Blockchain Technology in Healthcare - Concepts, Methodologies, and Applications

The development of new drugs by pharmaceutical companies becomes a challenging task as it takes longer timelines, and the clinical trial process involved before the introduction of any new drug is risky and highly unpredictable. The patient data available for the clinical trial process is distributed across several databases, and the data are stored in different formats; hence it becomes difficult to perform clinical trials. Many stakeholders (pharmaceutical companies, research labs, patients, participants, government authorities, and many more) across geography are involved in the clinical trial process. Cooperation among these stakeholders is necessary to conduct a clinical trial. A Clinical trial is a complex and time-consuming procedure that faces a constant challenge of data management, data sharing, and data security, resulting in being an expensive affair. Blockchain technology can be used to augment the entire workflow of clinical trials and overcome the mentioned challenges. It uses consensus protocol for efficient transmission and communication of data between nodes. Patient recruitment for clinical trials can be easily managed through “Smart contracts”. Any computational problem related to patient recruitment for a clinical trial, checking the validity of clinical trials, can be coded with smart contracts. This paper describes the utilization of blockchain to collect and store patient data and analysis results in a distributed yet secured manner, which can be shared in a transparent way and remain immutable as well as allows to tackle the challenges involved in the clinical trial process.

Discovering and developing new drugs/ medicines is very crucial for the pharmaceutical industry. The increasing number of drugs approved in recent years demonstrates the impact of modern drug discovery approaches, digital technologies, and automated drug development methodologies. Drug development is a systematic and methodological process of developing a new pharmaceutical drug once the process of Drug discovery has identified the prime pharmacological component. The structured sequence of steps followed for drug development aims to ensure the safety and efficacy of the drug being developed. It includes pre-clinical research on microorganisms and animals, preparation of detailed data with respect to pharmacology, pharmacokinetics and toxicology details, application and approval by regulatory authorities and conduction of clinical trials. The conduction of clinical trials is an expensive affair as it needs a collaborative effort by multiple stakeholders along with a high level of monitoring and regulation. The data generated during the lifecycle of clinical trials is very critical for pharmacological scientific publications, regulatory approval for the target drug and post-marketing surveillance that ultimately leads to the development of better decision support systems for drug development. Hence, the data integrity of such data is of prime importance. Several Clinical data management (CDM) systems have been developed to ensure seamless collection and management of clinical trial data. These CDM systems enable useful analysis and decisions supported by authentic data. However, such systems face several security challenges with respect to privacy, integrity and authenticity of the clinical data. Another major challenge in conducting the clinical trials is finding the appropriate willing candidate who is physically and clinically suitable for the study. In view of the above, it is highly desirable to have a technology component that can address the above-mentioned issues. In this chapter, the technologies like blockchain and cloud computing have been introduced to address the challenges posed by clinical trial data management. The paper also proposes a blockchain based secure clinical data management system. The proposed system intends to help the data security issues like data integrity, privacy, ease and quick access to immutable clinical trial data with thorough access control enabling greater transparency and accountability. 

The health sector has been a huge market in recent times. It is drawing minute attention regarding pathological tests, drug manufacturing and supply, clinical trials and diagnosis by doctors and finally, recovery of patients quickly. The technologies used in health care for the last decades are redundant. Clinical trials and diagnoses by doctors can be made more accurate, better and faster with a past medical history of the patient in hand. Drug manufacturing and distribution can be made tampered proof and monitored properly by designing a transparent supply management system for medicine and medical goods. Attempts were made in the past to record the medical history of patients in a centralized database server, which lacks security, immutability and consistency of the records. This paper reports a systematic review of the application of revolutionary and disruptive Blockchain technology in healthcare systems to address the above issues. Blockchain technology can be used to create cryptographically immutable, time-stamped, distributed and tamper-proof ledger in a distributed P2P network to maintain Electronic Health Records (EHR) in the health care system. This technology removes all intermediaries between the source and destination point of any transaction. In a Blockchain network, transactions are cryptographically connected and hence merely difficult to modify the content of any transaction. This review shows that a number of studies in the past have proposed the application of Blockchain in health care. However, many of these used cases lack detailed prototypes and consensus algorithms from an implementation point of view. The review also highlights and depicts in detail the application of Blockchain in EHR and medicine supply management systems. The review further highlights the bottleneck of Blockchain and the area of its research in the near future.

