Information Security Analysis and Audit

PROJECT COMPONENT

PROJECT REPORT

Blockchain based Smart Healthcare Systems

Submitted by

Garvin Chowdhary- 20BCE2239

Gaurav Gattani- 20BCE2250

Rahul Jestadi - 20BDS0389

Submitted To
Dr.Chandra Mohan B.
Abstract:

The architecture of the existing healthcare system is largely based on cloud or in

house servers. There is no central database storing the data of the patients and
their past health records. The data is mostly stored by the health management
organizations on their private databases. There is no data privacy in these cases
and such systems are also vulnerable to malicious attacks and cyber threats.
Moreover since the data is stored on the database in a server or cloud, the data
could be easily modified to give false reports by someone who has access to the
database at an admin level. Modified reports and data can have a lot of bad
consequences ranging from improper diagnosis of patients to making false
insurance claims. This can also sometimes lead to wrong prescription of medicines
and hence drug abuse.

All these problems can be solved by introducing blockchain into the picture of
healthcare management systems. Blockchain has the inherent nature of keeping
data immutable and also provides security since everything on a blockchain is
encrypted using various cryptographic techniques. Leveraging these advantages of
blockchain the existing problems with the existing architecture of the healthcare
management system could be solved to a great extent.

Storing medical records of a patient on blockchain ensures that the record can
never be mutated. Making this data accessible on a central blockchain available to
all authorized organizations, also makes diagnosis easier as doctors can retrieve
the past medical data of patients within seconds from the blockchain and be
assured that the data has never been tampered. This leads to a decentralized
repository of patient data. The data stored here is also anonymous since each
patient's reports are stored with their private hash ids and this also ensures the
patient privacy on the ledger. Furthermore, since the data cannot be mutated, this
also helps to settle and verify fake insurance claims much faster and easier.

Literature Survey:
In this section 18 research papers from reputed journals have been surveyed
and the findings have been listed.
Paper 1:

Title -
S2HS- A blockchain based approach for smart healthcare system

Summary -
The existing protocols about how patient data whether in real time or through records
are managed. The currently existing cloud based SHS (Smart Healthcare System)
where all the data be it from the wearable IOT devices or the records generated
through hospitals are stored on a central cloud storage from where all the data can
be accessed by the various end users. But the major issue with this is regarding the
privacy of data and the correctness and authenticity of the data. Also since there is
only a central storage with individual encryption of records and data and so many
micro services and dependencies are involved a single point of failure could
compromise the entire system and data. Another issue that persist is the question of
who actually owns the data.

The proposed S2SH(Secure and Smart Healthcare system) eliminates all the threat
possessed to the security of data by introducing the concept of blockchain ledger to
store the data.

Algorithms used -
Chain encryption for each block of data. Consensus Protocol

Methodology applied -
Instead of storing the data on a centralized cloud storage we use blockchain to store
the data which requires a consensus algorithm to approve the data being stored and
also makes the data immutable. Each patient is given a unique hash id and thus
records can be accessed with that id thus patient privacy is also achieved.

Advantages -
1. Removing single point of failure vulnerability
2. Achieving patient privacy
3. Achieving data transparency
4. Making it impossible for malicious attacks or data leaks.
5. Allow patients to participate in their data access
6. Remove central dependency and the issue of ownership of data since the
blockchain will be a distributed ledger.

Drawbacks -
There can be issues regarding the network bottlenecks, scalability and adoption
of new infrastructure to facilitate this on a central or global scale. Some other
social barriers like lack of trust and reluctance to use new technology have also
been discussed.

Metrics for evaluation -

Privacy of data, Protection against attacks and Data transparency.

