Blockchain Applications for Healthcare Informatics: Beyond 5G

Blockchain Applications for Healthcare Informatics: Beyond 5G offers a comprehensive survey of 5G-enabled technology in healthcare applications. This book investigates the latest research in blockchain technologies and seeks to answer some of the practical and methodological questions surrounding privacy and security in healthcare. It explores the most promising aspects of 5G for healthcare industries, including how hospitals and healthcare systems can do better. Chapters investigate the detailed framework needed to maintain security and privacy in 5G healthcare services using blockchain technologies, along with case studies that look at various performance evaluation metrics, such as privacy preservation, scalability and healthcare legislation.

• Introduces the basic architecture and taxonomy of 5G-enabled blockchain technology
• Analyzes issues and challenges surrounding 5G-enabled blockchain-based systems in healthcare
• Investigates blockchain-based healthcare applications such as telemedicine, telesurgery, remote patient monitoring, networking of the Internet of Medical Things, and augmented and virtual realty tools for training in complex medical scenarios
• Includes case studies and real-world examples in each chapter to demonstrate the adoption of 5G-enabled blockchain technology across various healthcare domains

• Language: English
• Publisher: Academic Press
• Release date: May 20, 2022
• ISBN: 9780323908290

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1: Blockchain-based transaction validation for patient interoperability in Healthcare 4.0

Kumud Tiwari; Sachin Kumar; Pooja Khanna; Anil Kumar    Amity School of Engineering and Technology, Amity University, Lucknow, India

Abstract

With the progressive increase in the use of disruptive technology in healthcare services, diversified solutions are being worked upon to make medical services patient-friendly and secure. In general, patient personal details and medical history are rigorously maintained in electronic health records. The data are sensitive and must be secured. Often data must be shared to obtain a second expert opinion and alternative solutions. This potentially increases data exposure, thereby risking breaches and unauthorized access. The blockchain architecture has immense potential to securely communicate and transform health, clinical, medical, and life science service delivery as required by healthcare applications in an immutable and decentralized manner. Blockchain innovation has caught the interest of health experts and biomedical researchers in different areas of medical care such as longitudinal clinical records, drug advancement, automated complaints, interoperability in people’s health, clinical exploration, patient portals, information security, and supply chain management system. It is being considered whether blockchain-integrated healthcare will disturb the flow of medical services. Still, medical associations are keenly observing its potential for ideas such as secure patient identification. Blockchain with features such as decentralized networks and tamper-proof platforms makes it an ideal technology to be investigated for its prospects in healthcare. This chapter provides an in-depth examination of the different intricacies of the blockchain in the healthcare sector, particularly with the 4.0 edition. The chapter also presents various techniques for secured transaction and validation methods of healthcare data that are evolving rapidly. Factors enhancing patient interoperability with the blockchain structure focusing on state-of-the-art security and privacy aspects have been addressed in the work. In addition, the work also presents a case study with already-existing electronic healthcare support application with online assistance and data accumulation at a cloud-based service to reduce the physical work done by patients, work also enumerates open issues, and challenges with the technology suggested.

Keywords

Electronic Health Record (EHR); Health management system; Blockchain; Patient interoperability; Smart contract

1: Introduction

Healthcare is one of the largest and fastest-growing industries, accounting for the majority of the economy. The medical business, often known as the healthcare industry, is a sector of the economy that offers health goods and services to individuals or patients, regardless of their socioeconomic level, for curative and rehabilitative purposes. Health professions include doctors, nurses, and administrators [1]. In the previous 20 years, hospital services as well as their structure, growth, operation, and administration have experienced significant changes. The implementation of issues such as changing the quality of life and cost-effectiveness, extensive media coverage of system flaws, increasing demands and awareness of patient rights, and limited resources in the age of expensive high-tech medical support systems and trajectories have all contributed to public dissatisfaction with the traditional role of the healthcare provider[2]. Patients and experts see a lack of access to medical records as a hindrance to transparency and effective medical care. While electronic clinical records frameworks assist adapt to this issue a bit, a considerable lot of these frameworks are heterogeneous, they end up being variable effective reconciliation into clinical work processes and show insignificant interoperability between stages. As a result, many EHR frameworks are now fighting to provide vital advantages of computerized innovation, including as improved customer experience, information trade advanced skills, and examination. This lack of interoperability is becoming more of a test of how complicated individuals present themselves to a variety of care providers in various medical care wards using multiple EHR systems [3]. The blockchain-based framework is a potential arrangement that presents a few advantages that could be used for information organization. However, blockchain is a fledgling innovation and there are key specialized, administrative, and institutional obstructions that limit its maximum use in the clinical field [4].

