BLOCKCHAIN BASED AUDITABLE
MEDICAL TRANSACTION SCHEME FOR
ORGAN TRANSPLANT SERVICES
Gasim Alandjani
Assistant Professor, CSE Department, Yanbu University College,
Royal Commission Yanbu (Saudi Arabia).
E-mail: alandjanig@rcyci.edu.sa
Recepción: 26/07/2019 Aceptación: 18/09/2019 Publicación: 06/11/2019
Citación sugerida:
Alandjani, G. (2019). Blockchain based auditable medical transaction scheme for
organ transplant services. 3C Tecnología. Glosas de innovación aplicadas a la pyme. Edición
Especial, Noviembre 2019, 41-63. doi: http://dx.doi.org/10.17993/3ctecno.2019.
specialissue3.41-63
Suggested citation:
Alandjani, G. (2019). Blockchain based auditable medical transaction scheme for organ
transplant services. 3C Tecnología. Glosas de innovación aplicadas a la pyme. Special Issue, November
2019, 41-63. doi: http://dx.doi.org/10.17993/3ctecno.2019.specialissue3.41-63
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ABSTRACT
Internet of Things have brought exciting changes in the social norms, work
environments and the prospects for future generations. These devices (Things)
have already changed the way our networks are used for communication. With
the introduction of machine to machine communication (M2M), where devices
communicate without human involvement to perform routine day to day tasks.
These tasks on one hand, include services that provide convenience to the device
owners such as setting o alarms, acting as personal assistant for reminders, keeping
track of daily activities etc. On the other hand, there are certain tasks where these
devices perform Transactions on behalf of the owners i.e. nancial transactions/
online ordering etc. These transactional tasks have signicant legal implications if
some problem / dispute arises due to such action performed by these devices on
behalf of the owners. To ensure that these interactions take place under observation
of the owners and to keep track of their occurrence, there is a need to keep record
of all such communication. We propose use of Blockchain for tracking all these
transactions without compromising secrecy of data by keeping its integrity intact for
medico-legal requirements and prevent risk of fraud.
KEYWORDS
IoT Security, Blockchain, Organ Donation, Smart Health, Nodes, Mining, UPRL,
IDoT, M-IOT, P2P.
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1. INTRODUCTION
Since the introduction of bitcoin cryptocurrency by Satoshi Nakamoto (2019)
and implementation of its underlying technology called Blockchain, many diverse
applications of Blockchain have been proposed by the researchers. Apart from
the traditional use of Blockchain that provides distributed, secure, trustable and
anonymous ecosystem to allow cryptocurrency transactions, its use in the eld of
medical record management, counterfeit drugs detection and fraud prevention
is a new area of research. As the economic disparity between the developed and
developing countries is increasing day by day, there is a continuous upsurge in the
demand of organs from third world countries to the advanced countries. This has
increased the potential of human organ tracking and poaching for nancial benets.
Despite, eorts by the governments to formalize the laws regarding organ donation
to prevent mistreatment of donors, there is a dire need of a secure, traceable and
distributed organ management and distribution system. In this paper, a Blockchain
based scheme is proposed to allow auditable medical transactions to prevent organ
tracking and tracking of legitimate organ donors & recipients. This will open a new
eld of Smart Health services based on Blockchain to safeguard the rights of medical
professionals and patients. With the advancement in science and technology, new
techniques have been introduced and humanity is getting benet from these latest
innovations especially in medical eld there came a revolution when transplantation
of human body part took place in recent history. Organ transplantation has been
used as a novel medical procedure that allows grafting of an organ from donor’s body
to replace a damaged or missing organ of the recipient. Due to its eectiveness and
importance as a lifesaving technique, there is an ever-increasing number of patients
waiting for transplant operations. Patients are no more on the mercy of fate to live
their lives with organ disabilities. Now they can easily change them with healthy body
parts of another person. With this level of advancement, it has become a routine
task in some prominent hospitals to transplant organs. According to the American
Transplant Foundation, 113,000 people in the United States are on the waiting list
to receive an organ as of March 2019. Every 12 minutes a new name is added to
the list and an average of 21 persons per day die due to a lack of organ availability.
