# Blockchain in Secure Healthcare Systems: State of the Art, Limitations, and Future Directions

Authors: Vahiny Sharma; Ankur Gupta; Najam Ul Hasan; Mohammad Shabaz; Isaac Ofori
Journal: Security and Communication Networks
 (2022)

---

## Abstract

Modern healthcare is a data-intensive domain representing an amalgamation of long-term electronic medical records, real-time patient monitoring data, and more recently sensor data from wearable computing. Blockchain in healthcare can address a multitude of challenges in healthcare, including care coordination, data security, and interoperability concerns, as technology advances. Technical challenges such as processing speed and massive data duplication will be resolved as improved technology. This data needs to be accessed seamlessly by a multitude of players from the general physicians to hospitals, medical service providers to insurance companies. Thus, healthcare-related data needs to be verified, securely stored, and shared while maintaining patient privacy and control over what portion of the data is shared, with whom it is shared, and how it is consumed. Blockchain has emerged as a technology stack of choice for distributed authentication, secure storage, and automated analysis of stored data in diverse domains including healthcare. Its distributed nature is a natural fit to the healthcare ecosystem with multiple participating entities and patients in different geographic locations. In this paper, we review the technology of blockchain to the healthcare domain analyzing and classifying work done in the field. Open challenges are identified and future directions for research are also presented.


---

## Body

## 1. Introduction

Healthcare systems are increasingly being digitized to make it easier to manage and access data. However, privacy concerns for patient data have also emerged [1, 2]. Blockchain is a new technology that is being utilized to create innovative solutions in a wide range of industries, including healthcare. In the healthcare sector, a blockchain-based technology network is used to store and transfer patient records across health facilities, testing centers, medications, and doctors [3, 4]. Furthermore, blockchain is important in finding fraud in clinical studies; therefore, the technique offers great ability to improve effectiveness of the model in healthcare. Developing a good data storage architecture with the maximum security measures attainable can help relieve concerns about data manipulation in clinical management [5, 6]. In healthcare, various information and communication technologies are being used which have resulted in issues of security, privacy, and interoperability. Over 200 million patient pieces of information were leaked in data theft between 2008 and 2018 [7, 8]. Bank account details, but also health and genetic test records, were stolen by the criminals. Healthcare Information Planning is the effective arrangement of digitized health information. This can range from electronic patient records involved in the creation of routine checkups to handwritten hospital records scanned and stored in a digital repository. Between 2009 and 2017, more than 176 million patient’s records were exposed in data breaches. Health Data Monitoring is entrusted for not only managing health information, but also combining it and allowing its evaluation in order to enhance patient safety and obtain insights that can enhance healthcare results while maintaining the information’s confidentiality [9, 10]. More options for usual medical data management, also for patients to acquire and discuss their own health information, develop as digitized health-related collection of data, cloud healthcare information storage, and patient information privacy protection policies develop [11, 12]. However, allowing technology-based effectiveness and efficiency considerations to be the key drivers of e-health planning, on the other hand, is succumbing to the technical imperative, because e-health is loaded with a plethora of potentially disastrous concerns [13, 14]. Health Data Management may provide substantial advantages to medical institutions, medical personnel, and patients by establishing a holistic perspective of patients, homes, and patient populations, as well as improving patient participation and healthcare results. However, related challenges like securing the data, data integration from diverse sources, change management, regulation, and patient privacy need to be addressed. The current global scenario in healthcare data management can be summed up in the following trends [15, 16]:(a)
Islands of data: each hospital or a group of hospitals typically manage patient data within their ecosystem without explicit provisions to share medical records with other hospitals. These systems are highly heterogeneous, fragmented, and not interoperable by design. An open platform for sharing medical records across stakeholders is currently not available.(b)
Lack of standardization: there are no global or national standards in existence which govern healthcare records management, facilitate sharing, or cater to the security and privacy requirements.(c)
Patient rights: very little work has been done in this area, especially in the developing world. There is no clarity on who owns the patient data and what are the rights of an individual patient concerning his/her own medical records.(d)
Excluded communities: the current healthcare system and its digitization efforts exclude several underserved communities. Current technology is not able to meet the needs of such communities and they continue to remain outside the ambit of the digital infrastructure being created for modern healthcare.(e)
Consumption of medical data and ethics: A dialogue on how medical data is to be shared and consumed and ethics of usage including patient consent is missing from the current landscape.


### 1.1. Motivation of the Study

As we all know, security and privacy issues are becoming increasingly problematic for sophisticated healthcare systems. To avoid such problems, it is vital to understand the security needs of such systems. Intelligent healthcare systems are now facing a plethora of security and privacy concerns. To avoid such issues, it is critical to understand the security requirements of such systems. As a consequence, a blockchain-based smart healthcare system is provided. Health Data Management may provide substantial advantages to medical institutions, medical personnel, and patients by establishing a holistic perspective of patients, homes, and patient populations, as well as improving patient participation and healthcare utilization. However, related challenges like securing the data, data integration from diverse sources, change management, regulation, and patient privacy need to be addressed. Blockchain as a technology naturally caters to several stated requirements for realizing the vision of an interconnected, interoperable healthcare data management framework with the relevant security and privacy provisions.It is not surprising therefore that the applications of blockchain to address the data management and security considerations for modern healthcare systems are gaining traction. Several researchers have examined different aspects of how blockchain technology can deliver the grand vision for healthcare data management systems. Blockchain features include decentralized storage, authentication, data security through cryptography, assurance, immutability, nonrepudiation, data access, and data sharing. Early adoption in the healthcare ecosystem has also started for instance Medicalchain in London, Guardtime in California, Robomed in Russia, Blockpharma in France, and many more [17]. However, the domain is nascent and several open challenges need to be addressed going forward.


### 1.2. Paper Organization

This article evaluates the current state of the art in the adoption of blockchain technology to healthcare information management, classifying and grouping the task undertaken in the sphere. Open obstacles are noted, and some future projects approaches are offered. The remainder of the paper is structured as follows: Section2 presents a summary of the domain’s research, while Section 3 focuses on open challenges. Section 4 outlines future study directions, while Section 5 concludes the work.


## 1.1. Motivation of the Study

As we all know, security and privacy issues are becoming increasingly problematic for sophisticated healthcare systems. To avoid such problems, it is vital to understand the security needs of such systems. Intelligent healthcare systems are now facing a plethora of security and privacy concerns. To avoid such issues, it is critical to understand the security requirements of such systems. As a consequence, a blockchain-based smart healthcare system is provided. Health Data Management may provide substantial advantages to medical institutions, medical personnel, and patients by establishing a holistic perspective of patients, homes, and patient populations, as well as improving patient participation and healthcare utilization. However, related challenges like securing the data, data integration from diverse sources, change management, regulation, and patient privacy need to be addressed. Blockchain as a technology naturally caters to several stated requirements for realizing the vision of an interconnected, interoperable healthcare data management framework with the relevant security and privacy provisions.It is not surprising therefore that the applications of blockchain to address the data management and security considerations for modern healthcare systems are gaining traction. Several researchers have examined different aspects of how blockchain technology can deliver the grand vision for healthcare data management systems. Blockchain features include decentralized storage, authentication, data security through cryptography, assurance, immutability, nonrepudiation, data access, and data sharing. Early adoption in the healthcare ecosystem has also started for instance Medicalchain in London, Guardtime in California, Robomed in Russia, Blockpharma in France, and many more [17]. However, the domain is nascent and several open challenges need to be addressed going forward.