Blockchain innovation is a peer-to-peer (P2P) network digital data distributed ledger system that can be distributed privately or publicly to all users, allowing any type of data to be stored reliably and verifiably [5]. Fig. 1 describes the application of blockchain in the healthcare industry. Another vital aspect of blockchain is the contract, which is a set of protocols. This is known as a smart contract, which is a legally binding strategy that contains a bunch of customizable guidelines/rules under which different parties agree to cooperate with each other in the form of decentralized automation. Several smart contract applications have emerged as a result of blockchain in different areas, including energy resources, financial services, voting, and healthcare. Blockchain innovation offers transparency while also eliminating the need for intermediaries. In an untrusted and untrustworthy environment, it uses consensus and encryption mechanisms to validate the legality of a transaction. In a P2P transaction network, the receiving node verifies the message and saves it in a block if it is correct. The data in each block are then confirmed using a consensus process known as proof of work (PoW). After the consensus method is completed, a block will be added to the chain and every node in the network will accept it, spreading the chain indefinitely [6].

Fig. 1

Fig. 1 Blockchain-based healthcare applications.

Taking the healthcare sector as a target, blockchain as a support technology can address challenges such as data sharing, privacy issues, data security, and storage. Interoperability is a requirement in the healthcare industry. Interoperability refers to the capacity of two parties, whether machine or human. Interoperability as a feature targets the information flow of healthcare personnel and patients in an efficient and secured manner, such as EHR, so that data can be shared and dispersed across multiple hospital systems. Regardless of provider location or trust connections, interoperability allows providers to securely share patient health records (with patient permission) [7]. It is particularly vital considering that health data sources are different. Blockchain technology solves this element of interoperability, and has demonstrated the potential to securely manage, store, and share electronic medical records between healthcare communities. In addition, the rising costs of healthcare infrastructure and software have put a terrific strain on global economies. Blockchain technology is influencing healthcare results in a beneficial way for businesses and stakeholders by streamlining business processes, managing patient data, improving patient outcomes, reducing costs, improving compliance, and enabling better use of health data [8].

1.1: Motivations

The motivation of conducting this study is to dissect the blockchain as a central innovation. It is as of now a piece of Bitcoin, but it is considered part of the new internet. The goal of this study is to track down the current situation of blockchain on the worldwide technological scene, to talk about potential outcomes of innovation execution, and track down various techniques for the secured transaction and validation methods of healthcare data that are evolving rapidly. We are studying the role of blockchain technology in securely sharing medical data among healthcare practitioners while also looking at how we might make blockchain adoption easier from a technological standpoint. Researchers want to learn about the application issues that blockchain presents and debate the technology’s future potential. The aim of this study is to determine the factors that can enhance the patient interoperability structure with blockchain technology while focusing on state-of-the-art security and privacy aspects as well as showcase the potential of blockchain technology. Further, researchers get to know about open issues, and challenges that blockchain technology is facing at the time of implementation.

1.2: Contributions

Patient-driven interoperability is a recent trend that has the capacity to set a new base for information sharing between medical service associations. However, patient-driven interoperability brings with it new challenges and requirements, such as security and protection, innovation that can deal with a variety of issues related to patient-driven interoperability, and the majority of these challenges for traditional interoperability have yet to be resolved. Blockchain is a novel innovation that can be used to further develop interoperability. Blockchain can possibly give sharing, security, protection, stability, information liquidity, information sharing, and encryption of health information. In this chapter, we propose improved blockchain-based patient-driven interoperability for medical care information.

1.3: Organization

This how the rest of the chapter is organized. The basic ideas for comprehending blockchain technology are presented in Section 2. In Section 3, healthcare 4.0 as the next step in innovation is presented. Functional blocks of blockchain integration with EHR systems are discussed in Section 4. In Section 5, blockchain-assisted secured transaction-validation for patient interoperability is explained. In Section 6, we suggest a model for flexible smart contracts for enhanced interoperability. The investigation’s problems and prospects are described in Section 7. Finally, Section 8 brings the paper to a close and makes recommendations for future development.