Reference - https://drive.google.com/drive/
folders/1Cdwt5KYN0QIvX94DBFzJe6w98To2A3Cy - Blockchain smarthelathcare

Paper 2:

Title -
Application of Blockchain Technology in Healthcare: A Comprehensive Study ((from
National Public Health emergency Collection)

Summary -
The paper proposes the application of blockchain in various fields related to
healthcare which include Electronic Medical Records, Remote Patient Monitoring,
Pharmaceutical Supply Chains and Health Insurance Claims. It discusses the
various issues with storage of electronic medical records and the role of blockchain
and how it helps in authorization, permissions and data sharing between
stakeholders. It also proposes a hybrid off chain and on chain methodology for
storing EMRs. For Remote Patient Monitoring, the role of how
blockchain(specifically Ethereum smart contracts has been talked about in the
paper) provides an automated intervention to support real time monitoring has been
discussed. The various issues in Pharmaceutical Supply chains such as quality
control, prevention of counterfeiting drugs and drug regulation issues have been
discussed and how a blockchain based storage can help to solve these as the data
on it is immutable, secure and traceable. Lastly the paper also discusses the role of
blockchain in health insurance claims as it provides immutability and transparency
and auditability of the data stored in it.

Algorithms used -
Proof of Work and Consensus Algorithm
(The paper mostly discusses the various approaches and doesn't focus much on the
algorithmic details)
Methodology applied -
Storing the data starting from electronic health records to real time remote patient
monitoring data on blockchain thus making it immutable and transparent.
Making the storage of drug details starting from quality control details like
temperature and Manufacture date etc directly and in an automated manner to the
blockchain so that there can be no tampering with the data.

Advantages -
1. Secure Data
2. Patient privacy
3. No tampering of drugs data to deal with drug counterfeit and drug
regulation details.
4. Easy investigation for health insurance companies to make decisions on
health insurances

Drawbacks -
1. Clinical malpractice still cannot be controlled
2. EMR systems do not address semantic interoperability
3. Scalability and Interoperability issues.
4. Large volume of medical data
5. Large data can lead to serious performance degradation

Metrics for evaluation -

Feasibility of the approaches suggested, in the various healthcare domains on
blockchain usage.

Reference -
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313278/
Paper 3:

Title -
Research on the Application of Blockchain in Smart Healthcare: Constructing a
Hierarchical Framework

Summary -
The paper aims at building a hierarchical blockchain model. It first recognizes the
various factors influencing the model that needs to be built around the sharing of
patient data on a blockchain. It identifies those as External Regulation, Medical
record management, Treatment Optimization, Doctor Management, Medical
Insurance, Internal Regulation, Cost Saving, Top Level Design, Community
Structure and Environmental management. Upon selecting the standards, it
combines fuzzy set theory, DEMATEL and ISM method to find the hierarchy in which
these chosen standards or factors are relevant. Upon calculation, it has been found
that Medical Record Management, Doctor Management and Top level design are
the major driving factors; and External Regulation, Medical Insurance and
Environmental Management are found to be the independent factors. Based on the
ISM structure calculation the hierarchy of building the system is found as:
Top priority - Doctor Management, Medical Record Management, Top Level Design
Second Priority - Treatment Optimization, Community Structure, Cost Saving
General Level - External Regulation, Internal Regulation
Lowest Level - Medical Insurance, Environmental Management
On a higher level the system is further divided into a transaction layer, an
information layer and a stakeholder layer. Blockchain is a large database of trans-
action information in the system. The feasibility and security of each transaction are
guaranteed by the multinode joint maintenance and traceability.

Algorithms used - Fuzzy Set Theory DEMATEL

ISM

Methodology applied -
All the 10 factors were first constituted into matrix of 10 * 10 and their influence
scores and impact scores with each other were calculated thus forming the influence
and the impact matrix. This was then analyzed to calculate the influence degree,
affected degree, centrality and casualty of each factor. Based on the quadrant in
which they fall in, on the casualty vs centrality plotting the factors were divided into
core driving factors and independent factors and this then helped us form the
hierarchical distribution and ISM analysis.
Advantages -
Since the system is hierarchical, equal importance is not given to every factor
influencing the blockchain based smart healthcare application. The ones with higher
priority are treated of utmost importance than the ones having high scores but of
low priority.

