Leveraging the Power of Blockchain for Secure Healthcare Data Management System

Abstract

Despite significant improvements in healthcare innovations and administration, little has been done to address security threats such as data breaches or cybersecurity. To ensure the best services, healthcare authorities must manage healthcare data effectively—not just during or post-pandemic situations such as COVID-19, but also in their regular operations. Blockchain (BC) technology can be utilized to increase the security of healthcare data management. Healthcare providers may create a transparent, tamper-proof system for handling patient records, authentication, and access control by utilizing blockchain. We offer a general blockchain-enabled healthcare architecture for managing healthcare data reflecting various participant interactions. Our system connects all parties, including physicians, patients, governments, supply chains, and other healthcare practitioners, via the Ethereum network. The smart contract code development and testing were done on the Remix IDE platform. We have combined Hyperledger Fabric (HLF) and the InterPlanetary File System (IPFS) to provide decentralized storage. In addition to examining numerous safety concerns, we also compared our solution to other blockchain-based systems and offered a cost analysis of the various transactions it proposes. We have also demonstrated the benefits of using Blockchain for a secure and reliable healthcare system. We also highlight the existing challenges in adopting BC in healthcare data management, as well as potential future research directions, both in terms of deployment and real-world application.

Full text

2023 26th International Conference on Computer and Information Technology (ICCIT)
13-15 December, Cox’s Bazar, Bangladesh
979-8-3503-5901-5/23/$31.00 ©2023 IEEE
Leveraging the Power of Blockchain for Secure
Healthcare Data Management System
Khadija Begum
Institute of Digital Anti-Aging
Healthcare
Inje University
Gimhae, Republic of Korea
khadijahappy.cse@gmail.com
Hee-Cheol Kim
Institute of Digital Anti-Aging
Healthcare
Inje University
Gimhae, Republic of Korea
heeki@inje.ac.kr
Md Mamunur Rashid
Department of Information Technology
Deakin University
Victoria, Australia
mamunrashid.ete88@gmail.com
Md Ariful Islam Mozumder
Institute of Digital Anti-Aging
Healthcare
Inje University
Gimhae, Republic of Korea
arifulislamro@gmail.com
Abstract—Despite significant improvements in healthcare
innovations and administration, little has been done to address
security threats such as data breaches or cybersecurity. To ensure
the best services, healthcare authorities must manage healthcare
data effectively—not just during or post-pandemic situations such
as COVID-19, but also in their regular operations. Blockchain
(BC) technology can be utilized to increase the security of
healthcare data management. Healthcare providers may create a
transparent, tamper-proof system for handling patient records,
authentication, and access control by utilizing blockchain. We
offer a general blockchain-enabled healthcare architecture for
managing healthcare data reflecting various participant
interactions. Our system connects all parties, including physicians,
patients, governments, supply chains, and other healthcare
practitioners, via the Ethereum network. The smart contract code
development and testing were done on the Remix IDE platform.
We have combined Hyperledger Fabric (HLF) and the
InterPlanetary File System (IPFS) to provide decentralized
storage. In addition to examining numerous safety concerns, we
also compared our solution to other blockchain-based systems and
offered a cost analysis of the various transactions it proposes. We
have also demonstrated the benefits of using Blockchain for a
secure and reliable healthcare system. We also highlight the
existing challenges in adopting BC in healthcare data
management, as well as potential future research directions, both
in terms of deployment and real-world application.
Keywords— Blockchain, Healthcare, Data management,
Security, Privacy
I. INTRODUCTION
Research on emerging technologies in the healthcare sector
is constantly increasing and new ideas are established. In the
next one or two decades, no healthcare system may be able to
provide healthcare as we currently know it. This is because
automated, computerized services will be accessible via quicker
communication from anywhere at any time. Medical data has
traditionally been primarily owned by physicians,
radiographers, doctors, and researchers in a closed ecosystem
of isolated institutions that make up the healthcare system. The
one-to-one flow of information is being replaced by a diversity
of information-sharing relationships with many-to-many, one-
to-many, and many-to-one. Various privacy concerns are raised
by tracing or monitoring infected individuals or their
connections [1]. To preserve patient privacy and share
information with other organizations in the healthcare
ecosystem, authentication, provenance, integrity of data, and
interoperability is critical. The conventional approach to
implementing access control frequently relies on confidence
between the owners of the data and the entities that store it.
These organizations—often servers—have complete authority
over the creation and application of access control policies [2].