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According to the Department of health (DoH) approximately 2,000 new waiting
patients are added into waiting list for organ transplantation in US only, Corneas,
kidneys, intestines, liver, bone marrow and lung, are the most common transplant
needs now a days (Decoded Science, 2019). WHO is working on this but the most
authentic data is from The U.S. DoH & Human Services related to complete Organ
translation process starting from its procurement from black market, selling to
targeted customers and then eventually its transplantation Network have publish a
report, according to this report there are approximately 121,333 organ transplant
are awaiting and kidney is having a very high number with awaiting 100,402 patients
of kidney recipients. Legally only 30,970 transplants took place in 2015 more and
less the same number was issued for 2014. WHO have reported about illegal import
of organs by many developed countries all the way from under developed countries,
USA is one of them and as per internet statistics patients are able to get transplant
of dierent organs starting from range of $70 to till $160,000.00 as per nature
and demand of organ. More than120650 patients waiting for organ transplant in
USA. There always more demand for fresh new organs which has created a perfect
condition for corrupt medics to exploit organs from those who are less privileged
and then sell them to needy people who have much and ultimately in this whole
process they get huge margin of prot (List25, 2019). According to the WHO, an
estimated 10,000 black market operations are being carried out by illegal purchase
of kidneys. Even in this current era of modern technologies still in some part of the
world many people have become victims of forcefully/involuntary organ donation
with the help of black market of pharmaceuticals. There are many international
organizations working to eliminate this illegal trac of organs which include Organ
failure solutions, ESOT and Organs watch, the average male organ donor is about
28.9 years old having a low average annual income of $480 on the recipient side
the average age for a male is about 48.1 years and an annual average income of
$53,000. Considering current situation, Medical experts have a view that based in
long queue due to lengthy procedure for organs retrieval from dead bodies, there is
a need to legalized organ donation by implementing strict and transparent policy in
place. Lack of legal framework on organ donation and poor law enforcement helps
black market where they oer little incentives to needy people and take away their
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organs. A great number of patients go to China, India or Pakistan for surgery can
pay up to $200,000 for a kidney to trackers who harvest organs from vulnerable,
desperate people, sometimes for as little as $5,000. Estimates state that kidneys
make up 75% of the global unlawful trade in organs and because of the rising
rates of diabetes, high blood pressure and heart problems the demand for kidneys
far outstrip supply (Whoin, 2019). According to the Bulletin of the World Health
Organization, Volume 85, Number 12, December 2007, 955-962, Many websites
are online that allow patients traveling abroad to purchase organs for transplants.
The transplant package range in China was as follows: Kidney ($ 70 000), Liver
($ 120 000), Pancreas ($ 110 000), Kidney and Pancreas ($ 160 000) while on
average, same package of Kidney transplant in Pakistan costed around US$17000
(Decoded Science, 2019). As there are many black markets in every walk of life so
is the case with human organs and there exist a black market where you can buy
livers, lungs, Kidney and even hearts based on worldwide failure rate there is more
demand for kidney in black market as compared to any other organ. According to
the World Health Organization, this is the reason that approximately 7,000 kidneys
are illegally harvested sent to their required destination by trackers as per their
black-market network. The prices for the same organ vary from country to country
based on its demand and supply conditions. If we calculate worldwide data for price
of human kidney then an average buyer spends $150,000 to purchase it from black
market depending on his access to any particular black market. On the other side
the average donor only gets an average amount of $5,000. This huge dierence in
prices facilitate the middlemen (commonly known as “organ brokers”) to get huge
margin of prot during this transaction. In this black-market business, the prots are
enormous, and money is used to lure many brokers and even doctors and supporting
paramedical sta and eventually they just cannot resist. In 2010 WHO estimated
about 11,000 organs were obtained on the black market. WHO based on statistical
data and associated ndings also claims that organs are being sold in black market
and continuous supply for organs is available which make to sell organ in almost
every hour 24/7/365.
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Figure 1. International black-market rates for organs.
On a world map you can nd many geographic locations where human organs are
being sold to potential recipients.
Figure 2. Global distribution of Living donor transplantation Activity -2017. Source: (Global Distribution,
2018).
Many international conferences are hosted by WHO and the February 2017 Summit
was one of them. This summit was organized on topic of Organ Tracking in Vatican
City, this summit also shared research and ndings on the state of the organ trade.