2: Intricacies of blockchain

Blockchain has evolved as one of the most promising technologies of the last decade, garnering the interest of academics as well as industry specialists. Satoshi Nakamoto first proposed this concept in a white paper published in 2008 [9]. It is a distributed, decentralized, and immutable ledger that’s used to securely record transactions over a network of computers on a P2P basis without the need for third parties. Bitcoin [9], the first blockchain implementation based on cryptocurrency applications, is supported by the first version of blockchain, Blockchain 1.0. The new Blockchain 2.0 generation introduces the concept of a smart contract, which is a piece of code specified by a set of rules that is performed, and recorded in the distributed ledger. The third version of blockchain technology, Blockchain 3.0, is mostly utilized in nonfinancial applications, including government, energy, and healthcare. Some healthcare institutions have accepted this technology and put it to use in a variety of ways. Decentralization, privacy, and security are the most exciting properties of blockchain that are helpful for healthcare applications. This is because blockchain technology can provide patients and other stakeholders with safe access to medical data, so it has great potential (hospitals, insurance companies, doctors, etc.). Bitcoin is based on blockchain technology, which stores an encrypted ledger in a public database. Blockchain is a technology used in a worldwide database that can be accessed by anybody, anywhere with an Internet connection. Unlike traditional databases that are held by central parties such as banks and governments, a blockchain is not owned by anybody. With an entire network dealing with it, cheating the system by forging papers, transactions, and other information becomes exceedingly difficult. Blockchain is a network of nodes that preserves information indefinitely. It’s not only about decentralizing data; it’s also about disseminating it. Each network node can store a local copy of the blockchain system that is updated on a regular basis to ensure consistency across all nodes. A blockchain is a distributed computing and information-sharing network that enables several nodes to make decisions, even if they do not trust one another. The only point of failure in the centralized system is the problem. There are several coordinate points in a decentralized system that exceed the single point of failure. In a distributed system, each node collaborates to complete the task [10,11]. Fig. 2 depicts blockchain’s basic architecture. Each user is represented as a linked node in a dispersed network. Each node maintains a copy of the blockchain list, which is updated on a regular basis. A node can perform a variety of functions, including initiating transactions, validating transactions, and mining.

Fig. 2

Fig. 2 The basic architecture of blockchain.

The structure of the blockchain technology includes:

1.Block: A collection of valid transactions; the transaction may be started by any node in a blockchain system and broadcast to the remaining network. The network’s nodes confirm the transaction by comparing it to previous transactions, and then the next step is added to the existing blockchain. During that period, the number of transactions that occurred is gathered into a block and then put in the blockchain block. A block can include on average more than 500 transactions, according to Bitcoin, and a block’s average size is around 1 MB (an upper limit suggested by Satoshi Nakamoto in 2010). It can grow to be as large as 8 MB in size, and occasionally much larger. Larger blocks can help with the simultaneous processing of many transactions.

2.Previous Block Hash: Every block inherits from the previous block. As the blockchain algorithm employs a hash of previous blocks to produce the next block’s hash, the sequence of generation makes the series tamper-proof.

3.Block header and list of transactions form the third and fourth components. The block header contains the metadata about a block.

4.The block was built using the following mining statistics. The mechanism needs to be complicated enough, to make the Blockchain tamper-proof Bitcoin Mining:

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3: Healthcare 4.0

Healthcare 4.0 refers to the final stage of healthcare digitization, in which advanced analytics tools and artificial intelligence (AI) assist clinicians and hospital administrators in making more precise diagnoses and better therapy choices [12–14]. Large volumes of data flow into the archiving cloud, not just from medical offices and imaging centers but also from distant gadgets and sensors operated by patients. At the same time, data assist in the formation of better-informed health management decisions, with the prospect of considerable efficiency benefits and cost control in the near future. Healthcare 1.0 was at the beginning of digitization in the early 1990s, when doctors changed hands written notes to record patient data on computers which were then archived and managed with systems like PACS and RIS. Although the shift has improved and accelerated access to patient data, the doctor-patient process has remained the same. Then came Healthcare 2.0, which saw hospitals develop systems to incorporate and handle digital data that employees were collecting via computers and tools. Workflow in hospitals and physician clinics began to change with the adaptation of managers to patient trends; this became apparent to all aggregated data in clinical settings. Healthcare 3.0 flourished with the primary focus of collecting all patient data in EHRs to which everyone had full access. People could upload extra information to their accounts, such as portable device self-test data or genomic information, in addition to the data obtained by doctors. With the growing avalanche of data processed with AI, the momentum has come in the last iteration, Healthcare 4.0. These huge volumes of information come from a variety of sources related to the IoMT's expansion. Healthcare 4.0 suggests digitization is much more than a mere technological solution, but rather is an innovative technique that impacts sanitary practices and industry frameworks, allowing healthcare practitioners to boost precision medicine, alter care delivery, and improve the patient experience. Fig. 3 shows the revolution from Healthcare 1.0 to 4.0. The goal of Healthcare 4.0 is to collect vast amounts of data and put that to use in applications. Remote aid and telemedicine are becoming more common, indicating that these applications are becoming a reality.