## 1.2. Paper Organization

This article evaluates the current state of the art in the adoption of blockchain technology to healthcare information management, classifying and grouping the task undertaken in the sphere. Open obstacles are noted, and some future projects approaches are offered. The remainder of the paper is structured as follows: Section2 presents a summary of the domain’s research, while Section 3 focuses on open challenges. Section 4 outlines future study directions, while Section 5 concludes the work.


## 2. Background

### 2.1. Privacy and Security of Electronic Health Records (without Blockchain)

There are various ways which are being used to secure the healthcare data. A number of researches have applied technical, physical, and administrative principles for that. These guidelines are made up of a number of security measures used among healthcare arrangements to provide better protection to the safe and secure patient data contained in digital health details [18–20]. Figure 1 shows the principles for sharing electronic health records.Figure 1
Principles for sharing electronic health records.The authors have made approaches for cloud computing. Despite its pervasiveness and various offerings, cloud computing creates serious privacy and security concerns. As a result, before using the cloud for business solutions, worldwide organizations have focused on developing security policies and practices for the cloud environment [21]. According to reports, healthcare data is enormous and varied, and it is frequently stored on the cloud. However, the number of cloud attackers is increasing, necessitating the development of a system that safeguards data privacy. Here we addressed a smart healthcare system built on blockchain technology, with the capability of enabling real-time data access that is accessible, traceable, and trustworthy [22]. The very first precaution is the topic of organizational safeguard, which includes applicable procedures such as executing inspections, hiring a commanding officer of data protection, and developing emergency plans [23, 24]. This subject includes measures that highlight the importance of having compliance security guidelines and regulations. Another concept is physiological protection, which include the method identified in institutional protective measures as well as focused on physically safeguarding health records because they are not handled by different individuals as well as those who may abuse them [25, 26]. Willfully violating protections is the largest source for security vulnerabilities, ranking second pick. Having allocated security operations is an example of this type of protection strategy [27–29].It is to be noted that scholars may be able to utilize this technology to investigate previously undisclosed facts on a certain group of individuals. Adequate financing for longitudinal research is important to the advancement of precision medicine. With the support of the Internet of Things (IoT) and wearable technologies, we leverage blockchain for healthcare in general to record and modify vital medical information such as high blood pressure and insulin levels [13, 30]. The third part of concepts is technological protections, which safeguard the entire data system contained in a health protected network [31, 32]. Although most security problems occur via digital media, such as computer system as well as other transferable digital equipment, this theme is critical in guaranteeing the institution’s security. This theme features security mechanisms such as routers and encrypting, virus scanning, and communication authentication measures [33]. Furthermore, it was determined that routers and cryptography have been the most widely used security methods. Numerous remarkable security mechanisms include virus protection, chief information security officers, and cloud services; however, their execution is entirely cost dependent.Cryptosystem has also been used to secure or safeguard digital medical details. Cryptography has enhanced the safety of healthcare data in general and during exchange of health information. The technique of transmitting patient data requires standards that have been developed via parameters that generally demand institutions to document the transfer method where cryptographic functions are either activated or disengaged. By securing transport protocol for patients’ information that also are transferred from one location to another, health records become significantly more available and secured. Another type of cryptography is the usage of usernames. They also aid in the prevention of cybersecurity incidents by incorporating privacy of individuals on credentials and encouraging passcode users to change their passwords regularly. For preventing a hacker from guessing the set passcode, avoid using widely utilized names and details. In the event of accomplishing restrictions, using identity and strong passwords techniques is beneficial. The role-based controls perform restriction on access of data to users through applying usernames and passwords created by system administrators. This technique does not offer effective protection of information within electronic health records from internal threats. Employees must log out of the system once they are finished to ensure that the dwindling health facts are not visible to unauthorised individuals [33].Implementation of virus protection, cloud services, initial risk evaluation encoders, the hiring of a chief information security officer, and radio frequency identification (RFID) are all common security techniques [34, 35]. A new technology being employed to ensure the protection and privacy of data in a health information system is Remote Healthcare Monitoring (RPM). Different sorts of monitors are employed in this example to measure suffering patients’ condition while they are at home. They employ wearable or implantable detectors. These detectors provide data from the local ground station, which is housed within the patient’s home, via wireless connectivity. Even though there are deviations from the predefined reasonable boundaries, the location guarantees that the data is reviewed and alerts a centralized server station. When alerted, the health professional can take the appropriate steps to support patients. Alzheimer, hypertension, and heart problems are just a few of the illnesses for which Clinical Decision support monitoring equipment is ideal. Many breakthroughs in the healthcare field could arise from installing the new technology. Information from digital health records is transmitted digitally over the Net or wireless networks, posing risks including such surveillance, data leaks, and abuse. Finally, there are issues such as significant societal consequences, like employers refusing to recruit employees in the organization due to their health issues, and insurance companies refusing to insure patients.Because of the growing Internet penetration, substantial investigation on cloud applications for connectivity into electronic health records has been done. Virtualization computing’s architecture allows for digital allocation and knowledge exchange, and also the “having to rent” of memory and processing capacity. This allows healthcare institutions to spend less money on developing an EHR system by transfer of ownership and reducing maintenance fees while also adding cryptographic protocols [36, 37]. Despite the fact that the cloud computing technology appears to be potential, antivirus program is a much more often used security solution. Figure 2 shows the techniques of handling privacy and security issues in HER. Figure 2 shows the block illustration for data encryption in maintaining electronic health records. Data insecurity is at peak as use of the Internet devices is increasing with every passing day. There are various privacy and security issues which need to be taken care of for stable system.Figure 2
Techniques of handling privacy and security issues in HER.


### 2.2. Problems in Storage of Electronic Medical Records

With the application of the Health Insurance Portability and Accountability Act (HIPAA) in the medical community, it has been found out that many issues are there in terms of storing medical health records, especially the confidentiality issues which are at the top. The HER challenges are highlighted by the Office of the National Coordinator for Health Information Technology (ONC), which drives the deployment of health systems in the United States [38, 39]. Those are as follows:(1)
Keeping track of patient records adds to the workload of day-to-day processes.(2)
EHRs are difficult to use leading to a shortage of integration with healthcare setting.(3)
Data processing and extraction for EHR accountability mechanisms are difficult; needs are sometimes out of sync with federal grants.(4)
Drug programs implemented are lacking in scalability and automated. All of these issues are classified by ONC as facility burdens.Many ways are being deployed to overcome these issues. One of them is using blockchain technology. Figure3 shows the ethical issues in electronic medical records.Figure 3
Ethical issues in electronic medical records.