Blockchain is part of the disruptive novel technology stemming from the cryptocurrency and bitcoin, which became large-scale around the year 2011. Subsequently, these technologies have triggered much need attention through the development and growth of more novel cryptocurrencies resulting in transactions, elections, peer reviews, democratic decision-making, identification and audit trails. The health sector has benefited immensely from the rapid advancement in blockchain, such as growth in biomedical research, drug traceability in the pharmaceutical sector, clinical trials, biological testing, patient’s data management, health informatics, data sharing, supply chain management of medical goods, legal medicine, telemedicine, health record, remote patient monitoring, payment services and security. Thus, this chapter will give a general overview of the principles, and applications of blockchain in healthcare industries and possible challenges with ways to resolve them. 

Blockchain technology is the technology of the twenty-first century. Web 3.0 is the name given to the next digital revolution. It was first developed to provide a secure payment mechanism, but it was later adapted and utilized in various industries. Healthcare is one of the domains where this technology has been deployed in the last few years and has yielded considerable results. The fast adoption of digital technology in the clinical sector has led to the construction of massive health records. As a result of this growth, there are never-before-seen requirements for clinical information security throughout usage and exchange. This adoption of the blockchain method as a reasonable and effective data storage and handling platform is opening up new opportunities in healthcare for tackling key data privacy, security, and integrity issues. Patients and healthcare providers have difficulty accessing, storing, integrating, and transmitting health information. Individuals are likely to access and control their medical information from everywhere on the planet, process and report their clinical findings, grant permissions, and even securely exchange that data with certain medical professionals. Straightforward health information access and an even more complete digital information architecture might help the medical industry better prepare for public health threats like COVID-19. We will examine several of the numerous ways that blockchain methodology has been employed in the clinical area, as well as its prospective scopes and possibilities for a better tomorrow, in this research. 

Healthcare institutions around the world are increasingly reliant on digital databases for the storage of medical data. The unprecedented growth of healthcare data’s scale and velocity has made it of paramount concern for the modern age. Digital databases are vulnerable and adversely affect both the patient and the healthcare industry as a whole. The risk of cyber threats can breach data and disrupt its integrity. Maintaining both data integrity and patient privacy is critical to healthcare organizations. Regulatory frameworks such as GDPR in the EU and HIPAA in the US are both bodies for compliance rules for maintaining healthcare data privacy. Unfortunately, the tendency of healthcare institutions to use proprietary systems creates isolated silos of data that become difficult to secure using traditional methods. A blockchain-based method provides a novel way of securing electronic healthcare records using a decentralized peer-to-peer based network on top of these isolated silos. Each block contains information and links to the other, forming a collective chain. This chain enables it to regulate on its own to store and share information instead of relying on a centralized system. Blockchain has many potential use cases in healthcare applications and can help in patient monitoring, storage, securing data, health information exchange, and clinical trial management, among others. The principle of decentralization and cryptography, at its core, will help transform the Healthcare system by improving the accessibility and security of patient information for the modern age. Through a systematic review of literature on Blockchain and healthcare data, this paper aims to explore the current application methods, challenges faced, open questions, data standards, and compliance issues that are core to implementing a Blockchain-based solution in the Healthcare industry. Further, the present study seeks to explore the concerns and scope of the blockchain experts operating in the healthcare industry. 

It has been discovered that the storage problem of complex health records and data has been addressed, but there were still several issues with data security sharing with cloud technology. The decentralization attribute of blockchain will help in solving the problem. In electronic health records, blockchain can assist in reducing data sharing and interoperability in the industry by creating an overarching mechanism connecting different personal forms. It can also mimic data sharing by directly bridging the gap between owners and buyers. Therefore, this chapter will provide detailed information on Advancing health research data analysis with blockchain. 

Blockchain is predicted to greatly transform the conventional methods of transacting between users, covering almost all sectors of the economy. While the expectations of blockchain technology are high, the actual impacts and benefits are still unclear, causing delays and skepticism in its adoption. As the coronavirus disease (COVID-19) continues to affect the world, businesses and governments scramble for answers in attempting to limit the impact of the pandemic. In order to assess the ability of blockchain technology in its efforts to minimize the impact of the pandemic and clearly define the challenges and prospects of blockchain, a structured literature review of peer-reviewed articles on block chain’s implementation and adoption in supply chain management, education, logistics and finance sectors was conducted. It is recommended that block chain’s implementation and adoption is not limited to the finance sector but can be applied in any sector, where it provides a decentralized network in which information is accessible and personal privacy and security are guaranteed. Therefore, the wider acceptance and implementation of blockchain in selected sectors of the economy, especially in finance and supply chain management, has proven that blockchain can be utilized by businesses, governments and health professionals in the fight against the virus by transforming the challenges into opportunities combined with the prominent essential enablers would fast track its wider adoption. 