Drawbacks -
In some edge cases it is highly possible that the low priority factors could have a
major effect but due to the way the system is built, the high priority factors might
overshadow them

Metrics for evaluation -

The paper uses a statistical analysis of the data using a combination of techniques.
Hence the results are mathematically backed by statistics.

Reference -
https://www.hindawi.com/journals/jhe/2021/6698122/

Paper 4:

Title -
Implementing Blockchains for Efficient Health Care: Systematic Review

Summary -
The paper discusses the efficiency and benefits of implementing a blockchain
based healthcare management system. The outcome of the study was found to be
that blockchain solved the issue of interoperability, access to health records and
data integrity. It states that the initial change from normal cloud based service to
blockchain will be expensive but in the long run it will prove to be advantageous
due to the major cost savings that will occur once shifted to blockchain based
platform.

Algorithms used -
Smart contracts to handle the access of data to individuals trying to access the
blockchain.
Methodology applied -
Use of blockchain based architecture to store the data and to allow the smart
contracts on the blockchain to manage access control to the record as well.

Advantages -
1. Interoperability of health data. Allow blockchain to manage access control of
data.
2. Fast access to comprehensive previous record of patients to doctors
3. Integrity of the data provided
4. Use of smart contracts to execute patients’ consent preferences immediately.

Drawbacks -
Shifting data ownership from the government to the individual owning the data will
require a lot of legal modifications.

Metrics for evaluation -

Feasibility of implementing the approaches mentioned in the paper.

Reference -
https://www.jmir.org/2019/2/e12439/

Paper 5:

Title -
Digital Transformation of Healthcare: A Blockchain study

Summary -
Decentralised consensus improves the Healthcare System transparency while
removing an intermediary party that inflates the cost of healthcare. Further benefits
include a significant reduction of inefficiency and waste in the healthcare ecosystem.
The use of encryption, transparency and decentralised ledger removes
miscommunication and mistrust and promotes a transition to value- based care
resulting in negotiations of complex bundle claims that are tied to value, but not on
an opportunistic fee-for-service model, while making the adjudication process
seamless.

Algorithms used -
Decentralized storing of data encrypted by cryptography techniques on the
blockchain

Methodology applied -
For releasing medical data of the patient the doctor enters the details along with the
patient's public key and signs it with his(doctor’s) own private key. The patient
verifies the signature of the institution after receiving data using his private key. The
patient may allow a third party entity to access complete or part of his medical data
through an access control system implemented on the blockchain.
It states that the major applications of blockchain in the field of healthcare are in
Electronic Health Record, Clinical Research, Medical Fraud Detection and
Pharmaceutical Industry.

Advantages -
1. Improved data and security
2. Health data ownership
3. Transparency and trust
4. Decentralization

Drawbacks -
1. The cost of migrating to blockchain can be high.
2. Modification of legal rules and regulations needed to integrate blockchain
into healthcare.
3. Uncertainty on the use of blockchain since it has not yet been widely used in
thai field.

Metrics for evaluation -

Application feasibility of the proposed technology and to what extent it eliminates
the issues persisting in the current healthcare system.

Reference - https://www.researchgate.net/
publication/353165009_Digital_Transformation_of_He althcare_A_Blockchain_study
Paper 6:

Title -
Blockchain Based Smart Contracts for Internet of Medical Things in e-Healthcare

Summary -
The paper proposes the blockchain approach to storage of medical records. It
discusses the similarity between the requirements for IoMT nodes and blockchain
nodes, and how it is becoming difficult to manage IoMT nodes day by day due to the
increasing amount of data. Thus it proposes to leverage blockchain to handle all
that with the help of smart contracts to automate things. It also provides a
comprehensive study on how the average packet delivery ratio, average latency and
average energy efficiency varies between different number of nodes on the network
between existing architecture and proposed architecture.

Algorithms used -
Decentralized blockchain based storage and Smart contracts to automate
transactions on the blockchain. It uses the basic P2P blockchain approach and
consensus algorithm.

