C. Eben Exceline; Sivakumar Nagarajan

The Security of Blockchain-based Electronic Health Record: A Systematic Review

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Author(s)

C. Eben Exceline ¹ Sivakumar Nagarajan ^2,*

1. School of Information Technology and Engineering, Vellore Institute of Technology, Vellore, India

2. School of Computer Science and Engineering, Vellore Institute of Technology, Vellore, India

* Corresponding author.

DOI: https://doi.org/10.5815/ijcnis.2023.06.09

Received: 15 Nov. 2021 / Revised: 4 Mar. 2022 / Accepted: 29 Jul. 2022 / Published: 8 Dec. 2023

Index Terms

Electronic Health Record, Blockchain, Cloud Computing, Data Integrity, User Privacy, Data Privacy

Abstract

The healthcare industry makes rampant strides in sharing electronic health records with upgraded efficiency and delivery. Electronic health records comprise personal and sensitive information of patients that are confidential. The current security mechanism in cloud computing to store and share electronic health records results in data breaches. In the recent era, blockchain is introduced in storing and accessing electronic health records. Blockchain is utilized for numerous applications in the healthcare industry, such as remote patient tracking, biomedical research, collaborative decision making and patient-centric data sharing with multiple healthcare providers. In all circumstances, blockchain guarantees immutability, data privacy, data integrity, transparency, interoperability, and user privacy that are strictly required to access electronic health records. This review paper provides a systematic study of the security of blockchain-based electronic health records. Moreover, based on thematic content analysis of various research literature, this paper provides open challenges in the blockchain-based electronic health record.

Cite This Paper

C. Eben Exceline, Sivakumar Nagarajan, "The Security of Blockchain-based Electronic Health Record: A Systematic Review", International Journal of Computer Network and Information Security(IJCNIS), Vol.15, No.6, pp.103-117, 2023. DOI:10.5815/ijcnis.2023.06.09

