Muhammad Hassan Nawaza; Muhammad Taimoor Khanb a Electrical Engineering Department, University of Debrecen, Debrecen, Hungary
b Medical Department, University of Debrecen, Debrecen, Hungary
Blockchain technology (BT) is a digital ecosystem which stores the series of data that is time-stamped and unchangeable. Clusters of computers manage the record of data without the ownership of a single entity or any third party (decentralized). Ranging from banking to supply chain logistics, it has also opened a new challenge in the healthcare industry. Blockchain technology offers massive opportunities for healthcare revolution to disrupt and lead a digital transformation. In this book chapter, we have overviewed the fundamental blockchain concepts and applications to be used for different aspects of smart healthcare industry and proposed a live patient monitoring system by deploying blockchain technology in the model. Keeping an eye on recent technologies in connected healthcare, we have finally presented various research factors and potential challenges where blockchain technologies can play an outstanding role to realize the concept of a smart optimization in the healthcare industry.
Blockchain in healthcare; Smart healthcare; Blockchain-enabled healthcare monitoring; Internet of Things; Healthcare data management; Healthcare data security; Decentralization
There are no competing interests or personal relationships to be declared by authors.
Blockchain technology now offers excellent potential in the connected world such as information and communication technologies, and it is still expanding in various aspects. After the emergence of cryptocurrencies, blockchain technology gains massive popularity over recent years. Cryptocurrencies are the digital assets or currencies that can be used to exchange within different currencies on a digital platform (Wikipedia, 2020). Traditionally, there used to be third parties such as banks and companies which work as a mediator for exchanging currencies among participants. Due to the centralized nature of the traditional system, it had many security and financial challenges. These challenges led to the implementation of cryptocurrencies. It is found that there are more than 1500 currencies (CoinMarketCap, 2020). Bitcoin was among the first, which was controlled by a decentralized system constituting the first generation of blockchain technology known as blockchain 1.0 (Kuhn and Sommers, 1981).
Blockchain 2.0 is the second generation that was first introduced to implement the smart contract concepts and properties. Smart properties refer to the digital resources or assets. The proprietorship of these assets is controlled via a digital platform enabled by blockchain technology. However, the smart-contracts refer to software programs used to set policies regarding the management of smart properties. Some of the common examples of blockchain 2.0 in cryptocurrencies are Ethereum (Home, ethereum.org, 2020), NEO (Neo-project, 2020), and QTUM (Home—Qtum, 2020), etc.
Blockchain 3.0 is the third generation which is still under development. Presently, it is mainly focused on nonfinancial applications of various connected technologies. In the modern world, Internet of Things (IoT) has impacted our lives with many changes (Kumar and Mallick, 2018). IoT, a connected network of smart devices, allows them to generate massive data and exchange information (Al-Turjman et al., 2020). With the advent of such technologies and sharing data, there are still many challenges that are hindering its continued growth, such as security issues precisely. To tackle such challenges, blockchain technology shows excellent potential by offering a decentralized-based security system to protect data from outside forces.
Ranging from the financial applications to connected objects, blockchain technology also offers great potential in healthcare industry (Pradeep, n.d.). However, it is still a new player in the domain of healthcare. Therefore, experts need to figure out what the specific scopes are and use case scenarios in healthcare enabled by blockchain. What are the applications that have been already developed in healthcare industry based on blockchain technology (Zafar and Rajnish, 2012)? What are the challenges that are hindering its continued growth and how it can be improved?
We provided a comprehensive survey of blockchain trends to address the questions mentioned above. Also, this chapter enlightened the current and new trends in healthcare. In literature, there are some review articles regarding blockchain technology in the context of healthcare applications. A review article on blockchain-based healthcare applications was discussed in Angraal et al. (2017). Implementation of blockchain was analyzed on very few and specified healthcare applications. However, this article failed to cover other sectors of healthcare applications such as healthcare management, clinical research, and Genomics. Similarly, Engelhardt (2017) reported the existing companies which are working on healthcare applications using blockchain services. This paper also proposed other healthcare areas when blockchain technology can be implemented efficiently. Mettler (2016) also reviewed similar blockchain trends by reporting different companies which are currently working in management sectors of public health, drug counterfeiting, and pharmaceutical research in medical sector. Kuo et al. (2017) proposed the essential benefits achieved by blockchain technology in data management and discussed how these benefits could leverage healthcare industry by improving record management, clinical research, and enhancing insurance process. Again, this paper failed to discuss the other aspects of healthcare, such as genomics and neuroscience. Clauson et al. (2018) reviewed blockchain technology in the context of supply chain and pharmaceuticals in healthcare industry. However, other areas of healthcare industry were not discussed in this study and also the potential challenges of blockchain-based healthcare systems are missing. Similarly, Zhang and Ji (2018) presented reviews which are only limited to EHRs and their potential challenges.