Methodology applied -
Since there are a lot of similarities between the IoMT nodes and Blockchain nodes
and the requirements for IoMt nodes are very much similar to what the blockchain
nodes already provides out the box, we can leverage the properties of blockchain to
run smart contracts and get rid of the issues that comes with maintaining IoMT
nodes.

Advantages -
1. Higher Average Packet Delivery Ratio as compared to existing method
2. Higher average energy efficiency as compared to existing method

Drawbacks -
1. The latency is higher in the proposed approach in case when there are
considerably high number of malicious node

Metrics for evaluation -

The difference between the network stats which include packet delivery ratio,
energy efficiency and latency between the proposed and existing architecture.

Reference -
https://www.mdpi.com/2079-9292/9/10/1609
Paper 7:

Title -
FHIRChain: Applying Blockchain to Securely and Scalably Share Clinical Data

Summary -
The paper proposes a software architecture for a blockchain based framework
called FHIRChain which facilitates data sharing in the healthcare domain to enable
collaborative decision making. FHIRchain focuses on keeping its APi and
blockchain ecosystem independent. Their architectural choices meet the key
requirements defined by ONC interoperability roadmap. Due to the modularity of the
approached architecture, the system is compatible to work with any existing
blockchain and supports execution of smart contracts. The framework complies with
the ONC requirements of all the major components like Verification of Participant
Identity, storage and exchange of data securely, permissioned access for the health
data resources, applying consistent data formats and maintaining modularity. It uses
digital health identity to verify participant identity.To address the storage and
exchange of data securely it stores sensitive data off chain reference pointers on
chain. This also helps in better scalability. To allow permission based models to
access data sources it implements token based permission models which includes
the public and private key cryptography.

Algorithms used -
1. Digital Health Identity
2. Use of hybrid on chin and off chain storage
3. Token based permission model - Private key Public key cryptography
4. MVC architecture

Methodology applied -
Storage of records using a hybrid on-chain and off-chain storage architecture and
usage of MVC architecture to keep the APi component and Blockchain component
as separate modules so as to enable the blockchain component to work with any
kind of existing blockchain. It leverages the decentralized and tamper proof nature
of blockchain to achieve its goal.

Advantages -
1. Tries to tackle scalability challenges by an on chain and off chain hybrid
model.
2. Complies with most of ONC interoperability roadmap requirements.

Drawbacks -
1. Services existing off the blockchain cannot be coiled such as OAuth services.
 2. Scalability challenges

Metrics for evaluation -

Feasibility of the approach suggested, scalability of the architecture and how in line
it is with the ONC requirements for the solution being interoperable.

Reference - https://www.researchgate.net/
publication/326677332_FHIRChain_Applying_Blockch
ain_to_Securely_and_Scalably_Share_Clinical_Data

Paper 8:

Title -
Implementing healthcare services on a large scale: Challenges and remedies based
on blockchain technology

Summary -
This paper focuses on the practical aspect of blockchain in healthcare and studies it.
It discusses blockchain in general, its types and types of consensus algorithms. It
then compares the various consensus algorithms and which one can be useful in
which scenario ranging from energy savings to tolerated power to node identity
management. It states about the benefits of using blockchain in healthcare which
range from its features like anonymity to immutability and easy role based shared
access of data. I propose the usefulness of this in maintaining EHRs as well as
detecting fraud insurance claims.

It also conducts an experimental study where it uses four different kinds of nodes i.e
the clients, endorsers, organizer and committers. This test is carried out on the
hyperledger fabric by IBM. It uses different number of combination s of these four
different kind of nodes to find the optimal throughput situation. It was observed that
the relationship between orderers variable and performance is statistically
significant and negatively highly correlated, which means that the presence of a
number of ordering nodes adversely affects the throughput of the network
considerably. While
the correlation throughput Vs. {committers, endorsers} is statistically insignificant and
endorsers and committers affect the throughput mainly due to network latencies. For
consensus algorithms it was observed that while POW algorithms provide better
node scalability but considerably low performance, algorithms like BFT, PBFT and
STELLAR provide low node scalability but higher performance.