Fig. 3

Fig. 3 Revolution from Healthcare 1.0 to 4.0.

The following are the major components of Healthcare 4.0:

1.Intelligence: The application of artificial intelligence (AI) algorithms to enhance the accurate identification of diseases, diagnosis, and interaction between doctors, patients, and stakeholders to achieve individualized and patient-centric smart health management systems, includes the following points of view:

a.Stratification and classification: Patient requirements and characteristics must be better recognized for patients to be classified into distinct classes (for example, risk assessment platforms for cancer and stroke [15,16]). It is possible to uncover key variables associated with a given illness using stratification and classification methods. We can go beyond examining this correlation to determine the causative link between patient variables and a specific condition, which will aid physicians in developing patient-specific intervention strategies that address these factors. This may be used as a starting point for improving diagnosis support and therapy to match the needs of patients.

2.Preventive-prognostic care: Prognostic detection can be employed to develop proactive and preventative treatment strategies [17]. This can help to effectively address how to provide minimized relevant medication with fewer mistakes and enhance patient safety in addition to preventing or delaying disease progression [18,19]. An investigation of key factors influencing patient outcomes and therapy responsiveness might lead to recommendations for creating treatment regimens.

3.Prediction analysis: For each patient, accurate predictions of disease development and results based on stratification and classification can be made to aid diagnosis and prognosis (e.g., prediction of hospital readmission, cardiovascular disease, and diagnosis of infection by COVID-19) [20]. Not only must such models predict risk levels, but they must also identify and understand the factors that influence those levels. The importance of prioritizing related components as well as the potential influence of causative elements might be investigated further to give recommendations and assistance for medical decision-making [21].

4.Closed loop: In a closed loop, all components of Healthcare 4.0 are dynamically interconnected. To put it another way, the outcomes of medicine and treatment decisions must be submitted to the prognostic analysis model so that prognoses, significant factors, and treatment and intervention plans may be dynamically updated in real time.

Deep learning, NLP, statistical analysis, augmented reality and virtual reality modeling, and optimization approaches all play key roles in the development of a smart healthcare system. In cyber-physical systems, robots, IoT, wearable devices, RFID, and blockchain technologies, as in Industry 4.0, provide a framework for data gathering, analysis, monitoring, intervention, and verification. Connecting them to customized medicine can aid in the implementation of genetics-based diagnostic and treatment techniques as well as increase patient therapeutic efficacy.

4: How a blockchain EHR system would work

Blockchain is a decentralized ledger technique that generates a record of immutable transactions. Distributed ledger technology produces an immutable record of transactions and an immutable exchange. Transactions in the healthcare industry are defined by parts of patient health information. Before reaching blockchain permanence, each occurrence of entering patient data into file registration was double-checked to keep a universal patient data record. There are numerous ways to verify a blockchain. With various governance and accessibility levels, there is no research procedure for participants in a public blockchain system, thus anybody may participate; this characteristic is employed in Bitcoin. Instead, a trustworthy consortium governs the blockchain and evaluates possible participants in a file with permission or a private blockchain. While both private and public blockchains might be useful in healthcare, a private blockchain mode potentially allows for additional monitoring because only authorized parties with a private digital key will have access to the blockchain. Both patients and clinicians would have access to relevant health information because of this. In this approach, the blockchain might expand access to documents while maintaining enough supervision, therefore impacting care quality. Transactions in the healthcare industry are defined by parts of the patient’s health information. Each transaction or occurrence of putting patient data into the file registration is evaluated before reaching blockchain permanence in order to preserve a universal patient data record.