This book chapter has overviewed a broader picture of blockchain technology in healthcare industry, as shown in Table 1. We have provided a comprehensive survey and proposed a novel blockchain-enabled healthcare monitoring model as shown in Fig. 2. Various examples of blockchain technology are presented within different areas of healthcare industry. Readers can also find the current trends and future challenges of blockchain-based healthcare systems proposed in our study. Essential requirements and potential challenges were not addressed by most of the above-mentioned surveys.
Table 1
Ref. | Blockchain-based healthcare applications | Key requirements | Potential challenges | |||||
---|---|---|---|---|---|---|---|---|
Healthcare data management | Clinical research | Supply chain | Neuroscience and genomics | Healthcare insurance | Pharmaceuticals | |||
Angraal et al. (2017) | ✓ | – | ✓ | – | – | – | – | ✓ |
Engelhardt (2017) | ✓ | – | – | – | – | – | – | ✓ |
Mettler (2016) | ✓ | ✓ | – | – | – | ✓ | – | – |
Kuo et al. (2017) | ✓ | ✓ | – | – | ✓ | – | ✓ | ✓ |
Clauson et al. (2018) | – | – | ✓ | – | – | ✓ | – | – |
Zhang and Ji (2018) | ✓ | – | – | – | – | – | – | ✓ |
[Our study] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
Following the rest, Section 2 defines the blockchain concept by classifying the digital systems into centralized and decentralized infrastructures. This section also presents the critical factors required for the development of efficient blockchain systems. Section 3 proposes a novel patient monitoring model which is securely enabled by blockchain technology. In Section 4, applications of blockchain systems are presented within different areas of healthcare industry. Section 5 overviews the future challenges of blockchain-based healthcare systems. Finally, Section 6 concludes the chapter.
Blockchain technology is a digital ecosystem which stores series of data that are time-stamped and unchangeable. Clusters of computers manage the record of data without the ownership of single entity or any third party (decentralized). Each set of record is interlinked to each other and is fully secured using the principles of cryptography. Don and Alex Tapscott, authors of Blockchain Revolution (2016), defines blockchain technology as a digital ledger which has an incorruptible ability to record everything of value such as financial transactions.
Fig. 1 explains how decentralized infrastructure differs from centralized infrastructure. In centralized infrastructure, all the devices or computers are interconnected, but at the same time, they are managed by a single authority which is an internet server in Fig. 1A. It means that these devices send a request to the internet server, which in return sends back the instructions or feedback for the operation. However, blockchain technology does not work like that because it is comprised of decentralized infrastructure which connects all the devices in a chain-like series, shown in Fig. 1B. Such a structure makes blockchain a unique technology. In centralized infrastructures, hackers can easily trace single authority server and leak data; however, in decentralized infrastructure (Blockchain technology), there is no single authority, hence making impossible to hack and leak the data.
To develop a successful and efficient blockchain-based system, some required critical factors must be addressed. This section presents the essential requirements of such systems as follows:
Our model comprises scenarios in which medical staff remotely monitor the health of patients outside the hospital. In this case, wearable medical devices and sensors can be attached to the patient in which parameters such as body temperature, blood pressure, oxygen saturation, and heart rate can be measured and compared to preexisting ranges. External sensors can also be placed around the patient's residence, which can detect a change in the environment, such as movement or surrounding temperature. This live evaluation of data allows for the systems to detect abnormalities and alert the medical staff in case of emergency. All of this data are then accumulated and permanently stored in a remote database which can then be accessed in the future by healthcare professionals to evaluate the health status of the patient. Since these data are personal and sensitive to all the pertaining parties, it needs to be stored securely and should only be accessed by authorized parties. The use of blockchain technology-based systems can achieve this.