Even with this much technology advancement still the extent of organ tracking
and their transplantation with success and failure rate is not precisely known. Which
further complicate human tracking due to demands of their organs in black market.
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In order to eectively combat organ tracking there is need to increase its visibility
by complete tracking record of organs starting from donor till recipients, every step
should be documented with some reference number, fully hashed with time stamp
and unchangeable. This will help to reduce this kind of organized crimes, there
should be eective engagement of public-private partnerships including healthcare
and insurance companies for complete success to get rid of these kind of crimes
(Alarming Facts, 2019).
The solution lies in secure, track able recipient/donor proles and historical integral
information system. Which ultimately means ensuring security of patient’s medical
data and personal information is of utmost importance for any application in medical
domain. Consider a patient with wearable sensors that record any change in the
patient health-such as-high blood pressure, heart attack, faintness, blood sugar level
etc. The sensors send the information to cloud storage, where analytical procedures
are built, and other data related to the patient such as his medical history is already
saved. Real-time data from the sensors and the historical data from the cloud is used
to conduct classication and predication of the patient’s case. These ndings are sent
to a monitoring doctor that can get alert of the changes in condition of that particular
patient. It works in a reverse order to keep track of all the all phases during from start
till current status of transaction. Before going to implement Blockchain solution we
present Blockchain internal architecture, its working and essential components which
play important role in building a secure Blockchain solution for organ donation
through a track able, secure and unchangeable solution.
2. BLOCKCHAIN HISTORY AND ARCHITECTURE
The history of Blockchain Technology started with in 2008 when Nakamoto
introduced E-currency platform which is commonly known as cryptocurrency for
Bitcoin. In technical terms it is considered as a distributed database for storing a
constantly developing detail of records stored in the form of list in the same database
also known as blocks. A Blockchain is redundant yet veried list of records which
manipulate as result of dierent transactions in a peer-to-peer network of nodes,
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with the condition that each node will be having a copy of all records in the form
of a mirror image of the whole database. Blockchain devices connect to each other
in sequential list of blocks since each block except rst block which is also known as
the Genesis Block in blockchain terminology, contains information about and also
a link to the previous block and considered as a hash of the previous block. Every
block in a Blockchain is also containing a time stamped which in a way dierentiate
them from other blocks. Blockchain provides a decentralized peer-to-peer platform
for tracking all transaction related to any process without the need of a trusted third
party. Using Blockchain for medical domain is a relatively new area of research.
In this paper, we propose using Blockchain for tracking organ donation process for
secure, safe and auditable operation. Following series of gures (3-6) are explaining
step by step procedure starting from formation of block its entry in the chain and
then its functionality.
Figure 3. Formation of a Block.
Figure 4. Adding of Blocks in a chain series.
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Figure 5. Block Addition with Hash Numbers.
Above gure5 is showing how blocks are connected to other blocks and keeping its
own hash tag and pointing to hash tag of previous block it will reject the entry into
block if hash is not matched as given in Figure 6 below.
Figure 6. Denial of Block based on incorrect hash Number.
Blockchain works as distributed ledger using blocks of data. Each block contains
multiple transactions by hashing them and each transaction will have the network
timestamps on it. When a new block is created it will be added to the previous
written blocks and the process goes on and on to complete the chain of blocks.
Then all blocks and details of all previous transaction are stored in the user disc
storage named node. The information held inside of nodes will be used to verify
new transaction so new nodes will be added to the user chain or will be aborted.
This technique is called mining which insures proof-of-work feature (Diawar, 2019)
Blockchain technology can be utilized in many elds of life i.e. Supply chain, Real
Estates, Automobiles, Digital identity, Governance etc. Let’s consider a use-case of
Blockchain in healthcare services.
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Figure 7. Complete Workow diagram of Blockchain.