The healthcare sector is particularly concerned about security
and privacy due to greater regulatory requirements to protect
patients' medical information. In the age of the Internet, record
and data sharing are becoming more widespread thanks to the
usage of cloud storage and mobile health devices. However,
this also raises the chance of harmful attacks and the potential
for personal data to be compromised as it is shared [3]. Since
it's getting simpler to obtain health information via smart
devices and because people are visiting multiple providers,
there are concerns about the sharing and privacy of this
information. Capture, process, use, store, and dispose of are the
five fundamental components of a healthcare data lifecycle.
Figure 1 represents a typical data lifecycle of a healthcare
system.
Blockchain is one of the top technological advances that
have received the most attention in recent years. Blockchain is
a decentralized shared ledger that operates peer-to-peer (P2P)
2023 26th International Conference on Computer and Information Technology (ICCIT) | 979-8-3503-5901-5/23/$31.00 ©2023 IEEE | DOI: 10.1109/ICCIT60459.2023.10441220
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and stores transactions digitally as blocks. Blocks must be
connected in chronological order by the nodes (miners) of the
blockchain network. Blockchain nodes monitor the activities in
the network and save a copy of the recorded data [4]. Healthcare
reform initiatives should concentrate on managing data that
could benefit from the ability to connect various systems and
enhance the accuracy of EHRs. Blockchain technology enables
data sharing, access control, and audit trail tracking for medical
activities. Additionally, it can help with access control, risk data
management, supply chain management, and prescription drug
management. They do this by employing self-executing
contracts, or "smart contracts (SC)." Blockchain technology is
used by smart contracts, which are digital agreements, to handle
data, transactions involving tangible assets, and other digital
transactions [5]. With its many appealing features, blockchain
can help stakeholders to achieve better interoperability, access
control, provenance, and data integrity.
Fig. 1. Data lifecycle in a healthcare system
The healthcare industry is a pioneer in leveraging complex
information to generate value and improve the wellness of
individuals. However, it has been established that conventional
approaches to resolving health data privacy issues are
insufficient for preserving individual privacy. Blockchain can be
a great solution to address the difficulties of data security
because it perfectly satisfies the data processing needs in
healthcare. Aggregating massive amounts of data from medical
laboratories and healthcare providers throughout the world
becomes more and more problematic for different analytical
applications in healthcare. Furthermore, it is challenging to keep
the acquired data samples' integrity, especially when they are
stored in a centralized database. Many of these issues relating to
the data needed for healthcare analytics can be resolved by
blockchain technology. Because of its distributed architecture, a
blockchain can grow with enormous volumes of data quite
effectively (in comparison to centralized systems). Also, it
makes it possible to gather information from multiple places.
Most notably, the blockchain's digital signature technology aids
in maintaining data security by preventing intruders from
altering the database. Also, the append-only feature of
blockchain makes it easier to track the data changes made by
each network participant. In Figure 2, we have demonstrated a
blockchain-based healthcare application scenario with different
data sources and stakeholders.
Fig. 2. A workflow of blockchain-based healthcare applications and data
sources.
We provide a blockchain-based architecture for tracking
end-to-end data healthcare management by fusing Ethereum
smart contracts with decentralized storage technologies. The
following are the primary contributions of this study:
 We provided a healthcare data management system based
on the Ethereum blockchain that ensures data security,
traceability, and accessibility.
 We developed smart contracts for healthcare data
management that can handle a variety of transactions
between parties.
 We established a double-layered decentralized storage
system (a mix of IPFS and Hyperledger Fabric) to secure
the security of the documents and information.
 In our research, we went into great detail about the
suggested model's implementation aspects.
 To demonstrate the viability of our strategy, we
exhaustively tested and validated the offered solution by
executing experiments in addition to cost analysis.
The remainder of the paper is structured as follows: Studies
on healthcare data management that are linked to this one is
briefly described in Section II. The theoretical details of the
proposed system are presented in Section III. Section IV
describes the testing results for the recommended solution. The
results and recommended future steps are discussed in Section
V.
II. RELATED WORK
This part of the paper highlights the contributions of the
most recent and pertinent studies on blockchain-based
healthcare data management.
To share patient data securely and increase data
accessibility and scalability, Abbas et al. [6] proposed a
Blockchain-enabled secured data management framework
(BSDMF). The IoMT-related security structure makes use of
BC to guarantee data management and data transaction security
among linked nodes. A novel contract-based consortium BC
method was presented by Kumar et al. [7]. The authors put
together cluster nodes and interplanetary file systems (IPFS)
where smart contracts can be implemented in their initial
phases. The nodes guarantee device security and authentication
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and even ensure storage protection in IoMT-based medical
systems. By utilizing blockchain technology, Tanwar et al. [8]
proposed several improvements to the current shortcomings in
healthcare systems. These include the Wireshark capture
engine, Hyperledger Fabric, Composer, Docker Container, and
Hyperledger Caliper frameworks and tools for measuring the
performance of such systems. Additionally, they created the
Access Control Policy Algorithm, which facilitates the
modeling of settings for the Hyperledger-based electronic
health record (EHR) sharing system, which makes use of the
chaincode concept to enhance data accessibility among
healthcare providers.