The advances in computer science & technology have gone to new levels. The process of computational technology and ubiquitous computing is expanding exponentially daily. The computer system & its related inventions have become an integral part of our lives. People & services are migrating towards clouds and decentralized platforms. Nowadays, commerce & finance on the Internet rely on trusted third parties like banks to process electronic online payments. Though it fits well with most transactions, it still suffers from the inherent weakness of trust-based models. Blockchain Technology- the technology behind the cryptocurrency Bitcoin is buzzing a lot nowadays to invent and witness the future of data storage & processing in an efficient, decentralized, tamper-proof, and peer-to-peer (P2P) network. Nowadays, the use of blockchain is not confined to crypto-currencies only. This revolutionary technology is drawing its impact & use in many fields and applications. Primarily, a blockchain network can be used for storing, sharing & transparently transferring data without the intervention of third parties and other intermediaries. In a blockchain network, blocks are added using a consensus algorithm & connected cryptographically. Hence it is merely impossible to delete and modify the content of blocks stored in a blockchain network. Other advantages of this technology include consistency, security, transparency, distributed ledger, decentralized network, etc. This paper systematically reviews the work accomplished by many researchers for the past 11 years. Specifically, the application & impact of blockchain technology in various fields like cryptocurrencies, the health sector, e-governance, banking, finance, and food supply management systems have been discussed, and a projection of a novel application of the same technology has been proposed.

The distributed ledger technology in the healthcare sector has been reported to be very important in generating patient information for research, medication adherence, management of several bedside information about patients, pharmaceutical supply chain, and quality of care. Its application has been documented in the biomedical domain and blockchain technology such as custom, IOTA, NEM, Gcoin, JUICE, TenderMint, Multichain, Hyperledger Fabric, Ethereum, Bitcoin, as well as in data integrity, data auditing, data provenance, data versioning, access control and non-repudiation. Therefore, this chapter will give an overview based on the applications of Blockchain distributed ledger technologies for biomedical and healthcare systems. 

It has been discovered that in the old electronic health record platform, each health service unit managed its health records, making sharing difficult on the different medical platforms. However, it has been discovered that blockchain technology is a panacea that makes it possible to enable medical service units that are based on different platforms to share electronic health record data. However, one major challenge with this approach is the difficulty in storing whole electronic health record data in the blockchain, given the price and size of the blockchain. As a way out, cloud computing was ticked as a potential solution. Cloud computing affords a unique opportunity, including storage of scalability and availability. But again, the electronic health record with cloud computing advantage may be susceptible to attacks because sensitive data is transferred through a public channel. The task of sharing and disseminating medical information and records electronically is inevitable as far as medical management and treatment combination are concerned. Unfortunately, the old cloud-based electronic medical record storage platform is hard to achieve data security sharing. Given the tamper resistance and traceability, blockchain technology makes it possible for highly sensitive health data to be shared. Therefore, this chapter intends to provide detailed information on the application of medical imaging systems using blockchain.

Blockchain was formerly originated to prevent fraud in digital currency exchanges. Blockchain refers to a collective decentralised ledger that is unaffected by tinkering. It provides the confirmed contributor access to the store, views, and shares the digital information in a situation that is rich in safety, which in turn supports the development of trust, liability, and transparent business associations. Identity theft and fraud safety are endless challenges for everyone in buying and selling. With each novelty in security technology, hackers and fraudsters learn how to outsmart the technology and breach these networks. The first section of the chapter describes the structure of the blockchain, its framework, the pros and cons of combining these technologies, and the role and importance of machine and deep learning algorithms in fraud detection and prevention in the blockchain. The next section focuses on the reported work, highlighting different researchers’ work for fraud detection and prevention using Blockchain technology. The chapter’s final section comprises a comparative analysis based on various performance parameters such as accuracy, the area under the curve, confidence, true negative, false positive, and truly positive for a different type of fraud detection using blockchain technology.

The Electronic Health Record (EHR) systems provide health information about patients. Data security, integrity, and management of EHR are crucial problems. Records can be modified and altered by different stockholders as the different users may be using them in more than one form. Medical records management is a suitable application for blockchain-enabled records that can be stored, tracked, and managed by all the transactions to prevent fraudulent activities. A novel framework has been presented here in the healthcare sector by using the blockchain concept. The major goal of this article is to implement BlockChain for electronic health records (EHR), and its decentralized approach eliminates the chance of a single point of failure, making the system robust. The proposed work also covers the extensible problem faced by BlockChain in common with the help of an off-chain repository of the data. The results indicate that computing is much more secure and free from a scam than the traditional health record system. Finally, the proposed approach suggests scenarios such as EHR where the introduced approach should prove adequate.