### 2.3. Blockchain-Based Data Storage and Sharing

Blockchain technology has become a main topic of attention amongst that varied variety of scholars and scientists since the invention of bitcoin, a virtual cryptocurrency, in 2008. Blockchain is a decentralized ledger that secures, verifies, and transparently archives all payment orders on top of a mentoring network. We will therefore discuss the important aims within establishment of safe bitcoin medical systems depending on the specification of a modern health service and the features of blockchain. Figures4 and 5 show the key goals for implementing blockchain in healthcare and aspects of blockchain in healthcare, respectively.(1)
Privacy: individual data will be used privately, and only authorized parties can access the requested data.(2)
Security: in terms of secrecy, reliability, and accessibility.(3)
Auditability: a critical element of security.(4)
Accountability: an individual or an institution will be investigated and held accountable for their actions.(5)
Authenticity: before granting access to sensitive material, requestors’ identification must be verified.(6)
Anonymity: for the sake of privacy, organizations also had no apparent identification. Absolute secrecy is difficult to achieve; hence, pseudoanonymity is much more widespread.Figure 4
Key goals for implementing blockchain in healthcare.Figure 5
Aspects of blockchain in healthcare.Figure 6
Blockchain-based data management within healthcare system.Recent blockchain-based healthcare study focuses on six primary issues in order to achieve the desired objectives.(i)
Data Storage. Blockchain is used to record a huge spectrum of confidential health records as a trustworthy ledger repository. If reliable preservation is accomplished, private information must be ensured. In actuality, though, the quantity of health records is vast and complex. As a result, a related difficulty is figuring out where to deal with huge information storage without compromising the blockchain network’s efficiency.(ii)
Data Sharing. In most existing healthcare systems, service providers usually maintain primary stewardship of data. With the notion of self-sovereignty, it is a trend to return the ownership of healthcare data back to the user who is capable of sharing (or not sharing) his personal data at will. It is also necessary to achieve secure data sharing across different organizations and domains.(iii)
Data Audit. When conflicts emerge, audit logs could be used as documentation to keep recipients answerable for their transactions with EHRs. Some applications use blockchain and smart contracts to keep track of transactions for traceability. Any action or desire will be documented in the blockchain ledger and accessible at any time.(iv)
Identity Manager. The system must ensure the authenticity of every user’s identification. To put it another way, just authorized personnel can make the required queries to maintain security system and prevent targeted activity. Figure 6 shows the blockchain-based data management within healthcare system.


### 2.4. Domains in Healthcare

Various domains and applications in healthcare and their blockchain-based solutions are listed in Tables1 and 2.Table 1
Domain in healthcare, existing problems, and blockchain-based solutions.
Domain in healthcareExisting problemsBlockchain-based solutionsPatient record management(i) Lack of access to complete medical records(ii) Ownership issues(i) Providing access to complete medical records(ii) Restricting the same diagnostic tests from being repeated(iii) Allowing new doctors to learn about past patients’ historiesMaintaining consistent permission(i) Accessing data takes a lot of time(ii) Permissions are not consistent(i) Access to the data is done on fast-track basis(ii) Permissions are managed securely(iii) Minimizing the amount of time it takes to obtain patient informationBilling system(i) System is not transparent(ii) Takes a lot of time and resources(i) The billing system is secure and transparent(ii) Using less resources, time, and costE-medicine system(i) Security flaws exist in virtual connections(ii) There is a risk that patients’ confidential and sensitive data will be leaked(i) Removing necessity middlemen while also assisting with legal issues(ii) Allowing for safe, unchangeable, and untraceable distributed systemsDrugs management(i) Fake medicines, pharmaceutical traceability(ii) Drug supply chain security(iii) Connecting multiple drug dealers(i) Aiding in the creation of clear drug traces(ii) Fake drugs are no longer a threat(iii) Data security is ensuredClinical trials and correctness of data(i) Reporting incorrect data(ii) Lack of transparency(i) Improving the information’s credibility(ii) Enhancing the precision of data analytics(iii) Aiding in the management of genomic sequences in personalized medicineTable 2
Various applications.
ApplicationDescriptionHERA digitalized EHR on an approved blockchain’s distributed ledger is guaranteed with consistency from the point of information creation to data retrievalClinical researchBlockchain includes a decentralized secure framework of any data collaboration related to clinical researchIn health fraud detectionBlockchain helped in fraud discovery by not permitting a few copied data in the transactionNeuroscienceBlockchain technology is used for reenactment of brainPharmacologyMedicine and its elements noticed at each phase of the pharmacological supply chain


### 2.5. Case Studies

Various healthcare organizations are using blockchain for storing and sharing patient’s data. Some of them are listed in Tables3 and 4.Table 3
Storing patient’s data.
NameLocationWhat they doFACTOMAustin, TexasIt develops technologies which assist the healthcare system in keeping personal electronic documents on the industry’s blockchain network, which is exclusively available to doctors and healthcare professionals. Physical documents can be outfitted with unique alternative for conventional safety circuits that save patient health information as private data which only allow users to visit. It secures electronic medical files by employing blockchain-based system.MEDICALCHAINLondon, EnglandIts blockchain maintains data reliability of medical files while having a new point of truth. Clinicians, hospitals, and laboratories can all require patient records that are traceable and the patient’s condition is safeguarded from prying eyes. Its blockchain-based infrastructure keeps records of origination and safeguards patient identification.GUARDTIMEIrvine, CaliforniaIt is assisting healthcare community organizers in using blockchain into their information security strategies. The organization was instrumental in the implementation of blockchain in Estonia’s medical systems, and in recent times it secured an agreement with such a private health professional in the United Arab Emirates to introduce data protection systems to it. It makes use of blockchain for network security domains such as healthcare.Table 4
Sharing patient’s data.
NameLocationWhat they doSimplyvital healthWatertown, MassachusettsIts autonomous technology is being made accessible to the healthcare sector. Its harmony wellness framework is an open-source database management system for healthcare practitioners to access necessary details on a patient’s blockchain. Public source to critical medical data allows healthcare professionals to integrate treatment activities faster than current approaches. Simplyvital employs blockchain technology to build a free software system that allows healthcare practitioners to retrieve patient information and perform care.Coral health research and discoveryVancouver, CanadaIt leverages blockchain to enhance the quality of care by speeding up the care process, automating administrative activities, and accelerating the healthcare system. By incorporating patient data in blockchain technology, the relations between the two doctors, specialists, laboratory staff, and health officials are more quickly than ever before. Coral health also uses smart agreements between patients and healthcare experts to assure the validity of the data and treatments. Coral’s blockchain technology speeds up care, minimizes administrative procedures, and uses smart contracts to connect patients and clinicians.ROBOMEDMoscow, RussiaIt blends artificial intelligence and bitcoin to provide patients with a consolidated point of service. Catboats, wearable diagnostic instruments, and teleconference conferences are used by the organization to collect patient content and communicate that with the patient’s healthcare staff. The panacea system from Robomed involves patients in smart contracts that incentivize and guide patients down the right path to greater health. Robomed employs blockchain technology to securely collect and distribute patient data with patient’s healthcare professionals.