Reference

[1]Sidra Anwar, Sadia Anayat, Sheeza Butt, Saher Butt, Muhammad Saad, "Generation Analysis of Blockchain Technology: Bitcoin and Ethereum", International Journal of Information Engineering and Electronic Business, Vol.12, No.4, pp. 30-39, 2020.
[2]Senny Hapiffah, Ardiles Sinaga, "Analysis of Blokchain Technology Recommendations to be Applied to Medical Record Data Storage Applications in Indonesia", International Journal of Information Engineering and Electronic Business, Vol.12, No.6, pp. 13-27, 2020.
[3]Y. Zhang, C. Xu, H. Li, and X. Liang, “Cryptographic Public Verification of Data Integrity for Cloud Storage Systems,” IEEE Cloud Computing, vol. 3, no. 5, pp. 44–52, 2016, doi: 10.1109/MCC.2016.94.
[4]M. Johnson, M. Jones, M. Shervey, J. T. Dudley, and N. Zimmerman, “Building a Secure Biomedical Data Sharing Decentralized App (DApp): Tutorial,” J Med Internet Res, vol. 21, no. 10, p. e13601, 2019, doi: 10.2196/13601.
[5]X. Liu, Z. Wang, C. Jin, F. Li, and G. Li, “A Blockchain-Based Medical Data Sharing and Protection Scheme,” IEEE Access, vol. 7, pp. 118943–118953, 2019, doi: 10.1109/access.2019.2937685.
[6]M. Benchoufi and P. Ravaud, “Blockchain technology for improving clinical research quality,” Trials, vol. 18, no. 1, pp. 1–5, 2017, doi: 10.1186/s13063-017-2035-z.
[7]X. Zhu, J. Shi, and C. Lu, “Cloud health resource sharing based on consensus-oriented blockchain technology: Case study on a breast tumor diagnosis service,” Journal of Medical Internet Research, vol. 21, no. 7, 2019, doi: 10.2196/13767.
[8]Y. Wang, A. Zhang, P. Zhang, and H. Wang, “Cloud-Assisted EHR Sharing With Security and Privacy Preservation via Consortium Blockchain,” IEEE Access, vol. 7, pp. 136704–136719, 2019, doi: 10.1109/access.2019.2943153.
[9]M. A. Cyran, “Blockchain as a Foundation for Sharing Healthcare Data,” Blockchain in Healthcare Today, 2018, doi: 10.30953/bhty.v1.13.
[10]A. Ekblaw, A. Azaria, J. D. Halamka, and A. Lippman, “A Case Study for Blockchain in Healthcare,” Proceedings of IEEE Open & Big Data Conference, vol. 13, p. 13, 2016, [Online]. Available: https://www.healthit.gov/sites/default/files/5-56-onc_blockchainchallenge_mitwhitepaper.pdf
[11]L. Ismail, H. Materwala, and S. Zeadally, “Lightweight Blockchain for Healthcare,” IEEE Access, vol. 7, pp. 1–1, 2019, doi: 10.1109/access.2019.2947613.
[12]Q. Xia, E. B. Sifah, K. O. Asamoah, J. Gao, X. Du, and M. Guizani, “MeDShare: Trust-Less Medical Data Sharing among Cloud Service Providers via Blockchain,” IEEE Access, vol. 5, no. July, pp. 14757–14767, 2017, doi: 10.1109/ACCESS.2017.2730843.
[13]S. Wang et al., “Blockchain-Powered Parallel Healthcare Systems Based on the ACP Approach,” IEEE Transactions on Computational Social Systems, vol. 5, no. 4, pp. 942–950, 2018, doi: 10.1109/TCSS.2018.2865526.
[14]R. R. Brooks et al., “Scrybe: A Blockchain Ledger for Clinical Trials”, [Online]. Available: https://blockchain.ieee.org/images/files/images/clinicaltrialsforum-2018/Clemson_WhitePaper.pdf
[15]J. H. Beinke, C. Fitte, and F. Teuteberg, “Towards a stakeholder-oriented blockchain-based architecture for electronic health records: Design science research study,” Journal of Medical Internet Research, vol. 21, no. 10, 2019, doi: 10.2196/13585.
[16]T. Motohashi, T. Hirano, K. Okumura, M. Kashiyama, D. Ichikawa, and T. Ueno, “Secure and scalable mhealth data management using blockchain combined with client hashchain: System design and validation,” Journal of Medical Internet Research, vol. 21, no. 5, pp. 1–14, 2019, doi: 10.2196/13385.