Even if they are not ready for time being, blockchain offers an incredible opportunity to address the above problems. As a result of this strategy, the blockchain may be able to increase document access while still retaining enough oversight, therefore affecting care quality. MedRec, for example, allows patients and physicians to share HER files across doctors. In the same way, the European Union established MyHealthMyData, a blockchain network that permits healthcare providers, government entities, vendors, and patients to exchange data. Despite these advancements, its usage is hampered by regulatory and institutional obstacles. Blockchain has several distinguishing characteristics. This makes it particularly well-suited to dealing with problems in EHR systems (Table 1).

Table 1

Because data are immutable, they offer a trustworthy event record and make it nearly difficult for bad actors to modify it. Furthermore, cryptography initiatives built into the blockchain make any erroneous data harder to comprehend. From the standpoint of accessibility, health data might be accessed by anybody, anywhere, with a wireless connection and authenticated credentials. This technique might result in a significant reduction in information exchange transaction costs. Data tampering and unauthorized access are concerns with any digital system, and these concerns reach the bare minimum with the blockchain technique. Innovation and research are minor factors that may benefit from the vast amount of data that blockchain would make available. EHRs are made accessible to patients, clinicians, and research organizations by utilizing blockchain technology. There are numerous advantages to working for the government. Consumerization of healthcare is a well-known trend among patients, and it has led to a significant volume of patient data being produced via mobile devices, apps, and other tools. It is expected that patients might take a proactive and involved part in their care if health information was made more available to them. Furthermore, at each appointment, physicians would be supplied with all essential health data, allowing for accurate and targeted care as well as avoiding diagnosis mistakes. Enhanced access to patient data on a wide scale might aid researchers in creating a large number of datasets, resulting in improved evidence-based decision-making. Likewise, easily accessible data and the capacity to handle consent through a patient-centric platform might result in cheaper research and development expenses for developers and pharmaceutical firms, allowing for a faster time to market and lower prices for both patients and providers.

5: Blockchain-assisted secured transaction validation for patient interoperability

Blockchain technology has the potential to improve interoperability across a global medical tourism sector by removing both system and geographical barriers. Access to patients’ accumulated clinical data– their medical history–to assist better care delivery in country is, however, a big problem. Blockchain technology may be used to create a decentralized, uniform worldwide EHR system. Members/patients can have global mobility thanks to blockchain, which ensures that their medical history data can be securely accessible by any provider, anywhere in the world, over the Internet. Clinics may share healthcare information without limits in an interoperable healthcare system, and they can also optimize their healthcare procedures [22–24]. Interoperability can be divided into three categories:

1.Structural interoperability: structured data formats facilitate data sharing. The use of these standardized data formats ensures data interpretation.

2.Data sharing across various healthcare facilities (fundamental interoperability). The responder is not needed to understand the data.

3.Semantic interoperability: information interpretation is facilitated at the semantic layer, allowing data meaning to be interpreted.

The three types of interoperability enable various information technology (IT) systems and data collection devices, such as mobile handsets for recording blood sugar or health monitoring devices for blood pressure, pulse, and other indicators. This can help ensure the quality, security, and cost-effectiveness of structured data [25,26]. In addition, seniors in the medical domain must exchange clinical domain information to scientists from the data domain. Advanced standards for data are needed for the preparation of unstructured data, which is acquired from mobile handsets and health data devices that monitor patients constantly for diagnostic data. The integration of clinical knowledge and data standards that exchange this knowledge from various case studies will be critical in the future [27,28] because a substantial number of health information sources are difficult for information systems to comprehend.

Advancements in EHR, cloud-based health data storage, and patient data as well as new privacy protection rules have opened new prospects for health data management, allowing patients to reach and forward their health data more easily [29–31]. Data security, transactions, and storage as well as the administration of continuous integration are the backbone to any data-assisted organization, especially for healthcare services, where blockchain has the ability to take care of these open issues securely and efficiently [32–34]. Fig. 4A depicts seven phases in the blockchain system’s health data management, which are explained further below. Blockchain-based applications include data sharing, data management, data storage, e.g., cloud-based applications and EHR.

Fig. 4

Fig. 4 (A) Health data management in blockchain. (B) Features available for the doctor’s domain.