## 2.1. Privacy and Security of Electronic Health Records (without Blockchain)

There are various ways which are being used to secure the healthcare data. A number of researches have applied technical, physical, and administrative principles for that. These guidelines are made up of a number of security measures used among healthcare arrangements to provide better protection to the safe and secure patient data contained in digital health details [18–20]. Figure 1 shows the principles for sharing electronic health records.Figure 1
Principles for sharing electronic health records.The authors have made approaches for cloud computing. Despite its pervasiveness and various offerings, cloud computing creates serious privacy and security concerns. As a result, before using the cloud for business solutions, worldwide organizations have focused on developing security policies and practices for the cloud environment [21]. According to reports, healthcare data is enormous and varied, and it is frequently stored on the cloud. However, the number of cloud attackers is increasing, necessitating the development of a system that safeguards data privacy. Here we addressed a smart healthcare system built on blockchain technology, with the capability of enabling real-time data access that is accessible, traceable, and trustworthy [22]. The very first precaution is the topic of organizational safeguard, which includes applicable procedures such as executing inspections, hiring a commanding officer of data protection, and developing emergency plans [23, 24]. This subject includes measures that highlight the importance of having compliance security guidelines and regulations. Another concept is physiological protection, which include the method identified in institutional protective measures as well as focused on physically safeguarding health records because they are not handled by different individuals as well as those who may abuse them [25, 26]. Willfully violating protections is the largest source for security vulnerabilities, ranking second pick. Having allocated security operations is an example of this type of protection strategy [27–29].It is to be noted that scholars may be able to utilize this technology to investigate previously undisclosed facts on a certain group of individuals. Adequate financing for longitudinal research is important to the advancement of precision medicine. With the support of the Internet of Things (IoT) and wearable technologies, we leverage blockchain for healthcare in general to record and modify vital medical information such as high blood pressure and insulin levels [13, 30]. The third part of concepts is technological protections, which safeguard the entire data system contained in a health protected network [31, 32]. Although most security problems occur via digital media, such as computer system as well as other transferable digital equipment, this theme is critical in guaranteeing the institution’s security. This theme features security mechanisms such as routers and encrypting, virus scanning, and communication authentication measures [33]. Furthermore, it was determined that routers and cryptography have been the most widely used security methods. Numerous remarkable security mechanisms include virus protection, chief information security officers, and cloud services; however, their execution is entirely cost dependent.Cryptosystem has also been used to secure or safeguard digital medical details. Cryptography has enhanced the safety of healthcare data in general and during exchange of health information. The technique of transmitting patient data requires standards that have been developed via parameters that generally demand institutions to document the transfer method where cryptographic functions are either activated or disengaged. By securing transport protocol for patients’ information that also are transferred from one location to another, health records become significantly more available and secured. Another type of cryptography is the usage of usernames. They also aid in the prevention of cybersecurity incidents by incorporating privacy of individuals on credentials and encouraging passcode users to change their passwords regularly. For preventing a hacker from guessing the set passcode, avoid using widely utilized names and details. In the event of accomplishing restrictions, using identity and strong passwords techniques is beneficial. The role-based controls perform restriction on access of data to users through applying usernames and passwords created by system administrators. This technique does not offer effective protection of information within electronic health records from internal threats. Employees must log out of the system once they are finished to ensure that the dwindling health facts are not visible to unauthorised individuals [33].Implementation of virus protection, cloud services, initial risk evaluation encoders, the hiring of a chief information security officer, and radio frequency identification (RFID) are all common security techniques [34, 35]. A new technology being employed to ensure the protection and privacy of data in a health information system is Remote Healthcare Monitoring (RPM). Different sorts of monitors are employed in this example to measure suffering patients’ condition while they are at home. They employ wearable or implantable detectors. These detectors provide data from the local ground station, which is housed within the patient’s home, via wireless connectivity. Even though there are deviations from the predefined reasonable boundaries, the location guarantees that the data is reviewed and alerts a centralized server station. When alerted, the health professional can take the appropriate steps to support patients. Alzheimer, hypertension, and heart problems are just a few of the illnesses for which Clinical Decision support monitoring equipment is ideal. Many breakthroughs in the healthcare field could arise from installing the new technology. Information from digital health records is transmitted digitally over the Net or wireless networks, posing risks including such surveillance, data leaks, and abuse. Finally, there are issues such as significant societal consequences, like employers refusing to recruit employees in the organization due to their health issues, and insurance companies refusing to insure patients.Because of the growing Internet penetration, substantial investigation on cloud applications for connectivity into electronic health records has been done. Virtualization computing’s architecture allows for digital allocation and knowledge exchange, and also the “having to rent” of memory and processing capacity. This allows healthcare institutions to spend less money on developing an EHR system by transfer of ownership and reducing maintenance fees while also adding cryptographic protocols [36, 37]. Despite the fact that the cloud computing technology appears to be potential, antivirus program is a much more often used security solution. Figure 2 shows the techniques of handling privacy and security issues in HER. Figure 2 shows the block illustration for data encryption in maintaining electronic health records. Data insecurity is at peak as use of the Internet devices is increasing with every passing day. There are various privacy and security issues which need to be taken care of for stable system.Figure 2
Techniques of handling privacy and security issues in HER.


## 2.2. Problems in Storage of Electronic Medical Records

With the application of the Health Insurance Portability and Accountability Act (HIPAA) in the medical community, it has been found out that many issues are there in terms of storing medical health records, especially the confidentiality issues which are at the top. The HER challenges are highlighted by the Office of the National Coordinator for Health Information Technology (ONC), which drives the deployment of health systems in the United States [38, 39]. Those are as follows:(1)
Keeping track of patient records adds to the workload of day-to-day processes.(2)
EHRs are difficult to use leading to a shortage of integration with healthcare setting.(3)
Data processing and extraction for EHR accountability mechanisms are difficult; needs are sometimes out of sync with federal grants.(4)
Drug programs implemented are lacking in scalability and automated. All of these issues are classified by ONC as facility burdens.Many ways are being deployed to overcome these issues. One of them is using blockchain technology. Figure3 shows the ethical issues in electronic medical records.Figure 3
Ethical issues in electronic medical records.