3. USE OF BLOCKCHAIN IN SERVICES
Blockchain technology is incorporated in various domains due to its compelling
benets in improving systems eciency, transparency, safety and integrity. A wide
range of domains are utilizing Blockchain approach including health, nancial,
manufacturing, business, governmental, and educational domains. With respect
to healthcare domain, several applications and ongoing systems are utilizing
Blockchain for improving medical record management, enhancing insurance claim
process, and accelerating clinical research (Ivan, 2016). Adopting Blockchain for
storing patient’s health record data and management of medical records will enable
patients to control access to their healthcare data. This will eliminate the need
to acquiring copies of the healthcare data or sending data to another healthcare
provider. Numerous companies are involved in adopting Blockchain technology
such as Healthcare Data Gateways (Snow, Deery, Kirby, & Johnston, 2015). Guard-
time, a well-known company, is using a Blockchain-based system to secure 1 million
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health records in Estonia (Williams-Grut Technology Behind Bitcoin, 2019). Due
to the transparency and immutability of Blockchain technology, it is used in some
of the governmental services. For example, Danish political party deployed the rst
Blockchain voting application for internal elections in which every vote is recorded in
a secure environment and stakeholders can participate and observe other votes (Millet,
2019; Ojo, n/d). In nancial domain, numerous applications have been introduced
for employing Blockchain technology. One of the most popular Blockchain-based
application in nancial area is cryptocurrency. It guarantees a secure environment
for nancial transactions in virtual currencies such as Bitcoin, Ripple, Litecoin, and
Monoro. Various Blockchain applications are related to stock markets services such
as securities exchange, smart contracts, trading and settlement, and payments and
remittance. Generally, these applications aim to simplify and speed up the traditional
process. Even in educational domain, Blockchain technology is used in dierent
scenarios. Several educational institutions have adopted Blockchain for various
problems. For example, the National University of La Plata (UNLP) developed a
Blockchain-based framework that veries students’ academic achievements and
accordingly issues the diploma. In 2015, a school in San Francisco started to utilize
Blockchain in order to assist employers to validate the academic credentials. Shahbaz
Pervez (2018) explains that in current technological era, everything revolves around
technology and technology rotates around cloud applications and communication
over internet. Security of data and associated applications is of great importance
which can result into drastic results if there is any negligence from programmers over
the security issues, SDLC cycle.
3.1. USE OF BLOCKCHAIN IN HEALTH INDUSTRY
Today’s healthcare industry is awfully multifaceted with a range of stakeholders, which
is a public private partnership of government agencies and private organizations
including insurance companies, pharmaceutical manufacturer and end users of
these medical products. There is a huge gap between healthcare providers and end
users because of non-transparent information exchange which ultimately aects the
entire healthcare including medical system. In the healthcare industry, collaboration
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for stakeholders is always dicult based on their particular business goals, intentions
and even approached to address all these issues and their solutions. The goals are
not properly aligned which result into fragmentation and unproductive services for
patients. Based on varied stakeholders and their business goals, conict of interest
is inevitable, there is a great need that healthcare system should have eective
collaboration, transparent processes and track able communication channels. But in
real world still there need to x some data handling and communication aws with
appropriate ow of information and its process audits which are extremely costly
and eventually resulting in slowing down of healthcare services. Governments and
health Insurance companies are major stakeholders which participate in drafting
and implementing healthcare policies with the help of paramedics. Blockchain helps
in several ways to ensure the integrity of data with proper tracking details of all
transactions right from start of Blockchain enabled UPRL. Government agencies
and international organization working in health sector, including WHO could have
the liberty to access real-time data from any hospital for research purposes and to
study dierent used cases based on this data which would help to determine the
health conditions of people living in specic area and even in a broader case over
all national health condition of a country. It will also help government agencies in
tracking of any infectious disease, their causes based on lifestyle of people and to
provide better health services with eective and more transparent way. This will
also help the insurance companies to solve the long-awaited problem by tracking all
transactional records which will ultimately prevent frauds, which is costing US only
about $68 billion per year ( The National Heath Care Anti-Fraud Association, 2018).
Use of Blockchain technology enables scientists, research organization, Universities
and even pharma companies. Through this technology they will get better access to
data without having fear for compromise on security of data and privacy of patients
which will eventually contribute for research. Paramedic’s sta including doctors and
other medical sta including doctors and nurses will also get advantage of Blockchain-
based systems in performing their day to day routine tasks with more eciency and
peace of mind. By accessing Universal Patient Record ledger, will reduce ambiguities
related to recovery or reaction of any medicine on any particular patient or group
of patients in some particular situation. If the UPRL is also connected with latest
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technology gadgets including wearable technology and Medical IoT (M-IOT)
devices, healthcare professionals can easily record rst response, set action plans and
emergency procedures with less error, by reducing number of casualties.
Figure 8. Illustrative Healthcare Blockchain Ecosystem. [10]
Above Figure 8 is showing overall Blockchain enabled healthcare ecosystem in four
stages, starting from healthcare organizations, through secure storage and ensuring
integrity of data and to end users by ensuring secure and temper free communication
from start to end of a medical process for a patient.
As far as cost is concerned, Use of Blockchain based services will also help in decreasing
response time and overhead costs by eliminating paperwork which unnecessarily
consume lot of time of doctors and nurses in paper work and administration tasks
(i.e. starting from patient entry till discharge) reduction in these tasks will eventually
help patients for gaining more attention of doctors, they can also utilize this time in
some innovative work for betterment of patients. With the use of Blockchain, all
stakeholders including patients, their relative’s and even hospital sta will be having
more condence on doctors, hospitals and even overall healthcare system related to
originality of medicines and other medical products by placing a complete tracking
system in Blockchain enabled network. Patients enjoy liberty of having access to their
personal information by monitoring medical history by accessing laboratory reports
and doctors’ recommendations for curing from a specic medical condition. This will
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also ensure transparency of whole process and ultimately it will turn health insurance
companies and governments into a patient-centric, traceable and more transparent
system. It will also prevent fraud, especially in international market by introducing
blockchain based supply chain management system. This is the most important issue
that we are going to address in this research, resulting in fraud prevention in organ
donation through transparent and traceable system of Blockchain.
4. PROPOSED SYSTEM: USE OF BLOCKCHAIN IN ORGAN
DONATION
Based on its practical outcomes, trust in results, integrity and almost foolproof security
in Blockchain there is an enormous increase in the use of Blockchain technology in
healthcare. The importance of Organ donation cannot be ignored in healthcare
system. It is a process of giving of an organ and tissue to support someone that
needs transplant. Which ultimately can protect or transform the life of a person.
The process of organ donation needs to be ecient, secure, distributed, trackable
and immutable that can only be achieved if Blockchain technology carefully used for
the processes.
Figure 9. Use of Blockchain in Organ donation Process.
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A typical use-case for organ donation and matching process is depicted in Figure 9.
The donor and receipt record can be seen as a global database, based on Blockchain
technology, secured with cryptographic tools. Using the Blockchain technology in
organ donation, the matching process increases chances of promptly nding an
appropriate match, while being completely secure. Condentiality and privacy can
be achieved using the encryption tools and techniques. Also, the authenticity can be
done using the approved digital certicates issued by authorized healthcare bodies.
The use case functions in real-time and is distributed. The process of organ donation
as shown in diagram (Figure 9) starts with the donor sign a smart contact for organ
donation and the patient/receipt les a request for transplant. Both the documents
are veried and hashed from authorized healthcare doctor, the doctor make a veried
mismatching pair and broadcast over the network pair. The network nds a match
and send the match to doctor for approval, if the match is perfect the doctor give
the approval and next step is to generate the hash and if doctor generate a hash,
the veried matched pair will then become the part of Blockchain which cannot be
altered or tempered at any later stage. Doctor and healthcare professionals receive all
the information needed to arrange the operation logistics.
Figure 10. Sequence Diagram for Organ donation system.
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The interaction and exchange of information among Organ donor, patient and
healthcare unit all are secure using the smart contact and hash tagging capabilities of
Blockchain technology. The veried matched pair when broadcasted to Blockchain,
this action become immutable and hence give all the involved parties the integrity,
security and conformance of available information. The health unit here can act as
a miner All the steps have been completed in a predened sequence which have
been shown in above sequence diagram in Figure 10 which initiates process from
the agreement between Organ donor and patient (which is also known as receipt of
organ), one both entities agree and sign document then its forwarded to healthcare
unit for verication of medical records and sample matching process. If samples are
not compatible then the request will be discarded and with the note from medical
experts not to proceed with this process based on their expert opinion supported by
technical details on this particular case, but if the samples are compatible and are
best t for the patient then request will be forwarded to network and with digital
signatures and after approval of that request it will become part of Blockchain which
nalize it and no further modication can be done after this step. Collaboration
between dierent entities which are part of this organ donor process have been
shown in in a collaborative diagram as shown in Figure 11 which is where medical
experts veries medical records of donor as well as for patient and create pair of
donor and recipient , After creation of this pair and verication they broadcast it on
network for nding best possible match shows the initiation of collaboration process
by organ donor, which signs a contract with Health Center for organ donation.
Organ
Donor
Patient
Health
Center
Network
Blockch
ain
2: Verifies donor record
4: Verfies patient record
5: Create pair of donor and reciept
7: Find a match
1: Sign the smart contract for organ donaton
3: Send medical record
6: Broadcast verfied pair
8: Send matched pair for verfication
9: Verified Pair added to Blockchain
Figure 11. Collaboration diagram for Organ Donation System.
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Once they get best t match, they further send that match for verication and after
successful verication from health center this will send to Blockchain to make it part
of Blockchain now this record will be considered unchangeable with integrity intact
for all kind of transactions on this process.
5. RELATED WORK
Signicant work has been done in the context of Blockchain and security. This section
surveys Blockchain-based security solutions by addressing some security issues and
provides an understanding for current research trends. Furthermore, some recent
research work has been carried out to make Blockchain technology appropriate for
IoT enabled medical equipment and hardware and software-based security issues.
The physical issues are related to computational power and memory. The software-
based issues are related to privacy, defense against malware, authentication and
the regularization of governmental /organizational policies as per international
technological norms, and monitoring. Main issue which is considered as one of the
biggest limitations in creating a decentralized topological design is mutual trust of
all the entities participating in this process. The main idea behind Blockchain is
its beauty of decentralization which means it’s not solely dependent on any single
authority, and is not prone for having a single point of failure by attacking that
particular target with the intention to target integrity of data, since complete mirror
image of data is stored in all nodes of a peer to peer (P2P) network. Which ultimately
making it dicult for attackers to fulll their goals. However, if an attacker somehow
manages to get control of several nodes in a P2P Blockchain network, with mining
access permission to mining nodes, then possibility to compromise integrity of data
in the attacked Blockchain. A Blockchain is considered as a distributed database for
storing an uninterruptedly growth of listed records called blocks. The public key is
used to identify a Blockchain user. Each Create, Read, Update or Delete operation
which is also known as CRUD operation on an IoT enabled Systems, which can be
registered as a transactional update/ record in a Blockchain based blocks of record.
The distributed and autonomous liberty of a Blockchain make it an ideal component
in IoT security enabled environment. The main limitation for resource limitation
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in IoT devices their low processing and storage capabilities due to nature of their
routine tasks. There is no Blockchain-based IoT security solution available with
a claim to foolproof security against threats and all kind of attacks by fullling all
security needs in proposed standard security procedures. As of now there is no such
system currently in operations, all these are just theoretical ndings which might
be implemented in future. Whereas a foolproof operational security model for an
IoT system can be combination of standard information security procedures and
Blockchain-based security.
As per normal practice is going on there are many known and unknown security
threats while distributing medical information which include the forgery, no
tracking of records updates. (Chen, 2018). Proposed blockchain based medical
information sharing model to cope with such security threats and constructed a
medical information sharing model based on blockchain by implementation to verify
satisfaction for security requirements for medical information. Which conrmed
that the blockchain based medical information sharing model can provide the
reliability and traceability of medical information for prevention of forgery and
modication in transaction or alteration of medical information. (Kuo, Kim, &
Ohno-Machado, 2017) summarize existing Blockchain protocols and application
domains of Blockchain technologies in Internet of Things (IoT) networks. The
application domains of Blockchain technologies in IoT discussed in this paper are:
Internet of Vehicles, Internet of Energy, Internet of Cloud, and Edge computing.
The authors also classify the threat models that are considered by the Blockchain
protocols in IoT networks, into ve main categories, namely, identity-based attacks,
manipulation-based attacks, cryptanalytic attacks, reputation-based attacks, and
service-based attacks. The study also outlines both open questions and research
challenges that could improve the capabilities and eectiveness of Blockchain for
the IoT. The paper has summarized research for Blockchain-based IoT security
and privacy in terms of Blockchain model, security model, Goal, Performance and
Complexity. To implement Hyper-Ledger Fabric in a smart-IoT environment to
assess the validity of the communicating devices whether normal or malicious i.e.,
to assure users of the integrity of the data from any device. There is history of well-
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known attacks such as DDoS attack. Shen (2019) have proposed a security solution
for IoT-eHealth system by presenting a context-aware and self-adaptive security
model to mitigate the traditional problems, including limited context with optimal
autonomous response. The IoT-eHealth multivariate and complex concepts have
been simplied using Ontology technique. The system structure shows procedure
from context collection till feedback. The system comprises of three layers Device
Layer, Security Management Layer and Cloud Layer (Waqas, 2019). At Device
Layer Local Context Manager collects device native context. Context Manager
Parse, rene and transform the monitored context in in Security Management Layer.
Context Agents are utilities to capture communication pattern for in/out-bound
of devices. Context Analyzer with support of Machine Learning models analyzes
the possible risks. Alert Generator converts any security context to an alert that will
be responding by Context Adapter for optimal security according to Adaptation
Rules. Evaluator will assess all the selected mechanism using a score to decide for
new optimal security conguration, which can be communicated by Messenger. The
proposed architecture aims to fulll the following objectives: Holistic security, Self-
Adaptation and context awareness, Open connectivity and Minimize decision delays.
The proposed model can manage and deal with dynamic and multifaceted traits of
a system. In fullling future regulatory demands, choosing Blockchain technology
would be a wise selection by technology companies (Legal Issues and Regulatory
Developments, 2018). Still some more research is required to design of Blockchain
supportive and IoT enabled devices, good news is that European Parliament has
approved new regulations and adopted them in some governmental services
(Alvarez, 2018). General Data Protection Regulation (GDPR) and the Directive on
Security of Network and Information Systems are approved legal acts for guiding the
development and maintenance of information systems. There are minor dierences
in GDPR between these members, but it lays the foundation for a unied digital
single market within the European Union by implementing its major theme. The
NIS will likely be adopted by all states with minor modications as per state laws of
dierent European union member states but overall it denes a minimum level to
implement security responsibilities for information systems which is the backbone
of Blockchain enabled systems. There is another regulation related to general data
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protection regulation which splits the role of the controller and processor as totally
separate legal entities. The GDPR also help to denes data in two categories which
are known as personal and sensitive data under special category. An identiable
natural person is one who can be identied by reference such as a name, location
of data, an identication number, or special category factors. IOT enables systems
are not new in practical world but still security challenges are there which are still
seeking attention to solve them with minimal security and privacy breach. In case of
IOT enabled networks there are some ndings which shows that they have potential
to securely work without human supervision. There are also some limitations to
use Blockchain in security solutions for IoT enabled systems (i.e. limited processing
& storage capabilities, absence of up to date rmware due to non-availability of
rapid rmware updates. As a result, when Blockchain nodes increase in its blocks
its ledger automatically grows. To alleviate these limitations, some alternate mining
procedures should be opted and only a device-dependent transaction ledger should
be maintained in case if device is too resource constrained.
6. CONCLUSION AND FUTURE WORK
In this article, we emphasized the prominent and vital impact of Blockchain
technology and its eective use in the entire healthcare sector (i.e. from manufacturer
till patients) by highlighting the hurdles in facilitating a clear exchange of information
from origin till its destination and also discussed the role of Blockchain technology
in solving problems related to grey market of organ donation and other related
issues to help every stakeholder for making better-informed decisions. Based on
our ndings during this research we can conclude that use of Blockchain is going
to be a must for any critical medical services and their tracking. As Blockchain
can provide a temper-proof feature of recording every transmission in the digital
communication, it will allow the saved data to be viewed publicly with no alteration
risk by accomplishing decentralized agreements. Since health information of any
person is very personal stu which cannot be shared publicly so there is great need
to address secrecy of individual health records. As medical records of a person
have more elds of information so there is a need to address these issues because
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Blockchain was primarily designed for small data (bitcoins) to store and process so
there was no issue related to data storage due to size and nature of this data while
on the other hand storing health information systems consisted of huge information
where the stored data are enormous, sensitive and it also needs further study to keep
track of patient condition. It should be dealt by storing data in traditional database
due to huge quantity and privacy of data and to track this hash references should be
stored in the Blockchain which allow an authenticate access to the database keeping
its authenticity intact. Further research can be done in this area to ensure security
of data stored in the conventional databases and their linking with the Blockchain.
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