When a patient interacts with a physician or specialist, primary data are created. This information includes the patient’s present issue, medical history, and other physiological facts. The primary data collected before are used to construct each patient’s EHR. Other medical information is also provided, such as that gained from nursing care, medication history, and medical imaging. The owner of this property is the sole patient who has access to confidential EHRs and individualized access control. Those who want access to this sensitive data must first submit an authorization request, which is then submitted to the EHR’s owner who decides who has access. The database, blockchain, and cloud storage are the three steps that make up the complete activity. Logs are kept in databases and cloud storage in a scattered manner, ensuring exceptional privacy as well as legal and customized user access. The end user is a health professional, such as ad hoc clinics, social care centers, or hospitals, who wishes to get access to a safe care service that is approved by the owner. For example, medical records will be available on the handset and authenticated employing a blockchain decentralized platform.

5.1: Data flow and operation

(a)After collaborating and registering on the app, doctors would be given authorization after confirming their authenticity through the medical board. Their data would then be stored permanently in cloud storage.

(b)The customer details along with their location would be saved on the cloud service after their biometric and key confirmation.

(c)The above step would take place depending on the chosen plan or as prescribed by the doctor himself.

(d)A doctor’s prescription along with a diet plan and necessary reminders would be sent for execution as entered.

(e)The names of the medicines would be searched and their prices fetched through registered sites, based on the minimal cost shown on the app. The doctor, with the patient’s approval, can place the order.

(f)Similarly, fruits, vegetables, and other items suggested by the doctor would all reach the patient’s registered location.

(g)Upon receiving the order, the patient would be required to confirm their received order.

(h)Reminders would be generated as scheduled.

(i)Throughout the registered period, both patients as well as doctors would be able to communicate with each other through the video/voice call facility provided.

5.2: Model design

Modeling of data flow for functional operation at the doctor domain:

In doctor-end functionalities: Healthcare experts will be authorized to access the application only upon verification as a licensed expert. The task will be achieved by establishing his/her entries (registration identification and region) in the licensed expert database, and concurrently in the blacklisted database. After access, the expert may go through a list of his former clients and scan their history, or simply see a new patient’s unique ID or Aadhaar card during the appointment. On scanning the patient’s unique identity, his/her complete medical record will be available to the expert if it exists; if the need arises, a new entry will be created. Depending on the medical record, the expert can add a new prescription, diet plan/precautions, or reminders for food, medications, and other items, as shown in Fig. 4B. The costs of prescription and medicine can be worked on by a price comparison tool.

The data of a chronic care patient can be upgraded to make medical history records available on a worldwide network, as shown in Fig. 5. This would allow any hospital in the world to obtain this information, regardless of where it is situated (once authorized by the patient). As a result, when a patient travels to another city or country to obtain treatment as outlined by the medical tourism policy, they no longer need to bring their medical documents with them. Smart contracts can be set up in an interoperable blockchain to act as a gateway for storing standardized data that are instantly accessible to any parties that have been granted access to the blockchain. To drive the smart contract, an application program interface (API)-oriented architecture might be created. The APIs will be made public and available to all collaborating organizations. All participating organizations connected to the blockchain will have access to the APIs, which will allow for seamless integration with each organization’s existing systems. The content of the patient interaction is sent to a blockchain-based smart contract when the API is called. Querying data from the blockchain is also possible via a set of API calls that may be used by any linked organization. These APIs allow organizations to query specific blocks in the chain or submit preset query criteria (patients older than 25, for example). APIs can be used to create a common portal that all linked healthcare companies can access and utilize for direct system integration. Because the API-oriented structure only necessitates the redirection of a few data fields, businesses may save time and money.

Fig. 5

Fig. 5 Chronic care patient’s data available on the global network via a smart contract.

6: Flexible smart contract for enhanced interoperability

The suggested smart contract structure for EHR is summarized in Fig. 6. The parameters of the agreement as well as how users interact with the Ethereum network are defined in this smart contract. The administrator (Admin in Fig. 6) is the governing authority in charge of enrolling healthcare providers in the app. The administrator has the ability to create, edit, add, and remove hospital accounts. A new block is produced on the backend when a new patient record is created, validated, and broadcast to all nodes in the network. The blockchain gets updated with a fresh block. The technology has been designed to permit hospitals to examine and formulate patient health records when a request is processed by the patient and the patient has permitted access. An expert from another domain may be required to aid a patient depending upon the nature of the illness; the hospital makes this request. When a request is refused, the hospital and its personnel are denied access to the patient’s medical records. Patients can also make an appointment by calling the facility. Two actions govern the boundaries of patient contact: (1) allowing or refusing access to medical records, and (2) viewing appointment records. Because blockchain is used as a record-sharing platform, it ensures that data transfer, security, privacy, and integrity are streamlined.