[17]A. S. Kleinaki, P. Mytis-Gkometh, G. Drosatos, P. S. Efraimidis, and E. Kaldoudi, “A Blockchain-Based Notarization Service for Biomedical Knowledge Retrieval,” Computational and Structural Biotechnology Journal, vol. 16, pp. 288–297, 2018, doi: 10.1016/j.csbj.2018.08.002.
[18]L. A. Linn and M. B. Koo, “Blockchain For Health Data and Its Potential Use in Health IT and Health Care Related Research,” ONC/NIST Use of Blockchain for Healthcare and Research Workshop, pp. 1–10, 2016.
[19]W. B. Smith, “Dokchain: Intelligent Automation in Healthcare Transaction Processing,” no. Figure 1, pp. 1–15, 2017.
[20]K. N. Griggs, O. Ossipova, C. P. Kohlios, A. N. Baccarini, E. A. Howson, and T. Hayajneh, “Healthcare Blockchain System Using Smart Contracts for Secure Automated Remote Patient Monitoring,” Journal of Medical Systems, vol. 42, no. 7, pp. 1–7, 2018, doi: 10.1007/s10916-018-0982-x.
[21]S. Badr, I. Gomaa, and E. Abd-Elrahman, “Multi-tier blockchain framework for IoT-EHRs systems,” Procedia Computer Science, vol. 141, pp. 159–166, 2018, doi: 10.1016/j.procs.2018.10.162.
[22]X. Zheng, S. Sun, R. R. Mukkamala, R. Vatrapu, and J. Ordieres-Meré, “Accelerating health data sharing: A solution based on the internet of things and distributed ledger technologies,” Journal of Medical Internet Research, vol. 21, no. 6, 2019, doi: 10.2196/13583.
[23]A. Ouaddah, A. Abou Elkalam, and A. Ait Ouahman, “FairAccess: a new Blockchain-based access control framework for the Internet of Things,” Security and Communication Networks, vol. 9, no. 18, pp. 5943–5964, 2016, doi: 10.1002/sec.1748.
[24]D. Ichikawa, M. Kashiyama, and T. Ueno, “Tamper-Resistant Mobile Health Using Blockchain Technology,” JMIR Mhealth Uhealth, vol. 5, no. 7, p. e111, 2017, doi: 10.2196/mhealth.7938.
[25]H. Guo, W. Li, M. Nejad, and C.-C. Shen, “Access Control for Electronic Health Records with Hybrid Blockchain-Edge Architecture,” 2019, [Online]. Available: http://arxiv.org/abs/1906.01188
[26]G. G. Dagher, J. Mohler, M. Milojkovic, and P. B. Marella, “Ancile: Privacy-preserving framework for access control and interoperability of electronic health records using blockchain technology,” Sustainable Cities and Society, vol. 39, no. December 2017, pp. 283–297, 2018, doi: 10.1016/j.scs.2018.02.014.
[27]S. Wang, X. Wang, and Y. Zhang, “A Secure Cloud Storage Framework With Access Control Based on Blockchain,” IEEE Access, vol. 7, pp. 112713–112725, 2019, doi: 10.1109/access.2019.2929205.
[28]K. Fan, S. Wang, Y. Ren, H. Li, and Y. Yang, “SYSTEMS-LEVEL QUALITY IMPROVEMENT MedBlock: Efficient and Secure Medical Data Sharing Via Blockchain,” Journal of Medical Systems, vol. 42, pp. 1–11, 2018, doi: 10.1007/s10916-018-0993-7.
[29]T. T. Thwin and S. Vasupongayya, “Blockchain-Based Access Control Model to Preserve Privacy for Personal Health Record Systems,” Security and Communication Networks, vol. 2019, 2019, doi: 10.1155/2019/8315614.
[30]H. Wang and Y. Song, “BAB 2 PITA ezahan,” 2018, doi: 10.1007/s10916-018-0994-6.
[31]J. N. Colloquium and B. E. Zrt, “Blockchain : solving the privacy and research availability tradeoff for EHR data,” IEEE 30th Jubilee Neumann Colloquium, pp. 135–140, 2017.
[32]Brodersen, C. B. Kalis, C. Leong, E. Mitchell, E. Pupo, and A. Truscott, “Blockchain : Securing a New Health Interoperability Experience,” NIST Workshop on Blockchain & Healthcare, no. August, pp. 1–11, 2016, doi: 10.1001/jama.2012.362.4.