HealthyBroker, a unique, trust-building brokering
architecture for various cloud settings, was put out by Kurdi et
al. [9]. This architecture was created especially for cloud-based,
patient-focused eHealth services. Care team members can
conduct secure eHealth transactions and gain "need-to-know"
access to pertinent patient data by data protection rules by using
it. Malamas et al. [10] offered a blockchain-enabled
authorization framework for the management of IoMT devices
and medical files, along with a distributed chain of custody and
health data privacy strategy. The main concept is to create trust
domains for different stakeholders and IoMT devices to enable
fine-grain access by considering crucial elements of the IoMT
ecosystem.
An Interplanetary File System (IPFS)-based solution to
these issues is suggested by Uppal et al. [11] The IoT devices'
health data is continuously added by the users to blockchain
transactions, where other user nodes like doctors, pharmacists,
insurance providers, hospital administrations, etc. can access
them. In the context of smart cities, Zakzouk et al. [12] offer a
system for managing Electronic Medical Records (EMR) that
is blockchain-based. The proposed framework uses blockchain
technology to guarantee the secure storage of electronic data
covered in their study as well as security and privacy for
healthcare information management.
The potential research prospects, difficulties, and future
study paths of BC in healthcare have been reviewed by McGhin
et al. [3]. The problem of diverse data in medical organizations
and how to merge them for analysis and insights, however, was
not addressed. Agbo et al.'s [13] systematic study of BC
healthcare technologies. The analysis reveals that numerous
studies have put forth multiple scenarios for the adoption of
blockchain in the healthcare industry, but the number of
prototype implementations and studies needed to assess these
use cases' viability is quite low. Gökalp et al. [14] presented a
thorough blockchain framework spanning all healthcare
stakeholders and providing an integrated blockchain
architecture to examine opportunities and problems. Peer-to-
peer insurance, personal genetic data storage, and access,
inventory monitoring and buy-sell mechanisms, health research
commons, notary services for medical documents, doctor
services, and digital health wallets are all included in the full
spectrum of a blockchain-based healthcare system. Blockchain
technology is used to create innovative and complex solutions
that will enhance the protocol for keeping, disseminating, and
processing clinical data and personalized health information,
according to a review of research by Saeed et al. [15]. In order
to address urgent problems with patient healthcare, data
integrity, and fraud protection, as well as to improve patient
care in remote monitoring or crises, the review concludes that
more research will be able to encourage the wider adoption of
BC.
III. PROPOSED DESIGN AND STYLING
We presented a blockchain-enabled approach for a secure
healthcare data management system, enabling end-to-end
visibility, and maintaining quality control. Our system makes
use of blockchain technology to foster increased trust among
many different parties involved in the management of healthcare
data, including patients, regulatory bodies, and healthcare
organizations like pharmacies and hospitals. The rules and
guidelines by which interactions between various stakeholders
are carried out have been established in smart contracts. Our
solution also makes use of decentralized storage platforms like
IPFS and Hyperledger Fabric, as seen in Figure 3.
A. Regulators
It ensures that all parties involved in data upload or use
abide by the fundamental laws and rules put in place by the
relevant authorities to guarantee their security and
functionality. Additionally, it is in charge of monitoring the
entire data management process as well as adding stakeholders
to the blockchain network.
B. Data Upload Participants
We'll briefly go over each of the elements of our developed
framework and their functions as data upload participants in this
section.
 Labs: By offering diagnostic testing services, healthcare
diagnostic labs play a key role in the healthcare industry.
These labs are outfitted with cutting-edge technology,
and qualified personnel perform a variety of tests to help
with disease diagnosis, observation, and treatment.
 Clinics: Healthcare institutions like clinics are crucial
players in the management of data upload since they
offer a wide range of healthcare services to patients.
These clinics might range in size and area of expertise,
and they often provide primary care services like regular
check-ups, immunizations, and care for minor diseases
and accidents.
 Patients, Bills, and Medical Images: Patients are
probably the most important stakeholders in healthcare
data generation and upload. Bills and different medical
images also contribute a great deal to the data upload.