Algorithms used -
Consensus Algorithms - Proof Of Work, Byzantine Fault Tolerance
Statistical Methods to measure coefficients - Pearson Correlation Method, Sperman
correlation method and Kolmogorov-Smirnov test

Methodology applied -
Testing the throughput against a variety of node numbers and calculating results for r
and p using various correlation methods to determine the differences between them
and which helps in what kind of situation.
Determination of Consensus algorithms and which works better for what situation
Use of blockchain based architecture to store the data to ensure immutability and
transparency of data.

Advantages -
1. Tamper free data
2. Data transparency
3. Data privacy
4. Choice of Consensus algorithm as per needs

Drawbacks -
1. Use of blockchain comes with the blockchain trilemma of Decentralization
Speed and Security as we have to compromise with one at every time since
decentralization and security comes at cost of speed
2. POW consensus algorithm is provides considerably lower performance
3. Need for a hybrid consensus algorithm that works well for both scalability and
performance.

Metrics for evaluation -

Statistical backing up of the data, scalability of architecture and performance for
consensus algorithm.

Reference - https://www.researchgate.net/
publication/338618919_Implementing_healthcare_serv
ices_on_a_large_scale_Challenges_and_remedies_based_on_blockchain_technolo
gy
Paper 9:

Title -
Future of blockchain in healthcare: potential to improve the accessibility, security
and interoperability of electronic health records

Summary -
This paper introduces a blockchain-based solution for managing electronic health
records. It proposes that when a patient goes to the hospital and gets any test done,
it will be represented digitally as a block and will be broadcasted to the network for
verification. Once verified, the block will be added to the patient’s medical data and
can be accessed in the future any time using the patient’s private key.

Algorithms used - Cryptographic encryption

Methodology applied -
Blockchain network is used for storing and verification of medical data of patients
Patient has complete access to his medical history data using his private key.
Medical professionals can also have access to their patient’s data on being
authorized and can check their details improving diagnosis speed to much extent.

Advantages -
1. Data is immutable in the blockchain which makes it a very reliable method of
sharing medical data.
2. Data could be shared by any individual in any location with a
connection who has the required credentials.

Drawbacks -
1. Verification of medical records can take long periods of time
2. There is a limit to the size of data that can be stored in blockchain
3. Safely maintaining the public and private keys is highly critical.

Metrics for evaluation -

Data integrity and verification speed

Reference -
https://informatics.bmj.com/content/27/3/e100217
Paper 10:

Title -
Using Blockchain for Electronic Health Records

Summary -
This paper presents a framework that used blockchain technology in the healthcare
sector for EHR. The aim of this framework is also to provide secure storing
capabilities of electronic records by defining granular access rules for the users of
the proposed framework. The paper also tries to makes the solution scalable via the
use of off-chain storage of the records.

Algorithms used -
Consensus algorithm

Methodology applied -
A Decentralized application for storing the medical records in the blockchain is
made and smart contracts are created for letting authorized users access the
medical data. When a user sends a transaction, it is sent to all the connected nodes
on a P2P
network for validation. Using a consensus algorithm, the connected nodes perform
validation, and once validated, the block is added to the blockchain and hence the
transaction is complete. Nodes receive their reward for doing the validation.

Advantages -
1. Data is decentralized
2. Data is transparent.
3. Completely secure application safe from any kind of tampering

Drawbacks -
1. Storing huge volumes of data on blockchain will cause storage and
scalability problems.