[33]K. Culver, “BIR in Billons,” pp. 1–10.
[34]D. Ivan, “Moving Toward a Blockchain-based Method for the Secure Storage of Patient Records,” NIST Workshop on Blockchain & Healthcare, no. August, p. 11, 2016, [Online]. Available: https://www.healthit.gov/sites/default/files/9-16-drew_ivan_20160804_blockchain_for_healthcare_final.pdf
[35]H. Yang and B. Yang, “A Blockchain-based Approach to the Secure Sharing of Healthcare Data,” Norwgian Information Security Conference, 2017, [Online]. Available: https://ojs.bibsys.no/index.php/NISK/article/view/462
[36]L. Castaldo and Cinque Vincenzo, Blockchain-Based Logging for the Cross-Border Exchange of eHealth Data in Europe.
[37]A. Shahnaz, U. Qamar, and A. Khalid, “Using Blockchain for Electronic Health Records,” IEEE Access, vol. 7, pp. 147782–147795, 2019, doi: 10.1109/access.2019.2946373.
[38]A. Roehrs, C. A. da Costa, R. da Rosa Righi, V. F. da Silva, J. R. Goldim, and D. C. Schmidt, “Analyzing the performance of a blockchain-based personal health record implementation,” Journal of Biomedical Informatics, vol. 92, no. October 2018, p. 103140, 2019, doi: 10.1016/j.jbi.2019.103140.
[39]S. Cao, G. Zhang, P. Liu, X. Zhang, and F. Neri, “Cloud-assisted secure eHealth systems for tamper-proofing EHR via blockchain,” Information Sciences, vol. 485, pp. 427–440, 2019, doi: 10.1016/j.ins.2019.02.038.
[40]L. Zhu, Y. Wu, K. Gai, and K. K. R. Choo, “Controllable and trustworthy blockchain-based cloud data management,” Future Generation Computer Systems, vol. 91, pp. 527–535, 2019, doi: 10.1016/j.future.2018.09.019.
[41]G. Yang, C. Li, and K. E. Marstein, “A blockchain-based architecture for securing electronic health record systems,” Concurrency Computation , no. July, pp. 1–10, 2019, doi: 10.1002/cpe.5479.
[42]F. Tang, S. Ma, Y. Xiang, and C. Lin, “An Efficient Authentication Scheme for Blockchain-Based Electronic Health Records,” IEEE Access, vol. 7, pp. 41678–41689, 2019, doi: 10.1109/ACCESS.2019.2904300.
[43]R. H. Hylock and X. Zeng, “A Blockchain Framework for Patient-Centered Health Records and Exchange (HealthChain): Evaluation and Proof-of-Concept Study,” J Med Internet Res, vol. 21, no. 8, p. e13592, 2019, doi: 10.2196/13592.
[44]Y. Sun, R. Zhang, X. Wang, K. Gao, and L. Liu, “A decentralizing attribute-based signature for healthcare blockchain,” Proceedings - International Conference on Computer Communications and Networks, ICCCN, vol. 2018-July, pp. 1–9, 2018, doi: 10.1109/ICCCN.2018.8487349.
[45]Q. Xia, E. B. Sifah, A. Smahi, S. Amofa, and X. Zhang, “BBDS: Blockchain-based data sharing for electronic medical records in cloud environments,” Information (Switzerland), vol. 8, no. 2, 2017, doi: 10.3390/info8020044.
[46]H. Kaur, M. A. Alam, R. Jameel, A. K. Mourya, and V. Chang, “A Proposed Solution and Future Direction for Blockchain-Based Heterogeneous Medicare Data in Cloud Environment,” Journal of Medical Systems, vol. 42, no. 8, 2018, doi: 10.1007/s10916-018-1007-5.
[47]H. Li, L. Zhu, M. Shen, F. Gao, X. Tao, and S. Liu, “Blockchain-Based Data Preservation System for Medical Data,” Journal of Medical Systems, vol. 42, no. 8, pp. 1–13, 2018, doi: 10.1007/s10916-018-0997-3.
[48]D. C. Nguyen, P. N. Pathirana, M. Ding, and A. Seneviratne, “Blockchain for Secure EHRs Sharing of Mobile Cloud Based E-Health Systems,” IEEE Access, vol. 7, pp. 66792–66806, 2019, doi: 10.1109/ACCESS.2019.2917555.