C. Data Users
Similar to data upload participants data users must be pre-
authorized by the regulatory authority. In a healthcare system,
we have different types of data users who use data for their
respective uses. Government, researchers, doctors, and patients
all have specific uses for healthcare data. In our proposed
system, we offer a blockchain-based transparent participation of
all data users which gets controlled by our designed smart
contracts.
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Fig. 3. Proposed architecture for blockchain-based healthcare data
management.
D. Ethereum Smart Contracts
Blockchain platforms like Ethereum, a type of code known
as a smart contract can be developed [16]. These contracts can
be set up to carry out tasks on their own without the
involvement of any outside parties. It is the fundamental and
crucial element that records transaction history and controls
hashes from the decentralized storage server, enabling
stakeholders to access healthcare data. Only parties that have
been granted access can perform the functions defined in the
smart contract for the healthcare system.
We created three smart contracts as part of our solution to
regulate every operation taking place in the healthcare data
management process.
 Registration Smart Contract: The regulators are
responsible for implementing this smart contract to
control all types of participants’ registration in the
proposed system. As seen in Figure 3, the first phase
covered by this contract is the registration procedure.
Stakeholders including laboratories, physicians, clinics,
and patients are approved by this smart contract.
 Data Upload Smart Contract: Registered clinics, labs,
doctors, and patients can upload their respective data
after getting approval from this Smart contract. The
Ethereum Address (EA), time, and details information
are stamped for each successful upload, which makes
these transactions tamper-proof.
 Data Use Smart Contract: These smart contracts are
triggered whenever a new attempt is made to access or
use data. Each user and successful access effort is
uniquely identified by their Ethereum Address (EA), and
once the contract is created, the data's details are stored
there.
E. Interactions among Smart Contracts:
The addresses of all stakeholders are collected and stored (up
to date) by the registration smart contract. Other smart contracts
and participants are utilized by this smart contract to verify the
identity of a unique entity/action. For instance, a data usage
smart contract can look at both the Ethereum Addresses (EA)
of the user requesting access to the data and the Ethereum
Addresses of the data's newly acquired ownership. Every data
user has a separate smart contract that stores their personal data.
Users or uploaders must be registered in order to use this type
of smart contract.
The data upload smart contract streamlines the uploading of
data into the healthcare system. Doctors or laboratories may
attempt to upload data, and the smart contract informs the
appropriate parties and maintains track of the requests. Then, to
confirm the attempt, the doctors or laboratories get in touch
with the smart contract. Only the registration smart contract,
which is governed by authorities, has the authority to allow an
attempt.
F. Decentralized Storage System
We built our decentralized storage solution using IPFS [17]
and Hyperledger Fabric [18] to provide the data with additional
safety and security. The data owner can upload files to IPFS
by our system design, after which the hashcode and asymmetric
encryption are transmitted to Hyperledger for storage. Multiple
users can examine the servers' material thanks to our design
while still being anonymous. For enhanced security, it also
offers integrating Hyperledger Fabric to provide a second layer
of security that stores the encryption key and encrypted hash
data. Only the data owner has access to the key that was utilized
for the encryption of the supplied data. The hash code and key
are prerequisites for any user to view or access the contents.
IV. TESTING AND EVALUATION
In this chapter, the experimental results are illustrated, and
the possible benefits of the proposed design are examined
regarding the integrated technologies and design goals
mentioned in Chapter 3 of the article. Because the technologies
employed had been carefully selected, the desired security
goals were achieved.
The in-browser Remix IDE development and testing
environment was utilized to test and appraise various
functionalities of the Ethereum-written smart contracts. The
source, the parameters, outcomes, execution costs, and events
initiated with their data are all included in a transaction. Errors
are evident to developers, making run-time troubleshooting and
debugging simpler.
A. Smart Contract Deployment Results
This part accommodates the detail description of the smart
contracts we created and the results of putting them into practice.
The StakeholdersAddition function in the registration smart
contract, as shown in Figure 4, represents the registration of
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several stakeholders. We can also see that our successfully
implemented smart contract includes the Ethereum Address
(EA), information specifics, and a set time of addition.
Fig. 4. Deployment of Registration Smart Contract to add authorized
participants.
Following that, successful data access or use attempts from
one stakeholder, such as the government or patients, are shown
in Figure 5. We can see the IPFS Hash information for this
smart contract that we obtained from the decentralized storage
system. Additionally, a data specific Ethereum address is
accommodated for security and authenticity.
B. Evaluation
This section discusses the blockchain features, security, and
cost analyses of the smart contracts of our blockchain-based
healthcare data management system.
Here we briefly discuss the suggested blockchain-based
approach for managing healthcare data security.