Metrics for evaluation -

Average Execution Time, Throughput and Average Latency

Reference -
https://ieeexplore.ieee.org/document/8863359
Paper 11:

Title -
Blockchain Technology for Healthcare: Facilitating the Transition to Patient-Driven
Interoperability

Summary -
This paper presents a blockchain-based solution to patient-driven interoperability
through digital access rules, data aggregation, data liquidity, patient identity, and
data immutability. Linking the stored data of the patient with his public key helps in
connecting the data with different organizational interfaces. This paper also
proposes to create a Public Key Infrastructure to help patients manage their public
keys,

Algorithms used -
Cryptographic encryption

Methodology applied -
Blockchain technology is used to decentralize medical data and increase
transparency. Clinical data—stored off-chain or on-chain—is linked to the public key
of a patient. The patient himself and decide rules for the data. To transfer data to the
various organizations the patient only has to share his public key to that specific
organization. The maintained data is securely distributed across multiple entities,
ensuring integrity, lowering the risk of loss, and offering an audit trail

Advantages -
1. Ensures high security
2. Data privacy is maintained
3. Patients is empowered with complete control of their data

Drawbacks -
1. There is a limit to the transaction volume of clinical data

Metrics for evaluation -

Privacy and interoperability

Reference -
https://www.sciencedirect.com/science/article/pii/S200103701830028X?via%3Dihub
Paper 12:

Title -
Applications of Blockchain Technology in Medicine and Healthcare: Challenges and
Future Perspectives

Summary -
This paper review the current and new solutions in the field of healthcare by using
blockchain as a model. It explores the application of blockchain in the domains of
Clinical Research, Medical Fraud Detection, Neuroscience, and the Pharmaceutical
Industry. It also discusses the various challenges faces by the blockchain
ecosystem like Managing Storage Capacity, Interoperability Issues, Standardization
Challenges.

Algorithms used -
Proof of Work

Methodology applied -
Using Smart contracts to manage every single transaction in the healthcare space.

Advantages -
1. Reduced cost of monitoring
2. Having one central server for data saves storage space

Drawbacks -
1. Large-scale data collection for blockchain remains a challenge

Metrics for evaluation -

Monitoring cost

Reference -
https://www.mdpi.com/2410-387X/3/1/3
Paper 13:

Title -
Blockchain distributed ledger technologies for biomedical and health care
applications

Summary -
This paper discusses the latest health care applications of blockchain technologies;
and the potential challenges and proposed solutions of adopting blockchain
technologies in healthcare. It also compares the alternative blockchain technologies
and tries to find the best among them for solving biomedical problems.

Algorithms used - Proof of Work Algorithms

Methodology applied -
Each block contains a hash value of the previous block's header, and thus forms a
hash-chain. Using hash-chain timestamping for determining the suitable transaction
and using blockchain as a distributed ledger to store arbitrary data in the metadata
of transactions

Advantages -
1. Decentralized management
2. Immutable audit trail,
3. Data provenance
4. Robust system

Drawbacks -
1. Blockchain is always prone to the 51% attack.

Metrics for evaluation - Decentralization

Reference -
https://academic.oup.com/jamia/article/24/6/1211/4108087
Paper 14:

Title -
Applying Blockchain to Securely and Scalably Share Clinical Data

Summary -
This paper presents four solutions for applying blockchain technology to
clinical data sharing. It introduces a blockchain based architecture called
FHIRChain to meet the ONC requirements. It also presents a
decentralized app based on the same FHIRChain architecture for
authentication of users
using collaborative decision making.

Algorithms used -
Encryption Algorithms

Methodology applied -
Smart contract is used for storing secure access tokens and maintain immutable
timestamped transaction log of all events.

Advantages -
1. The architecture provides trustless, decentralized storage for necessary
meta information and audit logs
2. The system facilitates data exchange without the need to
upload/download data.

Drawbacks -
1. Storing identification information directly on the blockchain is a
problem due to the transparent nature of blockchain.