Fig. 6

Fig. 6 For an electronic healthcare record system, a basic smart contract framework is required.

The suggested framework is depicted in detail in Fig. 7. It is made up of three primary layers: User, front end, and back end. The system user classes, which include the administrator, hospital personnel, and patient modules, make up the user layer. The following modules are discussed in detail:

1.The administrative module

Fig. 7

Fig. 7 Blockchain-assisted secured transaction validation for patient interoperability in electronic health records.

This module creates user interfaces for applications that are straightforward and simple to use. It is divided into six submodules that allow the administrator to manage hospital accounts. All administrator submodules are listed below:

(a)The Create-Hospital-Record Module allows administrators to create or update hospital records. It’s a completely verified online form that contains the programming logic for registering patients and creating hospital records.

(b)The Dashboard Module generates and provides all hospitals in the suggested blockchain network. Using the explore tag offered by the targeted hospital available on the dashboard, the administrator may investigate these hospital data and run the hospital.

(c)The Hospital Record Details Module permits the administrator to see facility data as well as do other administrative tasks related to the hospital’s present needs. Add personnel to the hospital, modify hospital records, suspend hospital accounts, and so on are examples of administrative tasks.

(d)Using the Create Hospital Staff Record Module, the administrator appends health center staff data to the present health center records.

(e)Edit Hospital Record Module allows administrators to make changes to hospital records.

(f)The Administrator Menu Module is integrated with all other modules of the administrator module. There are two possibilities. Administrator Dashboard and Create Hospital Record modules utilize one variation, whereas the Hospital Record Details and Create Hospital Staff-Record modules use the other.

2.Patient module

This module incorporates user-friendly and easy-to-use app interfaces that permit logged-in patients to communicate with the mode. There are six submodules in total:

(a)The Grant Access to Request Module permits a logged-in person to view and accept or reject all hospital requests for access to their medical information. After a patient authorizes a request, it is active for that day, and upon completion of patient consultation, access is revoked.

(b)The Patient-Menu Module is interconnected to all other modules. The module consists of a set of links that allows logged-in users to access additional content.

(c)The Dashboard Module displays logged patient alerts, such as notifying users of a new request from a hospital to reach their data or displaying the patient’s daily appointment. This module also shows the logged-in user’s profile information.

(d)The Medical History of Patients Module permits the logged user to access their own medical records. The information in their medical history cannot be modified or tampered with by the registered user; they can only see the data.

3.Hospital module

The hospital module presents user-friendly and easy-to-use user interfaces in the administration module. It contains seven submodules that allow logged-in individuals to complete activities that assist the hospital in managing their patients. Hospital submodules are:

(a)Medical Records for Patients Module: The logged hospital person has reached the patient’s records and they may then see the patient’s data and medical records. This module also gives hospital personnel the ability to update patient records following a thorough conversation with the patient as well as plan a follow-up meeting with the patient. The doctor’s access authorization is revoked when the expert exits the patient record page after successfully finishing the consultation. If the doctor needs access to the record again, he or she must make a new request.

(b)Dashboard Module: This module displays statistics on the number of patients the hospital has seen for the day, the total number of scheduled appointments, and scheduled appointments the hospital intends to keep for that day to log hospital personnel. This module also includes a list of all medical record access requests that have been granted as well as several appointments that the hospital has kept for the patient.

(c)Seek Access to Patient Medical Records Module: Logged hospital professionals (doctors) can use this module to request access to a patient’s medical record. A search function in the module allows the doctor to get a patient’s record by providing the public key or account token. The program searches the patient’s records in the back end using the provided token, and if the record is present, the doctor asks for access and waits for approval. If the user account cannot be discovered, the doctor must register the patient, prepare a patient report, and request access to the patient’s previous record. On approval of the request, the expert can access and analyze patient records.

(d)Hospital Appointment Module: This module displays the logged user’s hospital appointment logs. Appointments for the present day are first on the list, followed by all other appointments, which are displayed underneath the current day’s appointments.

(e)Add Medical Report Module: The module allows logged hospital staff to update the patient’s history and create a record depending on the doctor’s consultation and diagnosis.

(f)The Hospital Menu Module is integrated with all other modules of the hospital module. The module is a list of links that permits the logged user to access additional resources.