 Privacy: Only those who have received authorization from
the appropriate authorities are able to access any part of our
system, and authorization is only given after a thorough
review. Only a select group of vetted and reliable
participants have access to the data kept in the storage
facility. The agreement regarding who has permission to
use which resource and who has access to it ensures
privacy.
 Scalability: To adjust the load generated by its
stakeholders, distributed ledger participants can
dynamically add or remove nodes from the blockchain.
This improves the system's ability to scale.
 Authentication and Access Control: Without disclosing
their vital security credentials, users may exchange their
information with reputable organizations for an agreed-
upon amount of time and with a restricted set of resources.
Fig. 5. A successfully attempted data access that includes IPFS Hash and other
details.
 Efficiency: The need for time-consuming reporting
procedures, which might result in a single point of failure
among stakeholders, is diminished through transparent
design. As a result, there is more cooperation amongst
healthcare groups, which improves the system's quality and
effectiveness as a whole.
C. Cost Analysis
The smart contract functions' cost analysis is shown in this
subsection. Every time a transaction is carried out on the
Ethereum network, gas is needed to complete the transaction.
The amount of gas used by a function in a smart contract
depends on its inputs, outputs, code size, and complexity. The
cost of deploying the contract and any data transferred to the
blockchain network are included in the transaction cost, while
the cost of running the smart contract's various operations is
included in the execution cost.
The execution cost is estimated by Remix IDE when a call
to the smart contract is made. Optimizing functionality while
reducing operating costs is the goal of every smart contract
design and implementation. Table 1 displays the execution and
transaction costs of our created smart contract functions.
TABLE I. GAS COST OF SMART CONTRACTS FUNCTIONS.
Functions Transaction
Cost (Gas)
Execution Cost
(Gas)
StakeholdersAddition
29,234
16,173
DataUpload 29564 16,829
DataUseSC
26,967
14,325
D. Security Analysis of Smart Contracts
As already stated, the Remix IDE is used to develop smart
contracts and presents some code debugging and run-time error
alarms. We have thoroughly checked our developed smart
contracts by using the debugger option. Given that it enables
users to look at the current state of the blockchain and observe
how the contract interacts with it, it is very helpful for testing
and debugging smart contracts that are installed on the
Ethereum blockchain.
E. Challenges of Blockchain Healthcare Data Management
We discussed the potential challenges in this subsection
when attempting to apply blockchain in the healthcare industry
and data management.
 Resource Limitation, Capacity, and Data Storage: The
current state of technology also places limits on the number
of transactions that can be carried out in the blockchain
network each second. Additionally, using robust
computing resources is required to handle the transactions
on a wide scale.
 Speed, Latency, and Privacy Issues: Communication
latency and speed are significant barriers to establishing
methods to connect blockchain-based networks. This is
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because it's possible that some internal healthcare systems
or regionally unique procedures used in hospitals or
laboratories will be required for distributed networks to
function.
 Distributed and Diversified IoMT: A distributed
network allows for completely different storage,
computing, and communication capabilities among
devices. The primary variations are in the hardware (CPU,
RAM), network connectivity (3G, 4G, 5G, WiFi), and
replaceable power sources (battery level). Devices may
quit taking part before the allotted training iteration is
finished, hence fault tolerance is crucial.
V. CONCLUSION AND FUTURE SCOPE
For the management of healthcare data, we created a
blockchain-enabled healthcare management system for the
upload and access of healthcare data. Blockchain-based data
management techniques may significantly enhance
data traceability while preserving authenticity and integrity.
Additionally, it improves participant communication and trust.
Ethereum smart contracts are used in the proposed blockchain-
enabled data management system to monitor data upload, use,
and other operations in a decentralized network.
While the study's primary focus is on healthcare data
management, the suggested approach might be expanded to
address the tracking requirements in different industries.
Healthcare systems' operations can be helped by smart contracts
to accomplish verified automation, get rid of information
imbalances, and fix other mistakes. We plan on expanding the
recommended approach to eventually achieve end-to-end
auditability and transparency of medication use to enhance the
efficacy of healthcare data management.
ACKNOWLEDGMENT
THIS RESEARCH WAS SUPPORTED BY THE MSIT(MINISTRY OF SCIENCE
ICT), KOREA, UNDER THE NATIONAL PROGRAM FOR EXCELLENCE IN SW,
SUPERVISED BY THE IITP(INSTITUTE OF INFORMATION & COMMUNICATIONS
TECHNOLOGY PLANNING & EVALUATION) IN 2022 (2022-0-01091,
1711175863).
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