[49]S. Rahmadika and K. H. Rhee, “Blockchain technology for providing an architecture model of decentralized personal health information,” International Journal of Engineering Business Management, vol. 10, pp. 1–12, 2018, doi: 10.1177/1847979018790589.
[50]L. Chen, W. K. Lee, C. C. Chang, K. K. R. Choo, and N. Zhang, “Blockchain based searchable encryption for electronic health record sharing,” Future Generation Computer Systems, vol. 95, pp. 420–429, 2019, doi: 10.1016/j.future.2019.01.018.
[51]R. Buyya, C. S. Yeo, S. Venugopal, J. Broberg, and I. Brandic, “Cloud computing and emerging IT platforms: Vision, hype, and reality for delivering computing as the 5th utility,” Future Generation Computer Systems, vol. 25, no. 6, pp. 599–616, 2009, doi: 10.1016/j.future.2008.12.001.
[52]V. Casola, A. Castiglione, K. K. R. Choo, and C. Esposito, “Healthcare-Related Data in the Cloud: Challenges and Opportunities,” IEEE Cloud Computing, vol. 3, no. 6, pp. 10–14, 2016, doi: 10.1109/MCC.2016.139.
[53]Y. Zhang, C. Xu, H. Li, K. Yang, J. Zhou, and X. Lin, “HealthDep: An Efficient and Secure Deduplication Scheme for Cloud-Assisted eHealth Systems,” IEEE Transactions on Industrial Informatics, vol. 14, no. 9, pp. 4101–4112, 2018, doi: 10.1109/TII.2018.2832251.
[54]Z. Wan, J. Liu, and R. H. Deng, “HASBE: A hierarchical attribute-based solution for flexible and scalable access control in cloud computing,” IEEE Transactions on Information Forensics and Security, vol. 7, no. 2, pp. 743–754, 2012, doi: 10.1109/TIFS.2011.2172209.
[55]C. Mcfarlane, M. Beer, J. Brown, and N. Prendergast, “Patientory : A Healthcare Peer-to-Peer EMR Storage Network,” no. April, pp. 1–19, 2017, [Online]. Available: https://patientory.com/patientory_whitepaper.pdf
[56]A. Roehrs, C. A. da Costa, and R. da Rosa Righi, “OmniPHR: A distributed architecture model to integrate personal health records,” Journal of Biomedical Informatics, vol. 71, pp. 70–81, 2017, doi: 10.1016/j.jbi.2017.05.012.
[57]A. Azaria, A. Ekblaw, T. Vieira, and A. Lippman, “MedRec : Using Blockchain for Medical Data Access and Permission Management,” 2016 2nd International Conference on Open and Big Data (OBD), pp. 25–30, 2016, doi: 10.1109/OBD.2016.11.
[58]X. Yue, H. Wang, D. Jin, M. Li, and W. Jiang, “Healthcare Data Gateways: Found Healthcare Intelligence on Blockchain with Novel Privacy Risk Control,” Journal of Medical Systems, vol. 40, no. 10, 2016, doi: 10.1007/s10916-016-0574-6.
[59]K. Peterson, R. Deeduvanu, P. Kanjamala, and K. Boles, “A Blockchain-Based Approach to Health Information Exchange Networks,” no. 1, pp. 1–10.
[60]T. Ammbr, P. Token, S. Has, and B. Cancelled, “Whitepaper 21.” pp. 1–42, 2017.
[61]R. Guo, H. Shi, Q. Zhao, and D. Zheng, “Secure Attribute-Based Signature Scheme with Multiple Authorities for Blockchain in Electronic Health Records Systems,” IEEE Access, vol. 6, pp. 11676–11686, 2018, doi: 10.1109/ACCESS.2018.2801266.
[62]X. Zheng, R. R. Mukkamala, R. Vatrapu, and J. Ordieres-Mere, “Blockchain-based personal health data sharing system using cloud storage,” 2018 IEEE 20th International Conference on e-Health Networking, Applications and Services, Healthcom 2018, 2018, doi: 10.1109/HealthCom.2018.8531125.
[63]D. K. Tosh, S. Shetty, X. Liang, C. A. Kamhoua, K. A. Kwiat, and L. Njilla, “Security Implications of Blockchain Cloud with Analysis of Block Withholding Attack,” pp. 458–467, 2017, doi: 10.1109/CCGRID.2017.111.

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