# Towards an Optimized Blockchain-Based Secure Medical Prescription-Management System
## 1 Introduction
### Related Work  
Several studies have indicated that the transition to electronic prescription (e-prescription) systems has a positive impact on the overall healthcare experience. [PERSON] and [PERSON] [13] proposed a comprehensive framework for implementing e-prescription systems within healthcare information systems, leveraging cloud computing infrastructure. They designed a cloud computing architecture that accommodates the scalability demands of e-prescription systems, ensuring seamless expansion to meet the evolving needs of healthcare providers. The authors asserted that their solution enhances the security of e-prescription systems; however, no development efforts related to the security objective are addressed nor implemented. Additionally, their framework emphasizes scalability, but lacks a detailed discussion or implementation strategies for addressing security concerns. Similar to the work presented in [13], different papers [14; 15] leverage cloud computing to design e-prescription systems. Recently, a traceable medical prescription framework was proposed as a reliable tool that must be integrated into any strategy for the fight against drug fraud. In addition, since blockchain technology has proven to have incomparable features of traceability and transparency, several researchers have proposed to use it in drug prescription-management systems, to guarantee traceable transactions in a safe and fast way [16; 17]. [PERSON], [PERSON], [PERSON], and [PERSON] [1] exposed the problems of medical prescriptions, mainly related to patient data security and privacy, information authenticity, and service availability. To overcome these concerns, they proposed to rely on the distributed ledger technology (DLT) by the use of specific cryptographic mechanisms on data in transmission and at rest on the platform. Their solution is based on a permissioned blockchain architecture [18], under the governance of the National Health Services (NHS), in which medical prescriptions are represented as non-fungible tokens (NFTs) managed by specific smart contracts, based on the Ethereum standard called ERC-721 [19]. Through specific decentralized applications (DApps), a doctor who has been granted a minter's permission by the NHS creates the NFT, which ensures compliance with the roles of each of the actors. [PERSON] and [PERSON] [3] proposed RxBlock, a private decentralized application for digitized prescriptions that use Ethereum as the blockchain technology and enable the immutability principle to protect information exchange across users. The electronic prescription process, including mainly prescribing and filling medicines, is illustrated through the use of Ethereum smart contracts. Through smart contracts, each actor is allowed to apply for specific transactions that are recorded and serve as Prescription Drug Monitoring Programs (PDMPs), which are used for state-run databases. However, it is worth noting that the fully electronic prescription process outlined in these studies necessitates that all actors--doctors, pharmacists, and patients--are registered in the same system. This requirement may limit the system's ability to serve prescriptions originating from doctors who are not registered in the platform, reducing the ease and flexibility of prescription management for both healthcare providers and patients. [PERSON] and [PERSON] [20] proposed SecureRx, a web-based application developed based on the Ethereum blockchain and RxCheck hub. An actor can grant a request through a web application, and a data request is initiated and recorded on the Ethereum blockchain with a timestamp; the same thing happens with all transactions. [PERSON], [PERSON], and [PERSON] [12] explored smart contracts in two BFT-based blockchain platforms, namely Endermint and Hyperledger Besu, to build a decentralized e-prescription system. In this work, an empirical performance evaluation and comparison between Endermint, Hyperledger Besu, and Ethereum, a PoW blockchain, was presented.