Medical devices blockchain: Each patient is fitted with a set of medical devices that will be monitored by our model. The data collected by the medical devices are then stored in the medical devices blockchain. The dataset for the proposed model can also be achieved from online sources as shown in Table 2. Each patient has his own Medical Devices BlockChain configured.
Table 2
Datasets | Subjects | Activity | Application | Year |
---|---|---|---|---|
HMD (Corbillon et al., 2017) | 59 | Head movement | Health support (monitoring paralyzed patients) | 2017 |
USC CRCNS (Carmi and Itti, 2006) | 520 | Eye movement | Monitoring and detecting eye problems | 2004–05 |
Harvard Dataverse (Khamis et al., 2016) | 288 | ECG recordings | Monitoring heartrate | 2016 |
OhioT1DM (OhioT1DM Dataset, 2020) | 112 | Glucose level detection | Health monitoring of diabetes patients | 2020 |
Consultation BlockChain: The Consultation BlockChain shown in the architecture contains records of the patient's history. The Consultation BlockChain is then set up across hospitals, and it includes the patient's records. This way, the medical reports become easily accessible and are exchangeable between hospitals and health workers in a confidential and secure manner. In our case, two separate BlockChains are chosen because each serves its purpose as shown in Fig. 2. Data received from sensors need to be maintained during the period of treatment. Patient records must always be accessible throughout the patient's life.
Live monitoring device: It is a system that manipulates data continuously and scans through various information. It is used to alert (when necessary) the healthcare professional on standby.
Medical sensors: Data received from the medical devices and sensors attached to the patient are stored in the BlockChain through NDN paradigm. This means that we have established a hierarchy between the medical devices to enable communication between them.
Medical experts: Any healthcare staff is represented by a node (e.g., computer/device) in both Medical Devices BlockChain and Consultation BlockChain. They can access the data through the Live Monitoring System based on the data stored in the Medical Devices BlockChain.
Patient: The patient is also represented as a node (e.g., computer/device) in the Medical Devices BlockChain. The patient collects data from the attached medical sensors and transfers them to the Medical Devices BlockChain to store it in a ledger. This allows both users (patient and healthcare staff) to interconnect with each other.
Ranging from banking to supply chain logistics, it has also opened a new challenge in the healthcare industry (Fig. 3 and Table 3). Blockchain technology allows healthcare revolution to lead a digital transformation fast. There are various ways blockchain can change the healthcare industry:
Table 3
Healthcare areas | Examples |
---|---|
Pharmaceuticals | Hyperledger (SecuringIndustry, 2016) |
Electronic health records | Healthbank (HealthBank.coop, 2020), MeDShare (MedShare, 2020), MedRec (MedRec-m, 2020) |
Neuroscience | Neurogress (Neurogress, 2020) |
Genomics | Illumina HiSeq X Ten (Illumina, 2020) |
Clinical research | Ethereum (Home, ethereum.org, 2020) |
Health insurance | MIStore (Zhou et al., 2018) |
This section overviews the potential challenges that are hindering the continued growth of blockchain-based healthcare systems. These challenges are discussed as follows:
We have overviewed the interdisciplinary aspects of blockchain technology while discussing its evolution that started from financing applications such as cryptocurrencies. Later, blockchain technology got a colossal intention and popularity in the digital world. Being a decentralized nature, blockchain technology offers significant benefits such as security, privacy, data provenance, robustness, and optimized data management solutions.
As our healthcare systems are lacking in terms of security and privacy, blockchain technology can do a chief role by allowing its decentralized abilities to ensure full security and integrity for healthcare systems. Due to its peer-to-peer ability, blockchain can replace third-party service providers by enabling patients and medical workers to interact with each other in a more confidential and secure manner. Besides, the integration of machine learning/artificial technology along with IoT devices can also enhance the potentials of blockchain technology in healthcare applications. The whole idea in this work is to pinpoint these benefits and propose how these potentials could improve our healthcare industry.
Different blockchain-based healthcare applications are presented in this book chapter such as EHRs, clinical research, neuroscience, genomics, and health insurance claims. However, this technology is still a new player in healthcare industry. Therefore, there are some technical challenges that are hindering its continued growth. Finally, this book chapter has presented its potential challenges that must be considered very carefully during application designing and implementation.
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