(g)Module for Scheduling Appointments: The module enables logged hospital person to plan a patient’s next hospital visit. This module is a completely verified procedure that creates an appointment record when filled out with the correct information.

The smart contract that is distributed on the Ethereum network serves as the back end, and the smart contract is created by the dapp application. To deploy the smart contract, it must first be completed and the binary application interface, a json representative of a smart contract in terms of the user agreement, must be produced. The created smart contract gets interfaced using migration tools. The front end will have access to the smart contract, which will allow MetaMask to communicate with the distributed file. The program may be accessed via a web browser and MetaMask, a web3 protocol for accessing a decentralized network from your browser (dapp). To use the application, the user’s private key will be needed to import the user account into the browser using MetaMask and connect to the Ethereum network (administrator, hospital personnel, or patient).

With the Ethereum network, a public key is employed to identify and address an account. A request (login request) from the dapp application initiates the delivery backend transaction (smart contract). A processing charge known as gas is required for the submitted transaction. On the Ethereum network, gas is the needed cost for successfully completing a transaction or contract on the platform. The transaction is then transmitted to the backend, where it will be processed, after the commencement of the access request and the request confirmation opens in the MetaMask dialog. The miner employs mining algorithms to create new blocks on the blockchain to execute a transaction. The mined block may include several transactions, each of which is checked and validated by the network. After completion of block extraction and transaction, the back end sends its response to the front end, which changes the user interface based on the contents of the file server response.

The flowcharts above outline the functions aimed at delivering efficient and precise healthcare support for its users as well as simplicity of use and data management for doctors. The initial app activity allows a user as well as a doctor to log in. In the instance of a user, the following Flowchart, Fig. 8, explains the subsequent activities. In the case of a doctor, he may input his registration identification and region (which as one unit will constitute a unique identification key), and the OTP delivered to the doctor’s registered contact number guarantees that no nondoctor may get access. If any of these credentials are discovered in a database of authenticated doctors (and it should not possess any banned doctors), the doctor is granted access. The doctor can then check or see if any fresh pathology reports have been updated, analyze any existing records or contacts (mostly for persons he or she is presently taking care of), or simply scan the QR code on the patient’s unique ID card. If the patient’s current information and medical records are present, the Aadhaar card scanning procedure will bring them all, and if they are not, the new patient’s personal credentials will be added to the database. Any prescriptions, reminders, or other details added by the doctor will be saved with the patient’s records. A charge for the prescriptions, drugs, and vaccines available online would be created immediately after a prescription was filed. Whether to place an order is up to you, but in any case, all your information will be saved in the patient database. Fig. 9 depicts a snapshot of the electronic healthcare app.

Fig. 8

Fig. 8 Flowchart illustrating how the electronic healthcare app works (mostly from the doctor’s perspective).

Fig. 9

Fig. 9 Snapshot of the electronic healthcare app.

The app’s operation is depicted in the diagram below.

Step 1: Begin.

Step 2: If you are an existing user, enter your credentials; if you are a new user, select the registration option and proceed. If you are a doctor, go to Step 4 and pick DoctorLogin from the option, as shown in Fig. 9.

Step 3: After logging into the app, the user can choose from one of the following seven options:

(a)Doctor search by any field.

(b)Doctors near me option.

(c)Viewing the Gantt chart based on the previous sickness investigated.

(d)Finding a list of medical tests/check-ups needed and nearby pathologies depending on the disease/symptom input (These details are collected through the fog layer reduction system).

(e)Uploading a date-stamped test report (added to the patient’s record).

(f)Examining the patient’s prior medical records and visits (If needed, the patient can even contact the doctor in any of three ways: messaging, telephone calling, or video chat).

(g)Submitting a feedback form for each doctor seen.

Step 4: For doctors, the initial step in gaining access to the app is to get verified. He must give his registration number as well as the state in which he was registered, as shown in Fig. 10.

Fig. 10

Fig. 10 Snapshot of doctor’s side.

Step 5: Upon successful verification, access is granted.

Step 6: The doctor can then review or make an addition to the list of those who have already seen him.

Step 7: The following action contains the basic personal information (such as name, age, gender, and so on) as well as any medical history that may be discovered. Fig. 11 depicts the snapshot of the working of the app for personal details (name, age, gender, and address).

Fig. 11

Fig. 11 Snapshot of working of the app for personal details (name, age, gender, and