## 2.3. Blockchain-Based Data Storage and Sharing

Blockchain technology has become a main topic of attention amongst that varied variety of scholars and scientists since the invention of bitcoin, a virtual cryptocurrency, in 2008. Blockchain is a decentralized ledger that secures, verifies, and transparently archives all payment orders on top of a mentoring network. We will therefore discuss the important aims within establishment of safe bitcoin medical systems depending on the specification of a modern health service and the features of blockchain. Figures4 and 5 show the key goals for implementing blockchain in healthcare and aspects of blockchain in healthcare, respectively.(1)
Privacy: individual data will be used privately, and only authorized parties can access the requested data.(2)
Security: in terms of secrecy, reliability, and accessibility.(3)
Auditability: a critical element of security.(4)
Accountability: an individual or an institution will be investigated and held accountable for their actions.(5)
Authenticity: before granting access to sensitive material, requestors’ identification must be verified.(6)
Anonymity: for the sake of privacy, organizations also had no apparent identification. Absolute secrecy is difficult to achieve; hence, pseudoanonymity is much more widespread.Figure 4
Key goals for implementing blockchain in healthcare.Figure 5
Aspects of blockchain in healthcare.Figure 6
Blockchain-based data management within healthcare system.Recent blockchain-based healthcare study focuses on six primary issues in order to achieve the desired objectives.(i)
Data Storage. Blockchain is used to record a huge spectrum of confidential health records as a trustworthy ledger repository. If reliable preservation is accomplished, private information must be ensured. In actuality, though, the quantity of health records is vast and complex. As a result, a related difficulty is figuring out where to deal with huge information storage without compromising the blockchain network’s efficiency.(ii)
Data Sharing. In most existing healthcare systems, service providers usually maintain primary stewardship of data. With the notion of self-sovereignty, it is a trend to return the ownership of healthcare data back to the user who is capable of sharing (or not sharing) his personal data at will. It is also necessary to achieve secure data sharing across different organizations and domains.(iii)
Data Audit. When conflicts emerge, audit logs could be used as documentation to keep recipients answerable for their transactions with EHRs. Some applications use blockchain and smart contracts to keep track of transactions for traceability. Any action or desire will be documented in the blockchain ledger and accessible at any time.(iv)
Identity Manager. The system must ensure the authenticity of every user’s identification. To put it another way, just authorized personnel can make the required queries to maintain security system and prevent targeted activity. Figure 6 shows the blockchain-based data management within healthcare system.


## 2.4. Domains in Healthcare

Various domains and applications in healthcare and their blockchain-based solutions are listed in Tables1 and 2.Table 1
Domain in healthcare, existing problems, and blockchain-based solutions.
Domain in healthcareExisting problemsBlockchain-based solutionsPatient record management(i) Lack of access to complete medical records(ii) Ownership issues(i) Providing access to complete medical records(ii) Restricting the same diagnostic tests from being repeated(iii) Allowing new doctors to learn about past patients’ historiesMaintaining consistent permission(i) Accessing data takes a lot of time(ii) Permissions are not consistent(i) Access to the data is done on fast-track basis(ii) Permissions are managed securely(iii) Minimizing the amount of time it takes to obtain patient informationBilling system(i) System is not transparent(ii) Takes a lot of time and resources(i) The billing system is secure and transparent(ii) Using less resources, time, and costE-medicine system(i) Security flaws exist in virtual connections(ii) There is a risk that patients’ confidential and sensitive data will be leaked(i) Removing necessity middlemen while also assisting with legal issues(ii) Allowing for safe, unchangeable, and untraceable distributed systemsDrugs management(i) Fake medicines, pharmaceutical traceability(ii) Drug supply chain security(iii) Connecting multiple drug dealers(i) Aiding in the creation of clear drug traces(ii) Fake drugs are no longer a threat(iii) Data security is ensuredClinical trials and correctness of data(i) Reporting incorrect data(ii) Lack of transparency(i) Improving the information’s credibility(ii) Enhancing the precision of data analytics(iii) Aiding in the management of genomic sequences in personalized medicineTable 2
Various applications.
ApplicationDescriptionHERA digitalized EHR on an approved blockchain’s distributed ledger is guaranteed with consistency from the point of information creation to data retrievalClinical researchBlockchain includes a decentralized secure framework of any data collaboration related to clinical researchIn health fraud detectionBlockchain helped in fraud discovery by not permitting a few copied data in the transactionNeuroscienceBlockchain technology is used for reenactment of brainPharmacologyMedicine and its elements noticed at each phase of the pharmacological supply chain


## 2.5. Case Studies

Various healthcare organizations are using blockchain for storing and sharing patient’s data. Some of them are listed in Tables3 and 4.Table 3
Storing patient’s data.
NameLocationWhat they doFACTOMAustin, TexasIt develops technologies which assist the healthcare system in keeping personal electronic documents on the industry’s blockchain network, which is exclusively available to doctors and healthcare professionals. Physical documents can be outfitted with unique alternative for conventional safety circuits that save patient health information as private data which only allow users to visit. It secures electronic medical files by employing blockchain-based system.MEDICALCHAINLondon, EnglandIts blockchain maintains data reliability of medical files while having a new point of truth. Clinicians, hospitals, and laboratories can all require patient records that are traceable and the patient’s condition is safeguarded from prying eyes. Its blockchain-based infrastructure keeps records of origination and safeguards patient identification.GUARDTIMEIrvine, CaliforniaIt is assisting healthcare community organizers in using blockchain into their information security strategies. The organization was instrumental in the implementation of blockchain in Estonia’s medical systems, and in recent times it secured an agreement with such a private health professional in the United Arab Emirates to introduce data protection systems to it. It makes use of blockchain for network security domains such as healthcare.Table 4
Sharing patient’s data.
NameLocationWhat they doSimplyvital healthWatertown, MassachusettsIts autonomous technology is being made accessible to the healthcare sector. Its harmony wellness framework is an open-source database management system for healthcare practitioners to access necessary details on a patient’s blockchain. Public source to critical medical data allows healthcare professionals to integrate treatment activities faster than current approaches. Simplyvital employs blockchain technology to build a free software system that allows healthcare practitioners to retrieve patient information and perform care.Coral health research and discoveryVancouver, CanadaIt leverages blockchain to enhance the quality of care by speeding up the care process, automating administrative activities, and accelerating the healthcare system. By incorporating patient data in blockchain technology, the relations between the two doctors, specialists, laboratory staff, and health officials are more quickly than ever before. Coral health also uses smart agreements between patients and healthcare experts to assure the validity of the data and treatments. Coral’s blockchain technology speeds up care, minimizes administrative procedures, and uses smart contracts to connect patients and clinicians.ROBOMEDMoscow, RussiaIt blends artificial intelligence and bitcoin to provide patients with a consolidated point of service. Catboats, wearable diagnostic instruments, and teleconference conferences are used by the organization to collect patient content and communicate that with the patient’s healthcare staff. The panacea system from Robomed involves patients in smart contracts that incentivize and guide patients down the right path to greater health. Robomed employs blockchain technology to securely collect and distribute patient data with patient’s healthcare professionals.


## 3. State of the Art

Blockchain and its applications have grown through several stages. Various scholars have focused on blockchain in healthcare, especially. Distributed ledger technology has several applications in the healthcare field, and with its increasing prevalence, we could anticipate far more in the upcoming. To address the severe issues that this business is experiencing, it is critical to implement growth and achieve overall quality of healthcare services provided. Blockchain technology appears to be an adequate answer for this. Blockchain technology, assuming effective integration and comprehensive applications, has the potential to be the savior the health sector has been searching for. The following are some of the areas as shown in Figure7.Figure 7
Blockchain technology applications in the health sector.


