{**Latency**} & \multicolumn{2}{c}{**Throughput**} & \multicolumn{2}{c}{**Test Environment**} \\ \cline{3-8}  & & **Query** & **Open** & **Query** & **Open** & \\ \hline [PERSON] et al. & Fabric 0.6 & 5.18 & 5.18 & 19.26 & 155 & HPC server in Hertz, Xeon® CPU E5-2690, 2.60 GHz, \\ (2018) [75] & Fabric 1.0 & 1.37 & 5.18 & 461 & 185 & 24 core CPU, 64 GB RAM, and running Ubuntu 16.04 LTS \\ \hline [PERSON] et al. & Fabric 2.2 & 6.74 & 19.66 & 45.4 & 31.7 & Intel® Xeon®, 2.6 GHz with 12 core CPU, 16 GB RAM, 500 GB disk space, and running Ubuntu 18.04 LTS \\ \hline This study & Fabric 2.2 & 0.01 & 7.86 & 377.5 & 34.5 & AWS EC2 (2.2 \(\times\) large), 8 core CPU, 32 GB RAM, and running Ubuntu 22.04 LTS \\ \hline \hline \end{tabular}
\end{table}
Table 4: Overview of the performances of the different studies.  
Figure 27: Summary of the query throughput [73].  
their records, incomplete medical histories, and the disclosure of data without their knowledge via internal fraud, breaches caused by cyberattacks, and other forms of unauthorized access. This study proposed a solution for patient identity management, data ownership, and access control by applying a Hyperledger Fabric framework, which is a blockchain-based distributed ledger. Stakeholders in the industry were engaged to understand the real needs and to identify the requirements for PHRs. In addition to the requirements identified in previous studies, this research investigated fifteen new requirements that had not been found in the previous studies. Next, we designed and developed a prototype based on the collected requirements to elaborate the solution's utility by illustrating the high- and low-level architectures of the implementation process based on defined requirements with scenarios and demonstrations of the providing of patients with the power to own and benefit from their data, which was achieved after we applied DS and Hyperledger Fabric to access control over identity for peers and users, authentication, and verification. The proposed system was tested using Hyperledger Caliper. The results showed a 100% success rate in functionality when testing the gaining of access to a PHR. Moreover, the system received a 100% transaction success rate. Among the interviews, it was discovered that there was a lack of awareness of blockchain and its potential in the current healthcare industry in Saudi Arabia. There was also misinterpretation of some aspects of PHRs and EHRs, resulting in confusion between them, as illustrated in Section 6.4 (Limitations). Our proposed system could be a first step for healthcare providers who intend to adopt this technology based on a private blockchain and to utilize our framework, which considers highly sensitive data and focuses more on applications that put the patient at the center.  
A part of this research was presented and published at the 5 th International Conference on Future Networks and Distributed Systems [13]. Our contributions were twofold: major and minor, as listed below: