Blockchain technology refers to an information recording system. Blockchain technology provides an utmost level of digital security. Therefore, the electronic health record system is using Blockchain security for the purpose of ensuring a higher level of security in their medical system. Therefore, it hinders manipulation of medical data from any kinds of illegal activities such as hacking. An extensive level of exploration is going to be done on Blockchain in electronic health records. This study is done for the purpose of providing a large amount of knowledge about Blockchain technology recently used in electronic medical record systems. The objective of this study is to gain the concept of Blockchain technology and method of applying it. Furthermore, the objectives also include benefits and challenges of Blockchain in electronic health records. Therefore, this study is going to discuss factors and impact of Blockchain technology. Furthermore, previous experience of Blockchain aims to be discussed in this study.
Background of the study
Within a technically-advanced business world, Blockchain technology does refer to a system of recording data in such a way that makes it harder or next to impossible to change, cheat or hack a particular database system. A Blockchain is essentially considered as a digital leader of business or commercial transactions, which can be duplicated and distributed over an entire computer systems network on the system of Blockchain (Hoy, 2017). Each block within a chain does contain a number of transactions and each time new transactions occur in it, records of those transactions are added to participants’ ledger. The decentralised database that is managed by several participants is called “Distributed Ledger Technology (DLT)”. Thus, the Blockchain system is a kind of DLT where commercial transactions are recorded with an ‘immutable cryptographic signature’, named a hash (Benčić & Žarko, 2018). A Blockchain hash’s value usually depends on the cryptographic hash, which does connect newly-added information or records with every data block. With this, the architecture of distributed Blockchain ledger ensures that records or information are not processed within any centralised venue and it does also eliminate chances of data theft or hacking, by securing and strengthening the system. By this, the Blockchain system does facilitate proper control of healthcare records such as health and payment records of admitted patients, by reducing twice the level of medical monitoring practices.
Within healthcare operations, the system of Blockchain does have a broad range of functions and applications that helps healthcare researchers and professionals uncover genetic code by incorporating secure data transfers about patients’ medical information or records. Apart from that, protection of healthcare information, several genomics management, management of electronic medical data, interoperability and digitalised monitoring or tracking are some technical derived and advanced features employed for developing and practising Blockchain technologies in care networks. Blockchain does also involve the development of new patients’ record cards for medical professionals in other hospitals (Haleem et al. 2021). Newly-added data is repetitive and it leads to loss of time that is considered as a health malfunction. Individuals can have several accessibility or privileges choices due to location on the medical supply chain. Blockchain technologies can be utilised in healthcare to make ideal choices in healthcare ecosystems.
Figure 1: Capabilities of the Blockchain technology in healthcare domain
(Source: Influenced by Haleem et al. 2021)
Awareness of monitoring health records using Blockchain
Blockchain technology does have the potential to transform healthcare, by placing patients at the centre of healthcare ecosystems and increasing the privacy, security and interoperability of health records. A Blockchain-powered health data exchange can unlock the true values of interoperability. At its core, it is a distributed system that records and stores transaction records and health information, within healthcare networks. More precisely, the system of Blockchain is a shared and immutable data of peer-to-peer transactions developed from interlinked transaction blocks (Deloitte, 2022). There are several benefits created by the Blockchain technology within healthcare systems. It does bring disintermediation of trust between a health service-provider and patients as there would be no requirement of HIE operators because participants would have enough access to a distributed ledger for maintaining a safe and secure transaction without complicated brokered trust. In addition to this, due to disintermediation and real-time processing, the Blockchain system helps reduce transaction costs in monitoring health records. With this system, shared data does enable real-time health information or updates across an entire care network. It does also generate smart contracts that can create a rule-based and consistent method to access patients’ health or medical information.
Figure 2: Use of Blockchain systems in healthcare networks
(Source: Global Market Insights, 2021)
In the global healthcare sector, the overall market size of the Blockchain technology was valued at $281 million, in 2020. At the same time, it has been estimated that between 2021 and 2027, the healthcare sector would experience a growth of more than 52% CAGR in the application of Blockchain systems (Global Market Insights, 2021). The reason behind it is that enhanced implementation of Internet of Things (IoT) within healthcare networks has been anticipated to augment the business demand of Blockchain systems and tools. At present, the Covid-19 pandemic has become a massive health concern, along with economic damages and financial failures across the world. At the same time, the pandemic outbreak has propelled the market acceptance of advanced and innovative technology systems including the Blockchain system in healthcare. So, this is a fact that despite creating a huge turmoil with countries regarding health and economy, the pandemic situation has become an area of opportunity for generating digital health services with effective medical record monitoring and maintenance. Health organisations have gained and spread more awareness regarding the necessity in applying Blockchain systems in care networks to store, monitor and control patients’ health information and service transaction records.
Previous experiences of using Blockchain technologies in healthcare through a solution named Hyperledger Fabric
Hyperledger Fabric does refer to a modular Blockchain framework as well as de-facto standard for operational Blockchain systems, which was developed by Linux Foundation. With over 120000 contributing business operations and more than 15000 engineers are working together with this framework or tool (IBM, 2022). This framework does offer a unique process to consensus, which enables performances at scale while preserving data privacy and security, as per enterprises demand. Hyperledger Fabric is an open, distributed and enterprise-grade ledger platform that has advanced data security and privacy control mechanisms by which only the data likely to be shared gets shared among permissioned network participants. With this, the possibility level of data being hacked or theft by unauthorised persons is very low.
The concerned framework has been used by the healthcare sectors of various nations. Nations like Canada, the US and the EU countries have started various projects to redesign and upgrade their existing EHR (Electronic Health Record) systems for integrating patients’ health or medical data. In the United States, CommonWell Health Alliance is such a healthcare project that delivers a countrywide interoperability mechanism for connecting and sharing EHRs and healthcare information technology systems. Thus, the proposed framework of Hyperledger Fabric is immensely acquiescent and compliant with an act called “Health Insurance Portability and Accountability Act (HIPAA)” as well as a standard of ISO/TS 18308 (Uddin et al. 2021). To be precise, a US-based healthcare operation, Change Healthcare, has used the concerned framework to maintain their transaction processing workflow. The mission of their operation is to modernise the healthcare system of the United States that is plagued by fraud, theft, waste and inefficiency. To achieve their mission, the company has headed towards developing the Blockchain system with the integration of Hyperledger Fabric. After applying the framework, the organisation has been capable of generating the volume of 50 million transactions per day (Hyperledger.org. 2022). Thus, it can be stated that the Blockchain technology and its underlying framework solution, Hyperledger Fabric, has been widely accepted by global healthcare sectors.
Research Problem Statement
At present, the system of Electronic Health Record (EHR) delivers a tedious way of keeping track of chronological progression of health status of a patient. The existing EHR systems have left an inaccurate digitised complex in which paper records still remain ubiquitous at different levels in hospitals, pharmacies, labs and others, with disconnected and disintegrated electronic systems. It has led to various administrative issues based on data security, integrity, interoperability and scalability. Across the world, the sector of healthcare has become a vulnerable target of cyber-oriented attacks where health information of patients and health service transaction records containing names, location details, social security numbers are being hacked or theft. In 2015, nearly 79 million patients’ records were stolen or hacked from the data server of the “Anthem Insurance Corporation” (PBS NewsHour, 2016). The report also stated that every year, data breaches and thefts cost the care sector an estimated amount of $5.6 billion. The global healthcare sector has witnessed a massive threat of healthcare data being hacked and theft in 2017, due to a ransomware cyber-attack called WannaCry (England.nhs.uk. 2018). It affected around 80 of the overall 236 NHS Trusts and their care service operations. Another report states that currently in 2020, the incidents of healthcare data breaches had increased by 55%, which affected over 26 million patients all over the world (MedCity News, 2021). With all these identified issues faced by the global healthcare sector over the years, there is a high need of integrating Blockchain technology into the EHR systems, in order to keep patient data safe and secure.
The main aim of the research study is to identify the application of Blockchain technologies, with an effective use of an advanced solution or tool named Hyperledger Fabric.
The research objectives based on the chosen topic are briefly listed below:
- To identify the concept of the Blockchain technology system and its significance in maintaining electronic health records
- To determine the way of applying the Blockchain system in recording and monitoring health and transaction data within healthcare networks
- To investigate the benefits and challenges of applying the Blockchain system in monitoring and keeping electronic health and transaction records
- To analyse how Hyperledger Fabric works as an advanced solution or tool for Blockchain system in health record storing and monitoring
By considering the developed research objectives, a few research questions are set for the study, which are mentioned below:
- What is the concept of the Blockchain system and what is its significance in maintaining electronic health records?
- Which ways need to be followed to apply the Blockchain system in electronic health record monitoring?
- What are the underlying benefits and challenges of applying the Blockchain system in electronic health record or data maintenance?
- How does Hyperledger Fabric operate as an advanced tool or framework of the Blockchain system in health record storing and monitoring?
Structure of the Thesis
Figure 3: Structure of the thesis
(Source: Created by the author)
In this research thesis, the first introductory chapter sets the background of the research along with a series of research aim, objectives and questions. The section of literature review briefly discusses the topic, by considering several contexts like factors, importance, application, and benefits and challenges of Blockchain systems in electronic health record monitoring. The third chapter defines what methods are used to generate the implementation of data collection and analysis for this research study. The next chapter is about implementing the collected data and insights about Blockchain systems in healthcare networks. The chapter of results and discussions demonstrates the outcomes of analysis and implementation. In the final conclusive chapter, it is discussed how the research has significantly achieved its aim and objectives.
Therefore, in this chapter the introduction of Blockchain is made. Blockchain technology is used widely in maintaining electronic health records. However, monitoring this kind of electronic health record is a difficult task to do. One of the main reasons for this is the exchange of health data using Blockchain technology. Therefore, it requires a comprehensive level of awareness. Furthermore, hyperledger fabric is a previous method of using Blockchain technology. However, there are certain issues that have been found and therefore this tool requires to be updated to match the modern day requirements. Moreover, it is essential to monitor and control the health record system effectively. The aims and objectives of the research are discussed in this chapter. Therefore, these objectives result in forming some questions and the answer is going to be found in this research. Furthermore, research significance and contribution is discussed in this chapter.
Benčić, F. M., & Žarko, I. P. (2018). Distributed ledger technology: Blockchain compared to directed acyclic graph. In 2018 IEEE 38th International Conference on Distributed Computing Systems (ICDCS) (pp. 1569-1570). IEEE. https://arxiv.org/pdf/1804.10013.
Deloitte, (2022). Blockchain: Opportunities for health care. https://www2.deloitte.com/us/en/pages/public-sector/articles/blockchain-opportunities-for-health-care.html.
England.nhs.uk. (2018). Lessons learned review of the WannaCry Ransomware Cyber Attack. https://www.england.nhs.uk/wp-content/uploads/2018/02/lessons-learned-review-wannacry-ransomware-cyber-attack-cio-review.pdf.
Global Market Insights, (2021). Blockchain Technology in Healthcare Market 2021-2027 Share Statistics. https://www.gminsights.com/industry-analysis/blockchain-technology-in-healthcare-market.
Haleem, A., Javaid, M., Singh, R. P., Suman, R., & Rab, S. (2021). Blockchain technology applications in healthcare: An overview. International Journal of Intelligent Networks, 2, 130-139. https://doi.org/10.1016/j.ijin.2021.09.005.
Hoy, M. B. (2017). An introduction to the blockchain and its implications for libraries and medicine. Medical reference services quarterly, 36(3), 273-279. https://doi.org/10.1080/02763869.2017.1332261.
Hyperledger.org. (2022). Change Healthcare using Hyperledger Fabric to improve claims lifecycle throughput and transparency. https://www.hyperledger.org/wp-content/uploads/2019/06/Hyperledger_CaseStudy_ChangeHealthcare_Printable_6.19.pdf.
IBM, (2022). What is hyperledger fabric?. https://www.ibm.com/topics/hyperledger.
MedCity News, (2021). Report: Healthcare data breaches spiked 55% in 2020. https://medcitynews.com/2021/02/report-healthcare-data-breaches-spiked-55-in-2020/.
PBS NewsHour, (2016). Has health care hacking become an epidemic?. https://www.pbs.org/newshour/science/has-health-care-hacking-become-an-epidemic.
Uddin, M., Memon, M. S., Memon, I., Ali, I., Memon, J., Abdelhaq, M., & Alsaqour, R. (2021). Hyperledger Fabric Blockchain: Secure and Efficient Solution for Electronic Health Records. CMC-COMPUTERS MATERIALS & CONTINUA, 68(2), 2377-2397. DOI:10.32604/cmc.2021.015354