### 3.1. Contributions in Healthcare Using Blockchain

We followed the principles for research paper and the methodology for study consisted in researching and presenting this review. A related empirical study seeks to gain an outline of the subject area while also assessing the standard of evidence in particular issues. In this example, the cartography study’s findings would assist us all in identifying the key blockchain use instances in healthcare, as well as understanding the amount to which blockchain-based systems have been created in response to the specified use instances. They would also assist us in identifying potential studies needed to be done. The detailed review would allow us to investigate recent trends in architectural techniques, processes, and ideas used in implementing blockchain-based applications and services. Following that, we would go through the systematic mapping procedure as illustrated below in Figure8. Table 5 gives the detail of data items and their description. Figure 8 is a block representation in which proper and efficient methodology has been discussed to conduct the research. It should begin with the problem formulation for the proposed work and ends with the systemic map which will lead to successful work. Various relevant works will be explored in the whole process.Figure 8
Systematic mapping procedure.Table 5
Data items and their description.
#Data itemDescription1YearPublication year of the paper2TitleTitle of the paper3AuthorsThe authors of the paper4CountryCountry of affiliation of the authors5Publication channelThe channel through which the paper is published6Publication typeJournal/conference/workshop/etc.7Publication sourceAcademia/industry/both8Paper typeType based on classification scheme9Paper contributionsMain contributions of the paper10SummaryOur own summary or abstract of the paperWe were able to generate a total of 149 documents from research journals applying our monitoring strategy. 52 articles have been eliminated after the first screening, which was based on the titles of the papers, leaving 97 papers for secondary inspection. The publications that had been eliminated were not linked to healthcare; nonetheless, healthcare may be highlighted in their abstracts as a nonfinancial use instance of blockchain, and hence our discovery protocol found them. We then deleted the duplicates, reducing the number of publications chosen to 71. In the following screening stage, we examine the abstracts of the selected articles, as well as the introduction and closing in certain cases, to further analyze the publications. As a consequence of this, 47 manuscripts were chosen. After reading all of the selected papers in their entirety, 11 more manuscripts were removed as they were not concentrated on healthcare. These manuscripts just reference healthcare as a high potential of blockchain application in many of the subcategories, without providing any new knowledge. Depending on that, the following use cases and articles are described further in Table6.Table 6
Description of use cases.
Use caseFrameworkContributionOn-chain/off-chain storagePrivacy preservingElectronic medical recordsEthereumEnables a patient-centered system providing a comprehensive and approachable picture of medical recordsOn-chainYesEthereumCreates a mechanism for sharing health data in cloud archivesOn-chainYesSpecificA decentralized PHR paradigm that provides answers to delay difficultiesOff-chainNoEthereumOffers a blockchain-based EMR system that satisfies ONC criteriaOn-chainYesProprietaryA medical platform that utilizes combination off-chain storage and on-chain authenticationBothYesProprietaryA blockchain-based EMR administration solution is providedOn-chainYesEthereumProposed a digital health records technology that safeguards healthcare dataOn-chainYesRemote patient monitoringHyperledger fabricA blockchain-based portable medical system for cognitive behavioral therapy for sleeplessnessOn-chainYesEthereumThe use of blockchain-based consensus mechanism to accomplish real-time data processing is proposedOn-chainYesEthereumDevelops an infrastructure that combines blockchain and IoT sensed information obtained from patientsOn-chainYesPharmaceutical claimsEthereumEnables drug availability throughout transit by keeping public temperature dataOn-chainNoHyperledger fabricCreates a blockchain-based control mechanism for drug distributionOn-chainYesHyperledger fabricCreates a pharmaceutical supply chain that is safe, unchangeable, and transparentOn-chainYesHealth insurance claimsEthereumA blockchain-based medical insurance recordkeeping system has been proposedOn-chainYesOmar et al. [1] presented a blockchain-based medical data infrastructure that protects patient confidentiality. The information is secure and kept in a federated blockchain, and the secret key must be obtained from a data holder. Yue et al. [2] suggested a framework for healthcare data gateways. The information is encrypted and kept on a private blockchain server. A patient downloads encrypted information, decodes it, and then selects whether or not to disclose it. Whenever data is transferred, it is encoded once more, and the cipher text and decoding key are provided to the recipient.Azaria et al. [10] presented a blockchain-based health information access and authorization control system. Health information is kept in a database server. Gem Health, a GemOS program, creates a medical ecosystem that includes patients, pharmacies, families, physicians, nurses, and insurers. GemOS can link localized datasets into a blockchain-based data management system.Xia et al. [17] presented a blockchain-based medical data exchange system that strictly enforces smart contracts to have private keys. Because blockchain agreements are managed by blockchain nodes, the system necessitates that almost all blockchain nodes use the same key. Data privacy will be compromised if a blockchain network is hostile. Table 6 summarizes the contributions discussed previously in terms of accessibility, authenticity, and confidentiality. We feel that if patients are obliged to engage in the usage of data, the program’s accessibility would be restricted. We believe the program’s authenticity is compromised whether data is kept locally or on a cloud storage service. We believe a scheme’s confidentiality is compromised if it requires the storage of a key in a smart contract. On this work, encoded data is kept in a blockchain which was used without the involvement of a client, and an agreement with no inherent keys is being used to optimize the accuracy, accessibility, and confidentiality features of medical information. Table 7 gives the comparative analysis, various techniques, and their applications.Table 7
Comparative Analysis of various models along with the applications.
Author nameYearTechniqueApplicationsGapsLiu et al. [26]2018Light weight BC design modelHealthcare data managementHigh power usage and limited capacityGriggs et al. [33]2018EIGamal encryption network modelAnalyzing informationComplex dataBocek et al. [35]2017Global and local consensus modelIdentification and verificationTrust issueBryatov and Borodinov [37]2019BC-HIE methodStoring and sharing dataComplicated structure


## 3.1. Contributions in Healthcare Using Blockchain

We followed the principles for research paper and the methodology for study consisted in researching and presenting this review. A related empirical study seeks to gain an outline of the subject area while also assessing the standard of evidence in particular issues. In this example, the cartography study’s findings would assist us all in identifying the key blockchain use instances in healthcare, as well as understanding the amount to which blockchain-based systems have been created in response to the specified use instances. They would also assist us in identifying potential studies needed to be done. The detailed review would allow us to investigate recent trends in architectural techniques, processes, and ideas used in implementing blockchain-based applications and services. Following that, we would go through the systematic mapping procedure as illustrated below in Figure8. Table 5 gives the detail of data items and their description. Figure 8 is a block representation in which proper and efficient methodology has been discussed to conduct the research. It should begin with the problem formulation for the proposed work and ends with the systemic map which will lead to successful work. Various relevant works will be explored in the whole process.Figure 8
Systematic mapping procedure.Table 5
Data items and their description.
#Data itemDescription1YearPublication year of the paper2TitleTitle of the paper3AuthorsThe authors of the paper4CountryCountry of affiliation of the authors5Publication channelThe channel through which the paper is published6Publication typeJournal/conference/workshop/etc.7Publication sourceAcademia/industry/both8Paper typeType based on classification scheme9Paper contributionsMain contributions of the paper10SummaryOur own summary or abstract of the paperWe were able to generate a total of 149 documents from research journals applying our monitoring strategy. 52 articles have been eliminated after the first screening, which was based on the titles of the papers, leaving 97 papers for secondary inspection. The publications that had been eliminated were not linked to healthcare; nonetheless, healthcare may be highlighted in their abstracts as a nonfinancial use instance of blockchain, and hence our discovery protocol found them. We then deleted the duplicates, reducing the number of publications chosen to 71. In the following screening stage, we examine the abstracts of the selected articles, as well as the introduction and closing in certain cases, to further analyze the publications. As a consequence of this, 47 manuscripts were chosen. After reading all of the selected papers in their entirety, 11 more manuscripts were removed as they were not concentrated on healthcare. These manuscripts just reference healthcare as a high potential of blockchain application in many of the subcategories, without providing any new knowledge. Depending on that, the following use cases and articles are described further in Table6.Table 6
Description of use cases.
Use caseFrameworkContributionOn-chain/off-chain storagePrivacy preservingElectronic medical recordsEthereumEnables a patient-centered system providing a comprehensive and approachable picture of medical recordsOn-chainYesEthereumCreates a mechanism for sharing health data in cloud archivesOn-chainYesSpecificA decentralized PHR paradigm that provides answers to delay difficultiesOff-chainNoEthereumOffers a blockchain-based EMR system that satisfies ONC criteriaOn-chainYesProprietaryA medical platform that utilizes combination off-chain storage and on-chain authenticationBothYesProprietaryA blockchain-based EMR administration solution is providedOn-chainYesEthereumProposed a digital health records technology that safeguards healthcare dataOn-chainYesRemote patient monitoringHyperledger fabricA blockchain-based portable medical system for cognitive behavioral therapy for sleeplessnessOn-chainYesEthereumThe use of blockchain-based consensus mechanism to accomplish real-time data processing is proposedOn-chainYesEthereumDevelops an infrastructure that combines blockchain and IoT sensed information obtained from patientsOn-chainYesPharmaceutical claimsEthereumEnables drug availability throughout transit by keeping public temperature dataOn-chainNoHyperledger fabricCreates a blockchain-based control mechanism for drug distributionOn-chainYesHyperledger fabricCreates a pharmaceutical supply chain that is safe, unchangeable, and transparentOn-chainYesHealth insurance claimsEthereumA blockchain-based medical insurance recordkeeping system has been proposedOn-chainYesOmar et al. [1] presented a blockchain-based medical data infrastructure that protects patient confidentiality. The information is secure and kept in a federated blockchain, and the secret key must be obtained from a data holder. Yue et al. [2] suggested a framework for healthcare data gateways. The information is encrypted and kept on a private blockchain server. A patient downloads encrypted information, decodes it, and then selects whether or not to disclose it. Whenever data is transferred, it is encoded once more, and the cipher text and decoding key are provided to the recipient.Azaria et al. [10] presented a blockchain-based health information access and authorization control system. Health information is kept in a database server. Gem Health, a GemOS program, creates a medical ecosystem that includes patients, pharmacies, families, physicians, nurses, and insurers. GemOS can link localized datasets into a blockchain-based data management system.Xia et al. [17] presented a blockchain-based medical data exchange system that strictly enforces smart contracts to have private keys. Because blockchain agreements are managed by blockchain nodes, the system necessitates that almost all blockchain nodes use the same key. Data privacy will be compromised if a blockchain network is hostile. Table 6 summarizes the contributions discussed previously in terms of accessibility, authenticity, and confidentiality. We feel that if patients are obliged to engage in the usage of data, the program’s accessibility would be restricted. We believe the program’s authenticity is compromised whether data is kept locally or on a cloud storage service. We believe a scheme’s confidentiality is compromised if it requires the storage of a key in a smart contract. On this work, encoded data is kept in a blockchain which was used without the involvement of a client, and an agreement with no inherent keys is being used to optimize the accuracy, accessibility, and confidentiality features of medical information. Table 7 gives the comparative analysis, various techniques, and their applications.Table 7
Comparative Analysis of various models along with the applications.
Author nameYearTechniqueApplicationsGapsLiu et al. [26]2018Light weight BC design modelHealthcare data managementHigh power usage and limited capacityGriggs et al. [33]2018EIGamal encryption network modelAnalyzing informationComplex dataBocek et al. [35]2017Global and local consensus modelIdentification and verificationTrust issueBryatov and Borodinov [37]2019BC-HIE methodStoring and sharing dataComplicated structure


## 4. Technical Challenges

Figure9 shows the technical challenges in blockchain, whereas Figure 10 shows the blockchain-based proposals vs solutions in healthcare.(1)
Secure and Private Data. The major challenge is the security and privacy of the information. With the development of services based on blockchain technology, the need for a third party to carry out the transaction is being eliminated [40, 41]. Though the method of the BC (blockchain) permits the complete community, instead of uniquely trusted third party, to identify the list of the blockchain structures, the information becomes persistent to security and authentication risks. Though complete nodes may access the information transferred by a unique node, information security may not be undamaged. Without the third party administration, the patient may need to choose more than one representative who may access the data/medical records at the time of the emergency. If a group of people are permitted to access the lists of similar patients, then that may generate maximum data security attacks [42–44]. However, the limitations lie in transmitting the information to others where the destinations may have access to restricted data.(2)
Managing the Storage Ability. The other issue that appears is the maintenance of the storing ability. BC (blockchain) is constructed to build the list and lead the transaction information that has the restricted storage ability where it may not require maximum storage ability. Another difficulty that arises is the maintenance of storage capacity. With the passage of time, the groups in the area of healthcare storing issues become evident. BC (blockchain) is developed to build the list and lead the transaction information that has the restricted storage ability where it may not require maximum storage ability. Healthcare segments have large quantities of information that may be processed on a regular basis. Through the patient accounts, the medical records, test reports to MRI scan, X-rays, and other pictures in blockchain situations may be available to all nodes in a chain that needs a large storing space [45, 46]. Additionally, the services of blockchain are transaction-based and the dataset used in this technology has the ability to develop at a fast rate. With the increase in the dimension of the dataset, the velocity record discovery and accessing become lower which is highly not appropriate from the kinds of the transactions where the velocity is significant.(3)
Interoperability Problems. Blockchain faced this problem by making the blockchain from different connecting workers and applications to others at a faster rate. This issue generates interference in the efficient sharing of the information.(4)
Adjustment Issues. Blockchain technology is static in the beginning and applied in direction of the real development in medical and healthcare which may certainly face the adjustment problems. An amount of real authenticated and specialized standards may be required from worldwide standardization establishments. The already defined standards may be helpful to compute the dimension and set up the data interchanged in blockchain services. Such standards may not only examine the shared information but also remain as protective measures.(5)
Social Issues. BC (blockchain) technology is quite developing and thus faced social issues such as social change, along with already defined technological issues. Achieving a technological aspect that is diverse from the standard research techniques may not be too simple. Though the healthcare industry is moving at a slow rate in direction of digital data, there is still an issue for totally changing the technology, mainly the blockchain, that has not yet been identified in the medical sectors. However, encouraging medical experts to switch from research data to blockchain at the appropriate time is difficult due to the low acceptability value in the medical industry, as well as the technology and guidelines supplied.Figure 9
Technical challenges in blockchain.Figure 10
Blockchain-based proposals vs solutions in healthcare.Blockchain-based healthcare current challenges and opportunities are presented in Table8 [46].Table 8
Discussion of the blockchain healthcare current challenges and opportunities.
Main problems/challengesOpportunitiesMedical information accuracyThere is no worldwide list for medical information. The records are stored. The quality diagnosis influences whether patients may get treated or not.The association of the blockchain and medical care provided blockchain lists. The diagnosed accuracy forwarded must be enhanced.Medical information interoperabilityLess interoperability examined in medical related information. The data is disordered if information is forwarded from patient to caretaker, insurance presenter to presenter.Digitalized health-related lists reversed by blockchain models that may be simply used by medical related organizations.Fitness information securityThough medical information is simply reformed with fraudulent commits. Moreover, the information may have vanished because of normal calamity.Information lists placed in the blockchain are unmodified. This removes the risk of information. Medical related information in blockchain technology should be secured from the destruction stopping from natural catastrophe because there is no availability of disaster fact.Medical information handlingMaximum resources and time may not be managed and nonorganized medical organization dataset.The information in the blockchain structure is stored and may be simply accessed by related groups at specific time.Drug recommendationFraud medical recommendation is large. The drugs are not easy to differentiate from the authenticated party. It may have arranged significant influence on the health of patients.Blockchain information is not changeable. It is not possible to adjust once the recommendation is pertained. Positive influences are simple in terms of pushing revert on suggestions and drug circulation.Based on the proposed prototypes and developed applications, we can identify different limitations of the healthcare blockchain-based applications:(1)
EMR systems, for starters, do not handle interoperation. As a result, medical health data professionals must do systematic evaluation and mapping of preset taxonomies.(2)
Secondly, clinical misconduct is uncontrollable data at a specific stage.(3)
Furthermore, sustainability and compatibility challenges are the prime aim of ongoing and prospective research in this subject. The compatibility difficulty highlights the lack of standardization for implementing blockchain-based healthcare apps.As a result, the many built apps may be unable to communicate with one another. Furthermore, sustainability is a critical challenge in blockchain-based healthcare systems [12, 47], particularly given the huge amount of medical data entailed.Due to the huge volume of healthcare data, it is also not feasible to keep it on-chain, i.e., on blockchain, since this could result in significant efficiency reduction. Moreover, in blockchain-based network, there seems to be a delay error caused by the pace of information system and off-chain data load. Furthermore, agreements may now be exposed to cybercriminals due to blockchain irreversibility and consciousness of code [48].During 2016 and 2018, hacks like the highly autonomous organization (DAO) attack resulted in the loss of millions of dollars in cryptographic protocol assets.Future directions are as follows:(a)
Open standards (anonymous data sharing)(b)
National policy and supporting legislation(c)
Patient controls, privileges, and access(d)
Rural healthcare management systems(e)
AI integration(f)
Automation, microservices, and bots.


## 5. Key Future Trends of Blockchain in Healthcare

Some of the key future trends of the blockchain technology in medical care are listed below like (i) Medicare source chain, (ii) IT revolution, and (iii) faster development in digital market.(i)
Improving blockchain usage on medical care source chains: blockchain technology plays an essential role in the provision of digital world supply chain and also improving limpidity and effectiveness. Medical care administrations from producers to sellers may suggest the manufacture of goods by the supply chain for assuring the authentication as symptoms of tampering, high surroundings situations. If a builder detects the problem with a sensor or drug, the blockchain helps the seller further remember at a fast rate by recognizing the site of record in the direction of the supply chain that requires to be away from flow. For instance, the federal drug supply chain security is projected to improve the mistake of unclean, lost, and dangerous drugs. Few experimental schemes below this act test the method for securing the data shared towards medical initiatives. Walmart and IBM have selected the pilot system that discovers the technology by improving the security recommendation drug source and supply.(ii)
Fast integration to IT revolution: the Internet technology revolution like artificial intelligence, cloud resolutions, and blockchain developments may be measured as the additional technologies that helped speed up the achievement of the novel technologies. The novel hybrid cloud at client results provides high accessible public cloud services when storing the private medical information below initiative firewalls to estimate the regular needs [37]. Artificial intelligence combines and extracts features by identifying the designs and connection towards the large information placed on combined clouds and securely arranged in blockchain frameworks. When the connected sensors are associated with the Internet of things, blockchain has the capability to expose the demography developments, speed up the research and developments in the medical industry, and eventually enhance the patient’s results.(iii)
Fast developments in developed markets: the developed economy is ahead of blockchain and plans to strengthen the asset by 2020. Typically, high-income countries, particularly those in Asia, gain from blockchain development. And the Chinese government has positioned itself to control the blockchain area by granting more copyrights to blockchain. Normally China State Council constructed blockchain improvement in states with 13th five-year strategy. For instance, in 2019, the China President Xi identified that blockchain technology has an essential role in constructing power of China in Cyberspace, implementing the digitized economy, and developing social and economical enhancements. Hence, in 2018 in Estonia, the UAE arranged a goal strategy for using blockchain technology to enhance the various factors of the citizen lives like banking, transport, and medical care. The inventiveness group of the nation is en route to becoming the complete operational blockchain-based government in 2021. The medical care stage displays a data sharing output from those capable medical professionals, which includes medical experts, technological and local organisations for saving and sharing valuation data.


## 6. Conclusion

The approach is built on a smart health blockchain. As technology progresses, blockchain in healthcare can address a variety of difficulties in healthcare, such as care coordination, data security, and interoperability concerns. As technology advances, technical issues such as processing speed and large data duplication will be addressed. Healthcare data maintenance has been increasingly considered over the last few years as it presents more exact, effective, and cost-efficient patient care. The technology has maximum potential for improving the maintenance of the medical data because it may address problems like unique point failure, vulnerability, dispersed data, and privacy risks prevalent in current client server and cloud-based methods. The probability and applications of the blockchain with the trade-off are described by comparative analysis. Still various issues are required to be investigated for creating effective services that may fully profit through blockchain technology. The main use of the blockchain technology is the medical domain that uses a large amount of the experts, research and development experts, to efficiently distribute the large amount of information and share medical data. The effective growth of the blockchain technology in healthcare situations may effectively open a new area of research ways for development of medical research. The blockchain scheme is used in the neural control scheme and the digital brain may be used for storing the blockchain technology at the observation phase. However, machine learning models may directly focus on improving accuracy and efficiency rates. Healthcare industry is related to the lifespan of an individual. It may be helped by medical experts. According to the conclusions of the report, future research might focus on gender, age, and familiarity of blockchains, as well as their impact on blockchain adoption for smart healthcare systems. Another possible research topic is to investigate all of the elements that influence the acceptance of blockchain technology.



---

*Source: 9697545-2022-05-21.xml*