Metrics for evaluation - ONC requirements

Reference -
https://www.sciencedirect.com/science/article/pii/S2001037018300370?via%3Dihub
Paper 15:

Title -
MIStore: a Blockchain-Based Medical Insurance Storage System

Summary -
This paper introduces MIStore, a blockchain-based medical insurance storage
system, in an attempt to provide high credibility to its users due to the tamper-
proof nature of the blockchain. It requires less amount of memory and CPU and is
deployed on the Ethereum
Blockchain.
Algorithms used - Signature Algorithm

Methodology applied -
The solution consists of record nodes and light nodes. A peer-to-peer network
connects the record nodes and some light nodes and is connected with some number

of record nodes. Record nodes maintain the blockchain while light nodes store
the
block
to the headers. Any
absence of a node can generate an arbitrary number of key pairs by itself due
PKI.
Advantages -
1. Tamper-proof solution
2. Less amount of memory required for the system

Drawbacks -
1. The solution is prone to cyber-attacks like eclipse and Sybil attack

Metrics for evaluation -

Performance of cryptographic
schemes
Reference -
https://link.springer.com/article/10.1007/s10916-018-0996-4
Paper 16:

Title -
Utilizing blockchain technology for IoT-based healthcare systems

Summary -
This research presents a framework that allows the storage and transfer of patient
data in the blockchain by combining the electronic health record and remote patient
monitoring techniques into a single framework using Django. It used a smart
contract deployed on the Ethereum blockchain to facilitate data transfer from IoT
devices to many peers.

Algorithms used - Proof of authority

Methodology applied -
Each user is treated as a separate block and a third peer is added to create a multi-
peer system. A single smart contract is created to serve both systems, giving users
the option to choose one. Using the proof of authority algorithm unauthorized access
of the system is prevented. Ethereum protocols were followed for private
information transfer instead of using any public network.

Advantages -
1. Highly secure and privacy-controlled system
2. Data is immutability.

Drawbacks -
1. A high number of miners are required to keep the system protected from
attacks.

Metrics for evaluation - Cost and security

Reference - https://www.academia.edu/45611427/
Utilizing_blockchain_technology_for_IoT_based_healt
hcare_systems_Utilizing_blockchain_technology_for_IoT_based_healthcare_systems
Paper 17:

Title -
BBDS: Blockchain-Based Data Sharing for Electronic Medical Records in Cloud
Environments

Summary -
This paper proposes a blockchain-based data-sharing framework that can efficiently
store data in the cloud using the immutable and built-in autonomic behavior of the
blockchain. The system allows only authorized users to access the data. It is
achieved through a permissioned blockchain. It allows users to request data from
the shared pool after all the credentials are verified.

Algorithms used - Cryptographic algorithms

Methodology applied -
User-Issuer Protocol and User-Verifier Protocol is used for communication between
user-issuer and user-verifier respectively. The issuer generates membership issuing
keys and membership verification keys , while the verifier verifies these keys of the
user.

Advantages -
1. Highly scalable system
2. Lightweight application.

Drawbacks -
1. Communication and authentication protocols and algorithms between entities
were not fully investigated.

Metrics for evaluation - Scalability and Efficiency

Reference -
https://www.mdpi.com/2078-2489/8/2/44
Paper 1 8:

Title -
Integrating Blockchain for Data Sharing and Collaboration in Mobile Healthcare
Applications

Summary -
This paper proposes client-driven wellbeing information-sharing arrangement made
of decentralized and permissioned square chain, to make sure data is protected
using channel development plan and blockchain.
A tree-based data is generated for preparing informational points of individual
wellbeing information collected by various devices.

Algorithms used - Proof of work algorithm

Methodology applied -
A blockchain-based mobile user-controlled system is made for data sharing and
collaboration. User pattern is generated based on user behaviour by the system
using a permissioned blockchain. The application is deployed to collect health data
and synchronize it to the cloud enabling data sharing with healthcare providers and
health insurance companies.

Advantages -
1. The system can handle large data sets
2. The system is highly scalable.

Drawbacks -
1. The system is prone to cyber-attacks like 51% attack.

Metrics for evaluation - Scalability and Tamperproof

Reference - https://www.academia.edu/44832957/
Integrating_Blockchain_for_Data_Sharing_and_Collab
oration_in_Mobile_Healthcare_Applications
Literature Review Summary

Through the research papers we got to learn about the different consensus protocol
that can be applied for storing the medical records on a blockchain. Proof of Work
and Proof of Authority were the two algorithms, most discussed in the paper, out of
which Proof Of Work was found to the most efficient algorithm.

We also learned how smart contracts can be used in building the rules of
transactions that occurs over the chain the medical records. Requesting data of a
patient and processing that request were two best usecase of smart contracts for
this project.

We also learnt about the different encryption algorithms that can be used to store
the data of the medical records like AES-256, Block Cipher, IDEA and so on, out of
which Block Cipher is found to be the most efficient one due to its nature of
encrypting the data into several blocks that can be stored on the blockchain. Out of
all the different modes of Block Cipher like Electronic Code Book, Cipher Block
Chaining, Cipher Feedback Mode ad Counter Mode, the Cipher Block Mode is the
most suitable for us due to its strict tamper proof algorithm.
Proposed Solution

High Level Design

Low Level Design

User Registration
Data Storage

Request Access
Request Processing

Algorithm

Adding or updating data requires consensus of the network making it

nearly immutable. This means that once a block is written to the chain, it cannot be
altered or deleted. Transaction records are immutable, because each block of data
is linked to the previous block by including the previous block’s unique hash, which
is mathematically derived from the block’s content.

If a bad actor were to change the content of a block, the block’s hash would change,
which would then break its connection to the subsequent block. This would require
the bad actor to then re-hash the next block, and all subsequent blocks in order to
cover their tracks. However, since there are multiple copies of the ledger, the bad
actor would have to simultaneously change every version of the ledger at each
location, which is practically impossible especially as networks grow large and risk
of collusion becomes negligible.
To correct or remove data from the chain, one may append a new record with
corrected data that supersedes the original, or one may append a record that
marks a previous record as deleted. However, the original records added earlier
remain as is. This is an intentional characteristic that enables verification by all
parties in the consortium and helps to build trust.

To find the next block’s hash, we use the Proof Of Work algorithm –

Proof of Work(PoW) is the original consensus algorithm in a blockchain network.

The algorithm is used to confirm the transaction and creates a new block to the
chain. In this algorithm, minors (a group of people) compete against each other to
complete the transaction on the network. The process of competing against each
other is called mining. As soon as miners successfully created a valid block, he gets
rewarded. The most famous application of Proof of Work(PoW) is Bitcoin.

Producing proof of work can be a random process with low probability. In this, a lot
of trial and error is required before a valid proof of work is generated.

For encrypting the data of the medical records we use the Block Cipher
Encryption Algorithm –

We use the cipher block chaining mode of the block cipher algorithm.

In CBC, the previous cipher block is given as input to the next encryption
algorithm after XOR with the original plaintext block. In a nutshell here, a
cipher block is produced by encrypting an XOR output of the previous cipher
block and present plaintext block. Main advantage of the CBC is it makes the
medical records tamper proofs and there is not a fixed amount of bits that can
only be encrypted at a time into a block.
Result

Through this project we were able to implement a medical record storing

system which is immune from any kind of data breaches or tampering, and
which also helps in verifying the integrity of the medical data provided in
various institutions. Blockchain Technology combined with cipher block
encryption mechanism helped us in making the system decentralized and
tamper proof.

Conclusion

Blockchain Technology can help in solving many complex data security

problems in many trust less environment using cryptography, medical record
storage and access being one of those. Encryption techniques when
combined with blockchain also allows us to integrate cloud storage facilities in
the system which we implemented in the proposed solution. We found the
block cipher algorithm to be the most efficient encryption method due to its
nature of dividing the encrypting data into several blocks of a specific size that
can be stored in the blockchain and also due to its nature which makes
tampering the data in any one of the block almost impossible.

Future Work

Our application can also be extended to benefit insurance companies which

requires medical records to be provided to them before claiming any
insurance. The companies can easily verify the integrity of the medical records
provided to them. In the backend of the application, more features can be
added in the application like grouping medical records on the basis of patients,
ability to remove access to records from doctors and so on.

Screenshots

Ganache

Landing Page
Login Page

Patient Panel
Doctor Panel

MetaMask Notification
Code Snapshots
Contracts

ABI
Server